Scientific misconduct: A cross-sectional study of the perceptions, attitudes and experiences of Spanish researchers.

This study sought to identify the perceptions, attitudes and experiences of Spanish researchers regarding different aspects relating to scientific misconduct, both overall and by gender, years of research experience, and type of research institution. This is a cross-sectional study based on an anonymous online survey, targeting researchers in the field of biomedicine. The survey comprised a first block (13 questions) covering sociodemographic data, and a second block (14 questions) covering researchers' perceptions, attitudes and experiences. A descriptive analysis was performed. 403 researchers answered the survey: 51.1% (n = 205) women, median age 45 years. The observed frequency of scientific misconduct was 78.8%. Additionally, 43.3% of researchers acknowledged having intentionally engaged in some type of scientific misconduct (self-reported frequency). The most frequent type of scientific misconduct was false authorship. The most frequent types of both observed and self-reported scientific misconduct did not appear to differ by years of experience but did differ by gender and type of research institution. In conclusion, there is a high frequency of scientific misconduct among Spanish biomedical science researchers as 4 of 10 researchers recognized that took part in any type of scientific misconduct. There are differences between the most frequent types of misconduct according to different characteristics, mainly type of institution.

Assessing Health Care Providers' Knowledge and Practices of Nutrition during Pregnancy in Lebanon: A Cross-Sectional Study.

Background and objectives: Health care professionals (HCPs) are well-positioned to discuss healthy behaviors during pregnancy, but the published research of prenatal healthcare providers' knowledge about the significance of nutrition during pregnancy in Lebanon is scarce. The purpose of this study was to explore the knowledge, attitudes, and practices of Lebanese prenatal healthcare providers towards nutrition during pregnancy. Materials and Methods: A cross-sectional study using an online questionnaire was conducted. Health care providers were contacted by phone and email to participate in the online survey. A list of all clinics providing antenatal health services was obtained from the Order of Physicians and the Order of Midwives. A multistage random sample was selected. In the first stage, it was stratified per region (Beirut center or suburbs, and the southern region). In the second phase, it was stratified per clinic type (private, primary healthcare center, or hospital). Gynecologists and midwives who are members of the Order of Physicians and the Order of Midwives (n = 1333), were included. Results: Two-hundred and six responses (55% males) were obtained. Approximately 44% of the HCP were aged 50 and older, and 68.4% had more than 10 years of work experience. HCPs from Beirut represented 41.3% of the respondents. Eighty-eight percent of the HCPs were physicians, and 11% were midwives. The majority of the participants considered nutrition during pregnancy to be very important. Furthermore, half of these participants considered their position in delivering nutrition information as very significant. Most of the respondents reported that they provide nutrition advice to pregnant women, and they also received nutrition education during their profession. However, they perceived their nutrition knowledge as inadequate. Conclusion: Health care providers' attitude towards the importance of maternal nutrition and their confidence in talking about nutrition-related topics with pregnant women were positive despite the lack of knowledge in several areas related to nutrition during pregnancy. Therefore, there is a need for continuing nutrition education for health care providers and the implementation of nutrition education programs to achieve better health outcomes.

Access of Syrian refugees to COVID-19 testing in Lebanon.

Background: Polymerase chain reaction is a well-known method for testing COVID-19 infection, however, refugee populations often face difficulties in accessing testing. Several structural and cultural challenges have hindered access of Syrian refugees to COVID-19 testing in Lebanon, including financial barriers, stigma, and low perception of vulnerability. Aims: To explore barriers to accessing COVID-19 testing by Syrian refugees in Lebanon. Methods: This qualitative study conducted 10 focus group discussions among Syrian refugees and 21 individual semistructured interviews with healthcare workers. Ethical approval was obtained from the Institutional Review Board of the Lebanese International University, and the study followed the ethical principles of the Declaration of Helsinki. Results: Syrian refugees in Lebanon did not consider COVID-19 testing to be important. Despite the availability of free testing services, psychological, cultural, environmental, and financial barriers hindered them from getting tested. Some of them relied on consultation with pharmacists, who were easy to access and provided symptomatic treatment without the need to test for COVID-19. Fear of stigma, deportation, and isolation were common cultural barriers. Testing was considered unnecessary because of the perception of low disease severity and an attitude of negligence towards preventive practices. The harsh economic and living conditions were of greater concern to the refugees. Conclusion: Findings from this study add to existing literature regarding the social and cultural barriers to COVID-19 testing among Syrian refugees and should be considered when tailoring health promotion campaigns to halt the spread of the COVID-19 pandemic.

Social media addiction in university students in Lebanon and its effect on student performance.

Objective: This study aims to assess addiction to social media among university students and to explore the association of addiction to social media with academic performance. Methods: A random sample of 997 university students filled in a self-administered questionnaire using Google form (response rate 81%). The questionnaire adopted a validated scale (Social Media Addiction Scale, SMAS) and included questions about socio-demographics. Grade point average, absences, and passing rate were extracted for each student from the university management system. Results: Results showed that each of the three dimensions of addiction to social media (compulsive feelings, social consequences and time displacement) reduce at least one indicator of academic performance (GPA, absenteeism and passing rate). Conclusion: Results call to design and evaluate interventions that tackle different social media addiction dimensions to reduce their negative impact on academic performance.

Online breast-feeding support groups as a community asset in Lebanon after Beirut explosion.

OBJECTIVE: Breast-feeding rates are unsatisfactory in Lebanon. Social media groups could play an important role in promoting breast-feeding in normal conditions and post crisis. The aim of this study is to identify breast-feeding challenges, facilitators and assets and to describe how community assets via social media could build community resilience to pandemic's and disaster's effects. DESIGN: A two-phase qualitative content analysis was performed on posts and comments collected from a Facebook breast-feeding support group. Data were categorised into themes, categories and subcategories. SETTING: Posts and comments retrieved from a Facebook breast-feeding support group in Lebanon during the month of August 2020. PARTICIPANTS: Group members: mothers who breastfed, breast-feeding mothers and group admins that are lactation consultants. RESULTS: In phase one, breast-feeding 'Challenges' identified were lack of support from peers and family, lack of supportive policies, lack of knowledge and maternal stress related to political instability, COVID-19 and economic crisis. 'Assets and facilitators' included community support and donations. In phase two, analysis revealed how assets were being used on social media platform to build community resilience post crisis, through access to social support in challenging times, community engagement, material resources and transformative potential. CONCLUSION: Challenges faced during breast-feeding were diminished due to the support and assets received on a Facebook breast-feeding support group, and social media has been shown to be an important community asset implicated in empowering women to breastfeed and to build community resilience in moments of crisis.

Conspiracy beliefs and vaccination intent for COVID-19 in an infodemic.

BACKGROUND: The massive, free and unrestricted exchange of information on the social media during the Covid-19 pandemic has set fertile grounds for fear, uncertainty and the rise of fake news related to the virus. This "viral" spread of fake news created an "infodemic" that threatened the compliance with public health guidelines and recommendations. OBJECTIVE: This study aims to describe the trust in social media platforms and the exposure to fake news about COVID-19 in Lebanon and to explore their association with vaccination intent. METHODS: In this cross-sectional study conducted in Lebanon during July-August, 2020, a random sample of 1052 participants selected from a mobile-phone database responded to an anonymous structured questionnaire after obtaining informed consent (response rate = 40%). The questionnaire was conducted by telephone and measured socio-demographics, sources and trust in sources of information and exposure to fake news, social media activity, perceived threat and vaccination intent. RESULTS: Results indicated that the majority of participants (82%) believed that COVID-19 is a threat and 52% had intention to vaccinate. Exposure to fake/ unverified news was high (19.7% were often and 63.8% were sometimes exposed, mainly to fake news shared through Watsapp and Facebook). Trust in certain information sources (WHO, MoPH and TV) increased while trust in others (Watsapp, Facebook) reduced vaccination intent against Covid-19. Believing in the man-made theory and the business control theory significantly reduced the likelihood of vaccination intent (Beta = 0.43; p = 0.01 and Beta = -0.29; p = 0.05) respectively. CONCLUSION: In the context of the infodemic, understanding the role of exposure to fake news and of conspiracy believes in shaping healthy behavior is important for increasing vaccination intent and planning adequate response to tackle the Covid-19 pandemic.

Sleep Quality and Performance in Professional Athletes Fasting during the Month of Ramadan.

BACKGROUND: Maintaining physical performance during Ramadan Diurnal Fasting (RDF) is a challenge for professional athletes. The literature shows that sleep disturbances experienced by athletes during RDF are associated with reduced physical performance. The effect of sleep quality on physical performance, and the effect of work status on physical performance during RDF among athletes, besides engaging in trainings, have been little investigated. This study aims to evaluate the effect of RDF on the physical performance of professional athletes taking into consideration their sleep quality and work status. METHODS: Professional medium-distance male runners (n = 32) participated in our study in the summer of 2019. Data about socio-demographics, training characteristics, sleep quality (Pittsburg Sleep Quality Index: PSQI), physical performance (Cooper Test; Harvard step test) were collected before and during Ramadan. Student's-test and Welch and Wilcoxon tests were used for data analysis. RESULTS: Both quality of sleep and physical performance of athletes deteriorated during Ramadan. People with better quality of sleep had better physical fitness/performance both before and during RDF. Athletes who worked beside trainings achieved worse physical fitness test results and had worse quality of sleep. CONCLUSIONS: Policies aimed to improve physical performance in RDF should consider the quality of sleep and the work status of athletes.

Knowledge, attitude and practices related to COVID-19 among young Lebanese population.

BACKGROUND: As the world faces the most serious and widespread pandemic in recent history, claiming nearly 1,945,610 lives and infecting over 90 million individuals up to January 13, 2021, controlling the spread of COVID-19 is still limited to efforts done by the general population implementing rules and restrictions passed by world governments and organizations. As we wait for the approved vaccines to become widely distributed, the best approach to fighting the spread of this disease is mostly preventative depending largely on individuals' compliance. This study aimed to determine the knowledge, attitude and practices (KAP) towards COVID-19 in Lebanon. METHODS: A descriptive analysis was performed to describe the outcome measures of knowledge, attitudes and practices towards COVID-19 on a convenience sample from the Lebanese population in relation to socio-demographic characteristics and level of concern towards COVID-19. One thousand eight hundred sixty-one participants filled in an online survey (response rate: 18.5%) distributed by social media to social networks of the research team members. RESULTS: Participants were mainly young (49.4% between 18 and 24 years) and males (73.7%). Participants showed an overall appropriate knowledge of COVID-19 (67.1%) and positive attitude (around 90% were optimistic about treatment and vaccination) and had good preventive practices towards COVID-19 (around 75% washed hands and avoided public places). Knowledge and practices correlated positively with marriage, age, education, working in a healthcare field and with the level of concern about getting COVID-19. CONCLUSIONS: This study found good overall levels of KAP among the studied Lebanese population. This can help in controlling the spread of COVID-19 if individuals were forced to adhere to social distancing and appropriate preventative practices.

Justifying abuse of women migrant domestic workers in Lebanon: the opinion of recruitment agencies / Justificación del abuso de las trabajadoras domésticas inmigrantes en Líbano: la opinión de las agencias de contratación

OBJECTIVE: Gender-based violence against women migrant domestic workers (WMDW) is a serious public health concern in the Middle East region. The current study is the first to explore abuse of WMDW as perceived by recruitment agency managers. METHOD: A qualitative study was conducted using 42 personal semi-structural interviews with agency managers in Lebanon. The interview guidelines were designed based on the standards set by the International Labor Organization (ILO) Convention No. 189. The information was transcribed in Arabic, and data was analyzed using thematic analysis. RESULTS: The interviewees believe that WMDW are subject to abusive practices that represent various violations of the ILO Convention No. 189, including harassment and violence, compulsory labour, misinformation about conditions of employment, denial of periods of rest and restriction of movement and travel documents. In many situations, the interviewees justified some of these practices as being necessary to protect their business and to protect the workers. CONCLUSION: The results of this study have several policy implications for the protection of WMDW against abuse

OBJETIVO: La violencia basada en el género contra las trabajadoras domésticas inmigrantes es un problema serio de salud pública en Medio Oriente. El presente estudio es el primero que explora el abuso de trabajadoras domésticas inmigrantes tal como lo perciben los/las gerentes de empresas de contratación de trabajo doméstico. MÉTODO: Se realizó un estudio cualitativo basado en 42 entrevistas personales semiestructuradas con gerentes de agencias en Líbano. El guion de la entrevista se basó en los estándares establecidos por el Convenio N.° 189 de la Organización Internacional del Trabajo (OIT). La información se transcribió en árabe y los datos se analizaron utilizando un análisis temático. RESULTADOS: Las personas participantes creen que las trabajadoras domésticas inmigrantes están sujetas a prácticas abusivas que representan diversas violaciones del Convenio N.° 189 de la OIT, incluidos el acoso y la violencia, el trabajo forzado, la desinformación sobre las condiciones de trabajo, la negación de periodos de descanso, el encierro y el confinamiento del pasaporte. En muchas situaciones se justifican algunas de estas prácticas como necesarias para proteger sus negocios y proteger a las trabajadoras. DISCUSIÓN: Los resultados de este estudio tienen varias implicaciones de política para la protección de las trabajadoras domésticas inmigrantes contra el abuso

Energy drinks consumption and perceptions among University Students in Beirut, Lebanon: A mixed methods approach.

BACKGROUND: Energy drinks (ED) are caffeine- and sugar-rich beverages with other ingredients that are marketed for their energy-boosting and performance-enhancing effects. The consumption of these drinks, with and without alcohol, is dramatically increasing worldwide, despite the reported side effects and potential harms to consumers. Few studies, to date, have explored the perceptions and experiences of young adults towards these beverages. OBJECTIVE: The present study aimed to explore the consumption patterns and correlates of ED consumption, as well as the perceptions and experiences of university students in Lebanon towards these beverages. METHODS: A sequential explanatory mixed-methods approach was adopted. Data collection was conducted in two private universities in Beirut, Lebanon. A self-administered 36-item quantitative survey was first used to explore the prevalence and correlates of ED consumption among a convenience sample of university students (n = 226). The survey included questions related to socio-demographic characteristics, anthropometric measurements, and other lifestyle behaviors, including physical activity of university students. The subsequent qualitative phase consisted of focus group discussions (FGD) conducted to further examine the perceptions and experiences of university students towards ED. Descriptive statistics and logistic regression analyses were conducted using survey data, whereas the transcribed FGD were analyzed thematically. RESULTS: A total of 226 university students completed the survey. Results showed that 45% of survey respondents consumed ED at least once in their life (ever consumers), among which 30% reported consumption of ED mixed with alcohol (AmED). Adjusting for socio-demographic and anthropometric characteristics, coffee and sports drinks consumption were significantly associated with ED (OR = 2.45, 95% CI = 1.20, 5.00, and OR = 4.88, 95%CI = 2.41, 9.88, respectively). In addition, physically active participants were 1.89 times (95%CI = 1.01, 3.51) more likely to consume ED compared to their inactive counterparts. During the qualitative phase, a total of six FGD were conducted with 29 university students, who reported consuming ED at least once per month. Three main themes were derived reflecting individual-, interpersonal/social- and environmental-level factors affecting ED consumption among university students. These themes were further supported by eight subthemes, including: perceived benefits of ED, experienced side effects, misinformation about content of ED, peer pressure and social image, as well as affordability and accessibility of ED. CONCLUSION: Findings highlight the need for public health policies and programs to curb the growing public health phenomenon of ED consumption amongst university students. Such programs should consider the multi-level factors affecting ED consumption at the individual, interpersonal/social, and environmental levels, including educational campaigns on ED potential harms, regulating ED content and labeling, as well as restricting sales and marketing of these beverages, especially among young consumers.

Phenotypic and Genotypic Characterization of Extended-Spectrum Beta-Lactamases Produced by Escherichia coli Colonizing Pregnant Women.

Introduction: Infections caused by extended spectrum beta lactamase (ESBL) producing bacteria continue to be a challenge for choosing the appropriate therapy since they may exhibit coresistance to many other classes of antibiotics. The aim of the study was to screen pregnant women for ESBL producing bacteria in Beirut, Lebanon, to examine their phenotypic and genotypic characterization and to study the association between ESBL colonization with adverse neonatal outcomes. Method: In this cross-sectional study, vaginal samples from 308 pregnant women at 35-37 weeks of gestation were studied during a one-year period. The samples were plated on MacConkey agar and selective MacConkey agar supplemented with ceftazidime. Phenotypic confirmation of ESBL production was performed by double-disc synergy test and all isolates were screened by PCR for the resistance genes blaSHV, blaTEM, and blaCTX-M. Clonal relatedness of Escherichia coli isolates was investigated by pulsed-field gel electrophoresis. Results: In total, 59 women out of 308 (19.1%) were colonized by ESBL producing gram negative bacteria. Two babies born to mothers colonized with ESBL were diagnosed with sepsis. The susceptibility rates of isolates to other antibiotics were 39% to co-trimoxazole, 49.2% to ciprofloxacin, 91.5% to gentamicin, 18.6% to aztreonam and 35.6% to cefepime. Most of isolates were highly sensitive to meropenem and imipenem, with a susceptibility of 93.2%. PCR was performed on all E. coli isolates to detect the most common ESBL producing genes; blaCTX-M was the predominant gene (90.7%), followed by blaTEM (88.4%) and finally blaSHV (44.2%). PFGE analysis of 34 E. coli isolates revealed 22 distinct clusters showing more than 85% similarity. Conclusion: In conclusion, this study showed that Lebanon has a high prevalence of ESBL carriage in pregnant women. Further studies that include a continuous screening of pregnant women and follow up of their newborn clinical status should be conducted to foresee the risk of transmission.

Antibiotic use and resistance: an unprecedented assessment of university students' knowledge, attitude and practices (KAP) in Lebanon.

BACKGROUND: The emergence and spread of pathogenic bacteria that is resistant to antibiotics has become a major public health concern. The incorrect prescription, inappropriate consumption and excess use of antimicrobial drugs, specifically antibiotics, are possibly the main factors contributing to the widespread of antibiotic resistant bacteria. This study aims to evaluate the knowledge, attitude and practices (KAP) towards the use of antibiotics as well as their resistance among Lebanese university students in health and non-health related majors. METHODS: This cross-sectional study was conducted between May and June 2019 in Beirut (Lebanon) in which 750 students completed a questionnaire made up of four dimensions: Socio-demographic characteristics, 3 questions; assessment of knowledge, attitude and practices, 7, 10 and 1 question, respectively. The data was collected in spreadsheets and analysed with descriptive statistics. The difference in mean scores in each of the knowledge, attitude and practices dimensions between health and non-health related major students was analysed using t-student tests and the difference in percentages using chi-square tests. RESULTS: Almost 78% of respondents from the health related majors scored high knowledge compared to only 41% of non-health related majors (mean = 4.26; standard error = 0.05 versus mean = 3.41; standard error = 0.13, respectively). The attitude score of the health related major students (35.42%) was positive and more satisfactory compared to the non-health related students (7.32%); (mean = 9.34; standard error = 0.05 versus mean = 9.10; standard error = 0.21, respectively). However, the difference in the scores of attitudes was not statistically significant. CONCLUSIONS: Interventions to promote awareness in this area should focus more students in on non-health related majors.

Prevalence and antifungal susceptibility of Candida albicans causing vaginal discharge among pregnant women in Lebanon.

BACKGROUND: Vaginal candidiasis is frequent in pregnant women and is associated with sepsis and adverse neonatal outcomes. This study determined the prevalence of candida species in symptomatic pregnant women and evaluated the antifungal susceptibility profile of the isolated Candida strains. It also aimed to explore whether Candida species predicts gestational complications and adverse neonatal outcomes. METHODS: A total of 258 pregnant women with vaginal discharge at 35 to 37 week of gestation participated in this study. Vaginal swabs from these patients were collected at various obstetrics and gynecology clinics in Lebanon for a period of 14 months. Candida isolates were identified at species level and antifungal susceptibility of Candida albicans to fluconazole (FCZ), amphotericin B (AMB), itraconazole (ICZ) and voriconazole (VCZ) was determined by the agar-based E-test method. RESULTS: Among 258 women tested, 100 (39%) were positive for Candida species. C. albicans, C. glabrata and C. krusei were isolated from 42, 41 and 17% of the women, respectively. C. albicans was significantly associated only with gestational diabetes while C. krusei or C. glabrata had significant positive associations with other gestational complications. The antifungal susceptibility tests of C. albicans isolates revealed 97.5, 90, 87.5 and 97.5% susceptibility to AMB, FCZ, ICZ and VCZ, respectively. CONCLUSION: The current study revealed high incidence of both C. albicans and non-C. albicans Candida strains causing vulvovaginitis among pregnant women in Beirut, Lebanon. Candida screening as antenatal follow up is advised to minimize the risk of adverse neonatal outcome or gestational complications.

Justifying abuse of women migrant domestic workers in Lebanon: the opinion of recruitment agencies.

OBJECTIVE: Gender-based violence against women migrant domestic workers (WMDW) is a serious public health concern in the Middle East region. The current study is the first to explore abuse of WMDW as perceived by recruitment agency managers. METHOD: A qualitative study was conducted using 42 personal semi-structural interviews with agency managers in Lebanon. The interview guidelines were designed based on the standards set by the International Labor Organization (ILO) Convention No. 189. The information was transcribed in Arabic, and data was analyzed using thematic analysis. RESULTS: The interviewees believe that WMDW are subject to abusive practices that represent various violations of the ILO Convention No. 189, including harassment and violence, compulsory labour, misinformation about conditions of employment, denial of periods of rest and restriction of movement and travel documents. In many situations, the interviewees justified some of these practices as being necessary to protect their business and to protect the workers. CONCLUSION: The results of this study have several policy implications for the protection of WMDW against abuse.

Challenges in implementing opioid agonist therapy in Lebanon: a qualitative study from a user's perspective.

BACKGROUND: Opioid agonist therapy (OAT) has been implemented for the treatment of individuals with opioid use disorders in Lebanon since 2011, but has not been evaluated yet. The aim of the study is to describe the implementation of the first pilot OAT program in Lebanon from the users' perspective. METHODS: Data collectors gathered data from male participants during June 2016-July 2016. Eighty-one out of 94 patients agreed to participate in the study. Data regarding access to treatment, satisfaction with the treatment protocol and treatment outcomes, patient-provider relationship, and misuse and diversion was collected through semi-structured qualitative interviews. Data saturation was reached after 81 interviews; once no new themes were reported. RESULTS: Findings showed inequalities in access to treatment and showed that OAT improved mental and social wellbeing among users who had financial access and complied with the program protocols. Registering in the program protected users from arrest and reduced their economic burden. Among the main encountered challenges were fear of dependence to buprenorphine, restricted geographical access to treatment, misuse and diversion of buprenorphine. CONCLUSION: Results implicate inequalities in access to OAT as one important gap to be tackled in the management of OAT in Lebanon. Further research should be done in order to understand the challenges in the implementation of the program from the providers' perspectives.

Assessing the Psychometric Properties of the Internet Addiction Test (IAT) Among Lebanese College Students.

Internet addiction is an emergent problem; yet, both a strong conception of the factors precipitating challenging activities and a gold standard tool for evaluating symptoms are deficient. The aim of this study was to carry out a psychometric analysis using the most commonly employed screening tool, the young Internet Addiction Test (IAT), comprising a sample of Lebanese University medical students. Two hundred and fifty-six undergraduate medical students from a university in Beirut, Lebanon were included in our IAT. Exploratory factor analysis was employed, and four factors were extracted. These four factors were named as Lack of Control, Social Withdrawal and Emotional Conflict, Time Management Problems, and Concealing Problematic Behavior. Furthermore, the selected factors explained 56.5% of the total variance. Cronbach's alpha coefficient for the internal reliability of the scale was found to be 0.91. For each subscale, the internal consistency score was approximated and detected as 0.76, 0.74, 0.69, and 0.63 for the first through fourth factor, respectively. Item total correlations were calculated and had a value range from 0.37 to 0.63 for the 20 items. IAT is a proper tool for evaluating internet addiction in Lebanese college students.

Opiate agonist treatment to improve health of individuals with opioid use disorder in Lebanon.

BACKGROUND: Opioid agonist therapy has been widely used to reduce harms among individuals with opioid use disorder but its effectiveness has not been evaluated in the Middle East North African (MENA) region. This study aims to evaluate the effectiveness of a program using opioid agonist therapy in combination with psychosocial support on improving psychological and social well-being, reducing arrest, and reducing risky behavior in individuals with opioid use disorder in Lebanon. METHODS: A one-group pre-test post-test design study was performed at SKOUN Lebanese Addiction Centre between January 2013 and December 2014. Eighty-six out of 181 patients agreed to participate and completed the 3-month assessment and 38 concluded the 12-month assessment. Psychological (depression and anxiety, quality of life), substance dependence/abuse, behavioral (injecting behavior, sharing needles and paraphernalia), and social outcomes were evaluated at baseline, 3, and 12 months post-treatment. RESULTS: Remarkable statistical significance improvements were observed 3 months after treatment in most outcome variables including quality of life, anxiety, substance dependence, overdose, employment, and injecting behavior. Improvements were sustained 12 months after treatment. CONCLUSION: Results support expanding the access to opioid agonist therapy in other MENA countries to treat substance dependence and reduce harms among individuals with opioid use disorder.

Barriers to Access to Sterile Syringes as Perceived by Pharmacists and Injecting Drug Users: Implications for Harm Reduction in Lebanon.

BACKGROUND: Access to sterile syringes to injecting drug users (IDU) reduces sharing behavior and prevents the transmission of HIV. OBJECTIVES: To describe the barriers to access to sterile syringes for IDUs in Lebanon from the perspectives of pharmacists and IDUs. METHODS: in this qualitative study conducted in Lebanon, data were collected from 72 syringe purchase tests at pharmacies, 64 interviewees with pharmacists and 2 focus groups with injecting drug users. Two independent researchers analyzed the verbatim transcripts. RESULTS: Results revealed that pharmacists often deny access to sterile syringes to IDUs who are frequently stigmatized and intimidated at pharmacies. While no large gender differences in pharmacists' attitudes and practices were observed, inequalities in syringe access were noticed with men IDUs more often denied purchase. Pharmacists had several barriers to sell syringes to IDUs including fear of disease spread, increased drug use, inappropriately discarded syringes, staff and customer safety, and business concerns. IDUs had several challenges to purchase syringes including stigmatization, intimidation, physical harassment, concern to reveal identity, fear of arrest and syringe price abuse. CONCLUSIONS: Identifying the barriers to and facilitators of access to sterile syringes to IDUs is important to guide the development of efficient policies. Findings implicate the importance of empowering IDUs to purchase syringes at pharmacies through reducing the negative attitude towards IDUs and strengthening pharmacists' role in the promotion of health of IDUs. Findings also suggest that the habit of syringe sharing would decrease if the legal and cultural barriers to access are reduced.