Body appreciation is associated with optimism/pessimism in patients with chronic kidney disease: Results from a cross-sectional study and validation of the Arabic version of the Optimism-Pessimism Short Scale-2.

BACKGROUND: Chronic Kidney Disease (CKD) patients encounter many obstacles that affect their physical and psychological well-being. The primary objective of the present study was to investigate potential correlates of optimism/pessimism in a sample of patients with CKD, including socio-demographics, body appreciation and disordered eating symptoms. As a secondary objective, we proposed to examine the psychometric properties of an Arabic translation of the Optimism-Pessimism Short Scale-2 (SOP2) before its use in our sample. METHODS: A cross-sectional study was carried out between April and May 2023, enrolling 108 participants from three hospitals in Lebanon providing insights into their sociodemographic characteristics, physical activity levels, body appreciation, optimism, pessimism, and eating attitudes. RESULTS: Results indicated that the Arabic-language adaptation of the SOP2 has good reliability coefficients. The two facets of the scale displayed a strong correlation to each other, and highly similar correlations with external study variables (i.e., household crowding index, physical activity, body appreciation, disordered eating), suggesting that the SOP2 can be interpreted as a unidimensional measure for the psychological dispositional optimism as proposed by the developers. Furthermore, findings revealed a strong positive correlation between body appreciation and optimism, suggesting that CKD patients who appreciate their bodies tend to exhibit a more optimistic outlook on life. Conversely, higher body appreciation is associated with lower pessimism, indicating that a positive body image may mitigate feelings of hopelessness and despair in CKD patients. CONCLUSION: This study contributes to the literature in two ways. First, it offers the Arabic SOP2 as an brief tool to administer, and psychometrically sound instrument that can be useful for clinical and research purposes. Second, it unveils a clear correlation between higher body appreciation and a more optimistic, less pessimistic mindset in patients with CKD.

Immunogenicity and real-world effectiveness of COVID-19 vaccines in Lebanon: Insights from primary and booster schemes, variants, infections, and hospitalization.

In this study, we conducted a case-control investigation to assess the immunogenicity and effectiveness of primary and first booster homologous and heterologous COVID-19 vaccination regimens against infection and hospitalization, targeting variants circulating in Lebanon during 2021-2022. The study population comprised active Lebanese military personnel between February 2021 and September 2022. Vaccine effectiveness (VE) against laboratory-confirmed SARS-CoV-2 infection and associated hospitalization was retrospectively determined during different variant-predominant periods using a case-control study design. Vaccines developed by Sinopharm, Pfizer, and AstraZeneca as well as Sputnik V were analyzed. Prospective assessment of humoral immune response, which was measured based on the SARS-CoV-2 antispike receptor binding domain IgG titer, was performed post vaccination at various time points, focusing on Sinopharm and Pfizer vaccines. Statistical analyses were performed using IBM SPSS and GraphPad Prism. COVID-19 VE remained consistently high before the emergence of the Omicron variant, with lower estimates during the Delta wave than those during the Alpha wave for primary vaccination schemes. However, vaccines continued to offer significant protection against infection. VE estimates consistently decreased for the Omicron variant across post-vaccination timeframes and schemes. VE against hospitalization declined over time and was influenced by the variant. No breakthrough infections progressed to critical or fatal COVID-19. Immunogenicity analysis revealed that the homologous Pfizer regimen elicited a stronger humoral response than Sinopharm, while a heterologous Sinopharm/Pfizer regimen yielded comparable results to the Pfizer regimen. Over time, both Sinopharm's and Pfizer's primary vaccination schemes exhibited decreased humoral immunity titers, with Pfizer being a more effective booster than Sinopharm. This study, focusing on healthy young adults, provides insights into VE during different pandemic waves. Continuous research and monitoring are essential for understanding vaccine-mediated immune responses under evolving circumstances.

Adaptation and psychometric assessment of a sexual and reproductive empowerment scale in Arabic among refugee and non-refugee adolescent girls.

BACKGROUND: Sexual and reproductive empowerment (SRE) is an important determinant of women's and girls' health yet measuring it is complex due to cultural and domain-specific variations. This study describes the process of adapting an SRE scale consisting of four domains (self-efficacy; future orientation; social support; and safety) and testing its psychometric properties among Arabic speaking adolescent girls in Lebanon. METHODS: An SRE scale developed in a Western context was adapted in four steps: (1) reviewing the scale and selecting culturally appropriate domains for translation to standard Arabic; (2) conducting cognitive interviews with 30 11-17-year-old adolescent girls in Lebanon; (3) administering the scale to 339 refugee adolescent girls who participated in an early marriage intervention; and (4) conducting confirmatory factor analysis (CFA) on the data to assess the scale's psychometric properties. RESULTS: The original model for the 13-item, four-domain adapted scale demonstrated poor fit in CFA. After iteratively removing two items, scale properties were improved, albeit were not optimal. The validity and reliability results for the self-efficacy domain were acceptable. Cognitive interview data revealed that Arab adolescent girls understood self-efficacy in relational terms, recognizing that autonomous decision-making is not necessarily favored but is influenced by parents and family. CONCLUSIONS: This study presents an effort to customize an SRE scale for use in studies on the health of adolescent girls in an Arab cultural context. Findings from cognitive interviews highlight the importance of taking into consideration relationality in adolescent sexual and reproductive decision-making. The self-efficacy domain in the adapted scale demonstrates acceptable psychometric properties and is recommended for use in health studies to capture SRE.

Adherence to Dietary Approaches to Stop Hypertension (DASH) Diet as a Protective Factor for Ischemic Stroke and Its Influence on Disability Level: A Case-Control Study in Lebanon.

BACKGROUND: Hypertension is a major risk factor for ischemic stroke. An important strategy in controlling hypertension is dietary modification. The present study evaluates the effect of Dietary Approaches to Stop Hypertension (DASH) diet on the risk of ischemic stroke. METHODS: A case-control study was carried out, including 214 ischemic stroke cases recruited within the first 48 h of diagnosis and 214 controls, divided equally into hospitalized and non-hospitalized participants. Controls were matched to cases based on age and gender. Socio-demographic characteristics were assessed, in addition to adherence to the DASH diet, which was measured using a preconstructed DASH diet index (ranging from 0 (lowest) to 11 (highest)). For stroke patients, Modified Rankin Score (mRS) was measured to assess disability. RESULTS: Smoking, hypertension, hyperlipidemia, atrial fibrillation, and myocardial infarction were significantly associated with ischemic stroke (p < 0.001). Higher adherence to the DASH diet was correlated to lower rates of stroke, where cases scored 5.042 ± 1.486 compared to 6.654 ± 1.471 for controls (p < 0.001). Eating more grains, vegetables, fruits, dairy products, nuts, seeds, and beans, and lower levels of fat, fewer sweets, and less sodium were associated with lower rates of ischemic stroke (p = 0.038 for sweets and p < 0.001 for all the remaining), while meat, poultry, and fish did not have any significant effect (p = 0.46). A multivariate analysis showed that lower adherence to the DASH diet (p < 0.001, OR: 0.526, CI95% 0.428-0.645) was associated with a higher incidence of ischemic stroke and an increased likelihood of having high disability levels (mRS 5-6) (p = 0.041, OR: 2.49 × 10-8, CI95% 0-2.49 × 10-8). CONCLUSIONS: The relation between the DASH diet and risk of stroke highlights the necessity for strict adherence to dietary restrictions, suggesting a protective role for the DASH diet in stroke pathogenesis and prognosis.

Healthcare delivery in Lebanon: a critical scoping review of strengths, weaknesses, opportunities, and threats.

BACKGROUND: Lebanon, an Eastern Mediterranean country with a lower-middle income status, that once boasted a health care system that was functional despite its challenges and complexity. However, it has faced a series of crises-economic, an influx of refugees, political instability, and recent sanctions-that have significantly impacted its aim, principles and values that has impacted upon its ability to function. The objective of this study is to delve into the health service delivery within the Lebanese system and conduct a SWOT analysis (assessing strengths, weaknesses, opportunities, and threats). METHODS: We conducted a scoping review, examining literature related to the Lebanese health system and its performance in delivering healthcare services. We followed the Arksey and O'Malley framework, which involves six key phases: identifying the research question, identifying relevant studies, study selection, charting the data, collating, summarizing, and reporting the results, consultation. RESULTS: Despite Lebanon grappling with multiple crises in recent years-such as the COVID-19 pandemic and economic downturn-the health system has demonstrated resilience in service delivery. However, challenges persist. Healthcare providers, including physicians and nurses, must address these issues. Additionally, economic and political crises pose threats that have necessitated significant changes in healthcare service delivery. CONCLUSION: In the system of healthcare in Lebanon, there have been remarkable achievements, but continuous attention by healthcare providers and the Ministry of Public Health (MoPH) is critical. Economic and political challenges exert constant pressure on service delivery and thus reveal a need for strategic changes, most importantly in health financing if Universal Health Coverage (UHC) is to be attained. Proper resources to strategic reform and system implementation in all parts of the country to ensure equitable access and quality care that is sustained are obligatory.

Prevalence and associations of asymptomatic left ventricular systolic dysfunction in Lebanese patients with type 2 diabetes mellitus.

BACKGROUND: Diabetes Mellitus is a prevalent disease with a growing impact on individuals worldwide. Evaluating the prevalence of subclinical left ventricular dysfunction and understanding its associations with microvascular complications, uncontrolled glycemia, diabetes duration, and patient age is crucial. Our aim is to determine the utility of screening for this condition. METHODS: We conducted a retrospective cohort study involving 159 asymptomatic individuals with type 2 diabetes. Bivariate analysis was employed to assess potential factors and their associations with subclinical left ventricular dysfunction. Patients with a history of cardiac disease or interventions were excluded. RESULTS: The average age of our sample was 61.5 years. Almost half of the patients exhibited an HbA1c exceeding 7% (50.3%), and approximately half had an ejection fraction (EF) of less than 55% (50.9%). In the bivariate analysis, a notable difference in microvascular diabetic complications was observed among different EF groups. Specifically, nephropathy (62%), neuropathy (57.5%), and retinopathy (74.4%) were significantly more prevalent among patients with an EF < 55%. We also identified a significant age difference between groups, with a higher mean diabetes duration (14.1 ± 7.7 years) in the lower EF group. Notably, 63.7% of patients with an HbA1c exceeding 7% exhibited an EF < 55%. Older patients were associated with a lower EF, with an adjusted odds ratio (aOR) of 0.94. An HbA1c of 7% or less was linked to a higher likelihood of an EF > 55%. CONCLUSION: We established a correlation between subclinical left ventricular systolic dysfunction and microvascular complications. However, further extensive prospective research is necessary to deepen our understanding of these associations and their clinical implications.

Identifying vulnerabilities in essential health services: Analysing the effects of system shocks on childhood vaccination delivery in Lebanon.

Shocks effects are under-theorised in the growing literature on health system resilience. Existing work has focused on the effects of single shocks on discrete elements within the health system, typically at national level. Using qualitative system dynamics, we explored how effects of multiple shocks interacted across system levels and combined with existing vulnerabilities to produce effects on essential health services delivery, through the prism of a case study on childhood vaccination in Lebanon. Lebanon has experienced a series of shocks in recent years, including large-scale refugee arrivals from neighbouring Syria, the COVID-19 pandemic and a political-economic crisis. We developed a causal loop diagram (CLD) to explore the effects of each shock individually, and in combination. The CLD was developed and validated using qualitative data from interviews with 38 stakeholders working in Lebanon's vaccination delivery system, in roles ranging from national level policy to facility-level service delivery, conducted between February 2020 and January 2022. We found that each of the shocks had different effects on service demand- and supply-side dynamics. These effects cascaded from national through to local levels. Both Syrian refugee movement and the COVID-19 pandemic primarily exposed vulnerabilities in service demand, mainly through slowly emerging knock-on effects on vaccination uptake behaviour among host communities, and fear of contracting infection in crowded health facilities respectively. The economic crisis exposed wider system vulnerabilities, including demand for vaccination as household income collapsed, and supply-side effects such as reduced clinic time for vaccination, declining workforce retention, and reduced availability of viable vaccine doses, among others. Finally, important pathways of interaction between shocks were identified, particularly affecting the balance between demand for vaccination through publicly supported facilities and private clinics. Future research should incorporate dynamic approaches to identifying within-system vulnerabilities and their potential impacts under different scenarios, as a precursor to improved resilience measurement, system preparedness, and intervention targeting.

Disaster Preparedness among Healthcare Professionals in Lebanon.

BACKGROUND: Disaster disrupts the normal functioning of a community, causing significant damages and losses. In recent years, Lebanon faced multiple disasters, including one of the largest explosions ever recorded, the Beirut Blast, in August 2020. Limited studies in the literature have examined disaster medicine preparedness among healthcare professionals (HCPs). OBJECTIVE: To examine the knowledge (K), attitude (A), readiness to practice (rP), and KArP associated with disaster medicine preparedness among HCPs in Lebanon. METHODS: A cross-sectional observational study was conducted in Lebanon using data from participants answering an online survey. Participants enrolled in this study were HCPs (residents and faculty), medical students, and postdoctoral research scholars. Levels of knowledge, attitude, and readiness to practice were assessed and used to examine their association with participants' socio-demographic characteristics. RESULTS: A total of 195 participants (average age 30.6 ± 11.4 years) were included in this study. Participants reported moderate scores of knowledge, attitude, and readiness to practice. Older participants reported better readiness to practice and a KArP score. A significant difference was observed in all categories according to gender, with men having higher scores than women. No significant difference was observed between the level of education and knowledge, attitude, and total KArP scores. CONCLUSIONS: Our study's findings showed that age and the level of education were positively correlated with readiness to practice. Men, compared to women, had significantly higher scores in all categories. Barriers to the KArP should be identified and targeted in future studies, as disaster preparedness at the institutional level may improve outcomes in future disaster encounters.

Salmonella Prevalence and antibiotic resistance profile in raw poultry meat sold in North Lebanon: Insights from the COVID-19 pandemic and economic crisis.

Salmonella-related foodborne illness is a significant public health concern, with the primary source of human infection being animal-based food products, particularly chicken meat. Lebanon is currently experiencing a dual crisis: the COVID-19 pandemic and an unprecedented economic crisis, which has resulted in substantial challenges to the public health system and food safety. This study aims to assess the prevalence and antibiotic resistance profile of Salmonella in raw poultry meat sold in North Lebanon during this dual crisis. A cross-sectional study was carried out between May 2021 and April 2022 across six different districts in North Lebanon. A total of 288 whole, unprocessed chickens were examined. The isolation and identification of Salmonella isolates were done based on cultural and biochemical properties. All isolates were subjected to antimicrobial susceptibility testing and phenotypic assays for Extended-Spectrum Beta-lactamase (ESBL) detection. The prevalence of Salmonella in raw poultry meat purchased in North Lebanon reached 18.05 % (52/288). The dry season and chilled chicken were significantly associated with an increased risk of Salmonella contamination (P < 0.05). Additionally, 34.61 % of the isolates were potential ESBL producers, and 57.69 % exhibited multidrug resistance (MDR). This study highlights the existence of MDR in chicken meat in North Lebanon, posing a potential health risk if undercooked chicken meat is consumed. This emphasizes the importance of the implementation of preventive strategies and hygienic procedures throughout the food chain to reduce the risk of Salmonella spp. contamination in chicken meats and its potential transmission to humans.

Predicting poor mental health among older Syrian refugees in Lebanon during the COVID-19 pandemic: a nested cross-sectional study.

INTRODUCTION: The COVID-19 pandemic has worsened pre-existing vulnerabilities among older Syrian refugees in Lebanon, potentially impacting their mental health. The study aims to describe the evolution of poor mental health over time and to develop and internally validate a prediction model for poor mental health among older Syrian refugees in Lebanon. METHODS: This prognostic study used cross-sectional data from a multiwave telephone survey in Lebanon. It was conducted among all Syrian refugees aged 50 years or older from households that received assistance from a humanitarian organisation. Data were collected between 22 September 2020 and 20 January 2021. Poor mental health was defined as a Mental Health Inventory-5 score of 60 or less. The predictors were identified using backwards stepwise logistic regression. The model was internally validated using bootstrapping. The calibration of the model was presented using the calibration slope (C-slope), and the discrimination was presented using the optimised adjusted C-statistic. RESULTS: There were 3229 participants (median age=56 years (IQR=53-62)) and 47.5% were female. The prevalence of poor mental health was 76.7%. Predictors for poor mental health were younger age, food insecurity, water insecurity, lack of legal residency documentation, irregular employment, higher intensity of bodily pain, having debt and having chronic illnesses. The final model demonstrated good discriminative ability (C-statistic: 0.69 (95% CI 0.67 to 0.72)) and calibration (C-slope 0.93 (95%CI 0.82 to 1.07)). CONCLUSION: Mental health predictors were related to basic needs, rights and financial barriers. These allow humanitarian organisations to identify high-risk individuals, organise interventions and address root causes to boost resilience and well-being among older Syrian refugees in Lebanon.

Correlational Insights into Attention-Deficit/Hyperactivity Disorder in Lebanon.

Attention-Deficit/Hyperactivity Disorder (ADHD), a prevalent childhood neurodevelopmental disorder with complex etiology involving genetic and environmental factors, causes impairments across various life domains and substantial social and economic burden. Identifying correlates to prevent its onset and decrease its incidence is crucial. To our knowledge, our study represents the first case-control investigation of Lebanese ADHD patients to explore potential correlations between familial, maternal, and child health variables and ADHD to enhance understanding of its etiology and aid in prevention efforts. We recruited 61 Lebanese ADHD patients and 58 matched controls aged 6-24 years from all districts of Lebanon. The data to analyze were collected using a questionnaire. We employed statistical tests, including the independent samples t-test and the Chi-square test or Fisher's exact test. We conducted a multivariate logistic regression analysis to identify the statistically significant factors explaining ADHD likelihood. We observed male predominance (68.9%) among patients. Maternal anemia during pregnancy (OR = 3.654; 95% CI [1.158-11.529]), maternal self-reported stress during pregnancy (OR = 3.268; 95% CI [1.263-8.456]), neonatal jaundice (OR = 5.020; 95% CI [1.438-17.532]), and familial history of ADHD (OR = 12.033; 95% CI [2.950-49.072]) were significantly associated with increased odds of the disorder. On the other hand, breastfeeding (OR = 0.263; 95% CI [0.092-0.757]) was identified as a protective factor against ADHD. This pilot study shed light on risk and protective factors associated with ADHD in the Lebanese population. The results are relevant, as some identified correlates could be avoidable. Further rigorous investigation is required to expand upon the observed correlations and to assist in early detection, prevention, and intervention strategies targeting ADHD.

Using Outcome Harvesting to evaluate socio-economic development and social innovation generated by Social Enterprises in complex areas. The case of BADAEL project in Lebanon.

This paper delves into the utility of Outcome Harvesting as an effective methodology for evaluating development projects that seek to cultivate and advance social enterprises within intricate and multifaceted contexts. Amidst the ever-evolving socio-economic, political, and cultural dynamics characterizing complex environments, traditional evaluation approaches often fall short in capturing the nuanced outcomes of such projects. By adopting Outcome Harvesting, this study argues that evaluators gain a robust tool to systematically collect, analyze, and interpret the intended and unintended impacts of development initiatives in complex and changing contexts. The utilization of mixed methods in the gathering of both primary and secondary data to effectively implement the Outcome Harvesting method has been influenced by overarching theoretical frameworks in the realm of social enterprises. This approach resulted in a comprehensive research methodology that seeks to synergize the strengths of the Outcome Harvesting method within the broader context of understanding and advancing the concept of social entrepreneurship.

Unveiling food safety knowledge and practices among pet owners in Lebanon.

Owning pets offers various potential health benefits; however, it can be associated with gastrointestinal illnesses due to poor food safety knowledge and practices. This study aimed to evaluate the level of food safety knowledge and practices among pet owners in Lebanon, exploring the association between their knowledge/practices and socio-demographic characteristics. The participants included 300 pet owners, representing various genders, ages, educational levels, educational backgrounds, and incomes. They completed a questionnaire of 72 food handling practices and knowledge questions related to preparation, cross-contamination, storage and hygiene. In parallel, 300 non-pet owners with comparable sociodemographic characteristics to pet owners (control group) completed the questionnaire. On average, food safety knowledge scores were 62.1 ± 14.9% and 58.7 ± 15.5% among pet and non-pet owners, respectively, and the difference was significant (p = 0.05). On the other hand, mean food safety practice scores were 41.3 ± 14.8% and 40.4 ± 15.3% among pet and non-pet owners, respectively, and the difference was not significant (p = 0.41). In the food safety knowledge part, non-pet owners who were young, high income, university graduate, and from health-related majors scored significantly (p < 0.05) higher, while among pet-owners, only participants with a university degree and from health-related majors scored significantly (p < 0.05) higher, in terms of knowledge. On the other hand, In the food safety practices part, non-pet owners who were young, high income, and university graduates scored significantly (p < 0.05) higher, while among pet-owners, only young and high-income participants scored significantly (p < 0.05) higher. These results highlight the need for ongoing educational initiatives to improve food safety practices among both pet owners in Lebanon. The study suggests that targeted educational programs should be developed, considering specific socio-demographic characteristics, to enhance overall food safety awareness and practices among the population.

Impact of source, packaging and presence of food safety management system on heavy metals levels in spices and herbs.

Spices and herbs are susceptible to various contaminants, including heavy metals. Our study aimed to quantify the levels of lead (Pb), mercury (Hg), cadmium (As), and cadmium (Cd) in 96 composite samples of 13 herbs and spices frequently consumed in Lebanon. Twenty percent (19/96) and 4% (4/96) of the samples exceeded the permissible levels of Pb and Cd, respectively and all the samples met the permissible levels of As and Hg according to Codex Alimentarius standards. For Pb and Cd, unpackaged samples had the highest levels of unacceptable samples of 31% (8/26) and 8% (2/26), respectively. The samples locally packaged in companies with and without Food Safety Management System (FSMS) had the same levels of unacceptable samples of 12% (3/26) and 4% (1/26) for Pb and Cd, respectively. Imported packaged samples had unacceptable levels of Pb (28% (5/18)) and were acceptable for the three other heavy metals.

Dentistry from Ancient Phoenicia to Contemporary Lebanon: The USJ Faculty of Dental Medicine in Beirut.

In 2023, the Faculty of Dental Medicine, Saint Joseph University of Beirut (USJ) celebrated its 100th anniversary, marking a century of unwavering commitment to academic excellence. This milestone offers a valuable opportunity to navigate the history and evolution of dentistry in Lebanon, from its ancient roots in Phoenicia to its modern developments. It chronicles the transformative journey of dentistry while recognizing the key role played against all odds by the Society of Jesus and Saint Joseph University of Beirut in fostering the growth of dentistry as a distinct medical discipline.

States of Resistance: nosocomial and environmental approaches to antimicrobial resistance in Lebanon.

Drawing on institutional historical records, interviews and student theses, this article charts the intersection of hospital acquired illness, the emergence of antimicrobial resistance (AMR), environments of armed conflict, and larger questions of social governance in the specific case of the American University of Beirut Medical Center (AUBMC) in Lebanon. Taking a methodological cue from approaches in contemporary scientific work that understand non-clinical settings as a fundamental aspect of the history and development of AMR, we treat the hospital as not just nested in a set of social and environmental contexts, but frequently housing within itself elements of social and environmental history. AMR in Lebanon differs in important ways from the settings in which global protocols for infection control or rubrics for risk factor identification for resistant nosocomial outbreaks were originally generated. While such differences are all too often depicted as failures of low and middle-income countries (LMIC) to maintain universal standards, the historical question before us is quite the reverse: how have the putatively universal rubrics of AMR and hospital infection control failed to take account of social and environmental conditions that clearly matter deeply in the evolution and spread of resistance? Focusing on conditions of war as an organized chaos in which social, environmental and clinical factors shift dramatically, on the social and political topography of patient transfer, and on a missing "meso" level of AMR surveillance between the local and global settings, we show how a multisectoral One Health approach to AMR could be enriched by an answering multisectoral methodology in history, particularly one that unsettles a canonical focus on the story of AMR in the Euro-American context.

Knowledge, attitudes, and practices of Lebanese patients with type II diabetes towards the use and abuse of dietary supplements: A cross-sectional study.

Background: Dietary supplements (DS) use among Lebanese patients with type 2 diabetes mellitus (T2DM) increased widely due to the country's economic and financial situation. This study was conducted (1) to estimate the prevalence of DS use among persons with T2DM amid the escalating economic crisis in Lebanon; (2) to explore the knowledge, attitude, and practice (KAP) of DS use; and (3) to determine any significant association between socio-economic and socio-demographic factors and the use of DS modality. Methods: A cross-sectional study was conducted during the worst episode of the economic crisis between October and April 2022 on 460 adult patients with T2DM of both sexes. Patients were interviewed using a pre-tested questionnaire. Results: Almost 4 out of 10 patients with T2DM in our study were found to be using DS, where 27.6% take multivitamins frequently. One-third of the participants agreed that nutritional supplements are necessary to control diabetes symptoms and complications. Around 41.1% of the participants complained about hypoglycemia and used DS to control their blood sugar levels (56.4%), while the rest used it to improve their health (35.5%) and control their diet (2.2%). The predictors of DS usage were the patient's level of education [OR=3.9, CI=1.5-10, p=0.003), self-monitoring of blood sugars (OR=4.9, CI=1.68-14.6; p=0.004) and reading the nutrition label [OR=59.3, CI=6.3-55.8, p=0.000]. Conclusion: This study estimated the prevalence of DS use and abuse, among persons with diabetes type II and found three significant predictors of DS use among patients with T2DM. Public health experts should encourage healthy discussions and awareness with their patients to comprehend their views regarding DS use.

Gram-negative bacterial colonization in the gut: Isolation, characterization, and identification of resistance mechanisms.

BACKGROUND: The gut microbiome is made up of a diverse range of bacteria, especially gram-negative bacteria, and is crucial for human health and illness. There is a great deal of interest in the dynamic interactions between gram-negative bacteria and their host environment, especially considering antibiotic resistance. This work aims to isolate gram-negative bacteria that exist in the gut, identify their species, and use resistance-associated gene analysis to define their resistance mechanisms. METHODS: Samples were collected from all patients who had a stool culture at a tertiary care center in Lebanon. Each type of bacteria that was identified from the stool samples was subjected to critical evaluations, and all discovered strains underwent antimicrobial susceptibility testing. Polymerase chain reaction was used to profile the genes for Carbapenem-resistant Enterobacteriaceae (CRE), Extended-spectrum beta-lactamase (ESBL), and that of Pseudomonas aeruginosa strains. RESULTS: Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa turned out to be the predominant microbiota members. Escherichia coli strains had a high frequency of extended-spectrum beta-lactamase genes, with the most discovered gene being bla CTX-M. Additionally, a considerable percentage of isolates had carbapenemase-resistant Enterobacteriaceae genes, suggesting the rise of multidrug-resistant strains. Multidrug resistance genes, such as bla mexR, bla mexB, and bla mexA, were found in strains of Pseudomonas aeruginosa, highlighting the possible difficulties in treating infections brought on by these bacteria. CONCLUSION: The findings highlight the critical importance of effective surveillance and response measures to maintain the effectiveness of antibiotics considering the introduction of multidrug resistance genes in Pseudomonas aeruginosa and ESBL and CRE genes in Escherichia coli.

Time perspective and attachment predict perceived stress in Lebanese undergraduates: The mediating role of trait emotional intelligence.

BACKGROUND: Lebanese university students experience high levels of stress, which are linked to poor academic and health outcomes. Therefore, understanding the psychological predictors of this stress is crucial. The present study examines the roles of emotional, cognitive, and interpersonal factors in predicting perceived stress, namely trait emotional intelligence (trait EI), time perspective, and attachment. METHODS: The sample included 283 Lebanese undergraduate university students aged 18 to 33 years (M = 19.89, SD = 1.87). The main variables were assessed using the Trait Emotional Intelligence Questionnaire - Short Form, The Zimbardo Time Perspective Inventory, The Revised Adult Attachment Scale - Close Relationships Version, and the Perceived Stress Scale. RESULTS: Path analysis showed that trait EI mediated the relationship between time perspective and attachment (predictors) and perceived stress (outcome). In particular, the Past Positive and Future time perspectives positively predicted trait EI, while insecure attachment negatively predicted it. In turn, higher trait EI predicted lower perceived stress. CONCLUSION: The findings help inform theory and application, suggesting that managing stress and mitigating its impact on well-being can be achieved through interventions targeting time perspective, attachment, and trait EI.

Preparing for the next respiratory pathogen pandemic: using tabletop simulation exercises to strengthen national planning in Cook Islands, Costa Rica, Lebanon and Mongolia.

The Preparedness and Resilience for Emerging Threats (PRET) initiative takes an innovative mode-of-transmission approach to pandemic planning by advocating for integrated preparedness and response systems and capacities for groups of pathogens with common transmission pathways. The World Health Organization (WHO) launched this initiative in 2023 with the publication of PRET Module 1 addressing respiratory pathogens. Exercise PanPRET-1 is a customizable tabletop simulation exercise (TTX) package developed to complement PRET Module 1. The exercise scenario focuses on strengthening capacities for multisectoral coordination, risk communication and community engagement, and the triggers for operational decision-making. This article reports on the experiences of the first four countries to implement Exercise PanPRET-1: Cook Islands, Costa Rica, Lebanon and Mongolia. Exercise outcomes demonstrated that PanPRET-1 can be an effective tool for testing pandemic plans in a multisectoral forum and identifying opportunities to improve preparedness and response in key domains. In quantitative evaluations in Cook Islands, Costa Rica and Mongolia, high proportions of exercise participants indicated that multiple aspects of the exercise were well-designed and were beneficial for improving health emergency preparedness. Exercise participants in Lebanon provided qualitative feedback indicating that they found the exercise to be beneficial. Conducting a TTX and monitoring the implementation of action plans based on exercise findings facilitates a country-owned whole-of-society vision for pandemic planning. Countries are encouraged to incorporate TTX such as Exercise PanPRET-1 into a continuous cycle of activity to improve pandemic preparedness.