Digital Skills, STEM Occupation, and Job Automation Risks among the Older Workers in the United States.

BACKGROUND AND OBJECTIVES: Advancing automation technologies are replacing certain occupations such as those involving simple food preparation more than occupations such as those in STEM fields (e.g., engineering, health care). Older workers generally face higher job automation risks in part due to their lower levels of digital skills. A better understanding of the associations between job automation risk, digital skills, and type of occupation (e.g., STEM vs. non-STEM) can facilitate preparations for job automation and workforce population aging. RESEARCH DESIGN AND METHODS: We analyzed a nationally representative sample (N = 1,560) of middle-aged and older U.S. workers aged 50 to 74 years from the 2012/2014/2017 Program for International Assessment of Adult Competencies (PIAAC) restricted-use file. The estimated job automation risks (i.e., percentage of jobs to be automated in the next decades) \were derived from the previous studies. PIAAC digital problem-solving skills proficiency (measured on a scale of 0-500 points) was assessed based on a series of practical digital tasks (e.g., finding a job research website that does not require registration). RESULTS: Linear regression analysis showed that greater digital skill proficiency (b = -0.04, p < .05) and STEM occupations (b = -17.78, p < 0.001) each were associated with lower job automation risks, even after adjusting for a series of demographic, socioeconomic, and civic engagement characteristics. DISCUSSION AND IMPLICATIONS: Education and labor policy interventions to promote digital skills among older workers and non-STEM workers may better prepare an aging workforce for the dynamic labor market needs in the United States.

Developing the Lebanese health economic evaluation guideline.

OBJECTIVE: To report on the process of developing the Lebanese Economic Evaluation Guideline (LEEG), and to provide relevant material that could assist guideline developers in the future. METHODS: The development of the LEEG closely followed the process proposed by the World Health Organization, i.e. to set up a Guideline Development Group (composed of three Lebanese experts), to establish the rationale for developing the guideline in Lebanon, to identify its scope, to search and retrieve evidence through two systematic reviews, to assess and present the evidence, to translate the evidence into guidelines and recommendations through a deliberative process, and to consult international experts. The deliberative process included a survey, an in-person interview, and a consensus workshop with 16 Lebanese key stakeholders. Data was collected and quantitative analysis was conducted using SPSS software. International experts from Maastricht University - The Netherlands were consulted for issuing the LEEG. Supported by the Lebanese Ministry of Public Health (MoPH), the LEEG will be available for public consultation on the MoPH's webpage, and a final version will be made available thereafter. CONCLUSION: Clear and transparent reporting of the guideline development process should support international organizations as well as other developers in establishing their guidelines within their national context.

Reliance on Social Networks and Health Professionals for Health Information in the U.S. Adult Population.

The subpopulation of adults depends on non-online health information sources including their social networks and health professionals, to the exclusion of online sources. In view of the digital divide and health information disparities, the roles of race/ethnicity and digital skills are yet to be explored. A nationally representative sample of 6,830 adults from the Program for the International Assessment of Adult Competencies (PIAAC) was analyzed, using binary logistic regression. Black adults and adults with higher digital skills were less likely to be reliant on non-online health information sources, compared to White adults and those with lower digital skills, respectively. Differences in non-online health information source reliance by race/ethnicity and digital skills might be further nuanced by the relevant demographic and socioeconomic characteristics. Increasing digital skills may expand one's health information sources to include reliable online sources and empower adults to promote their health.

Trust in pharmaceuticals and vaccine hesitancy: exploring factors influencing COVID-19 immunization among Lebanese children aged 1 to 11 years.

INTRODUCTION: The COVID-19 pandemic is a serious threat to everyone's health. Numerous studies have demonstrated that vaccines are very effective in preventing COVID-19-related severe illness, hospitalization, and death. Children's vaccination exerts its protecting effect by preventing the spread of the virus. The purpose of this study was to analyze the rate of COVID-19 immunization among Lebanese children aged 1 to 11 years and assess parental factors that affect immunization rates. METHODS: An online cross-sectional study was conducted between January and March 2023. The online survey was distributed across all social media channels, including the Ministry of Public Health website. RESULTS: A total of 390 parents filled the survey (mean age = 37.48 ± 8.39 years; 50.5% mothers; 70% with a university level of education). Mothers compared to fathers, having a history of bad reaction to a vaccine vs. not, and higher vaccine hesitancy were significantly associated with less willingness to administer the vaccine to the child. Trusting pharmaceutical companies was significantly associated with more willingness to administer the vaccine to the child. CONCLUSION: The results of this study show that the factors associated with parents' decisions to vaccinate their children may vary. Our findings conclude that vaccine acceptance is being highly associated with parental concerns, trust, and information regarding the vaccine safety and efficacy.

A 1-year analysis of adverse events following COVID-19 vaccination in Lebanon: a retrospective study.

BACKGROUND: Since the deployment of Coronavirus Disease 2019 (COVID-19) vaccines, skepticism about the safety, incidence, and severity of Adverse Events Following Immunization (AEFI) was a concern. The study has two main objectives. First, to analyze AEFIs following COVID-19 vaccines (Pfizer-BioNTech, AstraZeneca, Sputnik, and Sinopharm) during the vaccination campaign in Lebanon and correlate them with age and gender. Second, to correlate Pfizer-BioNTech and AstraZeneca vaccines' AEFI with the dose administered. METHODS: A retrospective study was carried out between February 14th, 2021, and February 14th, 2022. AEFI case reports received to the Lebanese Pharmacovigilance (PV) Program were cleaned, validated, and analyzed using SPSS software. RESULTS: A total of 6808 AEFI case reports were received to the Lebanese PV Program during the period of this study. Case reports were mostly received from females (60.7%) and from vaccine recipients aged 18-44 years. As for the vaccine type, AEFIs occurred more frequently with the AstraZeneca vaccine compared to the Pfizer-BioNTech vaccine. The latter had AEFIs mainly following dose 2, whereas AEFIs with the AstraZeneca vaccine were more frequently reported after dose 1, with general body pain being the most reported systemic AEFI with PZ (34.6%), while fatigue was the most reported AEFI with AZ vaccine (56.5%). CONCLUSIONS: The AEFI reported with COVID-19 vaccines in Lebanon were aligned with those reported worldwide. The incidence of rare serious AEFIs should not discourage the public from getting vaccinated. Further studies are needed to evaluate their long-term potential risk.

Humanistic and Economic Burden of Atopic Dermatitis for Adults and Adolescents in the Middle East and Africa Region.

INTRODUCTION: Atopic dermatitis (AD) is a chronic skin disease that poses a significant burden on both patients and the society. AD causes the highest loss in disability-adjusted life years compared with other skin diseases. This study aimed to estimate the economic and humanistic burden of AD in adults and adolescents in seven countries in the Middle East and Africa region (Egypt, Lebanon, Saudi Arabia, Kuwait, Algeria, South Africa, and United Arab Emirates). METHODS: We conducted a literature review to identify country-specific data on this disease. Subsequently, meetings were organized with experts from each country to complete the missing data. The data were aggregated and calculation models were created to estimate the value of the humanistic and economic burden of the disease in each country. Finally, we conducted meetings with local experts to validate the results, and the necessary adjustments were made. RESULTS: On average, a patient with AD loses 0.19 quality-adjusted life years (QALYs) annually owing to this disease. The average annual healthcare cost per patient is highest in the United Arab Emirates, with an estimated value of US $3569 and a population-level indirect cost of US $112.5 million. The included countries allocated a range of 0.20-0.77% of their healthcare expenditure to AD-related healthcare services and technologies. The indirect cost of AD represents approximately 67% of the total disease cost and, on average, approximately 0.043% (range 0.022-0.059%) of the gross domestic product (GDP) of each country. CONCLUSION: Although the humanistic and economic burdens differ from country to country, AD carries a significant socioeconomic burden in all countries. The quality of life is severely affected by the disease. If AD is controlled, the costs, especially indirect costs, could decrease and the disease burden could be alleviated significantly.

Atopic dermatitis is a chronic condition characterized by inflamed and itchy skin. The prevalence and symptoms of atopic dermatitis are observed to increase in dry weather. Owing to its high prevalence in children, the majority of studies on atopic dermatitis are in children. Although it is also prevalent in adults and adolescents, its burden on adults has not been sufficiently studied, especially in Africa and the Middle East. This study quantified the burden of atopic dermatitis in adults and adolescents in seven countries in the Middle East and Africa. We estimated the economic and humanistic burden of this disease. We conducted a literature review and expert interviews to determine the effects on patients and caregivers. We created mathematical models to calculate the disease burden in each country, and local experts in each country validated the data. The study results showed that atopic dermatitis significantly affects the quality of life of patients. The direct medical costs of treatment in each country were calculated. The management of atopic dermatitis consumes around 0.20­0.77% of the healthcare expenditure in a country. The indirect cost of atopic dermatitis represents 0.022­0.059% of the gross domestic product (GDP) of a country. The country-specific burden data are essential to guide decision-makers in arriving at evidence-based decisions and efficiently allocating available resources. This study focused on the significant indirect economic burden of the disease, which can sometimes be underestimated because the disease is not fatal.

Implementation of a Pharmacovigilance System in a Resources-Limited Country in the Context of COVID-19: Lebanon's Success Story.

Implementation of Pharmacovigilance (PV) systems in resource-limited countries is a real challenge. The objective of this paper is to describe the implementation of an effective national PV system in Lebanon in the context of COVID-19, within a limited resources setting and with the absence of a guaranteed funding. In 2018, the PV center hosted at the Lebanese University, Faculty of Pharmacy under the supervision of the Quality Assurance of Pharmaceutical Products Program within the Lebanese Ministry of Public Health became an associate member of the World Health Organization (WHO) Program of International Drug Monitoring and recognized as Full member in 2021.This analysis highlights the requirements of the WHO that were met in Lebanon to create an effective PV system. The Lebanese experience shows that it is not only possible, but also crucial to implement a PV system in low to middle-income countries with limited resources and with the absence of a guaranteed funding in order to be able to promote patients' safety. Support from organizations like WHO and World Bank, skilled leadership, hard work and dedicated staff with efficient training, and finally mass awareness initiatives were all considered as key elements to implement a successful PV System. In the midst of a turbulent political, economic and health context, Lebanon has been able to develop one of the most active and rapidly evolving PV systems in the Middle East.

Non-adherence to antihypertensive medications in Lebanese adults hospitalized for hypertensive urgency and its cost.

BACKGROUND: Drug non-adherence is assumed to play an important role in development of hypertensive urgency, which is a common health problem resulting in frequent emergency department admissions and thus increased healthcare spending wastage. The objective of this study is to assess the rate of non-adherence to antihypertensives and to evaluate influencing factors predicting this behavior in Lebanese hypertensive adults. In addition, this study aim to estimate the cost of hospitalization for hypertensive urgency covered by the Ministry of Public Health in patients' non-adherent to their antihypertensives. METHODS: A multi-methods approach is used comprising a cross-sectional study, additionally to an observational, retrospective, cost of illness study. A cross-sectional questionnaire based study is conducted from May to Dec, 2019 to address the study objective. Using the Ministry of Public Health hospitalization data during 2019, the cost of hospitalization for hypertensive urgency is assessed. Multivariable analysis is performed to calculate the adjusted odd ratios by fitting a logistic regression model. RESULTS: The cross-sectional study includes 494 participants and shows that 43.0% of patients hospitalized and covered by the Ministry of Public Health are non-adherent. The univariate regression model shows that adherence to antihypertensive medications is significantly associated with age (p-value = 0.005) and follow-up visits (p-value = 0.046). The odds of adherence for participants earning more than USD 2000 was 3.27 times that for those who earn less than USD 1000 (p = 0.026). The estimated cost of hospitalization for non-adherent patients is USD 452,353 in 2019. CONCLUSION: Non-adherence associated hospitalization costs represents a financial burden to Lebanese health system.

Vaccination process evaluation at COVID-19 vaccination centers in Lebanon: a national study.

BACKGROUND: Upon the authorization of COVID-19 vaccines worldwide, national and international standards were developed to help integrate mass COVID-19 immunization campaigns into the healthcare network. The primary objective is to evaluate the overall COVID-19 vaccination process through on-site visits to vaccination centers all over Lebanon to assess whether these are abiding by the national and international requirements for both Pfizer-BioNTech and AstraZeneca vaccines. The secondary objective is to explore whether the type of the facility, private versus governmental, and educational versus non-education, affects the vaccination process in these centers. METHODS: A convenient sample of 33 vaccination centers was selected from a list of all COVID-19 vaccination centers operating in Lebanon. Data were collected using a structured checklist developed following an extensive literature review of the national and international standards for Pfizer-BioNTech and AstraZeneca COVID-19 vaccines. A scoring system for the overall vaccination process was developed. RESULTS: Quality deficiencies were identified in several steps of the immunization process; however, the international standards were followed in most vaccination centers visited despite their limited resources. It was noticed that there were no significant differences between private and governmental, between educational and non-educational, and between Pfizer and AstraZeneca vaccination centers; the 33 vaccination centers visited have scored above 75 on the entire process immunization against COVID-19 with P-values above 0.05 in all steps evaluated. CONCLUSION: An optimization of the immunization process should be performed to ensure that the practice is within international standards. This can be done by conducting periodic vaccination center visits, implementing clear guidelines, training staff involved in the vaccination process, and ensuring continuous support of the Lebanese Ministry of Public Health.

The development process of economic evaluation guidelines in low- and middle-income countries: a systematic review.

OBJECTIVES: To review the development of economic evaluation guidelines (EEGs) in low- and middle-income countries (LMICs), with the goal of assisting those developing EEGs in LMICs. METHODS: We conducted a systematic search in MEDLINE (Ovid), PubMed, EconLit, Embase (Ovid), the Cochrane Library, and the gray literature until March 2021. We extracted data on the methods used in the EEG development process, the responsible party engaged, and the development team's composition. We conducted a quality assessment, using the Appraisal of Guidelines for Research and Evaluation-Health Systems tool, and then carried out a relative comparison. RESULTS: Fourteen EEGs and nine studies were identified. In ten countries, the Ministry of Health was responsible for handling the development process. The majority of LMICs who developed EEGs did not explicitly report the discipline of those involved in the process. The developers of EEGs followed four main steps: conducting a review on national guidelines, organizing workshops, and getting support from international experts or from organizations. One-third of the identified EEGs failed to engage multisectoral or multidisciplinary developers, and approximately 14 percent did not follow or report any recommended step. CONCLUSIONS: This study identified a scarcity of published information related to the development process and the suboptimal quality of included studies. It provides relevant material to support international organizations and developers of guidelines in LMICs in developing EEGs that fit their national context. In addition, this paper recommends a transparent approach to the design of guidelines and to reporting on the methods for developing them.

Economic evaluation guidelines in low- and middle-income countries: a systematic review.

OBJECTIVES: To systematically identify the latest versions of official economic evaluation guidelines (EEGs) in low- and middle-income countries (LMICs) and explore similarities and differences in their content. METHODS: We conducted a systematic search in MEDLINE (Ovid), PubMed, EconLit, Embase (Ovid), the Cochrane Library, and the gray literature. Using a predefined checklist, we extracted the key features of economic evaluation and the general characteristics of EEGs. We conducted a comparative analysis, including a summary of similarities and differences across EEGs. RESULTS: Thirteen EEGs were identified, three pertaining to lower-middle-income countries (Bhutan, Egypt, and Indonesia), nine to upper-middle-income countries (Brazil, China, Colombia, Cuba, Malaysia, Mexico, Russian Federation, South Africa, and Thailand), in addition to Mercosur, and none to low-income countries. The majority (n = 12) considered cost-utility analysis and health-related quality-of-life outcome. Half of the EEGs recommended the societal perspective, whereas the other half recommended the healthcare perspective. Equity considerations were required in ten EEGs. Most EEGs (n = 11) required the incremental cost-effectiveness ratio and recommended sensitivity analysis, as well as the presentation of a budget impact analysis (n = 10). Seven of the identified EEGs were mandatory for pharmacoeconomics submission. Methodological gaps, contradictions, and heterogeneity in terminologies used were identified within the guidelines. CONCLUSION: As the importance of health technology assessment is increasing in LMICs, this systematic review could help researchers explore key aspects of existing EEGs in LMICs and explore differences among them. It could also support international organizations in guiding LMICs to develop their own EEGs and improve the methodological framework of existing ones.

Survey investigating the knowledge and awareness of payers and patient advocacy groups about the health technology assessment process in Lebanon.

The survey aims to assess the knowledge and awareness of Reimbursement Bodies (RBs) and Patient Advocacy Groups (PAGs) in Lebanon and the possible involvement of patients in the health technology assessment (HTA) process in the absence of a well-established HTA structure and to identify the actions to be taken at this level. Structured questionnaires were administered to eleven key participants from both RBs and PAGs. The survey utilized two different questionnaires, each composed of two open-ended questions and ten close-ended questions. RBs recognized the need for clinical and technical guidelines to optimize the HTA process, whereas PAGs stated that they are familiar with the current assessment and reimbursement process. A lack of interaction between the payers and the PAGs was reported mainly due to the absence of laws that involve patients in the assessment process. All the payers and three out of five of PAGs encouraged the involvement of PAGs in the assessment process. They reported that patients require support, education, and training to be efficiently involved. A short-term plan for involving patients in the assessment process can be implemented in light of RBs' and PAGs' openness for such involvement. In the long run, the collaboration between both parties needs to be more formalized and structured. Education and training programs are to be suggested for other PAGs. The institutionalization of an HTA body that unifies all the fragmented RBs, including a patient's representation to optimize the reimbursement process and to engage patients, is recommended.

Impact of Ramadan Intermittent Fasting on the Heart Rate Variability and Cardiovascular Parameters of Patients with Controlled Hypertension.

BACKGROUND: Conflicting results are reported on the effect of Ramadan fasting on the cardiovascular health of patients with hypertension, a highly prevalent cardiovascular disease risk factor. This research aimed to evaluate the impact of fasting on cardiac health and heart rate variability (as a measure of cardiac stress) of hypertensive patients. METHODS: Patients with controlled hypertension were followed in a prospective cohort during and after Ramadan. Lipid panel and blood glucose were measured at the end of each phase. Blood pressure and heart rate variability were monitored in the morning, afternoon, and evening of each follow-up day. RESULTS: The study included 58 subjects (mean age: 54 ± 11.5 years, 52% male). Fasting did not affect body composition, lipid panel parameters, and blood pressure of hypertensive subjects; males only presented lower body weight and hip circumference during Ramadan. Blood glucose was significantly higher during Ramadan. Fasting significantly increased HRV during the afternoon period. CONCLUSIONS: Ramadan intermittent fasting reduces cardiac stress among hypertensive patients controlled by and adherent to hypertensive medication, without affecting their hypertensive state.

Patients' knowledge and awareness about patient support programs: a cross-sectional study on Lebanese adults with chronic diseases.

OBJECTIVE: Patient Support Programs (PSPs) have become a trend among pharmaceutical companies and a standard service offering to patients. The objective of the present study is to describe the status of PSPs in Lebanon and to assess the extent of knowledge and awareness among Lebanese patients about the PSPs. METHODS: A cross-sectional study was conducted between April and July 2017. A convenient sample of patients was randomly selected from outpatient clinics at four hospitals within the Greater Beirut Area. A questionnaire was used to address the study objective. Bivariate analysis was performed using the Chi-square test. Data were analyzed by using SPSS version 23. RESULTS: Out of 385 patients who participated in the study, 45.45 percent were aged between 46 and 66 years. None of them indicated that they were enrolled in a PSP, and only 13 percent of the respondents were aware of the existence of such a program. In terms of adherence habits, 55.6 percent of the patients self-reported that they do not skip any dose of their medication and consume their medication as prescribed by their healthcare providers. The main reason for nonadherence reported by the majority of nonadherent participants 144 (84.2%) was simple forgetfulness. CONCLUSIONS: There is a severe lack of awareness of PSPs in Lebanon. Given the important role that PSPs play in creating value for patients-in terms of healthcare follow-up practices, improved adherence habits, and cost savings-there should be a more substantial effort by pharmaceutical companies to expand and promote their PSPs in the Lebanese market.

Factors Associated with Antihypertensive Medication Non-Adherence: A Cross-Sectional Study Among Lebanese Hypertensive Adults.

BACKGROUND: Poor adherence to antihypertensives is associated with negative outcome of the disease as well as loss of health-care resources. Addressing the epidemic of poor adherence requires identifying factors associated with this behaviour. The aim of this study is to describe adherence to antihypertensive medication among Lebanese hypertensive patients and to evaluate the association between socio-economic, patient- and conditions-related factors and non-adherence. METHODS: A cross-sectional study was carried out on adherence to antihypertensive medications covering all governorates of Lebanon. This study was conducted between February 2018 and January 2019 on a random sample of 1497 hypertensive patients. A face-to-face questionnaire was used to assess adherence to antihypertensive medication and its determinants according to the five World Health Organization (WHO) main categories. Logistic regression analysis was performed to test the adjusted association between the multiple exposure factors, and drug adherence data were collected by trained interviewers. RESULTS: Adherence to antihypertensive medications was reported by 1253 (83.7%) of the patients. After multivariate analysis, patients who tried to control their stress level (OR = 0.77, 95% CI [0.38-0.95]), those who had normal BP readings (OR =0.49, 95% CI [0.18-0.97]), and those who believed in the effectiveness of their treatment (OR = 0.31, 95% CI [0.14-0.76]) had a significantly lower chance to exhibit non-adherence to their treatment. However, older patients (OR= 1.87, 95% CI [1.23-2.21]), divorced/separated patients (OR= 2.14, 95% CI [1.31-5.48]), married (OR=1.96, 95% CI [1.27-3.90]), widowed (OR=2.11, 95% CI [1.62-6.50]), obese patients (OR = 1.76, 95% CI [1.21-1.94]), and patients who smoked hookah and cigarettes (OR = 2.62, 95% CI [1.17-6.76]) were more likely to exhibit non-adherence. CONCLUSION: Our study highlights the influence of factors such as old age, marital status, BMI and high level of emotional stress on non-adherence to medication in hypertensive patients. These determinants should be incorporated into adherence improving strategies.

Exposure to violence and its relationship to mental health among young people in Palestine.

BACKGROUND: Exposure to violence is a significant risk factor for the development of psychopathology in young people. Research on the mental health consequences of violence exposure in youth has focused mostly on post-traumatic stress disorder, however, the association with depression and anxiety has also been established. As a result of the longstanding Israeli-Palestinian conflict, young Palestinians are vulnerable to exposure to various types of violence. AIMS: We examined psychiatric symptomatology and its relationship to direct and indirect forms of violence exposure. METHODS: A representative household survey of 2481 Palestinian youth was conducted in 2014. Self-report measures included psychiatric symptomatology (global distress, depression, anxiety) and violence exposure (personal victimization, witnessed, vicariously heard about). RESULTS: The proportion of elevated symptoms of global distress (46%), depression (55%), and (37%) anxiety was high; 47% had been a personal victim, 71% had witnessed violence, and 69% had heard about violence experienced by someone close to them. In logistic regression analysis, controlling for other bivariate correlates, exposure to any violence event, as well as any of the 3 types of violence exposure, were independently associated with each of the 3 measures of elevated psychiatric symptomatology. Females were 4 times more likely to report elevated psychopathology, despite being less likely to experience each type of violence. CONCLUSIONS: These findings suggest the need for services that cater to the mental health needs of youth in settings of high violence exposure, and that gender-specific strategies may be useful.

Implementation of Health Technology Assessment in the Middle East and North Africa: Comparison Between the Current and Preferred Status.

INTRODUCTION: Implementation of health technology assessment (HTA) is still in an early stage with some heterogeneity in the Middle East and North Africa (MENA). Our objective was to assess the current and future status of HTA implementation in the MENA region by focusing on regional commonalities. METHODS: Preparatory discussions for the first ISPOR conference in the MENA region indicated some potentially generalizable trends of HTA roadmaps. To widen the perspective, a policy survey was conducted among conference participants by applying an HTA implementation scorecard. Discussion group members helped to validate key conclusions during and after the conference. RESULTS: Health policy experts in MENA countries would like to facilitate HTA implementation and expect significant changes with some generalizable directions in 10 years compared to the current status according. HTA capacity building has to be strengthened by more graduate and postgraduate programs. Increased public budget and enhanced institutionalization are necessary success factors of HTA implementation. The scope of HTA has to be extended from pharmaceuticals to non-pharmaceutical technologies and to revision of previous policy decisions. Although cost-effectiveness with explicit threshold remains the most preferred HTA criterion, several other criteria have to be considered, maybe even by applying an explicit MCDA framework. The role of local evidence and data has to be strengthened in MENA countries, which translates to the extended use of local patient registries and payers' databases. Duplication of efforts can be reduced if international collaboration is integrated into national HTA implementation. DISCUSSION: Our results should be viewed as an initial step in a multi-stakeholder dialogue on HTA implementation. Each MENA country should develop its context-specific HTA roadmap, as such roadmaps are not transferable without taking into account country size, economic status, public health priorities and adopted systems of health care financing.

Effect of Ramadan fasting on heart rate variability as a measure of cardiac stress in a Lebanese cohort.

BACKGROUND: Intermittent fasting is an annual religious practice of Muslims worldwide, which affects the physiology of the body due to lifestyle alterations. This study aimed to evaluate the effect of Ramadan fasting on the HRV, an indirect measure of cardiac sympathetic stress. METHODS: This study included 80 healthy Lebanese females (aged 18-25 years old) monitored for 24 h when following normal routine; 38 and 42 females were enrolled before and during Ramadan, respectively. RESULTS: Our results reveal no effect of fasting on HRV; there was insignificant change in HRV between the first and last weeks of Ramadan (P > 0.05). Morning fasting was significantly the least stressful period (lowest HR, P < 0.001), with lower HR compared with non-fasting day (P < 0.001). Therefore, Ramadan fasting does not alter the autonomic nervous activity of the heart, neither HRV levels. CONCLUSIONS: This may imply that intermittent fasting is a risk-free practice, which does not interfere with the cardiac autonomic nervous system function.

Requirements for a Successful Drug Launch in Small Markets: A Pilot Study in Lebanon.

OBJECTIVE: This study assesses the impact of an uncertain environment on pharmaceutical companies in Lebanon and investigates how they are launching new drugs despite Lebanon's economic instability, lack of data, low base salaries, and frequent drug repricing regulation adopted by Lebanese health authorities. METHODS: A cross-sectional descriptive survey was conducted in a multinational pharmaceutical company in Lebanon. Employees were asked to complete a questionnaire between June and July 2017. Chi-square testing was used to check correlation. RESULTS: Seventy-seven employees participated in this survey. Thirty-two (41.6%) emphasized the need for partnering with stakeholders. When asked about the activities to be improved, 17 (22.08%) stated that early stakeholder engagement was key to ensure launch success. Regarding the hurdles facing pharmaceutical companies, 35 (45.7%) indicated that patient access to the new medication was the key challenge, 19 (24.68%) agreed that tailored market access programs should be planned before actual launch, and 30 (38.96%) realized the need to demonstrate clinical and economic value of the product using health economic data. Finally, 39 (50.64%) agreed that launch failure was linked to poor pricing strategy. CONCLUSIONS: Major challenges facing pharmaceutical companies under Lebanon's uncertain environment did not hinder companies from bringing innovative products. A partnership among decision makers, consumers, and pharmaceutical companies is the most efficient method to ensure future access to new and innovative drugs.

Stress and Heart Rate Variability during University Final Examination among Lebanese Students.

Real-life stressors, such as university examination, cause an increase in sympathetic activity of the nervous system innervating the heart, and thus an increase in heart rate (HR). Our study aimed to detect changes in heart rate variability (HRV) during different stages of an exam in a group of 90 healthy university students (30 males and 60 females), over 4 h of monitoring divided into 1 h before, 2 h during, and 1 h after the examination. HRV was significantly highest after the exam, indicating release from stress, as compared to before and during the examination when stress was observable. Undergraduate students in different academic years did not differ in terms of stress, indicating the absence of adaptation to exam procedures. However, HR and R-R interval after the exam showed significant difference between first year undergraduate studies and first year of a graduate program, indicating a higher degree of confidence in graduate students. Results also suggest that HRV in females is significantly lower than that in males before and after examination, despite men having greater sympathetic input. In conclusion, the results of our novel study assessing stress in real-time examination show important gender differences, and lack of adaptation with academic study year.