Opioid use disorder in two samples of the Lebanese population: scale validation and correlation with sleep and mood disorders.

BACKGROUND: The revised Opioid Risk Tool (ORT-OUD) is a brief, self-report scale designed to provide clinicians with a simple, validated method to screen for the risk of developing an Opioid Use Disorder (OUD) in patients without a prior history of substance abuse. This study aimed to translate and validate the Arabic version of ORT-OUD in the Lebanese population and assess its clinical validity in a sample of patients with OUD. METHODS: This cross-sectional study in the Lebanese population used several validated scales to assess the risk of OUD, including the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Other tools evaluated chronotype and sleep and mood disturbances. Principal component analysis with Varimax rotation was applied to assess ORT-OUD construct validity. Convergent validity with the Arabic version of ASSIST was evaluated. The ORT-OUD criterion validity was then assessed in a clinical sample of patients with OUD. RESULTS: This study included 581 participants. The prevalence of the OUD risk in the Lebanese population using the ORT-OUD scale and the ASSIST-opioids scale was estimated at 14.5% and 6.54%, respectively. No items of the ORT-OUD were removed; all items converged over a solution of four factors with an eigenvalue > 1, explaining a total of 68.2% of the variance (Cronbach's alpha = 0.648). The correlation coefficients between the ORT-OUD total score and ASSIST subscales were as follows: ASSIST-opioids (r = 0.174; p = < 0.001), ASSIST-sedatives (r = 0.249; p < 0.001), and ASSIST-alcohol (r = 0.161; p = < 0.001). ORT-OUD clinical validation showed a correlation with ASSIST-opioids (r = 0.251; p = 0.093) and ASSIST-sedatives (r = 0.598; p < 0.001). Higher ORT-OUD scores were associated with a family and personal history of alcohol and substance consumption and higher insomnia and anxiety scores. CONCLUSIONS: This study is the first to validate the Arabic version of ORT-OUD in the Lebanese population, an essential step towards improving the detection and management of OUD in this population.

Clinical and genetic factors associated with self-reported cognitive deficits in women with breast cancer: the "CAGE-Cog" study.

BACKGROUND: Breast cancer patients undergoing chemotherapy treatment are at particular risk of experiencing acute cognitive impairment leading to daily challenges in decision-making and reduced quality of life and functional autonomy. The aim was to assess the relationship between clinical and genetic factors and cognitive function in a sample of patients with breast cancer undergoing chemotherapy. METHODS: A cross-sectional study was carried out between November 2017 and June 2019 on women (N = 112) treated for breast cancer by intravenous chemotherapy at the oncology outpatient unit of Hôtel-Dieu de France Hospital, Beirut. Patients were evaluated with the 37-item Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog). Other validated scales were also used to assess depression, anxiety, sleep disorders, pain, and fatigue. DNA was obtained by a buccal swab (FTA®technology) for genotyping of different genes (ABCB1, COMT, DRD2, OPRM1, CLOCK, CRY2, and PER2) using the Lightcycler®(Roche). RESULTS: The mean age of participants was 56.04 years. Multivariable analysis, taking the four FACT-Cog subscores as the dependent variables, showed that the mean cognitive score decreased with higher depression, anxiety, and insomnia scores. Patients with university education levels had better perceived cognitive abilities than those with primary education. Moreover, carrying the G allele for the OPRM1 polymorphism (c.118A > G;rs197791) was significantly associated with a better cognitive function compared to AA patients (B = 2.05; p = 0.038). CONCLUSIONS: A comprehensive oncological care plan should include a personalized assessment of all factors related to cognitive functioning in cancer patients, particularly anxiety and depression, to achieve an optimal patient outcome.

Public health risk associated with the co-occurrence of aflatoxin B1 and ochratoxin A in spices, herbs, and nuts in Lebanon.

Background: Aflatoxin B1 and ochratoxin A are mycotoxins produced by filamentous fungi that attack crops on field and storage. Both mycotoxins present a risk on public health since aflatoxin B1 is a hepatotoxic and hepatocarcinogenic agent while ochratoxin A can be nephrotoxic. Those mycotoxins can be found in several food items including spices, herbs, and nuts. Objectives: In Lebanon, few studies address aflatoxin B1 and ochratoxin A contamination in spices, herbs, and nuts. So, the aim of this study is to investigate the concentrations of those two mycotoxins particularly in spices and herbs and the concentration of aflatoxin B1 in nuts, and to determine the dietary exposure of the Lebanese population and their possible attribution to liver cancer and renal damage. Methods: In this work, a total of 198 samples of spices, herbs, and nuts were collected from different sites. Aflatoxin B1 and ochratoxin A were quantified using immune-affinity columns. A food frequency questionnaire was used to quantify the consumption of spices, herbs, and nuts in Lebanon. Exposure to aflatoxin B1 and ochratoxin A was calculated accordingly and liver and kidney cancer risks were evaluated. Results: Aflatoxin B1 was respectively found in 100, 20.4, and 98.6% of the spices, herbs, and nuts samples, while ochratoxin A was found in 100 and 44.4% of spices and herbs, respectively. Aflatoxin B1 was found at mean concentration of 0.97, 0.27, and 0.40 µg/kg in spices, herbs, and nuts, respectively while ochratoxin A was found at mean concentrations of 38.8 and 1.81 µg/kg in spices and herbs, respectively. Aflatoxin B1 occurrence was shown to be associated in this study with 0.017 additional cancer cases per 100,000 persons per year, and ochratoxin A weekly exposure was shown to be 5.04 ng/kg bw less than the Provisional Tolerable Weekly Intake of 100 ng/kg bw which indicates low risk of renal damage from spices and herbs consumption. Conclusion: The consumption of spices, herbs, and nuts in Lebanon could lead to an increase in health risks associated with aflatoxin B1 and ochratoxin A, specifically spices. The reported occurrence may be directly related to poor storage conditions.

Aflatoxin B1 and ochratoxin A in imported and Lebanese wheat and -products.

AFB1 and OTA are produced in food products due to climatic conditions like temperature and humidity. In Lebanon, few studies address AFB1 and OTA contamination in wheat and wheat products. In this study, a total of 312 samples of wheat and wheat products were collected from different sites, including port, silos, mills, and supermarkets were analysed. Wheat and wheat products consumption in Lebanon was quantified using a food frequency questionnaire. Exposure to AFB1 and OTA was calculated and liver and kidney cancer risk were evaluated. Results showed that AFB1 and OTA were, respectively, found in 65.7% and 100% of the samples, with 0.6% and 17.6% exceeding the maximum limit set by the European Commission. AFB1 was shown to be associated with 0.076 additional cancer cases per 100,000 persons per year and OTA weekly exposure was shown to be 53.2 ng/kg bw, which is less than the Provisional Tolerable Weekly Intake of 100 ng/kg bw.

Negative symptoms in schizophrenia: correlation with clinical and genetic factors.

Aim: Explore the possible association between clinical factors and genetic variants of the dopamine pathways and negative symptoms. Materials & methods: Negative symptoms were assessed in 206 patients with schizophrenia using the Arabic version of the self-evaluation of negative symptoms scale and the Positive and Negative Syndrome Scale. Genotyping for COMT, DRD2, MTHFR and OPRM1 genes was performed. Results: Multivariable analysis showed that higher self-evaluation of negative symptoms scale scores were significantly associated with higher age, higher chlorpromazine-equivalent daily dose for typical antipsychotics and in married patients. Higher negative Positive and Negative Syndrome Scale scores were significantly associated with women and having the CT genotype for MTHFR c.677C>T (ß = 4.25; p = 0.008) compared with CC patients. Conclusion: Understanding both clinical/genetic factors could help improve the treatment of patients.

Clinical and Genetic Factors Associated With the Breast Cancer-Related Sleep Disorders: The "CAGE-Sleep" Study-A Cross-Sectional Study.

CONTEXT: Despite being among the most reported concerns in breast cancer patients, sleep disturbances are still poorly assessed and managed in routine clinical practice. Correctly evaluating these symptoms and understanding the underlying clinical and genetic factors would help medical teams develop an adequate treatment strategy for each patient. OBJECTIVES: 1) To explore the severity of insomnia as well as sleep quality in a sample of Lebanese women with breast cancer undergoing chemotherapy; 2) To examine the correlation between sociodemographic, clinical, psychiatric (anxiety and depression), genetic factors, and alterations in sleep patterns. METHODS: A cross-sectional study was carried out using the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) (December 2017-June 2019; Ethical reference number: CEHDF1016). All patients gave their written consent and were genotyped for several polymorphisms in CLOCK, CRY2, PER2, COMT, DRD2, OPRM1, and ABCB1 genes using Lightcycler® (Roche). RESULTS: Our sample included a total of 112 women. Almost half of the patients reported insomnia problems (with 20.5% moderate insomnia and 7.1% severe insomnia). Multivariable analyses taking the PSQI score as the dependent variable, showed that higher depression score and dyslipidemia (yes versus no) were significantly associated with higher PSQI scores (worse sleep quality), whereas having the DRD2 CT genotype versus CC and a higher chemotherapy cycle number were significantly associated with lower PSQI scores (better sleep quality). Depression was also significantly associated with higher ISI scores. When forcing all the genes in each model, the results remained the same except for depression that has been replaced by anxiety in the multivariable analysis. CONCLUSION: Our study confirms the relationship between anxiety/depression, cycle number, dyslipidemia and DRD2 polymorphism with insomnia and highlights the importance of treating all associated factors to improve the overall QOL of patients.

Construction and validation of the water pipe harm perception scale (WHPS-6) among the Lebanese population.

Compared to cigarettes, water pipe is misconceived as being less addictive and containing less nicotine. This study aimed at constructing and validating a water pipe harm perception scale among a sample of the Lebanese population. A cross-sectional study was carried out between February and December 2017 using a proportionate cluster sample of Lebanese adults (492 participants). The water pipe harm scale items converged over a solution of one factor that had an eigenvalue over 1, explaining a total of 66.75% of the variance. The model used was adequate (Kaiser-Meyer-Olkin measure = 0.862 and Bartlett's test of sphericity p < 0.001). The reliability of all scale's items was high (Cronbach's alpha = 0.896). Higher cigarette dependence (LCD score) was significantly associated with higher water pipe harm perception scores, whereas exclusive water pipe smokers (Beta = - 2.142) and dual water pipe and cigarette smokers (Beta = -2.142) compared to nonsmokers, as well as those with high monthly income compared to a low one (Beta = -0.614), were significantly associated with lower water pipe harm perception scores. We constructed the first scale for measuring water pipe harm perception: the WHPS-6. The results of the present study demonstrate that the WHPS-6 can be used in clinical practice and research to assess the harm perception induced by water pipe smoking.

Validation of the Arabic version of the SF-36, generic questionnaire of quality of life related to health among the elderly in Lebanon.

BACKGROUND: Measuring health status of elderly is essential for the prediction of their health care needs. Health research usually considers objective outcome measure; however there is a need to increase self-reported measures of health. AIMS: The aim of this study was to assess the psychometric properties of the SF36 among a group of Lebanese elderly. METHODS: It was a cross-sectional observational study. A systematic sample of elderly people aged 60 years and more was selected from dispensary, private and governmental hospitals in Lebanon. Data were collected using face-to-face interview. The first part of the questionnaire consisted of sociodemographic characteristics. The second part consisted of the Arabic version of the SF-36. The third part consisted of Activity of Daily Living (ADL) scale, presence of health problems and number of medication consumed per day. RESULTS: A total of 250 elderly people were included. The mean age was 70.69±7.70 years. Cronbach alphas for all SF-36 scales exceeded 0.798. The intra-Class correlation coefficient varied between 0.675 (item 2) and 0.980 (items 14, 16 and 18) indicating good reliability. The quality of life (QoL) of women was poorer than men (p<0.001). It was significantly lesser when the number of health problems (p<0.001) and medications (p<0.001) increased, and the ADL score (p<0.05) decreased. CONCLUSION: SF-36 is a valid and reliable instrument for measuring QoL among Lebanese elderly and could be used for monitoring the QoL of this population.

Comparison of five international indices of adherence to the Mediterranean diet among healthy adults: similarities and differences.

BACKGROUND/OBJECTIVES: To compare five indices of adherence to the Mediterranean Diet (MD) among adults living in the Mediterranean region. SUBJECTS/METHODS: A total of 100 healthy Lebanese adults aged between 18 and 65 years. Face-to-face interviews to collect sociodemographic and medical information, to take anthropometric measurements, and to fill a validated, culturally adapted, food frequency questionnaire (FFQ). The score for each item was calculated following the recommendations for each corresponding index. The five MD indices were Mediterranean Diet Scale (MDScale), Mediterranean Food Pattern (MFP), MD Score (MDS), Short Mediterranean Diet Questionnaire (SMDQ), and the MedDiet score. RESULTS: Significant correlations were detected between items with P-values < 0.001. Minimal agreement was seen between MDScale and MedDiet score and maximal agreement between MDS and MedDiet score. Univariate and multivariate analyses showed that MDS and MedDiet scores had significant correlations with fiber and olive oil intake, main components of the MD. MDScale showed a significant correlation with waist-to-hip ratio and with total energy intake but none of the five indices was correlated to body mass index (BMI). CONCLUSIONS: The indices that showed the highest correlation with variables related to the MD are the MDScale and the MedDiet score; therefore, they can be used to assess our future study populations. Based on the current results, more than half of the study population was non-adherent to the MD and adherence to this diet did not appear to protect against being overweight (BMI ≥ 30).

Reproducibility and relative validity of a food frequency questionnaire to assess dietary intake of adults living in a Mediterranean country.

OBJECTIVE: Food frequency questionnaires (FFQs) must be validated among the population of interest due to the specificities in dietary habits, culture and food in each country of the Mediterranean region. The objective of this study was to determine the relative validity and reproducibility of a 157 item semi-quantitative FFQ among Lebanese adult population. MATERIAL AND METHODS: Dietary intake was assessed through dietary recalls, a FFQ with food items, and traditional recipes from the Mediterranean cuisine. Validity of the FFQ was measured by comparing the intake of calories, macro and micronutrients to the mean values derived from three dietary recalls (DR). Reproducibility of the FFQ was evaluated after repeating the same FFQ among the participant after a four-month period. RESULTS: 114 healthy adults aged between 18 and 60 years of which 52.6% are men participated in this study. 53 of these adults participated in the reproducibility study. Intra class correlation coefficient (ICC) between the two FFQ measurements ranged from 0.822 for sodium to 0.998 for energy indicating excellent reproducibility. The FFQ showed slightly higher intakes than the dietary recalls for most of the nutrients and foods reaching 2.1% for nutrients (polyunsaturated fatty acids) and 18% for food groups (olive oil). Correlation coefficients ranged between 0.783 (sodium) and 0.996 (carbs) for nutrients and between 0.906 (fish) and 1 (fruits and nuts) for food groups, with a significant p value (p = 0.038 for folate). Cross-classification of nutrients into quartiles showed that more than 81% of the participants were classified in the same quartile. Misclassifications were low for most nutrients with one to three persons misclassified at the extreme quartiles. CONCLUSION: The FFQ used in this research contained western and Mediterranean type of dishes and foods. Statistical analysis showed good reproducibility and validity of the tested tool in a heterogeneous sample of adults living in a Mediterranean country. It is a useful tool for future investigations and strategies promoting the comeback of this traditional diet.

Adherence to oral glucose lowering drugs, quality of life, treatment satisfaction and illness perception: A cross-sectional study in patients with type 2 diabetes.

OBJECTIVE: To evaluate treatment adherence to oral glucose lowering drugs (OGLD) and health related quality of life in Lebanese diabetics. Secondary objectives were to examine associations between treatment adherence, quality of life (QOL), treatment satisfaction and illness perception. METHODS: This cross-sectional study, conducted in all districts of Lebanon between August 2016 and April 2017, enrolled 207 adult patients, taking any OGLD. RESULTS: The effectiveness score (Beta = 0.55), female gender (Beta = 7.04), and the quality of life score (Beta = 0.28) would significantly increase the adherence score respectively. On another hand, the body mass index (Beta = -1.216) would significantly decrease the adherence score. Adherence was negatively and significantly associated to IPQ score (r = -0.181), effectiveness score (r = -0.504), side effects (r = -0.583), convenience (r = -0.317), global satisfaction (r = -0.428), physical health (r = -0.477), psychological health (r = -0.521), social relationships (r = -0.405) and environment (r = -0.429). CONCLUSION: Perceived effectiveness and patient's quality of life seem to be important parameters enhancing adherence. Based on this study, planning interventions to enhance treatment adherence and improve the quality of life is crucial for all diabetic patients. Additional efforts are suggested to be made by concerned authorities to set up awareness campaigns to increase alertness on the importance of adherence to medications in diabetics.

Discrepancies among different tools evaluating Mediterranean diet adherence during pregnancy, correlated to maternal anthropometric, dietary and biochemical characteristics.

BACKGROUND & AIMS: Scientific evidence confirms the favorable impact of Mediterranean diets (MD) on maternal and neonatal outcomes. However, the assessment of this dietary pattern requires valid indexes with scoring systems adapted to pregnant females. The aim of this cross-sectional study was to compare the adherence to MD, through 5 internationally validated tools, in pregnant women following a Mediterranean eating pattern, correlated to maternal anthropometric, dietary and biochemical markers. METHODS: 100 healthy pregnant females completed a sociodemographic questionnaire, a dietary recall and a food frequency questionnaire compatible with the MD. 10 ml of maternal blood were drawn for the analysis of biological markers such as C-reactive protein (CRP), leptin and adiponectin. RESULTS: We used the 50th percentile as cut-off of each scale (low or high adherence) to avoid the discrepancies noted in the literature among the large range of cut-offs points for the different tools. The % of agreement was high between the Mediterranean Food Pattern, MD Score, the MD Score and the Short MD Questionnaire. The MD Scale presented small agreement in relation to the other tested tools. All the tested indexes were significantly correlated with CRP levels, except for the MDScale. Significant correlations were reached regarding adiponectin and the MFP (p value = 0.04) and the MDScale (p value 0.03) tools. Pre-gestational body mass index was significantly correlated with all the tested biological markers. Significant correlations were seen between CRP on one hand and maternal age (p value = 0.033), adiponectin (p value = 0.028), and leptin (p value = 0.003) on the other. Fiber intake was significantly and negatively correlated to CRP (p value = 0.008) and positively to adiponectin levels (p value = 0.000). CONCLUSIONS: None of the tested tools were adapted for pregnancy, since a-priori scores were attributed for components already not consumed by pregnant females such as alcohol or recommended for daily or weekly consumptions such as whole dairy products and fish, respectively. In addition, the lack of inclusion of some traditional food ingredients of the MD implies the urge to create a new index adapted to pregnancy.

Validation of the Arabic Version of the Migraine Disability Assessment Scale Among Lebanese Patients with Migraine.

AIMS: To validate the Arabic version of the Migraine Disability Assessment Scale (MIDAS) and to evaluate the impact of the most frequently studied risk factors for migraine disability on the total MIDAS score in a Lebanese population. METHODS: This prospective study was performed from January 2017 to May 2017 and included 44 patients with migraine. Data were obtained using a questionnaire identifying sociodemographic characteristics, medical history, and migraine characteristics. The Arabic MIDAS was used to quantify the disability associated with headaches over a 3-month period. Ten days after completing the MIDAS, the participants were interviewed again to assess test-retest reproducibility. The validity of the MIDAS construct in the Lebanese population was confirmed by carrying out factor analyses for all the items of the questionnaire using the principal component analysis technique with a promax rotation. RESULTS: The MIDAS items converged over a solution of one factor that had an eigenvalue > 1, explaining a total of 63.25% of the variance (Cronbach's alpha = 0.812). Photophobia, vomiting, and duration of migraine attack of 24 to 48 hours significantly increased the MIDAS score by 21.396, 22.0, and 17.396 points, respectively, whereas a high socioeconomic level significantly decreased the MIDAS score by 6.837 points. CONCLUSION: This first linguistically validated Arabic version of the MIDAS was developed to improve migraine management in Arabic-speaking patients. Moreover, the results suggest that having longer migraine duration, more accompanying symptoms, and a low socioeconomic level can increase the MIDAS score and thus the level of disability.

Assessment of potentially inappropriate medications in elderly according to Beers 2015 and STOPP criteria and their association with treatment satisfaction.

OBJECTIVE: To assess and compare, according to Beers and STOPP criteria, the frequency and causes of potentially inappropriate medications (PIMs) in elderly, as well as the relationship between PIMs use and patient's treatment satisfaction, evaluated using the Treatment Satisfaction Questionnaire for Medications (TSQM). METHOD: 350 patients (mean age = 73.49 years), taking a total of 1893 medications, were enrolled from community pharmacies. RESULTS: 6.2% and 20.4% of the medications were inappropriate according to the STOPP and Beers lists respectively; 103 (29.4%) and 210 (60%) patients had at least one PIM according to STOPP and Beers criteria respectively. The most common cause of PIM was a full dose of proton pomp inhibitor for >8 weeks (STOPP) and using a drug that exacerbates/causes syndrome of inappropriate antidiuretic hormone secretion (Beers). The number of medications taken by the participant, advanced age, female gender, prescription of medications for anxiety/depression, ulcers/gastroesophageal reflux, rheumatoid arthritis and epilepsy significantly increased the PIMs number. When using STOPP criteria, all TSQM subscale scores were significantly lower among patients with PIM use compared to those without PIM. The same trend was observed for Beers critertia, with a significant difference reached for side effects and convenience subscales only. CONCLUSION: Selecting the appropriate tools to assess PIMs, prescribers and patient education regarding the risks associated with PIMs, and patient's perception and satisfaction regarding his treatment, are critical issues to be addressed among older adults.

Quality of Life and Its Association With Treatment Satisfaction, Adherence to Medication, and Trust in Physician Among Patients With Hypertension: A Cross-Sectional Designed Study.

OBJECTIVE: Patients with hypertension tend to have a lower health-related quality of life (HRQOL) compared to normotensive patients. This study's main objectives are to assess (1) HRQOL and factors that might impact it and (2) association between HRQOL and adherence to treatment, trust in physician, and treatment satisfaction among patients with hypertension. METHODS: A cross-sectional study enrolled 196 patients from medical-care offices in Beirut, North and South Lebanon. Eligible patients signed a consent form and were asked to complete the Trust in Physician Scale, World Health Organization Quality of Life-brief (WHOQOL-brief) questionnaire, and Treatment Satisfaction Questionnaire (TSQM 1.4) as well as questions assessing medication adherence. RESULTS: Better antihypertensive medication adherence was significantly and positively correlated with better HRQOL domains except general health where significance was not reached ( P = .089). Better adherence was also significantly related to better treatment satisfaction (side effects, convenience, and global satisfaction but not to effectiveness) and an increased trust in physicians ( P < .0001). Better treatment satisfaction (TSQM domains) was significantly and positively associated with a better overall HRQOL ( P ≤ .001). Increased trust in physician scores were significantly and positively correlated with a better psychological health, environment, and overall HRQOL domains ( P = .045, .005, and .006, respectively). Finally, TSQM effectiveness, convenience, and global satisfaction were significantly higher when trust in physician was greater ( P = .017, .035, and .002, respectively). CONCLUSION: The results of this study revealed an association between increased adherence to treatment, a higher global satisfaction, and an increased quality of life. An increased patient satisfaction with their antihypertensive treatment and trust in their physician were also correlated with a greater adherence to treatment.

Association Between Adherence to Statins, Illness Perception, Treatment Satisfaction, and Quality of Life among Lebanese patients.

OBJECTIVES: The main objective of this study was to evaluate treatment adherence to statin and health-related quality of life (QOL) in Lebanese patients with dyslipidemia. Secondary objectives were to examine associations between treatment adherence, QOL, treatment satisfaction, and illness perception. METHODS: This cross-sectional study, conducted in 20 community pharmacies from all districts of Lebanon between August 2016 and April 2017, enrolled 247 adult patients taking any statin. RESULTS: The mean age of the participants was 52.63 ± 11.92 years (57.5% males); the mean duration of treatment with a statin was 59.72 months. A significant association was found between adherence and marital status ( P < .0001), educational level ( P = .001), cigarette smoking ( P < .0001), and alcohol drinking ( P < .0001). A negative but significant correlation was found between the adherence score and the duration of dyslipidemia ( r = -0.199). A significant but negative correlation was also found between the side effect score and age ( r = -0.137). The monthly salary, the marital status, the educational level, smoking cigarettes or waterpipes, and drinking alcohol were all associated with the Illness Perception Questionnaire scores ( P < 0.0001 for all variables). Secondary level of education (ß = 13.43), smoking more than 3 waterpipes per week (ß = 14.06), global satisfaction score (ß = 0.32), convenience score (ß = 0.29), and effectiveness score (ß = 0.27) would significantly increase the adherence score. Smoking more than 15 cigarettes per day (ß = -11.15) and a divorced status (ß = -14.81) would however significantly decrease the adherence score. Significant associations were found between the illness perception score, the QOL domains, and the satisfaction domains ( P < .05 for all variables). CONCLUSION: This study showed that global satisfaction with treatment, convenience, and effectiveness are important factors that increase treatment adherence. Patient adherence results in patient satisfaction and improved QOL and is an important criterion for achieving desired therapeutic outcomes.

Social inequalities in oral health in a group of older people in a Middle Eastern country: a cross-sectional survey.

BACKGROUND AND OBJECTIVE: The percentage of Lebanese older people has increased considerably. Given that Lebanese seniors are marginalized in the health policy-making process, we suggest a high social inequality in oral health that has not been studied so far. The purpose of our study was to describe and compare oral health status in a group of Lebanese older people according to their socioeconomic status (SES) MATERIALS AND METHODS: Participants were recruited from three different primary health care clinics in Beirut, Lebanon. Data were collected from an administered questionnaire that included sociodemographic variables, perception of oral health, and regular dental visits. Oral examination included the number of missing and decayed teeth, the prosthetic status, and the number of functional dental units (FUs). The SES of the participants was determined by educational level, previous or actual work, and neighborhood level. RESULTS: 264 participants aged 71.4 ± 6.27 years (64.7% female) were included in the study. Regular dental visit, dental status, FU, and oral health perception were significantly related to the participants' place of residence, educational level, and work. Moreover, the mean number of missing teeth (p = 0.048) and decayed teeth (p = 0.018) was significantly elevated in the low SES. CONCLUSION: There is a clear socioeconomic inequality in oral health among the Lebanese older people. Further researches should explore the potential contribution of psychosocial and behavioral factors in explaining these disparities.

Adherence to Insulin, Emotional Distress, and Trust in Physician Among Patients with Diabetes: A Cross-Sectional Study.

INTRODUCTION: Type 2 diabetes represents a significant public health issue, with increasing prevalence in developing countries while adherence to insulin treatment remains a challenge. No studies have evaluated the relationship between adherence to insulin, diabetes-related distress, and trust in physician among persons with diabetes. Our objectives were to evaluate treatment adherence to insulin, emotional distress (using the Problem Areas in Diabetes Questionnaire, PAID), trust in physician, and to examine associations between them among Lebanese patients with diabetes. METHODS: This cross-sectional study, conducted in all districts of Lebanon between August 2016 and April 2017, enrolled 135 adult patients. RESULTS: The mean percentage score of adherence to insulin was 79.7 ± 19.94. A significantly higher mean adherence score was found in non-sedentary (81.96) compared to sedentary patients (67.41) (p = 0.017), with no difference between gender, employment, rural vs non-rural residence, or familial history of diabetes. In addition, no significant relationship was seen between adherence score and education level, smoking, or alcohol intake. A significant positive association was found between trust in physician and adherence scores, whereas a significant but negative one was found between PAID and adherence scores. The results of linear regressions showed that a secondary level of education (beta = - 13.48) significantly decreased the trust in physician score, whereas the total number of oral antidiabetics (beta = 0.93) increased it. Having a sedentary lifestyle (beta = - 12.73) and smoking < 3 waterpipes/week compared to no smoking (beta = - 16.82) significantly decreased the adherence score. Female gender (beta = 10.46), smoking < 3 waterpipes (beta = 27.42) and 3 + waterpipes/week (beta = 17.95) significantly increased the PAID score. CONCLUSION: Trust in physician is associated with an increased adherence and with decreased diabetes-related distress. This distress was also associated with poor adherence in our study.

Evaluating the impact of spirituality on the quality of life, anxiety, and depression among patients with cancer: an observational transversal study.

OBJECTIVE: Spiritual well-being was found to have some protective effect against end-of life despair in cancer patients. We aimed at assessing the impact of spirituality on the quality of life, depression, and anxiety of Lebanese cancer patients. METHODS: Our observational transversal monocentric study was conducted between January and April 2016 among a convenient sample of 115 Lebanese cancer patients admitted to Hôtel-Dieu de France Hospital (HDF), Beirut-Lebanon. In addition to socio-demographic and clinical data, three questionnaires were used: EORTC QLQ-C30 (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 3rd version), FACIT-Sp-12 (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being; The 12-item Spiritual Well-Being Scale, 4th version), and HADS (Hospital Anxiety and Depression Scale). Eighteen patients taking anxiolytic and/or antidepressants were not included in the analysis. The remaining 97 patients were analyzed. RESULTS: Better emotional and cognitive functioning was seen in patients with higher meaning, peace, faith, and total FACIT scores. Meaning, peace, and total FACIT scores were also higher among patients with better global health status and quality of life. Anxiety as well as depression was significantly associated to all spiritual well-being factors. CONCLUSION: Spirituality can improve quality of life and decrease the incidence of anxiety and depression in cancer patients. Our results highlight the need to incorporate spiritual care in healthcare systems.

Lethal hepatotoxicity following 5-fluorouracil/cisplatin chemotherapy: a relevant case report.

Some articles have reported severe toxicities induced by cisplatin/5-fluorouracil regimens, nevertheless, severe and lethal liver toxicity has not been previously reported. In this article, we report the case of a 72-year-old woman, who developed fulminant hepatitis, hypoglycemia and hypotension with atrial fibrillation not responding to treatment. After ruling out all other possible causes of hepatitis, the toxicity was more likely attributed to 5-fluorouracil. Genotyping was performed and the patient was found to be a homozygote carrier of the T variant of the MTHFR gene. The patient died two days later. Several factors, including genetic factors, could explain this severe toxicity. The present case discusses the importance of personalized medicine in oncology based on pharmacogenetic analysis of polymorphisms.