Attitudes and practices on antibiotic use and its emerging threats among Lebanese dairy veterinarians: a case study from a developing country.

Introduction: This study aimed to explore how veterinarians (vets) rationalized their prescribing decisions for antimicrobial (AM) uses, the barriers they perceived to implement proper farm management in Lebanon, and the consecutive threats that might arise concerning the emergent spread of antimicrobial resistance in animals and the population. Methods: Amid the COVID-19 pandemic, phone call interviews were conducted with 34 veterinarians working in different demographic regions across the country. Data were analyzed qualitatively using an inductive thematic analysis. Results and discussion: The majority of veterinarians called for responsible antibiotic use. The prescribing decision of veterinarians was based mainly on suspected disease from field examination, farmer's reports via phone calls, and the ability of the farmer to cover antibiotic costs. Very few veterinarians referred to laboratory diagnosis before prescribing a specific AM due to many obstacles. This study uncovered the absence of a trust relationship between veterinarians and farmers in Lebanon. Veterinarians provided different insights into farming practices, reflecting that farmers, in general, lack proper knowledge and implementation of farm management and that they mainly treat the herd on their own, especially in light of the current unprecedented economic crisis that Lebanon has been facing in the last three years. Above all, veterinarians revealed that AM resistance in Lebanon is markedly spreading, which calls for a serious and instantaneous set of governmental policies and regulations.

Assessment of mycotoxins in cornflakes marketed in Lebanon.

Cornflakes are a popular and convenient breakfast cereal made from corn and widely consumed worldwide, including in Lebanon. However, they are susceptible to mycotoxin contamination, which can have harmful effects on human health. Our study evaluated the occurrence of five mycotoxins (AFB1, OTA, FUM, ZEA, DON) levels in packed cornflakes marketed in Lebanon. A market screening identified 35 different cornflake stock-keeping units (SKU) in the Lebanese market, originating from 10 different brands and having different tastes and shapes. SKUs were collected and tested for five mycotoxins in triplicates using enzyme-linked immunosorbent assay technique. The results showed the presence of the five mycotoxins in the samples. The average levels of AFB1, OTA, ZEA and FUM among positive samples (above limit of detection) were 1.58, 1.2, 15.1 and 774.1 µg/kg, respectively, and were below the EU limits. On the other hand, the average level of DON was 1206.7 µg/kg, exceeding the EU limit. Furthermore, out of the positive samples, 60%, 17%, 9%, 14%, and 6% exceeded the EU limits for DON, OTA, AFB1, FUM, and ZEA, respectively. Notably, SKUs made in Lebanon had significantly (p < 0.05) higher levels of AFB1 and FUM. The packing size of the cornflakes had no significant (p > 0.05) effect on the levels of the five mycotoxins detected in the samples. AFB1, FUM and ZEA levels differed significantly among SKUs (p > 0.05). Considering these findings, further studies should be conducted to assess the exposure to mycotoxins from the consumption of cornflakes in Lebanon, especially among children.

A contextual approach for exploring faculty readiness to teach online.

Effective online teaching and learning requires readiness of all stakeholders, students, faculty, and administrators while considering contextual factors that influence the design and delivery of online learning. The purpose of this study is to explore how ready for online teaching faculty are in a Lebanese higher education context and to investigate readiness factors that impact their online teaching. It also aims at identifying any significant differences in readiness based on gender, years of teaching experience and discipline. A survey was developed based on a review of the literature and existing surveys that address readiness factors for online teaching. The survey was administered in Spring 2020, and 210 faculty at a private higher education institution completed the survey. Exploratory Factor Analysis (EFA), Multivariate Analysis of Variance (MANOVA) and descriptive statistics were conducted. The EFA resulted in 5 factors associated with faculty readiness to teach online, namely technology access and skills, course design, online pedagogy, attitude, and institutional support. Descriptive statistics revealed that faculty have the minimum required technology skills to teach online, yet they are faced with technical challenges associated with the context and the need for institutional support. MANOVA tests revealed a statistically significant difference between female faculty members who are readier in terms of course design and attitude than their counterpart males, a statistically significant difference in terms of course design for faculty who have more years of teaching experience. As for discipline specific readiness, majors that are focused on art and design revealed to be less ready for online teaching. This study implies the need for a more robust infrastructure to expand the delivery of online learning in Lebanon and the need for professional development for faculty to create pedagogically and technically enhanced online courses.

Food allergies and allergens in Lebanon: Characterization and perceptions toward labeling.

Background: Food allergy is a life-threatening medical condition of public health concern. The aim of our study was to characterize food allergies, in terms of sources, symptoms, severity, and history, as well as to assess the knowledge, practices, and attitudes towards food allergens and allergies, in addition to food allergen labeling, in Lebanon. Methods: For this, 1100 participants filled over the phone a comprehensive valid questionnaire composed of 41 questions. Results: Fruits were reported as top food allergens (29.6%), while itching and rash were the most reported symptoms (9.6% and 8.0%, respectively). In terms of knowledge, participants scored on average 67.9 ± 16.2%. Participants who identified as females, below 35 years, highly educated, and from health backgrounds had a significantly higher score (p < 0.05), while area of residence did not have any significant effect (p > 0.05). Participants who are medically diagnosed with allergies and those with health background were found to check the ingredients list and read nutritional claims significantly more frequently than those from a non-health background and who are non-medically diagnosed, respectively, while females were found to check ingredients list and read nutritional claims significantly more frequently (p < 0.05). The majority reported that ingredients are easy to understand (63.2%) and simple to read (61.3%), while allergic individuals agreed that the font size of the ingredients list is not big enough (56.8%) and that E-code numbers are not understood (68.7%). The majority considered it "important" to have the label writings larger and bolded (85.7%), to use simple language (95.5%), to place allergen warning (82.2%), and to use a striking allergen symbol (93.5%). Conclusions: Our results emphasize the need for national awareness campaigns to improve knowledge and practices, and to lobby policymakers for appropriate management of food allergies and allergens in Lebanon.

Hygienic sanitary risk and microbiological quality of meat and meat-contact surfaces in traditional butcher shops and retail establishments- lessons from a developing country.

In this study, we determined both hygienic sanitary risk and microbiological quality of raw meat and meat-contact surfaces in butcher shops and retails from the North Governorate in Lebanon. A total of 55 samples were analyzed (36 raw meat and 19 environmental swabs). The overall counts of pathogenic bacteria indicate high levels of contamination of both minced meat and contact surfaces. Presumptive Salmonella and Listeria were found in the samples. Salmonella spp. was observed in 63.8% of all cuts, of whom 41.6% is detected from butcher shops' meat. L. monocytogenes was present in 47.2% of meat from butcher shops and 30.5% of retails. Total aerobic count followed by S. aureus and fecal coliforms were the most detected pathogens in environmental swabs. Most visited facilities presented moderate hygienic sanitary risk, with average scores of 55.25 in butchers' shops and 65.25 in retail. Findings highlight the necessity for governmental surveillance and implementation of food safety laws.

Microbiological safety of commercial canned and dry pet food products in Lebanon.

Estimating the microbiological quality of pet food is essential in providing healthy and safe foods to pets. The aim of this study was to assess the microbiological safety of pet food marketed in Lebanon, namely cat and dog products. To the best of our knowledge, no studies have been conducted in Lebanon nor the Middle East region with reference to pet food quality. Lebanese market was screened and a total of 165 dry and canned pet food products were identified, collected and analyzed for their load of total aerobic microbial count, Enterobacteriaceae species, yeasts and molds, and for the presence of Salmonella and Listeria species. Dry pet food products had higher contamination level compared to canned ones. In terms of non-conformity to the European commission regulations, out of the 165 brands, 11 (7%) had a total aerobic microbial count above 106 cfu/g, and 27 (16%) exceeded 3 × 102 cfu/g as a maximum limit of presumptive Enterobacteriaceae. Among the dry brands, 8 out of 66 (12%) had a contamination level of yeasts and molds above 104 cfu/g. Presumptive Salmonella spp. was detected in 68 (41%) and presumptive Listeria spp. in 106 (64%) of brands. These alarming results necessitates setting and monitoring microbiological standards for pet food in Lebanon. This study contributes as well to the building of a database for knowledge development regarding the potential contamination of pet food by the abovementioned microorganisms.

Financial Wellbeing and Quality of Life Among a Sample of the Lebanese Population: The Mediating Effect of Food Insecurity.

Background: Lebanon is undergoing multiple overlapping crises, affecting the food security, financial well-being, and quality of life (QOL) of its residents. Objective: The primary objective was to assess the food insecurity (FI) status of a sample of the Lebanese population. The second objective was to explore factors related to QOL parameters and evaluate the mediating effect of food security between financial well-being and QOL. Methods: The study was cross-sectional and enrolled 412 participants recruited online using the snowball sampling technique. The survey included questions related to sociodemographic and economic characteristics of Lebanese households and validated scales to assess FI, QOL measures, financial well-being, and fear of COVID-19. Results: Almost 43% of the study participants reported being food insecure, with 31% experiencing mild FI, 10% moderate FI, and 1.5% severe FI. Compared to food-insecure participants, food secure participants had a significantly higher income (58.5% vs. 39.2%, p < 0.001), a university education level (96.6% vs. 88.1%, p = 0.002), an average perceived financial status (83.9% vs. 65.9%), higher financial well-being scores (5.14 vs. 3.19, p < 0.001), and lower crowding index (0.94 ± 0.4 vs. 1.09, p = 0.002). Multivariate analysis showed that FI was not associated with physical (Beta = -1.48, 95% CI: -3.10; 0.13) and mental (Beta = -1.46, 95% CI -3.68; 0.75) QOL, after adjusting for other demographic and socioeconomic correlates. This association remained non-significant when introducing the financial well-being variable to the model. Mediation analyses showed that the FI variable mediated the association between financial well-being and physical QOL (Beta = 0.19, 95% CI: 0.02; 0.36), but not the mental QOL (Beta = -0.02, 95% CI: -0.20; 0.14). Conclusion: Food insecurity was prevalent in our study sample, and it mediated the association between financial well-being and physical, but not mental, QOL parameters. These findings call for evidence-based policies and programs to help improve the food security and well-being of Lebanese households amidst these unprecedented circumstances.

Comparative Study Regarding the Adherence to the Mediterranean Diet Among Older Adults Living in Lebanon and Syria.

The Mediterranean diet (MedDiet) has been associated with many health benefits. Poor adherence to MedDiet has been found among Lebanese adults, while in Syria, little is known about the adherence to MedDiet. A quantitative research approach was used, and data were collected through convenience sampling. The structure of the survey included the socio-economic and demographic data and the validated 14-point MedDiet assessment tool. The target population included 367 Lebanese and Syrian adults respectively residing in Lebanon and Syria. Descriptive statistics were used to explore the characteristics of the sample population. Adequate adherence MedDiet was determined if the Med-Diet score ≥ 9. Significant differences among the variables and the adherence to the MedDiet were examined using the chi-square test. Approximately 47.42% of participants reported adherence to MedDiet higher than 9, with a mean of 7.98. Lebanese participants, men, and those who are aged between 64 and 67, had higher adherence than Syrian participants, women, and other age groups, respectively. Lebanese participants (7.82 ± 2.32) had slightly higher adherence than Syrian participants (7.31 ± 2.04). Wine, sofrito, vegetables, and olive oil were mostly consumed by participants, with differences in consumption between the Lebanese and Syrian adults. The statistical analysis performed using the chi-square test showed no statistical difference (P>.05) between Lebanese and Syrian participants regarding their consumption of 160 red meat, butter/margarine, and sugary drinks. Future studies in the aged population are required to explore furthermore the adherence to MedDiet in Lebanon and Syria and its impact on health.

Knowledge, attitudes, and perceptions of dairy farmers regarding antibiotic use: Lessons from a developing country.

In lower- and middle-income countries, uncontrolled use of antibiotics is causing antimicrobial resistance, affecting both animal welfare and public health. Meanwhile, studies on antibiotic use in these countries are limited. A crucial step to limit the spread of antimicrobial resistance (AMR) is to examine the use of these drugs and identify its determinants. The aim of our study, the first of its kind in Lebanon, was to assess dairy farmers' knowledge and awareness of antimicrobial use (AMU) and AMR. For this, 18 farmers from different regions, educational backgrounds, experience levels, and herd sizes were interviewed. Results showed that owners of larger farms were more aware of AMU and AMR, and trying to implement preventive actions, whereas nonsystematic antimicrobial use was prevalent among the smaller farms. Mastitis and laminitis were the most treated diseases, and antibiotics used were oxytetracycline, penicillin, streptomycin, and florfenicol. Overall, antibiotic use was found as a preventive measure and a treatment of nonbacterial diseases. Irregular uses were linked to easy access of farmers to antibiotics, interrupted relations with veterinary authorities, and lack of self-assessment and inspection. Lebanese dairy farmers and owners reported feeling disadvantaged in their local trade field, facing illegal competition and unauthorized farms and industries, and lacking support from the government. Training and awareness programs must be implemented, and policies and regulations must be set, to reduce antibiotic use and hinder the spread of AMR in Lebanon.

Investigation of the effects of some processing conditions on the fate of oxytetracycline and tylosin antibiotics in the making of commonly consumed cheeses from the East Mediterranean.

BACKGROUND AND AIM: Transfer of antibiotics from raw milk to derived products is directly related to the processes involved in the manufacturing of dairy products, including East Mediterranean cheeses, since these have particular flow diagrams of production. The aim of this study was to assess the effects of skimming, pasteurization, curding, pressing, salting, cheese boiling, and whey acidification/heating on two widely used antibiotics in Lebanon, oxytetracycline (OTC) and tylosin (TYL), in the manufacture of commonly consumed cheeses in the East Mediterranean. MATERIALS AND METHODS: Four hundred and fifty kilograms of full-fat bovine milk were spiked with OTC and TYL, then skimmed and pasteurized using holder and high-temperature short-time (HTST) methods. Milk was then processed to make cheeses (23 kg Baladi, 20 kg Akkawi, 20 kg Halloum, and 18 kg Double Cream). Liquid chromatography-mass-spectrometry was used to measure antibiotics. Analysis was performed using Statistical Package for the Social Sciences v25. RESULTS: Skimming significantly (p=0.015) decreased TYL concentration by 68.6%. OTC degradation during holder (41-54%) proved to be significant (p=0.015). HTST had a significant (p=0.012) effect on TYL with 32% degradation. Curding step in making Baladi had a significant (p=0.028) effect on OTC only with the concentration increasing by 1.5-fold. Acidification and heating of whey to produce Double Cream decreased significantly (p=0.037) OTC concentration (14.7-46.3%), while TYL concentration increased significantly (p=0.000) by 300%. Pressing and salting in making Akkawi did not have any significant effect, while cheese boiling in making Halloum significantly decreased both antibiotics. CONCLUSION: OTC is transferred to Baladi and Akkawi (curd based) mainly, while double cream (whey based) has a high level of TYL transfer. Hence, people who consume these cheeses excessively could be exposed to high amounts of both antibiotics and thus be prone to their detrimental effect on health.

Adherence to Mediterranean Diet among Lebanese University Students.

Scarce studies described eating habits and diet quality among university students in Lebanon. The aim of this study is to assess the rate of adherence to the Mediterranean diet (MedDiet) among Lebanese university students. A cross-sectional nutritional survey was carried out on 525 students (53% men, 18-25 years old) from the University of Balamand, Lebanon. Adherence to the MedDiet was assessed using a validated 14-item MedDiet adherence score. Mean adherence to the MedDiet was 7.96 (standard deviation 2.2), and it was adequate in 59% of participants. Adherence to the MedDiet was higher in older students and nonsmokers. Legumes, vegetables, fruits, and nuts were consumed according to the MedDiet standards among a minimum of 48.4% and a maximum of 69.5% of participants. Chicken, turkey, or rabbit was preferred by 66.9% of participants instead of beef, pork, hamburgers, or sausages; however, just 56.2% of participants showed adequate intake of red meat, hamburger, or meat products. Only 28.8% of them referred to an adequate intake of fish or shellfish. Most of the participants (86.3%) used olive oil as the main added fat, and 67.2% reported a low intake of butter and derivatives. Sofrito was also very usual among participants (79.6%). Only half of the studied sample reported an adequate intake of sweet or carbonated beverages and commercial sweets or pastries. Among the assessed sample, half the participants showed adequate adherence to the MedDiet; however, the mean of adherence among the sample is low.

The Impact of Food Service Attributes on Customer Satisfaction in a Rural University Campus Environment.

The purpose of this study was to determine different food service attributes that have an impact on customers' overall satisfaction at a rural university cafeteria. Over 5 weeks, 676 cafeteria users, including academics, staff, and students, were selected through convenience sampling. They completed an anonymous-designed survey with closed questions (n = 29) assessing quality of food and beverages, quality of service and setting, and satisfaction with food service attributes. In order to measure the existence and degree of significant relationships between different research variables, Pearson correlation coefficients were employed to analyse the data. Means of scores and frequencies were calculated. Results indicated that customers' satisfaction with different service attributes was above average. All service attributes had a significant and positive effect on the overall satisfaction. Since most customers (62.9%) would like to continue eating at the cafeteria, the most common improvements suggested to the university management included among others, improving diet quality by offering more nutritious food. Gaining insight into the different food service attributes can enable the university management to meet the needs and expectations of its academics, staff, and students in order to increase their confidence in the food provided.

Bacterial diversity of Darfiyeh, a Lebanese artisanal raw goat's milk cheese.

In order to contribute to the preservation of the Lebanese dairy heritage, the aim of this study was to characterize the Darfiyeh cheese, a traditional variety made from raw goat's milk and ripened in goat's skin. Three independent batches of Darfiyeh production were analyzed after 20, 40 and 60 days of ripening. Mesophilic lactobacilli, thermophilic coccal-shaped lactic acid bacteria (LAB) and thermophilic lactobacilli were enumerated. In order to explore the Darfiyeh natural ecosystem, a combination of phenotypical and molecular approaches was applied. The latter included Polymerase Chain Reaction-temporal temperature gel electrophoresis (PCR-TTGE), classical PCR and quantitative PCR. These methods revealed the presence of Streptococcus thermophilus, Enterococcus faecium, Enterococcus durans, Enterococcus faecalis, Enterococcus malodoratus, group D Streptococcus sp., Lactococcus lactis subsp. lactis and L. lactis subsp. cremoris, Lactobacillus plantarum, Lactobacillus curvatus, Staphylococcus haemolyticus, Escherichia coli, Clostridium sp./Eubacterium tenue. Real-time PCR enabled quantification of E. faecium, with a detection of 10(7)-10(9) cfu g(-1) of product. The present molecular approaches combined with phenotypic method allowed describing the complex natural ecosystem of Darfiyeh, giving useful information for the preservation of Lebanese artisanal dairy products.