In Lebanon, widespread antibiotic prescribing has led to antimicrobial resistance (AMR), a notable public health concern driven by inappropriate use. As future prescribers, medical students play a critical role in combating AMR. This study aimed to evaluate their AMR awareness and antibiotic prescribing practices, identify knowledge gaps, and suggest interventions to promote appropriate antibiotic use and limit local AMR emergence. A cross-sectional study was conducted among Lebanese medical students from July 1, 2021, to September 30, 2022. Data were collected via a structured online questionnaire using snowball sampling. The questionnaire was informed by published articles and the authors’ expertise. It included sociodemographic data and novel, context-specific scales assessing antibiotic prescribing attitudes, knowledge of AMR drivers, and prudent prescribing practices, addressing gaps in existing tools. The sample included 164 medical students, with a mean age of 22.78 ± 3.94 years. Furthermore, 89.6

Autism Spectrum Disorder (ASD) is a neurodevelopmental condition that requires public understanding to foster acceptance and reduce stigma. This study aimed to evaluate ASD knowledge and stigma among the Lebanese population and the factors influencing them. An online cross-sectional study was conducted between February and July 2022 among Lebanese adults. Participants completed a self-administered structured questionnaire that comprised a sociodemographic section and two validated scales serving the study's purpose (The Autism Stigma and Knowledge Questionnaire (ASK-Q) and The Autism Social Distance Scale). A total of 949 participants filled out the questionnaire. More than half of them had adequate knowledge of autism diagnosis and symptoms (57.9%), while only 6.6% and 9.6% showed adequate knowledge of its etiology and treatment, respectively. Additionally, 83.4% of the participants did not endorse stigma toward autism. The multivariate analysis taking the knowledge total score and subscales as the dependent variables showed that declaring prior knowledge of autism was significantly associated with better knowledge (Beta = 1.38) and higher stigma (Beta = 0.26). Furthermore, a higher knowledge score (Beta = - 0.06) and a declared prior knowledge of autism (Beta = - 0.62) were significantly associated with lower autism social distance. These findings highlight the need for targeted awareness campaigns to address knowledge gaps and further reduce stigma in Lebanon.

Context Orthorexia nervosa (ON) is characterized by compulsive behaviors and increased concerns about healthful eating. Dietitians appear to be especially vulnerable to ON, and it is still debatable whether the disordered eating behaviors motivate individuals to enroll in nutrition programs, or whether these behaviors result from an exaggerated preoccupation with healthy eating triggered during their nutrition studies.Objective The aim was to provide an overview of the present state of knowledge about the prevalence, risk factors, and interventions addressing ON among dietitians and dietetics students. More specifically, it was examined whether dietitians and dietetics students differ from students attending different education programs or other health professionals with regard to the severity and risk factors of ON, and whether the extent of ON changes during the progression in the nutrition education years of study.Data Sources MEDLINE (Ovid), PubMed, EMBASE (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), Cochrane, ProQuest Central, CABI, ProQuest Dissertations, Google Scholar, ScienceDirect, and SpringerLink were searched on May 8, 2021, and updated on November 12, 2022.Data Extraction Records were screened for eligibility; study characteristics, methodology, and findings of included articles were extracted; and the methodological quality assessed using the AXIS tool. Each step was preceded by a calibration exercise and conducted independently and in duplicate by pairs of 2 reviewers. Any disagreements were resolved through discussions.Data Analysis A narrative synthesis was performed, whereby the characteristics, methodologies, and results of included studies were compared.Conclusions Results were inconclusive; yet, a general status of the relatively "high" prevalence of ON among dietitians and dietetics students was established, stressing the need for systematic research to understand and mitigate orthorexic tendencies in this group. It is still too early to answer questions pertaining to prevalence, risk factors, interventions, and differences between dietetics students and other majors when it comes to severity and progress of ON throughout the continuing years of study, or between dietitians and other professional groups.Systematic review registration Open Science Framework Identifier: DOI 10.17605/OSF.IO/BY5KF.

Background The novel coronavirus disease 2019 (COVID-19) has quickly become a worldwide threat to human health and has significantly impacted peoples’ lives and changed their lifestyle and health behaviors (LHB). This study aims to assess changes in lifestyle and health-related behaviors such as daily habits, dietary habits, physical activity, sleep patterns, psychological problems, and sexual behaviors among the general population in Lebanon during the COVID-19 pandemic. Methods A cross-sectional web-based survey conducted between January 9 and January 28, 2021, enrolled 403 Lebanese adults. The study questionnaire was developed on Google forms in English and Arabic. It included questions about sociodemographic characteristics, COVID-19, and behavior changes (smoking, alcohol consumption, sexual and hygiene behaviors, and intake of nutritional supplements and immunity-boosting foods), in addition to three scales, i.e., the Lifestyle and Health Behaviors Changes (LHBC-17), WHO-5 Well-being Index, and Fear of COVID-19 scale (FCV-19S). Data analysis was done on SPSS software version 21. Results The mean age of participants was 29.74 ± 10.81 years, with 51.2% of females. Most participants reported that COVID-19 has profoundly affected their LHBs, whether positively or negatively. Female gender (Beta=-2.336), living in Lebanon (Beta=-7.502), smoking nargileh (Beta=-3.433), having a high BMI (Beta=-0.263), and spending more hours per day using electronic devices during the COVID-19 lockdown (Beta=-0.853) were significantly associated with lower LHBC-17 scores (negative LHB changes). Whereas, living in an urban region (Beta = 2.464), having a job (Beta = 1.920), good overall health (Beta = 3.543), a higher quality of life (Beta = 0.204), and having physical (Beta = 2.101) and mental (Beta = 1.586) health unaffected by the COVID-19 lockdown were all significantly associated with higher LHBC-17 scores (positive LHB changes). Conclusions Lebanese adults reported several unfavorable lifestyle changes and psychological problems during the lockdown due to COVID-19. Health-promotion strategies are needed to assess negative changes both on physical or mental health and maintain as much as possible positive health-related behaviors among the Lebanese population.

Introduction: Falls represent a significant public health concern affecting the elderly, yet epidemiological studies within Lebanese institutions are scarce. This study aimed to explore gender differences in falls and mobility patterns and assess causes, potential risks, and protective factors against falls among institutionalized elderly in the Chouf district, Lebanon. Methods This cross-sectional pilot study involved an elderly healthcare institution. Data were collected using an anonymous, custom-designed questionnaire and patient medical records. Fall risk was evaluated with the Tinetti Balance and Gait Assessment, the Timed Up and Go Test, the Morse Fall Assessment, and other tools. Relative risks were estimated using odds ratios (OR), and logistic regression was stratified by gender to control confounders and assess the associations between fall episodes and potential risk and protective factors. Results This study included 300 institutionalized elderly aged 65 years and older, with 57.7% females. The mean age was 79.27 ± 7.61. Among the participants, 197 (65.7%) reported at least one fall in the past twelve months, with a higher prevalence among women compared to men (69.9% vs. 59.8%). Elderly women exhibited higher levels of depression and consumed more sleeping pills and mood-enhancing medications, which were positively associated with increased falls (p = 0.003). Among elderly men, unsteady walking was positively associated with the history of falls (p = 0.004). Conclusion This study found a higher incidence of falls among institutionalized women, possibly associated with the intake of sleeping pills and mood stabilizers. These findings have positive implications for future research in Lebanon and neighboring countries, with the potential to inform preventive measures to reduce falls among the elderly.

People’s practice, including adherence to disease prevention strategies, is influenced by their knowledge and attitude, which differ by sex. This study aimed to validate a tool that measures knowledge, attitude, and practice (KAP) toward COVID-19 and explore the related factors, including socioeconomic features and sex disparities. An online cross-sectional study conducted between December 20, 2020, and January 5, 2021, enrolled 405 participants from the general Lebanese population using a snowball sampling technique. The COVID-19 KAP scales were constructed and validated. After confirming the validity of the generated scales, the results showed that a university education level (adjusted odds ratio [aOR] = 3.90) was related to a better knowledge of COVID-19. A higher household crowding index (aOR = 0.41), a higher anxiety (aOR = 0.88), and do not know if there was an indirect contact with a COVID-19 patient (aOR = 0.44) were significantly associated with low knowledge of COVID-19. Having a family member working in the medical field (aOR = 1.76) and higher COVID-19 fear scores (aOR = 1.04) were associated with a more acceptable attitude toward COVID-19. Furthermore, higher knowledge scores (aOR = 1.14), higher attitude scores (aOR = 1.41), higher COVID-19 fear scores (aOR = 1.10), and more time spent on COVID-19 information (aOR = 1.91) were associated with good practice during the COVID-19 pandemic. However, these associations differed by sex, except for the crowding index, which were inversely associated with knowledge in both sexes, while education level and indirect exposure to COVID-19 were significant only among females. Knowledge about COVID-19 did not affect attitudes, but a good attitude was related to better practice in both sexes. Moreover, higher fear and more time spent on COVID-19 information were significantly associated with better practice among females. Overall, this study validated tools to highlight the knowledge, attitude, and practice among the general population during the COVID-19 outbreak in Lebanon. Our findings suggest the need for health education programs tailored differentially according to sex, taking into account education, age, and socioeconomic status to raise awareness of COVID-19 and promote more acceptable attitudes and sustained safe practices among the general Lebanese population.

Sub-optimal feeding practices among under-5 children are the major drivers of malnutrition. This study aims to assess the prevalence of malnutrition and the factors affecting exclusive breastfeeding, bottle feeding, and complementary feeding practices among under 5 children amid the COVID-19 pandemic as well as the economic and the political crises in Lebanon. A nationally representative stratified random sample of mother–child dyads (n = 511) was collected from households using a stratified cluster sampling design. The survey inquired about infant’s feeding and complementary feeding practices using a valid questionnaire. Anthropometric measurements of the mother and child were collected. Multivariate logistic regression was conducted to explore the determinants associated with under-5 children’s practices. The prevalence of underweight, stunting, wasting, overweight and obese children was 0.5%, 8.4%, 6.7%, 16.8% and 8.9%, respectively. In total, among under-5 children, the prevalence of ever breastfeeding, exclusive breastfeeding, and bottle feeding at birth was 95.1%, 59.1% and 25.8%, respectively. Half the children in this study started solid foods between 4 and 6 months. Regression analysis showed that supporting breastfeeding at hospital (aOR = 8.20, 95% CI (3.03–22.17)) and husband’s support (aOR = 3.07, 95% CI (1.9–4.92)) were associated with increased breastfeeding odds. However, mother’s occupation (aOR = 0.18, 95% CI (0.55–0.58)) was inversely associated with breastfeeding practices. Male children (aOR = 2.119, 95% CI (1.37–3.27), mothers diagnosed with COVID-19 (aOR = 0.58, 95% CI (0.35–0.95)), and bottle feeding at hospital (aOR = 0.5, 95% CI (0.32–0.77)) were more likely to induce early initiation of solid foods at 4 months of age. This study demonstrated non-negligible rates of malnutrition, low prevalence of exclusive breastfeeding, and high rates of early introduction of formula feeding and solid foods among Lebanese under-5-children amid escalating crises.

• 16.1% of our cancer patients suffer from major depression. • Low educational level and a lack of insurance seem to increase the vulnerability to depression. • Contact with friends and family seems protective against depression.

Dans un contexte général de complexité grandissante des enjeux éthiques inhérents aux pratiques en santé, les professionnels de santé et spécifiquement les infirmières se trouvent contraints de suivre ces mutations en termes d’évolution des compétences et de capacitation éthique. La recherche présentée dans cet article est la suivante : dans le cadre de la formation à l’éthique, les infirmières, bénéficiant d’une formation basée sur l’analyse de l’activité centrée sur les schèmes qui gouvernent les comportements éthiques, verraient leur niveau d’auto-efficacité relatif aux comportements éthiques augmenter. Les résultats présentés ici pourraient amener plusieurs contributions au regard des pratiques pédagogiques et servir la formation et spécifiquement la formation des infirmières à l’éthique en santé.

PURPOSE:To assess the knowledge, attitudes, and practices toward the coronavirus disease 2019 (COVID-19) among nurses in Lebanon.METHODS:An online questionnaire was completed by 311 Lebanese nurses between March and April 2020.RESULTS:Only 2% of nurses worked in a specialized COVID-19 ward and 20% have cared for a COVID-19 patient. The majority had sufficient knowledge of COVID-19; 62% declared being afraid of getting infected whereas 90% were afraid for their family members to get infected due to their occupational exposure. The majority of nurses (84.6%) declared following infection prevention and control precautions. Protective equipments were available in limited amounts in hospitals.PRACTICE IMPLICATIONS:Nurses in Lebanon seem to have a satisfactory level of knowledge about COVID-19. Their safety and well-being remain a priority in this critical period.

Bloodstream infections (BSIs) among older patients are frequent with high rate of mortality. Infections with multidrug-resistant organisms (MDRO) are associated with higher mortality than with susceptible microorganisms. We aimed to evaluate the prevalence of MDRO infection during BSI in older population and the factors associated with unfavorable outcome. This study is a retrospective cohort of all BSI episodes occurring among older patients (> 65yo), from April 1, 2010, to December 31, 2016, in a French university hospital for geriatric medicine. A total of 255 BSI episodes were analyzed. Mean age was 86.3±6.5 years, and sex ratio (M/F) was 0.96. Main comorbidities were orthopedic device (26.7%), active neoplasia (24.3%), and diabetes mellitus (18.4%). Main primary sites of infection were urinary tract infections (56.9%), respiratory tract infections (10.6%), intra-abdominal infections (7.1%), and skin and soft tissue infections (4.7%). Main bacteria identified were Escherichia coli (45.1%), Staphylococcus aureus (14.1%), enterococci (10.7%), coagulase-negative staphylococci (CoNS) (5.5%), and streptococci (5.1%). MDROs were involved in 17.2% of BSI (gram-negative bacilli: 9.0%; CoNS: 4.3%; and methicillin-resistant S. aureus (MRSA): 3.9%). The main factor associated with MDRO BSI was colonization with MDRO (OR=6.29; 95%CI=2.9–14.32). Total mortality was 18.4% and significantly higher in case of initial severity (OR=3.83; 95%CI=1.75–8.38), healthcare-associated infection (OR=5.29; 95%CI=1.11–25.30), and MRSA BSI (OR=9.16; 95%CI=1.67–50.16). BSI due to MDRO is frequent in older population and is strongly associated with carriage of MDRO. Healthcare-associated BSI, severe episodes, and BSI due to MRSA are associated with unfavorable outcome. In these cases, a broad-spectrum antibiotic should be promptly initiated.

Smoking prevalence in Lebanon was reported by the World Health Organization to be 43%, which is among the highest rates in the Arab nation. The objectives of this study were to assess cigarette smoking knowledge and attitude among smokers and non-smokers using validated scales in the Lebanese general population and evaluate their association with current cigarette smoking; a secondary objective is to assess the dose effect relationship of knowledge and attitude with cumulative smoking. This cross-sectional took place between May and December 2018, and enrolled a sample of 2623 participants, representative from all Lebanese governorates. A questionnaire about knowledge of the harmful effects of tobacco and attitude toward smoking bans retrieved from other studies was used to collect data. Male gender (ORa = 0.75), having a low monthly income (ORa = 1.56) and a higher passive smoking score (ORa = 1.25), were significantly associated with higher odds of being current smokers. Higher knowledge score (ORa = 0.97) and positive attitude toward smoking ban score (ORa = 0.94) were significantly associated with lower odds of being current smokers. In addition, increased age (ß = 15.21) and higher passive smoking score (ß = 26.58) were significantly associated with higher cumulative cigarette smoking. More positive attitude toward smoking ban score (ß = − 6.51) and having a university degree (ß = − 68.35) were significantly associated with lower cumulative cigarette smoking. Higher knowledge about the smoking-related health problems and better attitudes toward smoking ban were observed among non-smokers compared to smokers. It is important to increase awareness campaigns and to propose effective interventions to put in place an adequate culture of smoking cessation among the general population.

To evaluate the proportions of current cigarette smokers (CCS) and current narghile smokers (CNS) as well as previous cigarette smokers (PCS) and previous narghile smokers (PNS) and to assess smoking knowledge and attitudes toward supporting smoking ban or cessation among previous compared with current smokers. This cross-sectional study took place between May and December 2018, and enrolled a sample of 1598 exclusive cigarette smokers (ECS) and 2091 exclusive narghile smokers (ENS), representative of all Lebanese governorates. A questionnaire designed specifically for this study was used to collect data. Among ECS, 45.2% were CCS and 54.8% were PCS. Among ENS, 83.5% were CNS and 16.5% were PNS. Higher age (adjusted odds ratio (aOR) (95% confidence interval (CI)) = 1.02 (1.01; 1.03)), higher knowledge (1.05 (1.02; 1.08)), and attitude scores (1.11(1.09; 1.13)) were significantly associated with higher odds of being PCS. Higher age (1.02 (1.01; 1.03)), being employed (1.32 (1.004; 1.72)), higher knowledge (1.04 (1.02; 1.07)), and attitude scores (1.09 (1.07; 1.12)) were significantly associated with higher odds of being PNS. Previous smokers have higher knowledge and better attitude toward supporting smoking cessation compared with current smokers. A better knowledge along with effective interventions, might lead to a positive attitude toward supporting smoking ban or smoking cessation among the general population.

BACKGROUND:Allergic diseases are recognized as a burden on the public health. They stand as one of the most common chronic diseases, especially in developed countries. Therefore, the objective of this study is to evaluate the association between the development of atopic allergy and the presence of food allergy in children, and food consumption.METHODS:This multidisciplinary cross-observational epidemiological study was conducted among 1199 schoolchildren who were recruited in 4th grade and 5th grade (9-11 years old from Marseille). Data were collected by means of a standardized epidemiological questionnaire with a medical assessment focusing on allergic diseases, and questions on lifestyle and child nutrition (FFQ).RESULTS:During the last 12 months, prevalence of allergic diseases were shown as follows: 41% of children presented allergic rhinitis symptoms, 24% reported having asthma related symptoms, while 28% suffered of eczema and 7% complained of food allergy. There was a significant association between food allergy and asthma symptoms (P-value<0.001, IC=[2.29-7.69]), eczema (P-value<0.001, IC=[2.37-8.32]) and allergic rhinitis (P-value<0.001, IC=[2.32-8.17]). Regarding dietary habits, the multivariate analysis shows that the consumption of vegetables (ORa=0.72 [0.64-0.74]) and fish (ORa=0.74 [0.50-1.09], ORa=0.66 [0.47-0.94] respectively) are associated decreased risk of developing asthma and allergic rhinitis symptoms, while fruit consumption (ORa=0.68 [0.45-1.03]) is associated with a decrease in eczema symptoms.CONCLUSION:This study shows that the presence of a food allergy is strongly associated with allergic diseases. Indeed, the consumption of vegetables, fruits and fish seems to have a protective effect on the occurrence of these diseases.