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Objective: This study aimed to assess the public’s knowledge of stroke before and after viewing an educational video about stroke risk factors, preventive measures, and alarming signs. Methods: A single-arm interventional study was conducted in Lebanon using a 3-minute video-based education about stroke. A pre- and post-structured questionnaire compared the level of knowledge about stroke. Results: The study included 685 participants. Knowledge of stroke, risk factors, warning signs, treatment, and preventive measures significantly increased post-educational video sessions. A higher baseline knowledge score was associated with a family history of stroke (Beta = 1.76) and being a healthcare professional (Beta = 3.35). Participants between 25 and 34 years (Beta=-1.39) and those with a high risk of stroke (Beta=-1.03) were significantly associated with a lower knowledge score. Conclusion: This study demonstrated the effectiveness of a video-based educational tool to raise awareness about stroke. Short, targeted audio-visual resources using lay language can convey health education messages and influence behavioral changes. The community can benefit from a large-scale educational campaign that targets different socio-economic statuses to enhance knowledge of stroke and save lives. [ABSTRACT FROM AUTHOR]

Introduction: Tokophobia is an intense and pathological fear of pregnancy and childbirth. Despite its significance, no research in Lebanon has investigated primary tokophobia within the general population. Nevertheless, it is crucial to assess the attitudes of both women and men, as potential future parents, towards pregnancy and childbirth, particularly during these challenging times for the Lebanese population. Therefore, this study aims to evaluate the psychometric properties of the Tokophobia Severity Scale (TSS) and Fathers' Fear of Childbirth Scale (FFCS) for assessing primary tokophobia among Lebanese nulliparous women and childless men, respectively. Methods: This cross-sectional investigation encompassed all Lebanese governorates; 651 women and 618 men were recruited via social media platforms, using a snowball sampling technique. The questionnaire included the Tokophobia Severity Scale, the Fathers' Fear of Childbirth Scale, the Patient Health Questionnaire, and the Lebanese Anxiety Scale. Results: Factorial analysis of the TSS in women revealed a three-factor model: concerns related to personal complications (Factor 1), fetal well-being (Factor 2), and outward behavioral responses to fear (Factor 3). The FFCS also yielded a three-factor measurement model: emotional responses during the partner's childbirth (Factor 1), concerns regarding the hospital environment during childbirth (Factor 2), and anxieties surrounding the perinatal health of both the partner and child (Factor 3). Both scales were internally consistent with Cronbach's alpha > 0.9, indicating their reliability. The TSS and FFCS demonstrated statistically significant correlations with measures of anxiety and depression, thus attesting to convergent validity. Conclusion: The results of this study provide evidence for the psychometric validity and reliability of the TSS and FFCS scales in Arabic-speaking populations. Given the previously overlooked nature of primary tokophobia in these populations, the availability of these validated instruments can significantly enhance the ability to detect and address this condition, ultimately facilitating the provision of necessary support services. [ABSTRACT FROM AUTHOR]

Background: Dysmenorrhea, characterized by painful menstrual cramps, significantly impacts the well-being of women globally. Despite its prevalence and adverse effects, dysmenorrhea is often underdiagnosed and inadequately treated. This study aims to validate the Arabic version of the Working ability, Location, Intensity, Days of pain, and Dysmenorrhea (WaLIDD) scale among Lebanese female university students aged 18– 45. Methods: This cross-sectional study, involving 729 participants, utilized a translated WaLIDD scale and the Depression, Anxiety, and Stress Scales (DASS-8). Results: Confirmatory Factor Analysis (CFA) confirmed the one-factor structure of the WaLIDD scale, demonstrating excellent fit indices, with good internal reliability. Concurrent validity analysis revealed significant associations between higher WaLIDD scores and elevated levels of depression, anxiety, and stress. The prevalence of dysmenorrhea in the study was estimated at 7.3%. Conclusion: The study underscores the importance of the WaLIDD scale as a reliable and valid tool for assessing dysmenorrhea among Arabic-speaking populations. The successful validation of the Arabic version facilitates its application in Lebanon and potentially other Arab regions, providing a universal tool to predict and assess dysmenorrhea and its impact. Further research is encouraged to explore the scale's applicability in clinical settings and tailor interventions for improved women's well-being. [ABSTRACT FROM AUTHOR]

Background: Acknowledging the increasing worry over climate change and its psychological effects, the aim of this research is to clarify the dynamics between religiosity, climate anxiety and death anxiety, seeking to figure out the way religiosity mitigates the psychological effects of existential anxieties and climate related anxiety. Methods: Using Google Forms, a questionnaire was developed and disseminated through a variety of messaging platforms, such as WhatsApp, Instagram, and Facebook Messenger. Through a snowball sampling technique, 763 participants were recruited in this cross-sectional during September 2023. Results: The subsequent variables were adjusted in the moderation analysis: age, gender, and place of living. The results suggested that religiosity levels moderated the association between climate anxiety and death anxiety (Beta = 0.02, t = 1.97, p =.05, 95% CI 0.001, 0.035). At low, moderate, and high levels of religiosity, higher climate anxiety was significantly associated with more death anxiety. In addition, at low levels of climate anxiety, individuals with higher levels of religiosity (22.66) had more decreased levels of death anxiety compared to those with lower levels of religiosity (11.99). As climate anxiety levels increase, inverted patterns can be observed, with highly religious individuals showing higher levels of death anxiety than those with lower levels of religiosity. Overall, the relationship between climate anxiety and death anxiety was found to be weakest at low levels of religiosity and strongest at high levels of religiosity. Conclusion: Our findings suggest a possible beneficial effect of high religiosity at low levels of climate anxiety. This effect is reversed as climate anxiety starts to increase. Therefore, clinicians and policy-makers should bear in mind these complex interactions when designing strategies to mitigate mental health problems in the context of climate crisis. [ABSTRACT FROM AUTHOR]

Background: The Nightmare Distress Questionnaire (NDQ), known and commonly used for its adequate psychometric properties, is the most widely used instrument for the measurement of nightmare distress. This study aimed to assess the psychometric properties of a newly translated Arabic version of the Nightmare Distress Questionnaire (NDQ-AV). Methods: A total of 546 Lebanese adolescents was recruited for this study and completed the NDQ-AV, the Insomnia Severity Index (ISI), and the eight-item Depression, Anxiety and Stress Scale (DASS-8). Results: The results of the exploratory factor analysis (EFA) and the confirmatory factor analysis (CFA) supported both a one-factor model and a two-factor model of the NDQ-AV, with the latter consisting of seven items within both factors. The first factor was referred to as the "general nightmare distress and coping" while the second was named "nightmare impact and perception". The reliability of the scale was excellent (α = 0.930 and ω = 0.915). Moreover, measurement invariance was shown across gender, demonstrating that this measure performs consistently for both men and women. Additionally, the NDQ-AV scores exhibited excellent reliability alongside factorial and concurrent validity. Conclusion: In conclusion, these results support the psychometric validity of the Arabic version of the NDQ. The availability of the NDQ-AV is expected to facilitate the understanding of nightmare distress within the Lebanese context. [ABSTRACT FROM AUTHOR]

Background: Anxiety and depression are psychiatric disorders that often coexist and share some features. Developing a simple and cost-effective tool to assess anxiety and depression in the Arabic-speaking population, predominantly residing in low- and middle-income nations where research can be arduous, would be immensely beneficial. The study aimed to translate the four-item composite Patient Health Questionnaire – 4 (PHQ-4) into Arabic and evaluate its psychometric properties, including internal reliability, sex invariance, composite reliability, and correlation with measures of psychological distress. Methods: 587 Arabic-speaking adults were recruited between February and March 2023. An anonymous self-administered Google Forms link was distributed via social media networks. We utilized the FACTOR software to explore the factor structure of the Arabic PHQ-4. Results: Confirmatory factor analysis (CFA) indicated that fit of the two-factor model of the PHQ-4 scores was modest (χ2/df =.13/1 =.13, RMSEA =.001, SRMR =.002, CFI = 1.005, TLI = 1.000). Internal reliability was excellent (McDonald's omega =.86; Cronbach's alpha =.86). Indices suggested that configural, metric, and scalar invariance were supported across sex. No significant difference was found between males and females in terms of the PHQ-4 total scores, PHQ-4 anxiety scores, and PHQ-4 depression scores. The total score of the PHQ-4 and its depression and anxiety scores were significantly and moderately-to-strongly associated with lower wellbeing and higher Depression Anxiety and Stress Scale (DASS) total and subscales scores. Conclusion: The PHQ-4 proves to be a reliable, valid, and cost-effective tool for assessing symptoms related to depression and anxiety. To evaluate the practical effectiveness of the Arabic PHQ-4 and to further enhance the data on its construct validity, future studies should assess the measure in diverse contexts and among specific populations. [ABSTRACT FROM AUTHOR]

Background: The Arab world is one of the global regions the most directly concerned by, and suffering from climate change's adverse consequences. As such, there appears to be a strong need for an understanding of how Arab people may emotionally respond to climate change. Providing valid and reliable measures of climate change anxiety (CCA) can help gain a clear overview of the situation in Arab countries, and allow to intervene timely and effectively to mitigate any adverse effects on Arab people's mental health. To this end, the present study sought to validate the Arabic language version of the Climate Change Anxiety Scale (CCAS) in a sample of native Arabic-speaking adults from the general population of Lebanon. Methods: This study adopted a cross-sectional approach and enrolled 763 adults between July and September 2023. Results: A confirmatory analysis of the one-factor model showed poor fit indices as follows: CFI = 0.90, GFI = 0.83, SRMR = 0.048 and RMSEA 0.131 [90% CI 0.123, 0.138). The two-factor model showed a satisfactory fit with a high CFI of and a GFI of 0.91 and a SRMR of 0.04 and RMSEA of 0.05 [90% CI 0.04, 0.06]. Both McDonald's omega and Cronbach alpha values were high for the overall CCAS score (α = 0.96 and ω = 0.96) in the whole sample. Configural, metric and scalar invariance across gender was demonstrated. No significant difference was found between males and females in terms of total CCAS scores (24.53 ± 10.59 vs. 26.03 ± 11.17, t(761) = -1.82, p =.069). Higher CCA, functional impairment and cognitive impairment scores were significantly associated with higher depression, anxiety and stress. Conclusion: The reliability and validity of the CCAS in its Arabic version were proven. The availability of this self-report measure could offer a chance to assess CCA among Adults speaking Arabic, and to spread its future use for screening and research purposes. [ABSTRACT FROM AUTHOR]

Binarization is an extreme quantization technique that is attracting research in the Internet of Things (IoT) field, as it radically reduces the memory footprint of deep neural networks without a correspondingly significant accuracy drop. To support the effective deployment of Binarized Neural Networks (BNNs), we propose CBin-NN, a library of layer operators that allows the building of simple yet flexible convolutional neural networks (CNNs) with binary weights and activations. CBin-NN is platform-independent and is thus portable to virtually any software-programmable device. Experimental analysis on the CIFAR-10 dataset shows that our library, compared to a set of state-of-the-art inference engines, speeds up inference by 3.6 times and reduces the memory required to store model weights and activations by 7.5 times and 28 times, respectively, at the cost of slightly lower accuracy (2.5%). An ablation study stresses the importance of a Quantized Input Quantized Kernel Convolution layer to improve accuracy and reduce latency at the cost of a slight increase in model size. [ABSTRACT FROM AUTHOR]

Background: As climate change persists, accelerates, and intensifies, and since mitigating factors are absent, mental health impacts are expected to follow the same patterns. Therefore, it appears of utmost importance to deepen and broaden the knowledge and understanding of how and through which mechanisms climate change anxiety (CCA) may interplay with mental health outcomes. Based on the stress-vulnerability model of psychosis, the present study proposed to examine the relationship between CCA and psychotic experiences (PEs), and to test the theoretically-driven hypothesis that death anxiety acts as a mediator in this relationship. Method: This study adopted a cross-sectional approach involving a sample of young adults aged 18 to 35 years (mean age = 24.56 ± 22.49 years; 63.9% females) originating from, and residing in Lebanon. Results: The results of the mediation analysis showed that death anxiety partially mediated the association between CCA and PEs. Higher CCA was significantly associated with higher death anxiety; higher death anxiety was significantly associated with more PEs. Finally, higher CCA was directly and significantly associated with more PEs. Conclusion: Drawing from the present preliminary findings, the key tentative recommendation is that addressing death anxiety might alleviate the association between CCA and PEs. In addition, government decision-makers need to recognize the necessity of considering climate change implications on mental health in policy and decision-making. [ABSTRACT FROM AUTHOR]

Background: Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis added to the DSM-5 characterized by pathological eating habits without body image disturbances. Previous findings demonstrated a general association between high levels of perfectionism and low levels of self-esteem in association with general eating disorders. However, research is scant when it comes to ARFID specifically. Subsequently, although self-esteem is seen to moderate the association between perfectionism and general eating disorders, this research study aims to explore the same moderation but with ARFID specifically. Methods: For this study, 515 Lebanese adults from the general Lebanese population were recruited from all over Lebanon, 60.1% of which were females. The Arabic version of the Big Three Perfectionism Scale– Short Form (BTPS-SF) was used to measure self-critical, rigid and narcissistic perfectionism; the Avoidant/Restrictive Food Intake Disorder screen (NIAS) was used to score the ARFID variable; the Arabic-Single Item Self-Esteem (A-SISE) was the scale used to measure self-esteem. Results: Across the different perfectionism types, self-esteem was seen to moderate the association between narcissistic perfectionism and ARFID (Beta = − 0.22; p =.006). At low (Beta = 0.77; p <.001), moderate (Beta = 0.56; p <.001) and high (Beta = 0.36; p =.001) levels of self-esteem, higher narcissistic perfectionism was significantly associated with higher ARFID scores. Conclusion: This study brought to light some crucial clinical implications that highlight the need for interventions that help in the enhancement of self-esteem in patients with high perfectionism and ARFID. This study suggests that clinicians and healthcare professionals should focus more on risk factors influencing the development and maintenance of ARFID-like symptoms. [ABSTRACT FROM AUTHOR]

Background: There is a lack of measures and data on interpersonal mindfulness from non-Western cultures, which can hinder advances in our understanding of the construct, its conceptual representation, and its effects on human connection and relationships within different cultural settings. To fill this gap and help spark future research in this area in the Arab world, the current study aimed to examine the psychometric properties of an Arabic translation of the 27-item and the 13-item versions of the interpersonal Mindfulness Scale (IMS) in a sample of Arabic-speaking adolescents from the general population. Methods: A web-based survey was conducted in a sample of 527 Lebanese community adolescents (Mean age = 15.73 ± 1.81 years; 56% females). The IMS was translated from English into Arabic using the forward-backward translation method. Participants completed the long and short forms of the IMS, as well as the Buss–Perry Aggression Questionnaire-Short Form (BPAQ-SF), and the 5-item Brief Irritability Test. Results: Confirmatory factor analyses provided support to the four-factor structure of both the 27-item and the 13-item IMS (i.e., Presence, Awareness of Self and Others, Nonjudgmental Acceptance, and Nonreactivity). The original and the short form versions of the IMS yielded excellent internal consistency in our sample, with a Cronbach's α coefficients of 0.95 and 0.90, and McDonald's omega coefficients of 0.95 and 0.90, respectively. Multigroup comparisons suggested the factorial invariance of the Arabic 27-item and 13-item IMS between male and female participants at the metric, configural, and scalar levels. Finally, the concurrent validity of both full-length and short form of the IMS appeared to be good and comparable, as attested by patterns of correlations in expected directions with outcome variables (i.e., aggression, anger, hostility, and irritability). Conclusion: The present findings provide support for the good psychometric qualities of the Arabic translation of the IMS in both long and short forms, suggesting that these scales are suitable for use to measure interpersonal mindfulness in Arabic-speaking youth, at least in Lebanon. We expect that the IMS, in particular its shortest form, will prompt more systematic investigation of interpersonal mindfulness in the Arabic-speaking populations, especially with regard to enhancing healthy communications with others and building effective social relationships. [ABSTRACT FROM AUTHOR]

Introduction: It is common for people to experience anxiety when contemplating their unknown future. Studies have shown that those who tend to worry more about their future are more likely to be intolerant of uncertainty. In order to study the way people from the Middle East tackle uncertainty, a valid and reliable scale is needed. In this context, the present study aimed to examine the psychometric properties of the Arabic version of the 12-item Intolerance of Uncertainty Scale (IUS-12) in a community sample of native Arabic–speaking participants from Lebanon, Egypt, and Kuwait. Methods: A sample of 2038 university students answered the survey, with a mean age of 22.30 ± 4.15 years and 77.5% females. A Google Form link was dissipated among participants that included some demographic questions, the IUS-12 and the Depression, Anxiety and Stress Scale (DASS-8). Results: Following the confirmatory factor analysis (CFA), a bi-dimensional model of the Arabic version of the IUS-12 was found. The scale showed an excellent internal reliability for the prospective anxiety (ω = 0.85 / α = 0.85) and inhibitory anxiety (ω = 0.87 / α = 0.87). Additionally, the results illustrated configural, metric, and scalar invariance across genders and countries. Furthermore, Egypt and Lebanon were seen to have statistically significant higher levels of inhibitory anxiety compared to Kuwait, while only Egypt showed statistically significant higher prospective anxiety compared to Kuwait. Finally, higher psychological distress was significantly and positively associated with higher prospective and inhibitory anxiety. Conclusion: The results of this study provide support for the psychometric reliability and validity of the Arabic version of the IUS-12, allowing for its generalizability and suitability for use among individuals from different Arabic-speaking nations. [ABSTRACT FROM AUTHOR]

Background: Research on dysmorphic concerns (DC) in Arabic-speaking contexts is hampered by the lack of validated tools. Because DC are culturally dependent, psychometrically sound measures are needed at the national level to closely and accurately investigate the construct in specific societies and populations. The purpose of the current research was to investigate the psychometric properties of Dysmorphic Concern Questionnaire (DCQ) in its Arabic translation in Lebanese adults. Methods: The study involved 515 participants (69.9% females, mean age of 27.55 ± 10.92 years) who completed a self-report, web-based questionnaire. Results: Confirmatory factor analysis indicated excellent construct validity, as the one-factor structure of the Arabic DCQ fits well with the data. McDonald's omega was 0.89 in our sample, evidencing an excellent level of internal consistency. Furthermore, the results from the multigroup analysis showed that the DCQ holds similar structural model between genders at the metric, configural, and scalar levels. Finally, DC levels correlated inversely with body appreciation and self-esteem and positively with disordered eating symptoms, thus supporting the concurrent and convergent validity of the Arabic DCQ. Conclusion: The DCQ translated into Arabic appears to have a valid self-assessment measure to capture the presence of DC manifestations. It is anticipated that the Arabic DCQ will be advantageous for healthcare professionals and researchers working with Arabic-speaking people around the world. [ABSTRACT FROM AUTHOR]

Objectives: This study examined the mediating effect of psychological distress and mindful eating behaviors between orthorexia nervosa and academic self-efficacy among Lebanese university female students. Methods: A total of 769 female participants enrolled in this cross-sectional study (mean age 21.58 ± 3.20 years). A self-administered questionnaire was distributed among university female students. The questionnaire consisted of Mindful Eating Behaviors Scale, ORTO-R, Depression Anxiety Stress Scale, and Arabic version of Academic Self-Efficacy Scale. Results: The results showed that psychological distress fully mediated the association between orthorexia nervosa and academic self-efficacy; higher orthorexia nervosa was significantly associated with less psychological distress (β= -0.31, p =.05), with more psychological distress significantly associated with lower academic self-efficacy (β= -0.32, p =.09). Focused eating fully mediated the association between orthorexia nervosa and academic self-efficacy; higher orthorexia nervosa was significantly associated with less focused eating (β=-0.09, p =.04), with more focused eating significantly associated with better academic self-efficacy (β = 1.40, p =.10). Orthorexia nervosa was not directly associated with academic self-efficacy in both models. Conclusion: This study shed light on important connections between orthorexia nervosa, psychological distress, mindful eating behaviors, and academic self-efficacy within the Lebanese context. The findings will have practical implications for both educational institutions and healthcare providers striving to support young female adults' overall well-being and academic success. [ABSTRACT FROM AUTHOR]

Background: Reflecting on the existing literature on suicidal ideation and Avoidant/Restrictive Food Intake Disorder (ARFID), this article investigates the complex relationship between them, hypothesizing about the possibility of dysmorphic concerns, being a mediator linking ARFID to suicidal ideation. Methods: Using a snowball sampling approach, a survey was created on Google Forms and circulated across messaging applications and social media networks (WhatsApp, Instagram, Messenger). The sample involved 515 participants recruited between February and March 2023. The questionnaire included the following scales: Nine-items Avoidant/Restrictive Food Intake Disorder screen (NIAS), Dysmorphic Concern Questionnaire (DCQ), and Columbia-Suicide Severity Rating Scale (C-SSRS). When filling the questionnaire, respondents were warned that they can experience distress when answering certain questions and received information about mental health services. Five hundred fifteen adults participated in this study, with a mean age of 27.55 ± 10.92 years and 60.1% females. Results: After adjusting over potential confounders (i.e., age, education, marital status, and household crowding index), analyses showed that dysmorphic concerns fully mediated the association between avoidant restrictive eating and suicidal ideation. Higher avoidant restrictive eating was significantly associated with more dysmorphic concerns, and higher dysmorphic concerns were significantly associated with the presence of suicidal ideation. Finally, avoidant restrictive eating was not significantly associated with suicidal ideation. Conclusion: This study highlights the potential indirect link between ARFID and suicidal ideation mediated by dysmorphic concerns. While no direct connection was observed between ARFID and suicidal ideation, the presence of dysmorphic concerns appeared to be a crucial factor in amplifying the risk of suicidal ideation in individuals with ARFID. This emphasizes the importance of addressing dysmorphic concerns alongside ARFID treatment to enhance mental health interventions and outcomes. [ABSTRACT FROM AUTHOR]

Background: Exploring the levels of death anxiety and factors that can undermine its impact are crucial for the Lebanese nationals. Even though studies have shown various relationships between death anxiety and several factors, very few to no research has been done to show the relationship of death anxiety, gratitude and optimism. Therefore, the objectives of our study were to assess the mediating role of optimism in the association between gratitude and death anxiety, along with investigating the validity and reliability of the Arabic version of the Death Anxiety Scale. Methods: A one-time-point online survey was conducted among Arabic-speaking community adults from the general population of Lebanon (N = 601; mean age 29.91 ± 12.61; 62.7% females). The following scales were used: Scale of Death Anxiety, Optimism–Pessimism Short Scale–2, and Gratitude Questionnaire-Six-Item Form. Results: The results of the mediation analysis showed that optimism fully mediated the association between gratitude and death anxiety. Higher gratitude was significantly associated with more optimism; higher optimism was significantly associated with less death anxiety. Finally, higher gratitude was not directly associated with death anxiety. Conclusion: Our study reveals the relationship between gratitude and death anxiety and the mediating role of optimism. Our results need to be confirmed in a longitudinal study, but point to the importance of assessing optimism in prevention and management of persons with death anxiety. [ABSTRACT FROM AUTHOR]

Background: Accurately measuring violent ideations would be of particular high relevance in Arab countries, which are witnessing an unprecedented increase in violence rates among adolescents because of the widespread social, economic and political unrest in the region. Therefore, the present study aimed to test the psychometric properties of an Arabic translation of the 12-item and the 7-item forms of the Violent Ideations Scale (VIS and VIS-SF) in a sample on non-clinical Arabic-speaking adolescents. Methods: Five hundred seventy-seven community adolescents (mean age of 15.90 ± 1.73 years, 56.5% females) answered an anonymous online survey comprising an Arabic translation of the Violent Ideations Scale (VIS) and a measure of physical aggression. Results: Confirmatory factor analyses (CFA) offered support for the single-factor structure of the Arabic VIS and the VIS-SF. Both the long and short forms of the scale yielded excellent internal consistency, with McDonald's ω coefficients of 0.96 and 0.94 and Cronbach's α coefficients of 0.96 and 0.94, respectively. Multi-group CFA established measurement invariance across gender groups. Finally, results revealed significant and positive correlations between the two forms of the VIS and physical aggression scores, thus supporting concurrent validity. Conclusion: Both the VIS and VIS-SF have demonstrated good psychometric properties in their Arabic versions, and suitability for sound assessment of violent ideations. We therefore expect that these measures assist clinicians in risk assessment and management of violence, and help foster research in this area in Arab countries. [ABSTRACT FROM AUTHOR]

Background: Despite the high clinical relevance of the perfectionism construct as a transdiagnostic contributor to different mental health symptoms, and the recent burgeoning of research in this area across cultures in the past two decades, the Arab region was one of the cultural settings experiencing the slowest progress in this line of research. This study aimed to make a meaningful contribution to the literature by validating an Arabic-language version of the 16-item Big Three Perfectionism Scale–Short Form (BTPS-SF). In particular, we sought to examine structure and concurrent validity, internal consistency, and measurement invariance across gender groups. Method: A web-based, convenience sampling method was adopted to collect a sample of Arabic-speaking adults from the general population of Lebanon (N = 515; aged 27.55 ± 10.92 years; 69.9% females). The forward-backward method was applied in translating the Arabic version of the BTPS-SF. Results: The examination of the internal structure, using Confirmatory Factor Analysis (CFA), demonstrated that the three-factor model (i.e., rigid, self-critical, and narcissistic perfectionism) fitted well to the data. All three factors of the Arabic 16-item BTPS-SF yielded excellent reliability estimates, with both Cronbach's alpha and McDonald's omega ranging from 0.83 to 0.86. Multi-group CFA revealed that fit indices showed no significant difference in model fit at the configural, metric, and scalar levels, thus suggesting that the factor loadings, pattern structure, and item intercepts are invariant across gender groups. Finally, BTPS-SF subscales scores correlated positively with psychological distress (i.e., depression, stress and anxiety), and inversely with subjective well-being, indicating an acceptable concurrent validity. Conclusion: The present findings allow us to conclude that the Arabic BTPS-SF permits to capture reliably and validly three main factors of perfectionism. We hope that providing this psychometrically sound scale will encourage its large use not only in empirical research, but also in clinical applications, including psychological screening and treatment monitoring. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess nutrition knowledge (NK) and willingness to seek nutritional counseling (WSNC) and their predictors among university students in Lebanon. Design/methodology/approach: A cross-sectional design was used to enroll students from two large private universities in Lebanon. Data were collected by a standardized questionnaire. NK scores on general and specific nutrition areas were computed. The predictors of NK and WSNC were determined by multivariable logistic regression analyses. Findings: A total of 370 students were included, among which 68% had good general nutritional knowledge, which appears to be associated with being a pharmacy student (adjusted OR (aOR) = 4.26 [95% confidence interval (CI) 1.55; 11.7]), and having a dietitian as a reference for nutritional information (aOR = 8.84 [95% CI 1.94; 40.3]). However, 64% of participants had a high specific nutritional knowledge score, which was related to either attending a school of arts and sciences or being a pharmacy student (aOR = 10.8 [95% CI 4.08; 28.5]). Most students (80%) had the will to seek nutritional counseling, which was positively associated with being a female (aOR = 2.01 [95% CI 1.10; 3.67]) and a pharmacy student (aOR = 2.62 [95% CI 1.15; 5.95]). The general nutritional knowledge score was significantly associated with the WSNC (aOR = 2.10 [95% CI 1.04; 4.25]). Originality/value: Higher nutritional knowledge and WSNC were found among students enrolled in health-related fields. These results underline how important nutrition education is as a strategy for inspiring college students to adopt healthy lifestyles. [ABSTRACT FROM AUTHOR]

Background and Objectives: Stroke prevention has traditionally concentrated on research to improve knowledge and awareness of the disease in the general population. Since stroke incidents increase with age, there is a need to focus on the elderly, a high-risk group for developing the disease. This study aimed to examine the level of stroke awareness and knowledge, their predictors, and their source of information. Materials and Methods: A prospective cross-sectional study targeted Lebanese senior citizens aged 65 years and above. A total of 513 participants enrolled in the study through a self-administered survey distributed using a snowball sampling technique. Results: Most participants had appropriate baseline knowledge (more than 75% correct answers) of stroke, including risk factors, alarming signs, and preventive measures. Better knowledge of disease risks was significantly associated with having a university degree (ORa = 1.609; p = 0.029). Participants who had previous ischemic attacks showed significantly lower knowledge of the alarming signs (ORa = 0.467; p = 0.036) and prevention measures (ORa = 0.427; p = 0.029). Those suffering from depression had better knowledge of stroke alarming signs (ORa = 2.060.; p = 0.050). Seeking information from pharmacists, physicians, or the internet was not significantly associated with better knowledge of stroke risks, alarming signs, and preventive measures. Conclusions: The present study showed that seniors had fair knowledge of stroke, despite gaps in stroke prevention measures. Healthcare providers could play a leading role in improving public health by educating seniors to enhance awareness about prevention measures, detecting alarming signs, and acting fast to save a life. [ABSTRACT FROM AUTHOR]

Background: The Weinstein Noise Sensitivity Scale (NSS) is widely recognized as a prominent unidimensional self-reported questionnaire to measure noise sensitivity, which is regarded as the foremost subjective factor moderating the impact of noise on perceived levels of annoyance. In this current study, we conducted an examination of the psychometric properties of a newly translated Arabic version of the short form of the scale (NSS-SF). Methods: A sample of 527 Lebanese adolescents participated in the study, completing the NSS-SF with measures of noise annoyance and insomnia. The total sample was randomly divided into two subsamples. Exploratory-to-Confirmatory Factor Analysis (EFA-CFA) was conducted. The normed model chi-square (χ²/df), the Steiger-Lind root mean square error of approximation (RMSEA), the Tucker-Lewis Index (TLI) and the comparative fit index (CFI). Values ≤ 5 for χ²/df, and ≤ 0.08 for RMSEA, and 0.90 for CFI and TLI indicate good fit of the model to the data. Composite reliability in both subsamples was assessed using McDonald's ω and Cronbach's alpha. Results: EFA results on the first split-half subsample revealed that one item (item 2) was removed because of low communality (< 0.3); the other 4 items converged on one factor, which explained 67.85% of the common variance (ω = 0.84 and α = 0.84). CFA was conducted on the second half-split subsample in adults according to the model obtained on the first split-half subsample; the fit indices were acceptable as follows: χ2/df = 5.07/2 = 2.54, p <.001, RMSEA = 0.076 (90% CI 0.001, 0.160), SRMR = 0.021, CFI = 0.992, and TLI = 0.976 (ω = 0.84 and α = 0.84). Configural, metric, and scalar invariance was supported across gender in the total sample. Conclusion: Our findings substantiate that the Arabic version of the NSS-SF is a reliable, psychometrically valid instrument for assessing noise sensitivity among Arab adolescents, thereby enhancing its overall utility and applicability within Arab countries. [ABSTRACT FROM AUTHOR]

Background: In the absence of a similar study in the Lebanese context, this study aimed to validate the content of the specialized competencies frameworks of academic pharmacists (educators, researchers, and clinical preceptors) and pilot their use for practice assessment in the context of multiple severe crises. Methods: A web-based cross-sectional study was conducted between March and September 2022 among academic pharmacists enrolled by snowball sampling using a questionnaire created on Google Forms. Results: The suggested frameworks had appropriate content to assess the competencies of academic pharmacists. Educators and clinical preceptors were confident in all their competencies except for emergency preparedness. Researchers had varying levels of confidence, ranging from moderate to high confidence for many competencies, but gaps were reported in fundamental research, conducting clinical trials, and pharmacy practice research (mean < 80). Educators and researchers relied primarily on experience and postgraduate studies, while clinical preceptors emphasized undergraduate studies to acquire their respective competencies. Continuing education sessions/programs were the least cited as a competency-acquiring venue across all roles. Conclusion: This study could develop and validate the content of frameworks for specialized competencies of academic pharmacists, including educators, researchers, and clinical preceptors, in a challenging setting. The frameworks were also piloted for practice assessment, which could contribute to supporting effective performance and sustained development of practitioners and help link the skills and competencies pharmacists learn during their studies with those required for a career in academia. [ABSTRACT FROM AUTHOR]

Background: Given the excessive length and inconsistent validity of the existing long stroke-specific quality of life (SS-QOL) scales, there is a need to validate a shorter measuring tool. The aim of this study was to validate the Arabic version of the short 12-item SS-QOL (SS-QOL-12-AR) and examine its validity measures and psychometric properties. Additionally, the study aimed to assess the QOL after stroke and identify the sociodemographic and clinical factors that influence it in Lebanon. Methods: A cross-sectional study was conducted. The SS-QOL-12-AR structure was validated, and its reliability and internal consistency were assessed. The scale's specificity and sensitivity were evaluated and then compared with those of other SS-QOL scales. The correlation between each item and the overall scale were examined, and its convergent validity was evaluated. Results: A total of 172 stroke survivors were included. The SS-QOL-12-AR structure was validated with a solution of two factors, with a Kaiser-Meyer-Olkin measure of sampling adequacy of 0.850 and a significant Bartlett's test of sphericity (p < 0.001). The Cronbach's alpha of the scale was 0.917. According to ROC curve analysis, the optimal cut-off point for distinguishing between lower and better QOL was 32.50. At this cut-off, the sensitivity and specificity were 70.0% and 71.2%, respectively. The area under the curve was 0.779 (95% CI 0.704-0.855, p < 0.001). The SS-QOL-12-AR demonstrated a strong and highly significant correlation with existing versions of the SS-QOL, confirming its convergent validity. 61.6% of stroke survivors had a lower QOL, which was significantly associated with poor stroke prognosis, increased physical dependence, current smoking, and alcohol abstinence. Conclusion: The SS-QOL-12-AR exhibits strong validity and reliability, demonstrating excellent psychometric properties. The scale holds potential for application in clinical practice and research settings, enabling the measurement of stroke-related consequences and evaluation of management outcomes. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the impact of implementing instructional educational games on attaining the intended learning outcomes mapped with the competencies of a pharmacy practice experience course, and to assess students' attitudes towards motivation and engagement in this active learning activity. Methods: This was a quasi-experimental study that utilized a pretest-posttest for the research groups. Students were divided into teams and challenged to answer different questions related to the case scenarios. Different gaming platforms as Gamilab, Wisc-Online, and Quizizz were accordingly used to create different questions that help students memorize medications' brand names, and acquire the advanced community knowledge and skills. The attainment of the intended learning outcomes was assessed and compared between the experimental and control groups through the course total average of grades, and the subsequent averages of domains relating to the course competencies. Attitudes towards motivation and engagement in educational games activities were also assessed among the experimental group. Results: A total of 233 students were enrolled in the study. The experimental group had significantly higher total posttest average compared to the control group (Beta = 7.695, 95% CI = 4.964–10.425, P < 0.001). The experimental group had also significantly higher averages of competency domains related to foundational knowledge (Beta = 1.471, 95% CI = 0.723–2.219, P < 0.001), pharmaceutical care (Beta = 1.650, 95% CI = 0.673–2.627, P < 0.001), essentials to practice and care (Beta = 1.838, 95% CI = 0.626–3.050, P < 0.003), and approach to practice and care (Beta = 2.736, 95% CI = 1.384–4.088, P < 0.001) averages. The experimental group reflected positive attitudes toward gamification engagement and motivation, with greater than 60% of the students recommend engage educational games to be part of the course. Conclusion: Incorporation of educational games into pharmacy practice experiences resulted in better learning outcomes. This kind of active learning appears to be acceptable and motivational for students, and is recommended for further research in didactic courses in the pharmacy curriculum. [ABSTRACT FROM AUTHOR]

Background: Medication errors can often occur due to the patient's inability to comprehend written or verbal medication orders. This study aimed to develop pictograms of selected medication orders and to validate the comprehension of prescription orders index and compare the comprehension scores with and without pictograms. In addition to determine the predictors that could be associated with a better or worse comprehension of prescription orders with pictograms versus that of their written counterparts. Methods: A cross-sectional study was conducted using a snowball sampling technique. Six pictograms were developed to depict specific medication orders. The comprehension of prescription orders index was constructed and validated. The study then compared the comprehension scores of prescription orders with and without pictograms, and identified the predicting factors score difference. Results: A total of 1848 participants were included in the study. The structure of the comprehension of prescription orders index was validated over a solution of four factors, with an adequate Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy of 0.711 and a significant Bartlett's test of sphericity (P < 0.001). The construct validity of the index was further confirmed by highly significant correlations between each item and the full index (P < 0.001). The study also found a significant association between the difference in comprehension scores for prescription orders with and without pictograms and several factors, including age, level of education, area of residence, number of children, and smoking status with the difference of comprehension scores (P < 0.001). Conclusion: Pictogram-based instructions of medication orders were better understood by the Lebanese population than written instructions, making the incorporation of pictograms in pharmacy practice paramount to optimize medication use by the patient and thus yielding better health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Adolescents react differently to challenging negative life events. Resilience, a dynamic characteristic of individuals, was studied to be a protective factor against such events. In order to study the resilience among Arabic-speaking adolescent populations, age-appropriate measures that are fully apprehended by younger respondents are needed. In this context, the present study aimed to examine the psychometric properties of an Arabic translation of the Resilience Scale for Adolescents (READ) in a community sample of native Arabic–speaking adolescents aged 13–18 years. Methods: A sample of 546 community Arabic-speaking adolescents from Lebanon was recruited (n = 328 females, with a mean age of 15.76 ± 1.65 years). Through an online questionnaire, participants were requested to complete the READ, Depression, Anxiety and Stress Scale (DASS-8) and the 13-item Children's Impact of Event Scale (CRIES-13). Results: Following the exploratory and confirmatory factor analysis (EFA-to-CFA) strategy, a unidimensional model of the Arabic version of the READ was met after 10 items were removed from the scale, and showed strong internal consistency (Cronbach's alpha of 0.943). Additionally, the one-factor solution of the Arabic version of the READ was identical across male and female adolescents at the three levels of invariance (Configural, Metric and Scalar). Finally, higher resilience scores were significantly correlated with lower levels of psychopathology, namely depression, anxiety, stress and PTSD, thus attesting to the concurrent validity of the Arabic READ. Conclusion: Findings lend support to the psychometric reliability and validity of the Arabic version of the READ, and therefore its suitability for use among Arabic-speaking adolescents. The availability of this tool facilitates the implementation of interventions that foster resilience, especially in adolescents who have faced a number of negative life events. [ABSTRACT FROM AUTHOR]

Background: Despite the substantial clinical relevance of irritability in the development and maintenance of several mental disorders and its negative effects on functioning, no valid and reliable measures are available yet to identify the presence and consequences of irritability as a distinct construct among the Arabic-speaking populations. To bridge this gap, and help advance this field in the under-researched Arab region, we aimed to validate an Arabic-language version of the Brief Irritability Test (BITe). Methods: Eligible participants were native Arabic-speaking non-clinical adolescents from Lebanon; 527 participants aged 15.73 ± 1.81 years (56% females) completed the survey. Results: Utilizing the Confirmatory Factor Analysis approach, we found that the five items of the Arabic BITe loaded into a single factor structure. The scale showed excellent reliability, as both Cronbach's alpha and McDonald's omega coefficient values were of 0.88. Multi-group analyses showed invariance across sex groups in our sample at the configural, metric, and scalar levels. Female adolescents exhibited higher BITe scores than their male counterparts (14.01 vs. 13.25), but this difference did not reach the statistical significance. Good concurrent validity was supported based on positive correlations between irritability scores and measures of aggression, anger and hostility (r Pearson's coefficients ranging from 0.35 to 0.42), as well as positive correlations with insomnia symptoms scores. Conclusion: The present findings allow us to conclude that the Arabic version of the BITe is a unidimensional, reliable, valid, brief, and economic self-report measure of the irritability construct for both male and female Arabic-speakers. Providing an Arabic validated version of the BITe will hopefully foster the research efforts of the Arab scientific community in this area, and promote the implementation of timely, evidence-informed and culturally-sensitive mental health interventions that appropriately address irritability-related problems and consequences among Arab young populations. [ABSTRACT FROM AUTHOR]

Background: No epidemiological data is yet available on Avoidant/Restrictive Food Intake Disorder (ARFID) in Arab countries, which may in part be due to the lack of measures available in Arabic language. This constitutes a major obstacle to further progress of our understanding of the nature, aetiology, course, treatment, and prevention of ARFID, especially as some evidence suggested that ARFID may vary across cultures and food environments. We aimed to contribute to the literature in the eating disorders field by examining the psychometric properties of an Arabic translation of the Nine Item ARFID Screen (NIAS). Method: This was a cross-sectional, web-based study. A total of 515 Lebanese community adults (mean age of 27.55 ± 10.92 years, 69.9% females) participated. The forward–backward method was adopted to translate the NIAS from English to Arabic. Results: Confirmatory Factor Analyses provided evidence for the adequate fit indices for the three-factor model (i.e., Picky eating, Fear, and Appetite) and the 9-item version of the NIAS. An adequate reliability of the Arabic NIAS was achieved, with McDonald's ω ranging from.75 to.90 for the total score and all three subscores. Multi-group analyses demonstrated measurement invariance by sex (males vs. females) and weight groups (underweight/healthy weight [BMI ≤ 25] vs. overweight/obese [BMI > 25]) at the configural, metric, and scalar levels. Adequate patterns of correlations between the NIAS and measures of disordered eating symptoms, psychological distress and well-being were seen. In particular, fear was significantly associated with non-ARFID disordered eating symptoms. Appetite and Picky eating, but not Fear, were inversely correlated with well-being. All three NIAS subscores and the total score were positively correlated with psychological distress. Conclusion: Findings provided evidence that the Arabic NIAS is a short, valid and reliable self-report measure to screen for ARFID symptoms. In light of these findings, we recommend its use for clinical and research purposes among Arabic-speaking adults. Plain English summary: Avoidant/restrictive food intake disorder (ARFID) is an eating disorder characterized by food avoidance or dietary restriction associated with at least one of four consequences––weight loss, nutritional deficiency, nutritional supplement dependence, and/or psychosocial impairment. The Nine Item ARFID Screen (NIAS) was developed as a screening measure to detect ARFID symptoms and has nine items with three subscales that map onto symptoms of each ARFID presentation. The NIAS have been translated into multiple languages but not yet validated in Arabic. To that end, we aimed to translate and validate the Arabic version of the NIAS in the present study, which would in turn facilitate improved research and clinical practices related to ARFID in Arabic-speaking nations. The present findings provide support for the psychometric properties of the Arabic version of the NIAS in examining ARFID in Arabic-speaking adults in Lebanon. [ABSTRACT FROM AUTHOR]

Background: Monoclonal gammopathy of undetermined significance (MGUS) is a non-malignant precursor of multiple myeloma (MM). MGUS has been suggested to be associated with a higher risk of cardiovascular diseases, including AFIB, but it is still unclear whether this association is real. Studies are lacking on the impact of atrial fibrillation on health outcomes in this population. The association of AFIB in this population is lagging and merits further investigation. Methods: The study conducted a retrospective analysis of the Nationwide Inpatient Sample (NIS) for 2018, including adult patients with primary diagnoses of MGUS and AFIB. Patients were divided into two groups based on AFIB presence. Outcomes assessed included complications, length of stay, mortality, hospital charges, and discharge disposition. Results: The study included 9007 patients with MGUS of whom 2404 had AFIB. Patients with both MGUS and AFIB had higher rates of acute kidney injury [AKI] (31.5% vs. 27.5%; p = 0.002) and pericarditis (2% vs. 1.2%; p = 0.029). They also had longer hospital stays (5 vs. 4 days; p < 0.001) and higher hospitalization costs ($43,729 vs. $41,169; p < 0.001). Conclusions: The study showed that the prevalence of AFIB in MGUS patients is high. Patients with AFIB had increased rates of complications (AKI and pericarditis) and higher mortality compared to patients without AFIB. Further studies screening for AFIB in this patient population are warranted. [ABSTRACT FROM AUTHOR]

Background: In the absence of similar studies in Lebanon, this study aimed at upgrading and validating the Lebanese specialized competencies framework for community pharmacists (SCF-CP) as a tool to transform community practice and support the professional development and career progression of community pharmacists. Methods: Content validity was assessed and improved through a team of experts. After a thorough literature review and utilizing the Delphi technique, six domains were defined in the framework, with their respective competencies and behaviors. A cross-sectional study was then carried out from March to October 2022 using an online questionnaire created on Google Forms. The snowball technique was applied to reach community pharmacists across all the Lebanese governorates. Results: The final sample included 512 community pharmacists. The construct validity of the framework was confirmed by factor analysis. The Kaiser–Meyer–Olkin measures of sampling adequacy were satisfactory for all models ranging from 0.500 to 0.956 with a significant Bartlett's test of sphericity (P < 0.001). The internal consistency of all competency domains was confirmed by Cronbach's alpha, with values ranging from 0.803 to 0.953. All competencies were significantly correlated with their respective domains (P < 0.001), and all domains were significantly correlated with each other and with the framework (P < 0.001). The participants declared being competent in all domains relating to fundamental skills, safe and rational use of medicines, pharmacy management, professional skills, public health fundamentals, and emergency preparedness and response, with some exceptions, such as compounding, management, and emergency preparedness. A higher declared competency level was associated with having more experience and receiving more than 50 patients per day. Conclusion: Our findings could demonstrate that the Lebanese specialized competency framework is a valid and reliable tool. This framework could help assess the minimum competencies that community pharmacists should possess or acquire and direct initial and continuing education for better practice. Hence, it could be adopted by the authorities and implemented in the Lebanese community pharmacy setting. [ABSTRACT FROM AUTHOR]

Background and Aims: Vaccine‐preventable illnesses continue to be a global health concern as immunization coverage remains below its targets. National plans emphasize on the essential role of multidisciplinary efforts and approaches to vaccination programs. Pharmacists are globally getting involved in immunization services as important members of the healthcare team. This study aimed to determine barriers, and assess challenges and possible opportunities to provide immunization in the Lebanese pharmacy practice. Methods: This was a cross‐sectional study that included pharmacists from all over Lebanon, as part of a national research to assess the role of pharmacists as immunizers. All registered pharmacists in Lebanon practicing in community, hospital, or other clinical settings were considered eligible for participation. A web‐based self‐administered validated questionnaire, which is initially developed by the American Pharmacists Association, was adapted with permission. Results: A total of 315 pharmacists responded to the survey. Only 23.1% declared completing an immunization training program. Over half of pharmacists (58.4%) administer vaccines to patients. A significant association between lack of support from physicians to pharmacists (adjusted odds ratio [ORa] = 2.099, 95% confidence interval [CI] = 1.290–3.414, p = 0.003) and vaccine administration was found, while cost associated with professional development and additional training (ORa = 0.533, 95% CI = 0.287–0.989, p = 0.046) was inversely associated to it. Logistic, financial, and legislative requirements as essential necessities were determined to successfully expand pharmacist‐led immunization services. Conclusions: The major barriers and challenges to vaccine administration by pharmacists comprised a lack of physicians' support and expenses associated with professional development and additional training. Pharmacists administer more vaccination despite lack of support from physicians; whereas they administer less vaccination due to cost associated with professional development and further training. The scope of pharmacy practice in Lebanon is not well recognized by other healthcare providers and stakeholders to include immunization services. [ABSTRACT FROM AUTHOR]

Heparin-induced thrombocytopenia (HIT) is a disorder originating from exposure to heparin and has a spectrum of presentation ranging from asymptomatic positive antibodies to thrombotic complications. When symptomatic, it is associated with morbidity and mortality. The incidence of HIT in the ESRD population is yet to be defined. End-stage renal disease (ESRD) patients are at particular risk due to constant exposure to heparin. The main treatment of HIT is to avoid heparin and pursue alternative anticoagulants. Since 1 of the main advantages of heparin in ESRD patients is the ease of its use due to non-renal clearance, the use of alternative anticoagulants poses yet another challenge for this population due to cost, availability, and adverse effects on ESRD patients. Argatroban seems like the best alternative to heparin in hemodialysis (HD) patients due to its liver clearance. Despite having limited studies in HIT, direct oral anticoagulants (DOACs) were added as a potential treatment for HIT, with apixaban favored in kidney dysfunction as it is the least dependent on kidney clearance. Other treatment modalities exist but are still being studied in ESRD patients. The presence of HIT antibodies is not always associated with clinical syndrome, and some studies suggested that heparin antibodies are transient, and the reintroduction of heparin is still being evaluated as a treatment option. Hence, HIT is a challenging diagnosis in ESRD patients, a population that has frequent exposure to anticoagulants, and a risk/benefit ratio should be weighed between the risk of progression to symptomatic HIT and the benefit of switching to a non-heparin anticoagulant bearing in mind the difficulties associated with the latter. [ABSTRACT FROM AUTHOR]

Purpose: To describe injuries and outcomes of casualties of Beirut Port Blast treated at a large tertiary care center in Beirut, Lebanon. Methods: A retrospective observational study assessing the spectrum of injuries, treatment, and medical outcome among casualties of the Beirut Port Blast, immediately after the blast and up to 1 week from the blast to the emergency department of the American University of Beirut Medical Center (AUBMC). Results: A total of 359 patients were included. Most (n = 343, 95.6%) were adults (> 19 years), and males (56%) with a mean age of 42 ± 20 years. The most frequent mechanism of injury was a penetrating injury (45.7%), followed by other blast-related injuries (30.4%), and blunt injuries (23.4%). The most affected anatomical location were the limbs. Most (n = 217, 60.4%) patients required imaging. The most frequently administered medication was analgesics (38%), followed by anesthetics (35%), antibiotics (31%), tetanus vaccine (31%), and fluids (28%). Blood and blood products were administered in 3.8% of cases. Emergent procedures included endotracheal intubation (n = 18, 5%), surgical airway (n = 3, 0.8%), chest tube insertion (n = 4, 1.1%), thoracotomy (n = 1, 0.3%), and CPR (n = 5, 1.4%). A quarter of patients required surgical operations in the operating room (n = 85, 23.6%) and 18% required noncritical care admissions, 5.3% required critical care admissions, and 2.8% were dead on arrival. Conclusion: Casualties from this event had significant injuries requiring lifesaving interventions, surgical procedures, and admission to critical care units. High utilization of imaging modalities and of medications from existing stockpiles was also observed. [ABSTRACT FROM AUTHOR]

Background and Objectives: Adherence to post-stroke pharmacotherapy has been less studied compared with other cardiovascular diseases, and previous research in this context utilized generic tools without cross-validating for stroke specific factors and patient characteristics. This study aimed to validate the Lebanese Medication Adherence Scale (LMAS-14) among stroke survivors to assess adherence to post-stroke pharmacotherapy. It also aimed to determine the socioeconomic, clinical characteristics, and health related quality of life correlates of medication adherence among stroke survivors. Materials and Methods: This was a cross-sectional study that included stroke survivors from districts throughout Lebanon. A well-structured questionnaire consisting of three parts was developed and utilized to collect data. The first part included questions about the sociodemographic and socioeconomic characteristics. The second part included questions about medical history, current clinical characteristics of the patients, and use of medications. The third part included validated scales to assess stroke outcomes, daily performance and activities, and quality of life. Results: A total of 172 stroke survivors were included. The LMAS-14 structure was validated over a solution of three factors, with a Kaiser–Meyer–Olkin (KMO) measure of sampling adequacy = 0.836 and a significant Bartlett's test of sphericity (p < 0.001). Severe difficulty in obtaining medications within the current Lebanese economic crisis was significantly associated with lower medication adherence (Beta = −8.473, p = 0.001). Lower medication adherence was also associated with poor stroke prognosis (Beta = −3.264, p = 0.027), higher number of used medications (Beta = −0.610, p = 0.034), and longer duration of stroke diagnosis (Beta = −4.292, p = 0.002). Conclusions: The LMAS−14 is a valid and reliable tool to assess medication adherence in stroke practice and research. Severe difficulty in obtaining medications due to unpredictable availability and shortage of supplies is associated with lower medication adherence, and thus places stroke survivors at higher risk of complications and morality. Additional measures and urgent action by stroke care providers and public health stakeholders are necessary to ensure adequate post-stroke management and outcomes. [ABSTRACT FROM AUTHOR]

(1) Background: The provision of healthcare is transforming, necessitating changes in descriptions and frameworks for ethical leadership. This study aimed to assess the association of the different leadership skills with the work ethical constructs and attitudes among healthcare professionals. (2) Methods: A cross-sectional study design using a snowball sampling technique was used to enroll healthcare practitioners. The questionnaire used in this study included two parts: the first part gathered the sociodemographic characteristics of the participants, while the second part consisted of three validated assessment scales, i.e., work ethics, ethical attitudes questionnaire for public health professionals, and leadership skills questionnaire. (3) Results: Higher work ethics and a higher intrinsic work motivation subscale were significantly associated with high leadership administrative skills (Beta = 6.04, p = 0.019, and Beta = 2.55, p < 0.001, respectively). However, higher leadership conceptual skills (Beta = −1.07, p = 0.027) were associated with a lower intrinsic work motivation subscale. Higher leadership administrative skills (Beta = 28.39, p < 0.001) were significantly associated with higher ethical attitudes scores. (4) Conclusions: Higher administrative leadership has an imperative positive impact on work ethic in the provision of different public health services. Leadership skills are not limited to a specific profession, experience, or career stage of health care, and could significantly predict the individual ethical attitude and professional behavior. [ABSTRACT FROM AUTHOR]

Introduction: Good knowledge and early identification of chronic kidney disease (CKD) can help in preventing disease progression in its early stages and reducing undesired outcomes. The aim of the current study was to assess the level of public knowledge about CKD, determine predictors of better knowledge, and to construct and validate a CKD knowledge scale for public health assessment and research use.Methods: A community-based cross-sectional study was conducted using an electronic self-administered questionnaire. All people living in Lebanon and being 18 years of age and above were considered eligible for recruitment. CKD knowledge was assessed by a 37-item scale that was constructed by principal component analysis and then validated. The score of the CKD knowledge scale was computed from the extracted factors. A multivariable binomial logistic regression model evaluated the sociodemographic and clinical predictors of the knowledge score.Results: A total of 1308 participants were included. The scale items converged over 9 factors with Eigenvalue greater than 1 and explaining 53.26% of the total variance, and the total scale had a high Cronbach's alpha of 0.804. All items of the scale significantly correlated with the full scale with correlation coefficients ranging from 0.082 to 0.558. The ROC curve analysis determined an optimal cutoff point of better knowledge at 47.5 with 70.6% sensitivity and 44.2% specificity. The CKD knowledge score had a median of 51.00 (IQR 47.00-55.00). Higher knowledge score was significantly associated with old age (ORa = 1.018, 95% CI 1.006-1.030, P = 0.003),, occupation (ORa = 3.919, 95% CI 2.107-7.288, P <  0.001), and recent renal function assessment (ORa = 2.314, 95% CI 1.532-3.495, P <  0.001). However, a lower knowledge score was significantly associated with lower level of education (ORa = 0.462, 95% CI 0.327-0.653, P <  0.001).Conclusion: A reliable tool to assess public knowledge and awareness about CKD was developed and validated. The overall knowledge was good, however, important gaps in CKD awareness were detected in some areas and subpopulations. Therefore, public health stakeholders need to implement targeted CKD educational activities to minimize the disease burden. [ABSTRACT FROM AUTHOR]

(1) Background: There is a scarcity of data regarding game-based learning (GBL) in experiential pharmacy education; in addition, the impact of educational games on the attainment of intended learning outcomes and students' motivation to actively learn and practice through non-traditional pedagogical tools are yet to be explored. (2) Methods: This was a prospective quasi-experimental study that introduced GBL into the Pharmacy Practice Experience course of the Bachelor of Pharmacy (BPharm) program at the Lebanese International University in Lebanon. Data collection took place between July and September 2021. The study objectives were to assess the impact of GBL on attaining intended learning outcomes, determine students' motivation to engage in GBL, and assess the impact of this motivation on the attainment of learning outcomes. (3) Results: GBL was associated with a significantly higher exam average (mean difference = 7.152, p < 0.001). Moreover, an active learning motivation assessment scale (ALMAS) was constructed and validated; it was found to have good reliability as well as high sensitivity and specificity, and it determined a good level of motivation to engage in GBL. Game-based learners with higher motivation scores had significantly higher exam averages compared to those with lower scores (Beta = 0.296, 95% CI 0.110–0.545, p = 0.004). (4) Conclusion: GBL was associated with better attainment of intended learning outcomes. Students appear to be motivated to learn by this style of active learning, and motivation is prognostic of the attainment of learning outcomes. [ABSTRACT FROM AUTHOR]

Objective To explore the types and frequency of dermatologic disorders routinely encountered by community pharmacists in Lebanon, identify their educational preparedness and confidence, reasons for referrals to dermatologists and their attitude toward the potential pharmacist role in the treatment of dermatologic disorders. Methods A cross-sectional descriptive study was conducted between June and October 2017. It involved the use of a self-administered questionnaire, distributed to a randomly selected sample of 500 community pharmacists from all Lebanese districts. Key findings A total of 456 pharmacists completed the questionnaire. Sixty-four per cent of participants had received a dermatology course at university and 38.7% had undertaken some form of postgraduate education in dermatology. Pharmacists believed that the most commonly encountered disorders were sunburn (22.6%) and acne (15.6%) during spring/summer and skin dryness (18.8%) followed by head lice (13.1%) during autumn/winter. Additionally, more than half of respondents reported that skin-related advice requests were 6–15% of the total advice offered to patients. Sixty-four per cent were confident or extremely confident in advising patients with dermatological complaints. Pharmacists ranked 'unsure of diagnosis' as the most common reason for patient referral to dermatologists. Pharmacists who received postgraduate dermatology training had higher self-reported confidence in tackling skin diseases and their treatments (P < 0.05). Conclusions Our study revealed that community pharmacists in Lebanon commonly encounter a limited number of dermatologic disorders and the majority believed that they can confidently advise and manage patients. Nonetheless, they admitted a gap in their dermatology education at both undergraduate and postgraduate levels. [ABSTRACT FROM AUTHOR]

Introduction: Early police transport (PT) of penetrating trauma patients has the potential to improve survival rates for trauma patients. There are no well-established guidelines for the transport of blunt trauma patients by PT currently.Study Objective: This study examines the association between the survival rate of blunt trauma patients and the transport modality (police versus ground ambulance).Methods: A retrospective, matched cohort study was conducted using the National Trauma Data Bank (NTDB). All blunt trauma patients transported by police to trauma centers were identified and matched (one-to-four) to patients transported by ground Emergency Medical Services (EMS) for analysis. Descriptive analysis was carried out. This was followed by comparing all patients' characteristics and their survival rates in terms of the mode of transportation.Results: Out of the 2,469 patients with blunt injuries, EMS transported 1,846 patients and police transported 623 patients. Most patients were 16-64 years of age (86.2%) with a male predominance (82.5%). Fall (38.4%) was the most common mechanism of injury with majority of injuries involving the head and neck body part (64.8%). Fractures were the most common nature of injury (62.1%). The overall survival rate of adult blunt trauma patients was similar for both methods of transportation (99.2%; P = 1.000).Conclusion: In this study, adult blunt trauma patients transported by police had similar outcomes to those transported by EMS. As such, PT in trauma should be encouraged and protocolized to improve resource utilization and outcomes further. [ABSTRACT FROM AUTHOR]

This document is a correction notice for an article titled "Psychometric properties of the Arabic version of the intolerance of uncertainty scale: a multinational study" published in BMC Psychology. The correction addresses the omission of an additional affiliation for one of the authors, Hanaa Ahmed Mohamed Shuwiekh. The corrected version of the article can be found online. Springer Nature, the publisher, remains neutral and does not endorse any jurisdictional claims or institutional affiliations. The authors of the article are Roni Chaaya, Rabih Hallit, Alvaro Postigo, Diana Malaeb, Fouad Sakr, Mariam Dabbous, Amthal Alhuwailah, Hanaa Ahmed Mohamed Shuwiekh, Sahar Obeid, Feten Fekih-Romdhane, and Souheil Hallit. [Extracted from the article]

The trend of bringing machine learning (ML) to the Internet of Things (IoT) field devices is becoming ever more relevant, also reducing the overall energy need of the applications. ML models are usually trained in the cloud and then deployed on edge devices. Most IoT devices generate large amounts of unlabeled data, which are expensive and challenging to annotate. This paper introduces the self-learning autonomous edge learning and inferencing pipeline (AEP), deployable in a resource-constrained embedded system, which can be used for unsupervised local training and classification. AEP uses two complementary approaches: pseudo-label generation with a confidence measure using k-means clustering and periodic training of one of the supported classifiers, namely decision tree (DT) and k-nearest neighbor (k-NN), exploiting the pseudo-labels. We tested the proposed system on two IoT datasets. The AEP, running on the STM NUCLEO-H743ZI2 microcontroller, achieves comparable accuracy levels as same-type models trained on actual labels. The paper makes an in-depth performance analysis of the system, particularly addressing the limited memory footprint of embedded devices and the need to support remote training robustness. [ABSTRACT FROM AUTHOR]

Experiential education is an essential component of pharmacy education in order to allow intern students to experience real conditions and training opportunities in different inpatient and outpatient settings. This paper provides a description of the pharmacy practice experiences (PPEs) in the Lebanese International University (LIU) 5-year bachelor of pharmacy (BPharm) and postgraduate doctor of pharmacy (PharmD) programs; focuses on the opportunities and challenges encountered; and presents a model for experiential education in Lebanon. Learning outcomes and thus students' acquisition of predefined competencies are evaluated in actual practice settings through assessment tools. Our experiential education program aligns with the accreditation/certification criteria set by the Accreditation Council for Pharmacy Education (ACPE) and equips future pharmacists with the knowledge and skills to become major components in the healthcare team. [ABSTRACT FROM AUTHOR]

This paper presents the Edge Learning Machine (ELM), a machine learning framework for edge devices, which manages the training phase on a desktop computer and performs inferences on microcontrollers. The framework implements, in a platform-independent C language, three supervised machine learning algorithms (Support Vector Machine (SVM) with a linear kernel, k-Nearest Neighbors (K-NN), and Decision Tree (DT)), and exploits STM X-Cube-AI to implement Artificial Neural Networks (ANNs) on STM32 Nucleo boards. We investigated the performance of these algorithms on six embedded boards and six datasets (four classifications and two regression). Our analysis—which aims to plug a gap in the literature—shows that the target platforms allow us to achieve the same performance score as a desktop machine, with a similar time latency. ANN performs better than the other algorithms in most cases, with no difference among the target devices. We observed that increasing the depth of an NN improves performance, up to a saturation level. k-NN performs similarly to ANN and, in one case, even better, but requires all the training sets to be kept in the inference phase, posing a significant memory demand, which can be afforded only by high-end edge devices. DT performance has a larger variance across datasets. In general, several factors impact performance in different ways across datasets. This highlights the importance of a framework like ELM, which is able to train and compare different algorithms. To support the developer community, ELM is released on an open-source basis. [ABSTRACT FROM AUTHOR]