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This paper investigates the potential that mediated text can have on expanding Lebanese young people's notions and understandings of sexuality beyond their personal boundaries and the immediate local context to uncover the portrayal of these notions within a global mediated space. It specifically seeks to examine the intersection between Lebanese youth media practices and sexual learning by identifying the extent to which watching the hit Netflix series "Sex Education," affected young people's sexual identities, knowledge and practices. Four focus groups, each comprised of six respondents, described the importance of the series in influencing young people's sexual learning and thoughts in a society where sexuality and sexual subjects are taboo. The four main discussion themes that were developed -- namely, Open Mindedness: transgression, acceptance and respect; Transformation: life skills and right choices; Gender Equality, Well-being and Health; Reliability/identification and the Need for Trustworthy Connections; and the Need to Re-educate Family and Society about Sex -- underscore the importance of the series as a learning tool, the need for the re-introduction of sexual education as part of school curricula in Lebanon, and the re-education of society more generally to help foster healthier sexual lives among young people.

Academic advising is inhibited at most of the high schools to help students identify appropriate academic pathways. The choice of a career domain is significantly influenced by the complexity of life and the volatility of the labor market. Thus, high school students feel confused during the shift period from high school to university, especially with the enormous amounts of data available on the Web. In this paper, an extensive comparative study is conducted to investigate five approaches of recommender systems for university study field and career domain guidance. A novel ontology is constructed to include all the needed information for this purpose. The developed approaches considered user-based and item-based collaborative filtering, demographic-based recommendation, knowledge base supported by case-based reasoning, ontology, as well as different hybridizations of them. A case study on Lebanese high school students is analyzed to evaluate the effectiveness and efficiency of the implemented approaches. The experimental results indicate that the knowledge-based hybrid recommender system, combined with the user-based collaborative filtering and braced with case-based reasoning as well as ontology, generated 98% of similar cases, 95% of them are personalized based on the interests of the high school students. The average usefulness feedback and satisfaction level of the students concerning this proposed hybrid approach reached 95% and 92.5% respectively, which could be a solution to similar problems, regardless of the application domain. Besides, the constructed ontology could be reused in other systems in the educational domain.

The purpose of this research was to investigate and develop an effective assessment tool to measure and evaluate course learning outcomes. Course learning outcomes from four different departments in the Faculty of Humanities at a private university in Lebanon were examined and revised according to Bloom's Taxonomy. The learning outcomes were mapped with the program learning outcomes which were also linked to the program educational objectives of the appropriate majors. After which, the assessment process took place. This paper used a case study approach with accumulation of the data dating back to the 2014/2015 academic year, as well as survey methodology to further understand the Faculty instructors' attitudes and experience in utilizing an assessment guide that was prepared by the Faculty Outcomes Assessment Committee. This article details the aforementioned processes in three phases, establishing criteria, setting an assessment strategy, and testing the implementation of such strategies in courses. Findings are not only significant to this university, but coincide with the New England Commission of Higher Education (NECHE) accreditation requirements.

Pharmacogenomics and precision medicine are promising new tools in the fight against antimicrobial resistance by providing personalized treatment approaches based on an individual genetic makeup. Pharmacists, equipped with appropriate education and tools, can play a significant role in integrating pharmacogenomics and precision medicine into clinical practice and lead the rational use of pharmacogenomics in daily patient care. Improving patient outcomes in primary healthcare settings is the ultimate output. To date, there has been a lack of assessment and comparison of the knowledge and perceptions of pharmacists across different countries. A self-administered questionnaire was sent to 223 participants from Greece and Lebanon. Results showed that 96% and 68% of the pharmacists in both countries were familiar with the terminology of antimicrobial resistance and precision medicine. A deeper investigation showed gaps concerning the profound understanding of antimicrobial resistance from the one health perspective and the preventive measures. Knowledge of pharmacogenomics, its tests, and the value of precision medicine was low in both groups, with more pronounced deficiencies in the Lebanese group. Additionally, pharmacists didn't perceive their current role in implementing pharmacogenomics and precision medicine in the combat against antimicrobial resistance, but they expressed openness to future involvement in this area. This research can serve as a foundational tool to establish or adjust policies to allocate resources and support both systems and people to enhance precision medicine implementation in low-to-middle-income countries. Furthermore, it highlights the importance of leveraging the experiences and knowledge of high-income countries to effectively address the challenge of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Background/Objectives: Women's health represents an integral component of public health. With breast cancer being the first worldwide and cervical cancer the fourth most common cancer among women, and while habits of intimate hygiene remain mediocre, it is crucial to address these issues. We aimed to evaluate the efficacy of a community-based intervention on the knowledge and preventive measures (K&P) of women toward breast cancer, cervical cancer, and intimate hygiene. Methods: This longitudinal multicentric prospective interventional study was conducted on women residing in Lebanon aged 18–83 years old. The awareness sessions took place either in person or online to address these three topics, covering the eight governorates of Lebanon. Our sample included women both from the general population and from Order of Malta Lebanon (OML)'s centers and mobile medical units. A stratified randomized sampling method was implemented using age and governorates. Women were interviewed before (pre-test) and after (post-test) the awareness session. The K&P score and the improvement post-intervention were represented in a function of all the study variables. A p ˂ 0.05 was found statistically significant. Results: A total of 657 women, with the majority being nonsmokers and having a bachelor's degree as their highest level of education, completed surveys before and after the intervention, showcasing a significant overall K&P mean score improvement of 50.48% in the pre- vs. post-test (an average score of 22.01 ± 5.95 over 38 (57.93% of correct answers) vs. 33.12 ± 3.41 over 38 (89.58% of correct answers), respectively, p < 0.001). A significant difference was also noted between pre- and post-test (p < 0.001) in each of the three topics individually, with improvements of 52.39% for breast cancer, 60.00% for cervical cancer, and 22.27% for intimate hygiene. Conclusions: National awareness campaigns are key to shedding light on breast and cervical cancer matters and improving women's reproductive health and intimate hygiene in Lebanon. Addressing the knowledge gaps and promoting early screening and healthy habits through national public health policies can empower women to protect their health and well-being. [ABSTRACT FROM AUTHOR]

Background and Aim: Atopic dermatitis (AD) impacts the quality of life of patients and their families. This survey‐based study aimed to understand the perspectives of physicians in Egypt and Lebanon regarding available educational initiatives and support programs for patients with AD, which was complemented by the social analytics study, offering a more comprehensive understanding of the perceptions of AD among social media users. Methods: The survey included 200 physicians, comprising primary care physicians, family medicine physicians, pediatricians, and dermatologists from Egypt and Lebanon. The social analytics study leveraged artificial intelligence to analyze 100 million websites across the region, identifying mentions of AD‐related terminologies. Results: The physician survey uncovered gaps in AD awareness and education in Egypt and Lebanon, with limited educational initiatives and digital applications available for patients. The perceptions of physicians varied regarding the use of telemedicine in dermatological disease management. According to the social analytics study, online discussions about AD predominantly originated from Egypt, featuring educational content on causes, diagnosis, management, and AD patient journey. Discussions included news about training programs, AD‐related healthcare initiatives, and drug approvals. Some authors, beauty clinics, and manufacturers actively promoted their services and products. Patients actively engaged in online discussions on self‐care and natural remedies, sharing their experiences of living with AD. Notably, there were substantial volumes of incorrect and inaccurate information being shared and promoted by some authors. Conclusion: Education about AD is crucial for patients and healthcare professionals. While social media offers opportunities for increased patient engagement, the prevalence of misinformation poses a significant challenge. Addressing issues related to education and discerning misinformation is essential for achieving optimal outcomes in the management of AD within the region. [ABSTRACT FROM AUTHOR]

The Lebanese media sector has played a pioneering role in the Arab world due to its free and diverse system. However, the lack of professional and ethical structures in journalistic practices can be attributed to political and economic pressures. Through both a quantitative and qualitative methodology, this study contributes to the complex boundaries of the Lebanese media landscape that make the gap between media ethics education and real-world pressures in need of sustained analysis. This research aims to explore the challenges media ethics education in Lebanon faces, along with the perceptions formed by media students about journalistic practices and the application of moral reasoning in the field. In addition, the study investigates whether media ethics courses prepare students for settling moral dilemmas in the professional arena. To address the multiple factors affecting ethics education, it is significant to understand the relationship between journalists and power, democratic norms, technological change, global community, and academic critiques. Survey and focus groups results indicated that the majority of students rated moral reasoning as important for their future media professions, and that the media ethics course prepares them for professional life. On the other hand, the majority believe that the corrupt system in Lebanon makes journalists resort to unethical practices which in turn compromise journalists' credibility and integrity. Students consider that journalists have power as the so-called fourth estate, yet that power seems minimal when journalists lack the freedom to write facts without fear from editors and/or gatekeepers' political views, economic pressure, and on-the-job demands, placing journalistic integrity again at stake.

Introduction: Well-being of young adults is known to be compromised in times of significant changes, such as economic and political turmoil. This study focuses on university students in Lebanon during one of the most prominent social unrests of its modern history to determine potential understudied protective factors that would predict the youth capacity to strive. Methods: A sample of 489 university students were asked to fill an online survey including standardized questionnaires of wellbeing (WEMWBS), depression (PHQ-9), anxiety (HAM-A), intolerance of uncertainty (IUS-12), coping (Brief COPE) in addition to demographics and questions about their attitudes and future perspectives. Results: We found increased rates of mental distress, predominantly in women, with around 80% of the sample being highly intolerant to the uncertainty climate. Results unsurprisingly show that well-being negatively correlated with anxiety, depression and intolerance of uncertainty. Overall, mental distress was found to mediate the relation between uncertainty and wellbeing, and the relation between maladaptive coping and wellbeing. Students who were intolerant of uncertainty and who used maladaptive coping strategies were more likely develop anxiety and depression and subsequently report poorer wellbeing. Conversely, having adaptive strategies was directly linked to higher well-being. Discussion: In spite of increased distress, some university students managed to preserve their well-being within a climate of severe socio-political uprise. These findings suggest that modifying subjective experience of events and using soft skillset could alleviate young adults' emotional distress in unstable societies. [ABSTRACT FROM AUTHOR]

Promoting sustainable communities aims at creating both environmentally and socially responsible living environments. This paper explores the role of affordable housing in promoting the long-term sustainability of a community within healthy living conditions by closely examining the relationship between affordable housing, urban development policies, and sustainability, with the capital of Lebanon, Beirut, serving as a case study. The first part of the paper focuses on the current building laws issued in the official newspaper in 2004 using a content analysis methodology to demonstrate the impact of the changes in the laws on the new morphology and social fabric of the city through the creation of a favorable environment for big developers, wealthy property owners, and real estate agencies and, at the expense of old city residents and low-income families. The second part of the paper uses the qualitative analysis methodology to justify the presence of large unused stock of residential units in Beirut, referring to information from multiple data sources selected based on their applicability to sustainable development, affordable housing, and urban planning in areas related to the case study, Beirut. This part then investigates the potential presented by this stock of residential units in Beirut to increase the supply of affordable housing and foster a sustainable community. This paper argues that the promoted vertical expansion of the city weighs heavily on the environment and fails to provide a diverse mix of housing units, excluding a significant portion of the community from the city. Alternative development models aligning with principles of sustainable development and challenging the current building laws can promote social inclusivity, reduce urban sprawl, and minimize environmental impacts associated with new constructions, thus preserving the city's physical and social fabric. [ABSTRACT FROM AUTHOR]

While national Lebanese studies done on breast cancer attest to the importance of awareness campaigns none, however, examine the type of content that most effectively reaches women. The purpose of this study, therefore, was to examine, through an experiment, the effectiveness of direct versus indirect messaging, in altering knowledge, risk perception, attitudes, behaviors and self-efficacy among two groups of women, those aged 18–40 and 41–65 years. Findings suggest that the designed breast cancer communication messages were perceived as informative, trustworthy and believable regardless of message type. An interaction effect indicated that the older age group (41+) who were exposed to the indirect message felt more confident in taking proactive measures than the 18- to 40-year-old participants. In addition, those exposed to the indirect message were more likely to behave as communicated than those in the direct message condition. At the very least, the messages, both direct and indirect, helped minimize misconception or correct people's knowledge about the subject. This shows that participants and by extension people, in general, pay attention to breast cancer awareness messaging. Making these messages available to all age groups and motivating them to take proactive/preventative measures becomes even more significant, especially with the higher incidence of cancer among women aged 18–40 years in Lebanon. [ABSTRACT FROM AUTHOR]

This study aims to reveal the factors behind students' personal biases and preferences in the evaluation process in order to assess the value of using students' ratings of professors' teaching effectiveness. A questionnaire was completed by 330 students at Lebanese universities asking them to provide their feedback on 23 traits commonly regarded as characteristics of effective teachers. Using factor analysis, four factors were extracted: Teacher's Teaching Skills (F1), Teacher's Leniency (F2), Teacher's Personal Characteristics (F3), and Teacher's Relationship With Students (F4). Results showed that F4 received the highest rating, followed by F1, F2, and F3. Differences in instructor ratings were investigated according to students' gender, class level, major, and GPA. The authors make recommendations for faculty members and administrators based on the results.

Almost one year since the COVID-19 was declared a global pandemic, mental distress remains elevated with high prevalence of post-traumatic stress disorder (PTSD). Yet studies suggest these challenging circumstances might be conducive of post-traumatic growth (PTG). This study aims to investigate the factors associated with growth after the original trauma. A sample of 252 Lebanese adults filled an online survey to determine levels of PTG, PTSD and gratitude using validated self-rating scales. Participants also subjectively evaluated the sources of their distress such as the COVID-19 pandemic, the Beirut port explosion and/or their deteriorating financials. The PTGi-SF evaluated dimensions of growth while the IES-R_22 measured the degree of distress post-trauma. The GQ-6 was used to measure the proneness to experience gratitude daily. Results indicated 41% of participants scored above the cutoff for PTSD symptomatology. Yet, PTSD was positively correlated, alongside gratitude and accumulated subjective distress, with higher levels of PTG. A forward linear regression taking PTG scores as the dependent variable further showed that more gratitude (Beta = 0.57), a higher impact of events (Beta = 0.16), and knowing anyone who died from COVID-19 (Beta = 3.93) were significantly associated with more growth. The study highlights elevated levels of PTSD symptoms in a context of a global pandemic worsened by financial and socio-political instabilities. It mostly identifies personal factors, including high initial symptomatology post-trauma and gratitude, related to the capacity for growth in spite of these accumulating hardships. As such, it advocates the need to investigate and bolster silver linings amidst unprecedented traumas. [ABSTRACT FROM AUTHOR]

The article focuses on intervention research as a design science that devises action to change existing situations. Topics include market penetration strategies using intervention research, dysfunctions in the import and distribution of agricultural nutrients, and recommendations for developing effective market strategies based on lived market realities.

Mycotoxins have been linked to adverse health impacts, including liver cancer and kidney diseases. The objectives of the current study were to evaluate the dietary exposure of Lebanese adults to multi-mycotoxins (aflatoxin B1 (AFB1), aflatoxin M1 (AFM1), ochratoxin A (OTA), ochratoxin B (OTB), deoxynivalenol (DON), T-2 and HT-2) and to assess their associated health risks. Hence, a nationally representative sample of 449 participants aged 18-64 years old were interviewed to obtain their socio-demographic characteristics, food consumption data and exposure estimates. A food frequency questionnaire and 24 h-recall were used to collect data. The concentration of mycotoxins in all foods consumed by the participants was collected from previous national published studies. The estimated daily intake (EDI), the hazard quotient (HQ) and the margin of exposure (MOE) were calculated. The total exposure to AFB1, AFM1, OTA and DON was 1.26, 0.39, 4.10 and 411.18 ng/kg bw/day, respectively. The MOE to AFB1, AFM1, OTA and DON in the Lebanese food basket was 316, 1454, 3539 and 510, respectively, indicating high health-related risks. Per food items, the MOE to AFB1 was below 10,000 in cereals (466.5), mainly in rice (827.9) and Burgul (4868.5). Similarly, the MOE to OTA in cereals was 1439, in which bread (4022), rice (7589) and bulgur (7628) were considered unsafe. Moreover, the MOE to DON in cereals (605) is alarming, especially in bread (632) and manakesh (6879). The MOE to AFM1 in dairy products was 1454, indicating health-related risks with a focus on yogurt (9788) and labneh (8153). As for the herbs/spices group and traditional dishes, the MOE to AFB1 was relatively lower than 10,000 (3690 and 1625, respectively), with a focus on thyme (2624) and kishik (3297), respectively. It is noteworthy that the MOE to DON and the MOE to OTA in traditional foods and coffee were lower than 10,000 (8047 and 8867, respectively). All hazard quotient (HQ) values were below 1, except the HQ value of milk and dairy products (1.96). The intake of some food groups varied between age categories, corresponding to differences in EDI between them. Thus, it is essential to put control measures in place to decrease the contamination and exposure to mycotoxins by Lebanese consumers. [ABSTRACT FROM AUTHOR]

Background. Cervical cancer is the fourth most common cancer in women, worldwide. Most often, cervical cancer is caused by a human papillomavirus (HPV) infection. A lack of studies concerning HPV knowledge and vaccination among the Lebanese population is noticed. We aim to assess the prevalence of HPV vaccine administration among female university students in Lebanon alongside determining the predictors influencing vaccine uptake. Lastly, knowledge scores concerning HPV and HPV vaccination are also computed. Methods. This is a cross-sectional analytical study. It is an anonymous, online-based, close-ended questions survey conducted between the 24th of February 2021 and the 30th of March 2021. Our questionnaire was addressed to females aged between 17 and 30 years and enrolled in a Lebanese university. The collected data were analyzed using Statistical Package for Social Sciences (SPSS) v.26. We used bivariate analysis to compare the rate of vaccination with different variables. We used the chi-square test for categorical variables and Student's t-test for continuous variables. Logistic linear regression was conducted between the state of vaccination and other statistically significant variables from the bivariate analysis. Results. We have received a total of 454 questionnaires. Among the respondents, only 18.9% had received a minimum of one dose of the HPV vaccine. The mean age of up taking the first dose of the vaccine was 17.5 years. In addition, 48% of the respondents were not willing to take the HPV vaccine during the upcoming year. Barriers to not taking the HPV vaccine were mainly the low levels of knowledge concerning HPV and its vaccine. In the multivariate analysis, three predictors were found to affect the rate of HPV vaccination: university type, paternal educational level, and HPV vaccine knowledge score. In detail, a student enrolled in a public university had 77% likelihood of not being vaccinated. Furthermore, female students with a paternal educational level higher than a university degree had 88% probability of being vaccinated. Finally, every increase in the HPV vaccination knowledge of one point increased the likelihood of being vaccinated by 37%. Conclusion. A low vaccination rate among female university students in Lebanon was noticed in our study. In addition, a lack of HPV and HPV vaccine knowledge was found in our population. An awareness campaign alongside public vaccination programs is recommended in order to accomplish higher rates of HPV immunization. [ABSTRACT FROM AUTHOR]

This paper investigates the potential that mediated text can have on expanding Lebanese young people's notions and understandings of sexuality beyond their personal boundaries and the immediate local context to uncover the portrayal of these notions within a global mediated space. It specifically seeks to examine the intersection between Lebanese youth media practices and sexual learning by identifying the extent to which watching the hit Netflix series Sex Education, affected young people's sexual identities, knowledge and practices. Four focus groups, each comprised of six respondents, described the importance of the series in influencing young people's sexual learning and thoughts in a society where sexuality and sexual subjects are taboo. The four main discussion themes that were developed – namely, Open Mindedness: transgression, acceptance and respect; Transformation: life skills and right choices; Gender Equality, Well-being and Health; Reliability/identification and the Need for Trustworthy Connections; and the Need to Re-educate Family and Society about Sex – underscore the importance of the series as a learning tool, the need for the re-introduction of sexual education as part of school curricula in Lebanon, and the re-education of society more generally to help foster healthier sexual lives among young people. [ABSTRACT FROM AUTHOR]

The emergence, persistence, and spread of antibiotic-resistant microbes is a tremendous public health threat that is considered nowadays a critical One Health issue. In Lebanon, the consumption of raw bovine milk has been recently reported as a result of the financial crisis. The objectives of the current study were (1) to evaluate raw bovine milk samples in a comprehensive manner for the types of antibiotics used and their residues, (2) to determine the presence of mesophilic bacteria, extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and methicillin-resistant Staphylococcus aureus (MRSA), and (3) to determine the associated human health risk caused by drinking raw milk with antibiotic residues among all age categories. LC-MS-MS was used to carry out the analysis. From 200 milk samples, 30 (15%) were found contaminated with four major antibiotics. The highest average concentration detected was for oxytetracyline 31.51 ± 13.23 μg/kg, followed by 5.5 ± 0.55 μg/kg for gentamicin, 4.56 ± 0.73 μg/kg for colistin, and 4.44 ± 0.89 μg/kg for tylosin. The mean contamination among most samples was below the maximum residue limits (MRLs). Upon comparison with the acceptable daily intake (ADI), the estimated daily intake (EDI) across all age groups was acceptable. The hazard quotient (HQ) was also below 1 across all age groups, signifying the absence of associated health risks for the Lebanese consumers. On the other hand, all milk samples were found exceeding the maximum tolerable value of mesophilic flora. Antibiotic-resistant bacteria (ARB) were detected and represented by ESBL-producing E. coli and MRSA isolates. Thus, the greatest threat of antibiotic use in Lebanon does not fall under antibiotic residues but rather the proliferation of antibiotic resistance in potentially pathogenic bacteria. In this study, the virulence profile of detected bacteria was not investigated; thus their pathogenicity remains unknown. Therefore, to mitigate this health threat in Lebanon, a "One Health" action plan against ABR is required. It will provide a framework for continued, more extensive action to reduce the emergence and spread of ABR in Lebanon. [ABSTRACT FROM AUTHOR]

Purpose: Many studies revealed positive health impacts of the Mediterranean diet (MedDiet), especially on metabolic disorders. Conversely, in Lebanon, recent information about determinants of adherence to the MedDiet are limited. This study aimed to examine the individual determinants of MedDiet adherence among adults in Lebanon. Design/methodology/approach: A cross-sectional study was carried out during July 2021 among a convenient sample of 326 Lebanese adults. Data from participants were collected via an online survey developed by study researchers, composed of two well-structured questionnaires: a background questionnaire and a 14-item Mediterranean Diet Adherence Screener (14-MEDAS). Findings: The mean MedDiet score in the total sample was 7.59 ± 2.22, reflecting moderate/fair MedDiet adherence. Consumption of fruits, vegetables, legumes and olive oil met the recommended MedDiet intake among most participants. Older age and having a regular routine of physical activity emerged as significant independent determinants of better MedDiet adherence. Originality/value: Future public health interventions aiming at promoting MedDiet adherence shall target predominantly younger age groups of the Lebanese population and incorporate strategies to boost physical activity among target groups. [ABSTRACT FROM AUTHOR]

Purpose: Lebanon has faced one of the most severe financial and economic crises since the end of 2019. The practices of the Lebanese banks are blamed for dangerously exposing economic agents and precipitating the current financial collapse. This paper examines the patterns of manipulation of the 10 biggest banks before and after implementing the financial engineering mechanism. Design/methodology/approach: The authors apply Benford law for the first and second positions of the reports of condition and income and four out of the six aspects of the CAMELS rating system (Capital Adequacy, Assets Quality, Management expertise, Earnings Strength, Liquidity and Sensitivity to the market) by excluding Management and Sensitivity. The deviations from BL frequencies are tested using Z-statistic and Chi-square tests. Findings: Banks seem to have manipulated their Capital Adequacy, Liquidity and Assets Quality in the pre-financial engineering and considerably in the post-financial engineering periods. Fraudulent manipulations in the banking sector can distort depositors, shareholders and regulating authorities. Research limitations/implications: This study has many implications for governmental authorities, commercial banks, depositors, businesses, accounting and auditing firms, and policymakers. The Lebanese government needs to implement corrective fiscal and monetary policies and apply amendments to the bank secrecy and capital control law. The central bank should revamp its organizational structure, improve its disclosure practices and significantly reduce its ties to the government and the political elite. Practical implications: The study findings suggest that the central bank should revamp its organizational structure, improve its disclosure practices and significantly reduce its ties to the government and the political elite. Originality/value: The study is the first to examine the patterns of fraudulent manipulation in the Lebanese banking industry using Benford Law (BL). [ABSTRACT FROM AUTHOR]

It has been previously established that sexual minorities are more likely to suffer from mental health illnesses due to experiencing unique stressors such as fear, anxiety, stigma, harassment, and prejudice. Results revealed two noteworthy mental health disorders reported by lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals, disordered eating behaviors and disturbed body image. Yet, a-priori studies revealed inconsistent results with regards to body image concerns and eating disorder symptoms and attitudes among sexual minorities. Therefore, this cross-sectional study aimed at investigating the occurrence of disordered eating behaviors (DEB) and body image disturbance (BID) among sexual minorities in Lebanon. Additionally, the correlation between several determinants of DEB and BID including fear of negative evaluation, generalized anxiety, social support, and harassment levels have been examined. Generally, the present study revealed that LGBTQ population scored higher than cisgender and heterosexual individuals for the mean and global scores of the EDE-Q6.0 and BAS-2. Only generalized anxiety and fear of negative evaluation scales were significantly associated with DEB and BID among different sexual orientation and gender identity individuals. Therefore, it is very important that health professionals working with such vulnerable populations meticulously assess for disordered eating behaviors and body image disturbance for better communication and management. Plain English Summary: Sexual minorities are individuals who are more likely to experience mental health illnesses due to their increased experiences of social stresses, such as stigma, discrimination, prejudice, and fear of rejection. Two of the common mental health illnesses lesbian, gay, bisexual, transgender, and queer individuals develop are eating disorders and disturbed body image. Eating disorders and body image concerns are serious mental health illnesses with the likelihood of progressing into life-threatening conditions. Behavioral characteristics of eating disorders can be seen as binge eating episodes, extreme dieting, and inappropriate compensatory behaviors such as fasting, self-induced vomiting, excessive exercise, laxative or diuretic misuse, and or misuse of other "weight loss/diet" pills. Disordered eating patterns and body image concerns are multifactorial and complex, involving a wide range of psychological, sociocultural, and biological determinants. The current study is one of the few observational studies that tackle sexual minority health related issues, specifically investigate the presence and determinants of body image disturbances and disordered eating behaviors in gay, lesbian, bisexual, transgender, and queer individuals compared to heterosexual and/or cis-gender population in Lebanon. The study findings suggest a potential higher risk of disorder eating behaviors and body image disturbances among sexual and gender minorities. [ABSTRACT FROM AUTHOR]

The future of consumers' online shopping trends post COVID-19 remains among the contemporary topics that necessitate further explorations. The aim of this research is to explore the intention of Lebanese and Bahraini consumers to shop online in the post pandemic era. This study extends the technology acceptance model that has exhibited prominent results when it comes of online purchasing. An online survey was addressed to consumers in Lebanon and the Kingdom of Bahrain to collect the data. More precisely, a total of 778 responses equally divided between the two countries was collected. Following the analysis of the data, it was found that both Lebanese and Bahraini shoppers demonstrate variations in the positive evidence associated with the elements of the technology acceptance model, except the perceived usefulness positive impact on consumers' intention toward online shopping where no significant impact was shown in both countries. Contactless payment modes have no significant impact on attitudes in both countries contrary to their positive impacts on the intention toward online shopping in both countries. The use of social media and price consciousness also have variations in the positive evidence linked to consumers attitudes in both countries. Finally, both the use of social media and price consciousness reveal differences in the level of negative association with consumers' intention toward online shopping in Lebanon and the Kingdom of Bahrain. [ABSTRACT FROM AUTHOR]

Background: Desire thinking, impulsivity and suppression are psychological variables that are intricately related to behavioral addictions. Bearing in mind the scarcity of data on desire thinking, impulsivity, thought suppression and pathological social media use in developing countries such as Lebanon, with the existing literature suggesting a heightened mental health burden associated with this problematic social media use, it becomes all the more important to elucidate their relationship. Our study aims at investigating the association between desire thinking and problematic social media use specifically, and to further test the effect of impulsivity and thought suppression in mediating the relation between the two distinct facets of desire thinking and problematic social media use. Methods: A cross-sectional study was carried out between November 2021 and March 2022 using a sample of 414 community-dwelling participants aged above 18 years from all Lebanese districts. The data was collected through an online questionnaire including a section about sociodemographic information, the Desire Thinking Questionnaire (DTQ), Impulsive Behavior Scale (S-UPPS-P), White Bear Suppression Inventory (WBSI) and Social Media Disorder Short Form (SMD). The tests used in the bivariate analysis to assess correlates of SMD were the Student t test to compare two means and the Pearson test to correlate two continuous scores. The PROCESS SPSS Macro version 3.4, model four was used to conduct the mediation analysis. Results: Desire thinking was shown to correlate with increased social media use. Moreover, we found that suppression and lack of premeditation mediated the association between verbal perseveration and social media use disorder whereas suppression and urgency mediated the association between imaginal prefiguration and social media use disorder. Conclusion: This study provides new insight on a topic of increasing public health concern. Although understudied to date, suppression and impulsivity differentially mediate the influence of both facets of desire thinking on problematic social media use disorder. The current findings point to the highly pervasive issue of social media use disorder and the need to investigate underlying psychological factors that aggravate it to better profile and support individuals struggling with it. [ABSTRACT FROM AUTHOR]

Objectives: To identify individual and clinical risk factors of aggressiveness, including exposure to different forms of childhood trauma, in a sample of Lebanese patients with schizophrenia. Methods: A total of 131 patients diagnosed with schizophrenia participated in this cross‐sectional study. Results: Higher physical (Beta = 0.24, p < 0.001) and sexual (Beta = 0.29, p = 0.003) abuse, alcohol drinking (Beta = 1.46, p = 0.008), having a history of head trauma (Beta = 1.10, p = 0.041), and male gender (Beta = −1.59, p = 0.009) were significantly associated with higher mean aggression scores. Practical implications: Our investigation of the factors linked to aggressiveness in patients with schizophrenia complement those of earlier findings, showing that the relationship between interacting individual and environmental risk factors and later aggressiveness is quite complex, and needs further longitudinal and prospective studies. [ABSTRACT FROM AUTHOR]

We are not aware of any validated sexual health communication scales for use with young men who have sex with men (YMSM). We used data from an HIV prevention study in Lebanon with 226 YMSM aged 18–29 to assess the psychometric characteristics of our scale, Judgmental Communication with Peers about Sex (JCPS). The construct validity of the JCPS scale was supported by it being negatively correlated with general social support, percentage of alters perceived to be supportive, and the percentage of peers who are perceived to use condoms. The scale was positively correlated with gay-related discrimination, feeling part of the gay community, and gay social integration. These findings reflect a reliable, valid measure to assess judgmental sexual health communication between YMSM. [ABSTRACT FROM AUTHOR]

Fasting during the holy month of Ramadan is one of the five pillars of Islam. Adherents to the Muslim faith are expected to abstain from drinking or eating during daylight hours. Exclusions to fasting apply, including for medical reasons. There is no consensus on the specific implications for psychiatric conditions. This qualitative study explores the decision-making process of Muslim patients on antipsychotic treatment with regard to fasting during Ramadan. The sample consisted of eleven outpatients actively treated at three psychiatric clinics in Lebanon. They were asked about the different factors that influence their decision to fast or not. Most participants prioritized their personal interpretation of the religious dogma. The opinion of the psychiatrist was important but not always readily available. The wider community, including religious figures, had the least influence. The findings highlight an important role for psychiatrists in proactively supporting patients in their decision on fasting in Ramadan. [ABSTRACT FROM AUTHOR]

In adults, elevated levels of circulating Proprotein Convertase Subtilisin/Kexin type 9 (PCSK9) have been associated with increased Low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), and worse cardiovascular outcomes. However, few studies analyzed the relation between PCSK9 and lipid parameters in pediatric populations. The aim of our study is to evaluate the distribution and the correlation of serum PCSK9 levels with lipid parameters in a sample of Lebanese school children. Using an immunofluorescence assay, we measured serum PCSK9 levels in 681 school children recruited from ten public and private Lebanese schools. We analyzed the association between PCSK9 and age, sex, Body Mass Index (BMI), and lipid parameters (total cholesterol (TC), LDL-C, TG, High-density lipoprotein cholesterol (HDL-C), non-HDL-C, and lipoprotein (a) (Lp(a)). Serum PCSK9 levels were significantly correlated with TC, LDL-C, and non-HDL-C (p value < 0.0001) but not with TG, HDL-C, and Lp(a). PCSK9 levels were also significantly higher in children with high TC, LDL-C, and non-HDL-C (p values = 0.0012, 0.0002, 0.001, respectively). No significant gender differences in PCSK9 were found. In addition, no significant associations between PCSK9 and both age and BMI percentiles were observed. In girls, no difference in PCSK9 values was observed according to menarche while in boys, testosterone levels were not significantly associated with PCSK9. Serum PCSK9 levels were significantly correlated with TC, LDL-C, and non-HDL-C levels. Further studies are needed to find if PCSK9 measurements have an additional value to predict future cardiovascular outcomes in pediatric populations. [ABSTRACT FROM AUTHOR]

Aflatoxin M1 (AFM1) is a salient metabolite that can be used to assess Aflatoxin B1 (AFB1) exposure in humans and animals. The carcinogenic potency of AFB1 and AFM1 was severely reported. The aims of this study were (1) to survey the contamination level of AFM1 in the most traded infant powdered formula brands (IPF) (n = 42) along with the AFB1 level in under 5's children food brands (biscuits, cornflakes, and cereals) (n = 42) and (2) to assess the estimated daily intake (EDI), the hazard quotient (HQ) and the margin of exposure (MOE) of AFM1 among infants (0–12 months) in Lebanon. All of the samples were analyzed using ELISA technique. AFB1 was below detection limit in all of the children's food brands samples. Out of 42 IPF samples 9.5% were AFM1-positive in the range of 29.54–140.16 ng/L and exceeded the maximum tolerable limit (MTL) set by the European commission (25 ng/kg). The overall average contamination level was 5.72 ± 0.014 ng/L. The EDI of AMF1 for male was in the range of 0.37–0.78 ng/kg/b.w./day and 0.40–0.87 ng/kg/b.w./day for females. Similarly, the HQ calculation resulted in an average of 3.05 for males and 3.28 for females. MOE calculations were far lower from 10,000 in both genders which indicates a high risk of genotoxicity and carcinogenicity. Our findings show that AFM1's EDI, HQ and MOE scored high among Lebanese infants. As infants consume more IPF relative to their body weight, the persistence of IPF with high AFM1 levels threatens their health. Thus, infant's exposure risk to AFM1 in IPF should be a continuous focus of attention. [ABSTRACT FROM AUTHOR]

Introduction: Subcutaneous infusion (SC) or hypodermoclysis is an old perfusion technique that is often used off-label although it has been shown to be effective. Acetaminophen (paracetamol) subcutaneous injection is performed in some centers despite the lack of conclusive evidence on its effectiveness. This study aims to evaluate the efficacy of subcutaneous infusion of Acetaminophen in the treatment of pain and fever in geriatrics and in palliative care and to determine its safety profile and possible side effects. Material and methods: This experimental study was conducted between 2018 and 2019 on adult patients in palliative care or in geriatrics in several hospitals and nursing homes in Lebanon. Primary outcomes were change in temperature; change in pain score on the numerical rating scale (NS) or on the Algoplus scale after 60 min from the start of the infusion; and the appearance of local side effects at the infusion site. Changes in the various parameters at 30 min and 180 min were also evaluated as secondary outcomes. Results: Thirty-one patients were included in the study, with a total of 120 doses of acetaminophen. At 60 min, the mean decrease in pain on the NS was 5.35 points, while the mean decrease in temperature was 0.79 degrees Celsius. At 60 min, 75%, CI = [47.62-92.73] of the patients who received acetaminophen for pain and 66.67%, CI = [38.38-88.17] of those who received it for fever had clinically significant improvement. The overall effect of subcutaneous acetaminophen, defined as any clinically significant effect on pain or fever, was 70.97%, CI = [51.96-85.78]. The overall effect at 30 min and at 180 min was 23.33%, CI = [9.93-42.28] and 87.10%, CI = [70.17-96.37], respectively. The side effects reported 30 min after the injection and observed after at least one of the doses were: local edema in 16 patients (51.61%), induration in one patient (3.23%), local pain in one patient (3.23%) and local heat in one patient (3.23%). At 180 min, only 2 patients (6.45%) still had edema at the infusion site. Conclusion: Subcutaneous administration of acetaminophen is effective and well tolerated in geriatric and palliative care patients. It is appropriate when no other route is available, especially for home-based care. Comparative studies are needed to allow the expansion of this practice. [ABSTRACT FROM AUTHOR]

The Beirut port explosion on August 4, 2020, traumatized the Lebanese population. It also revealed a lack of disaster mental health preparedness in a country subject to significant political, economic, and security challenges. The Trauma Assessment and Support Clinic at the American University of Beirut Medical Center was one of many initiatives set up nationally as a dedicated emergency benevolent service. The authors recommend anticipating the psychiatric consequences of such rare events at a professional and systemic level. The experiences of clinicians and the challenges faced in Lebanon can guide the improvement of disaster mental health care on a global level. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the heat resistance of isolated Staphylococcus aureus, Salmonella sp., and Escherichia coli bacterial strains obtained from frequently consumed foods (chicken sandwiches, cheese, raw chicken, tahini, and raw meat) in Lebanon. The isolated bacterial strains were heat-treated at 55, 60, 65, 70, and 75°C. The colony-forming unit per gram (CFU.g−1) was recorded for each temperature every minute for 10 min. Survival curves were plotted, and D- and z-values were calculated and compared using a two-sample T-test. All bacterial strains exhibited total resistance to heat at 55°C. Their D60 ranged from 3.00 to 28.80 min, D65 from 0.47 to 1.78 min, D70 from 0.19 to 1.91 min, and D75 from 0.11 to 0.46 min. Their z-values ranged from 4.74 to 19.65°C. When comparing these results to previous years, the need for combined interventions, such as active packaging solution, seems necessary as S. aureus, Salmonella sp., and E. coli are continually developing resistance to thermal processing. This study highlights emerging concerns regarding the safety of certain food products in the market. These results suggest further revising of the associated processing conditions to ensure compliance with food safety standards and avoid foodborne disease outbreaks. [ABSTRACT FROM AUTHOR]

In Lebanon, sports have been heavily linked to politics and religion. The purpose of this study is to investigate the influence of politics on Lebanese sports in the two most prominent sports fields, football and basketball, using the Spiral of Silence and the Two-Step theories investigated through a mixed methods approach (survey: fan participants, and interviews: professional players). Results showed that politics and religion play a major role in sports, especially through funding, and fans are affected by this former integration. Results also indicated mostly negative attitudes towards this interference, and many have noted being affected by opinions related to teams and decisions that circulate on social media. The results pave the way to understanding how the sports-religion system intertwines in Lebanon, provides an assessment of fans' and players' behavior, and emphasizes the need for financial support for the teams' and fans' sustainability, as a recommendation to reduce this interference in a healthy manner. [ABSTRACT FROM AUTHOR]

Coronavirus Disease (COVID-19) has caused global mental health impacts, and healthcare workers (HCWs) face an increased risk of exposure to the disease when compared to the general population. This study aimed to assess factors associated with mental health among Lebanese HCWs six months after the start of the COVID-19 pandemic. A cross-sectional study was conducted among HCWs at a tertiary hospital, in Lebanon between June and July 2020. The survey included data on demographics, exposure to COVID-19, preparedness to COVID-19 outbreak, risk perceptions of COVID-19, and mental health dimensions. Chi-squared and Fisher's exact tests were used to understand the association among these variables. One hundred and ninety-three of 1,600 Lebanese HCWs participated. More than 80% reported high preparedness levels towards the COVID-19 outbreak, 69% believed that their job was putting them at risk, and 70% altruistically accepted these risks. Anxiety and depression symptomatology were present in 24% and 23% of HCWs; who were more likely to feel more stress at work (83% vs 60%; p = 0.004; 82% vs 61%; p = 0.01, respectively), feel afraid of falling ill (72% vs 55%; p = 0.03; 77% vs 54%; p = 0.01, respectively), fear death (21% vs 7%; p = 0.01; 25% vs 6%; p ≤ 0.001, respectively), and believed that people avoided their families (39% vs 21%; p = 0.01; 35% vs 65%; p = 0.02, respectively). HCWs who reported signs of depression were less likely to altruistically accept the risks of caring for COVID-19 patients, compared to those who did not (57% vs 74%; p = 0.03). This study aimed to detect factors associated with mental health among Lebanese HCWs during the COVID-19 pandemic. Findings suggested that altruistic acceptance of COVID-19 risks is higher among HCWs with positive exposure history to COVID-19 and those with less depressive symptomatology. [ABSTRACT FROM AUTHOR]

Background: Research has shown that organizational leadership and support affect organizational outcomes in several sectors, including healthcare. However, less is known about how organizational leadership might influence the wellbeing of clinical trainees as well as the quality of their patient care practices. Objectives: This study examined the mediating effects of burnout and engagement between program director-resident relationship quality and residents' reported quality of care, and the moderating effect of perceived departmental support. Methods: The authors conducted a cross-sectional study in September 2020, using a 41-item questionnaire, among 20 residency programs in an academic medical center in Lebanon. Measures included program director-resident relationship quality, perceived departmental support, burnout subcomponents, engagement, and self-reported quality of care. Ordinary least squares regression was used to conduct parallel mediation and moderated mediation analyses using SPSS macro-PROCESS, to assess the strength and direction of each of the proposed associations. Results: A total of 95/332 (28.6%) residents responded. Results revealed that program director-resident relationship quality had a significant indirect effect on residents' suboptimal patient care practices and attitudes towards patients, through at least one of the wellbeing dimensions (p <.05). Perceived departmental support did not play a dominant role over program director-resident relationship quality, and thus did not influence any of the mediated relationships. Conclusion: Our study adds a new dimension to the body of literature suggesting that program director-resident relationship quality plays an important role in promoting residents' wellbeing and achieving important clinical health outcomes. Such findings imply that the quality of program director-resident relationship could be an important component of residents' wellbeing and patient safety. If further research confirms these associations, it will become imperative to determine what interventions might improve the quality of relationships between program directors and residents. [ABSTRACT FROM AUTHOR]

Sexual violence has been found to have psychosocial and sexual ramifications for men who have sex with men (MSM) but has not been studied in the Middle East. We assessed the prevalence and correlates of experiences of child and post-child sexual violence among young MSM residing in Beirut, Lebanon. In total, 226 MSM, aged 18 to 29, were recruited with long-chain peer referrals and administered a survey that included questions on history of being pressured to have sex, as well as specific forms of sexual harassment and abuse, in addition to measures of psychosocial functioning and sexual behavior. Logistic regression analysis was used to examine correlates of child sex abuse and experiences of sexual violence post-childhood; 17.3% experienced sexual abuse as a child (below age 13), while 63.3% experienced any form of sexual violence post-childhood—furthermore, 48.7% had experienced being forced or pressured to have sex during their lifetime, including 32.3% prior to age 18. Participants who experienced child sex abuse were more likely to experience abusive relationships in adulthood, as well as at least one type of sexual harassment/abuse post-childhood. Experience of any sexual violence post-childhood was correlated with greater recent sexuality-related discrimination and more recent male sex partners. These findings reveal a high prevalence of sexual violence among MSM in Beirut, both in childhood and post-childhood. More research within the Middle East is needed to better understand the drivers of sexual violence in this population, and how to best provide prevention and coping services. [ABSTRACT FROM AUTHOR]

High-resolution air quality maps are critical towards assessing and understanding exposures to elevated air pollution in dense urban areas. However, these surfaces are rarely available in low- and middle-income countries that suffer from some of the highest air pollution levels worldwide. In this study, we make use of land use regressions (LURs) to generate annual and seasonal, high-resolution nitrogen dioxide (NO2), nitrogen oxides (NOx), and ozone (O3) exposure surfaces for the Greater Beirut Area (GBA) in Lebanon. NO2, NOx and O3 concentrations were monitored using passive samplers that were deployed at 55 pre-defined monitoring locations. The average annual concentrations of NO2, NOx, and O3 across the GBA were 36.0, 89.7, and 26.9 ppb, respectively. Overall, the performance of the generated models was appropriate, with low biases, high model robustness, and acceptable R2 values that ranged between 0.66 and 0.73 for NO2, 0.56 and 0.60 for NOx, and 0.54 and 0.65 for O3. Traffic-related emissions as well as the operation of a fossil-fuel power plant were found to be the main contributors to the measured NO2 and NOx levels in the GBA, whereas they acted as sinks for O3 concentrations. No seasonally significant differences were found for the NO2 and NOx pollution surfaces; as their seasonal and annual models were largely similar (Pearson's r > 0.85 for both pollutants). On the other hand, seasonal O3 pollution surfaces were significantly different. The model results showed that around 99% of the population of the GBA were exposed to NO2 levels that exceeded the World Health Organization defined annual standard. [ABSTRACT FROM AUTHOR]

Background: Prostate cancer (Pca) is the second most common cause of cancer among Lebanese men. Screening is an effective method to reduce prostate cancer mortality. This study assessed the knowledge, awareness, and screening practices among Lebanese population regarding Pca.Methods: A cross-sectional national study over all the Lebanese governorates on 1558 persons was undergone. Information on Pca knowledge and attitudes towards screening was obtained using a semi structured questionnaire. Bivariate and binary logistic regression were used to assess relations between Pca knowledge and socio-demographic characteristics.Results: The sample consisted of 1088 (69.8%) males and 470 (30.2%) females, with a mean age of 40 Y.O. Concerning early detection methods of Pca, its frequency, the ideal screening age, symptoms and curability of Pca, a significant difference (p < 0.05) was found when studying the following variables: the educational level (university level group having the highest percentage of correct answers), the individual monthly income (more correct answers were found with higher monthly income) and the age groups (most correct answers in the younger age groups).Conclusion: Our study points to the need of developing Pca prevention and education programs that should especially target older men, and people of low socioeconomic status and education in Lebanon. Such programs would increase awareness to Pca and screening, ultimately reducing the burden of advanced cancer through its early diagnosis. [ABSTRACT FROM AUTHOR]

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

The World Food Programme (WFP) offers yearly health and nutrition summer camps hosting vulnerable Syrian and Lebanese children and aiming at improving physical, mental and social well-being while contributing to better social cohesion. The present study aimed to assess the 2019 WFP summer camps' effectiveness in reaching the intended outcomes and to provide recommendations for improvement. A multi-method approach using (1) quantitative student pre-/post-surveys (n 443), (2) focus group discussions and (3) key informant interviews and surveys (n 42) was adopted. Mean test results showed improvements in nutrition (4·79 (sd 1·9) v. 5·34 (sd 2·7); t(269) = 4·51, P = 0·000) and life skills knowledge (4·97 (sd 1·9) v. 5·55 (sd 2); t(294) = 4·52, P = 0·000) but no improvement in health knowledge and social cohesion scores. Qualitative data revealed positive changes in social cohesion and an increase in health knowledge. In addition, there was a positive attitude towards the summer camps from students, instructors and administrators specifically regarding the integrated content, snacks and atmosphere of fun and learning. The main weaknesses identified were the short time to prepare for the camps, shortage in instructor training and short camp duration. There were also points of debate regarding sexual and reproductive health-related topics and how they should be delivered. All in all, the camps were shown to be a commendable initiative for incorporating an integrated and holistic approach in the support of education and development among vulnerable children and adolescents. [ABSTRACT FROM AUTHOR]

Background: Multipurpose cash transfers (MPCs) are used on a widespread basis in the Syrian refugee response; however, there is little to no evidence as to how they affect health in humanitarian crises.Methods: A prospective cohort study was conducted from May 2018 through July 2019 to evaluate the impact of MPCs on health care-seeking and expenditures for child, adult acute, and adult chronic illness by Syrian refugees in Lebanon. Households receiving MPCs from UNHCR were compared to control households not receiving UNHCR MPCs.Results: Care-seeking for childhood illness was consistently high in both MPC and non-MPC households. An increased proportion of households did not receive all recommended care due to cost; this increase was 19.3% greater among MPC recipients than controls (P = 0.002). Increases in child hospitalizations were significantly smaller among MPC recipients than controls (DiD -6.1%; P = 0.037). For adult acute illnesses, care-seeking increased among MPC recipients but decreased in controls (adjusted DiD 11.3%; P = 0.057); differences in change for other utilization outcomes were not significant. The adjusted difference in change in the proportion of MPC households not receiving recommended chronic illness care due to cost compared to controls was - 28.2% (P = 0.073). Access to medication for adult chronic illness also marginally significantly improved for MPC households relative to controls. The proportion of MPC recipients reporting expenses for the most recent child and adult acute illness increased significantly, as did the [log] total visit cost. Both MPC and control households reported significant increases in borrowing to pay for health expenses over the year study period, but differences in change in borrowing or asset sales were not significant, indicating that MPC was not protective against for household financial risks associated with health.Conclusions: While MPC may have shown some positive effects, findings were mixed and MPC appears insufficient on its own to address health utilization and expenditures. A broader strategy addressing Syrian refugee health in Lebanon is needed of which MPC should be incorporated, with additional support such as additional conditional cash transfers for health. [ABSTRACT FROM AUTHOR]

Background: Lebanon, a developing Middle Eastern country, was hit by the COVID-19 pandemic that occurred amid a severe national economic crisis. Community pharmacists are responsible for dispensing appropriate medications and products in addition to counseling, informing and educating the public, and promoting disease prevention and infection control. Objective: This study aimed to assess community pharmacists' knowledge, attitude, and practice towards the COVID-19 pandemic and evaluate behavior changes and safety measures. Methods: An anonymous and standardized online questionnaire in English was disseminated via social media platforms to Lebanese community pharmacists. The questionnaire consisted of 95 items designed as Likert-scales and multiple-choice questions divided into four different sections: socio-demographic characteristics, knowledge-based, attitude-based, and pharmacy practice questions. Descriptive statistical analysis was used to summarize the demographic characteristics, and indices were created for knowledge, attitude, and practice by computing the correct answers for each section. Results: A total of 310 questionnaires were completed. Around 61% have expressed their fear of getting infected with COVID-19 due to occupational exposure. The respondents were able to answer 80–90% of the knowledge-based questions of the survey. A more careful/anxious attitude, but not knowledge, was associated with overall better practice (p = 0.03). Also, respondents stated that they are dispensing protective equipment items such as masks (87%), gloves (60%), and sanitizers (77%) in small quantities due to limited availability. Conclusion: Our findings revealed an adequate level of knowledge and good practice towards COVID-19 among Lebanese community pharmacists. Their fears of contracting the virus and compromising the safety of those around them are justified. However, their supply of protective equipment is limited. [ABSTRACT FROM AUTHOR]

This article discusses a small cemetery on the outskirts of Beirut in Lebanon. The cemetery contains the tombs of two of the nineteenth-century governors of Lebanon as well as a handful of high ranking people associated with Ottoman rule in Lebanon. The cemetery is unique because it contains the graves of both Muslims and Christians as well those of men and women. The article records both the tombs themselves and their inscriptions and sets them within the context of nineteenth-century Lebanon and the Ottoman empire as a whole. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the adequacy of the then proposed International Classification of Diseases version 11 (ICD-11) diagnostic guidelines for Gender Incongruence of Adolescence and Adulthood in a sample of transgender people accessing multi-disciplinary health care services at specialised organisations in Lebanon. The cross-sectional study reported here was part of the ICD-11 field test studies that took place in several countries. Twenty-eight Arab transgender adults residing in Lebanon were recruited after giving consent to participate in a structured interview with a mental health professional. The questions asked of them consisted of the following: socio-demographic data; medical history related to gender identity; experiences of gender incongruence; psychological distress; rejection; violence; and functional impairment. Results showed that Arab transgender individuals living in Lebanon report being the victims of violence, abuse, discrimination and rejection from family, peers and society in general. As a result, they develop psychological distress that is better explained by the social context in which they live, rather than by their transgender identity. Reformulating ICD-10 Transsexualism as Gender Incongruence of Adolescence and Adulthood in ICD-11 and moving this diagnosis out of the chapter on mental disorders chapter would be favourable to the Lebanese sample. [ABSTRACT FROM AUTHOR]

This paper analyzes the relationship between change in capital and change in risk for a sample of 23 Lebanese banks between 2009 and 2014. Using the simultaneous equations model, our evidence reveals that banks determine their capital and risk levels simultaneously, with a negative relationship. While banks adjust their capital rapidly, they adjust their risk slowly. Furthermore, undercapitalized banks adjust their capital levels more rapidly than well-capitalized banks, and they increase their capital when they decrease their risk. However, there is no conclusive evidence regarding the role of regulatory pressure in driving risk-taking behavior. Finally, there are no major differences in the relationships between capital and risk regardless of whether banks are listed or not. [ABSTRACT FROM AUTHOR]

Background: The prevalence of iron deficiency in the Lebanese pediatric population is unknown. The aim of this study is to estimate this prevalence in Lebanese schoolchildren and to assess the relation between iron status and related factors.Subjects/methods: A total of 903 children aged 8-18 years (466 boys and 437 girls) were included in the study. Recruitment was done from ten schools with different SES levels and located in the Great Beirut and Mount Lebanon areas. Serum ferritin was measured in all participants and testosterone was measured only in boys using Immulite chemiluminescent assays.Results: For the entire sample, the median serum ferritin concentration was 30.0 [19.8-44.8] ng/mL and the prevalence of iron deficiency (ferritin < 15 ng/mL) was 14.2%. Iron deficiency was higher in girls compared with boys (respectively, 20.8% and 7.9%). This prevalence varied with the SES (respectively, 11.6%, 11.9%, and 16.8% in high, middle, and low SES, p = 0.09). Iron deficiency increased with age (9.5%, 15.7%, and 17.5%, respectively, for the age groups 8-11, 12-14, and 15-18, p = 0.014) and did not differ between normal, overweight, and obese groups (p = 0.07). In boys, a significant positive correlation was observed between ferritin and total testosterone (rho = 0.150, p = 0.001).Conclusion: The prevalence of iron deficiency is relatively low in Lebanon. Younger boys, menstruating girls, and children from low SES are more prone to iron deficiency, while BMI has no impact. [ABSTRACT FROM AUTHOR]

Background: The Breastfeeding Behavior Questionnaire (BBQ) assesses women's perceptions of their breastfeeding behavior. It was adapted to several languages and used in different settings, but has not been validated in Arabic-speaking populations. None of the previous studies that used the BBQ in other cultures examined its ability to predict the actual breastfeeding behaviors of mothers postpartum. This study validated the BBQ in a cohort of Lebanese pregnant women between December 2013 and January 2016, and examined whether it can predict exclusive breastfeeding at one, three and six months. Methods: The internal consistency reliability and construct validity of the Arabic BBQ (BBQ-A) were tested on 354 pregnant women. Its predictive ability was assessed by correlating the women's BBQ-A scores with their breastfeeding outcomes at one, three and six months post-delivery. Results: The BBQ-A had a good internal consistency reliability (Cronbach's alpha = 0.78). Exploratory factor analysis revealed that it is unidimensional. Inter-item correlations ranged between − 0.016 and 0.934, with corrected-item total correlations ranging from 0.273 to 0.678. Perceived positive breastfeeding behavior correlated with positive breastfeeding attitudes, good breastfeeding knowledge and stronger breastfeeding intention supporting its external validity. However, in binomial multivariate logistic regression analysis, the BBQ-A did not predict exclusive breastfeeding at one, three or six months. Conclusions: The BBQ-A is a reliable and valid instrument to assess women's perceptions of their breastfeeding behavior in an Arab context. Availability of this instrument is important for investigators conducting breastfeeding research in the Arab world. However, the BBQ-A does not predict exclusive breastfeeding at one, three or six months. Further research on the Breastfeeding Behavior Questionnaire is needed to examine its predictive validity in other cultures. [ABSTRACT FROM AUTHOR]

Background: Aspects of sexual identity development, including integration into gay community, have been found to be associated with sexual risk behavior among men who have sex with men (MSM), but not in the Middle East. Method: Drawing on the minority stress model and integrated theory of health behavior, we examined the relationships between measures of sexual identity development and HIV protective behaviors (condomless anal sex and HIV testing) and the mediating roles of HIV knowledge, peer judgmentalism, and discrimination, in a sample of 226 young MSM in Beirut, Lebanon. A cross-sectional, mediation analysis was conducted using a bootstrapping approach and logistic regression models. Results: Fifteen percent of the sample reported recent condomless anal sex with partners whose HIV status was positive or unknown, and 82.3% had ever been tested for HIV. Multivariate logistic regression analysis showed that greater integration into the gay community was significantly associated with having recent condomless anal sex with positive/unknown HIV status partners and having any history of HIV testing, after controlling for covariates. Knowledge of HIV risk was associated with gay integration as well as both condomless anal sex with positive or unknown HIV status partners and any history of HIV testing, but it only served as a (partial) mediator of HIV testing. Peer judgmental communication about sex and sexuality-related discrimination were related in bivariate analysis to gay integration and condomless anal sex, but they too did not prove to be significant mediators of the relationship between these two constructs. Conclusion: These findings highlight the potential sexual health benefits and vulnerabilities associated with increased integration into the gay community for young MSM in Beirut and the need to better understand how to increase HIV knowledge while limiting its potential to increase sexual risk behavior. [ABSTRACT FROM AUTHOR]

Purpose: Vegetative roofs (VRs) are fully planted roof spaces that offer aesthetic view, storm water management, sound insulation, energy savings, and air improvement. The aim on this work is to compare the life cycle environmental impacts of traditional gravel ballasted roof (TGBR) and extensive green roof (EGR) each having a surface area of 650 m2. Methods: Environmental impacts were determined and analyzed using a cradle to grave life cycle assessment (LCA) including two end-of-life scenarios (landfilling and recycling). In particular, for the use phase, the updated Lebanese electricity grid was integrated for the first time in the LCA software SimaPro and real-time temperature monitoring for TGBR and EGR roof mockups that were installed on the rooftop of the Chemical Engineering Building at the University of Balamand-Lebanon were used. Life cycle impact assessment was performed using the IMPACT 2002+ methodology for all impact categories except for water scarcity, which was determined from the water use in life cycle assessment (WULCA) consensus model. Results and discussion: Results demonstrated that the assembly and the use phase were the highest contributors to the environmental impacts for TGBR and EGR. Comparing the two types of roofs, TGBR had the highest contribution for all impact categories except for "land occupation." This is justified by the presence of the vegetation layer in the vegetative roofs. Conclusions: EGRs are more efficient than TGBR from an environmental perspective. Moreover, increasing the share of renewable energy in the total Lebanese energy production will lower greenhouse gases emissions from the energy sector and the other life cycle environmental impacts. [ABSTRACT FROM AUTHOR]

Background: Despite the misconceptions regarding E-cigarettes (ECs), only a few studies have been conducted in the Middle East that focused on this topic. This study assesses the knowledge of and attitudes towards ECs in Lebanon, determines how these two measures are associated, and identifies the variables that explain each of these measures.Methods: A cross sectional study was conducted on a convenience sample of Lebanese pedestrians aged between 18 and 64 inclusive. A structured self-administered questionnaire comprising of knowledge and attitude scales, and questions on demographical, health and smoking characteristics was used.Results: Scores for attitudes and knowledge of ECs were summed and dichotomized using a 75% cutoff, above which the participant was considered to have a positive attitude and good knowledge. Among the 352 participants (56.6% males, 43.3% females, mean age 30.3, 46.2% smokers), 63.3% exhibited a lower level of EC knowledge. More than 50% erroneously thought that ECs are not associated with lung and bladder cancer or impair lung and heart function. 65% falsely thought that it is harmless and not addictive. As for attitude, 43.3, 53.9, and 44.3% thought that it is socially acceptable, helps in smoking cessation, and is a good replacement for cigarettes and an enjoyable recreational device respectively. Our results revealed an inverse correlation between attitude and knowledge scores (Spearman's correlation = -.30, p < .001). Predictors of knowledge included health-related occupation (p = .010), regular exercise (p = .016), healthy diet (p = .026), EC use (p = .026), perception that ECs are not harmful (p = .001), and help in smoking cessation (p = .017). Predictors of attitude included EC use (p = .008), sex (p = .010), and knowledge that most ECs are addictive (p = .006), harmful (p = .014), and impair heart and lung function (p = .047).Conclusions: Our study revealed a gap in EC knowledge, especially among participants who displayed a positive attitude towards ECs. Hence, measures should be undertaken to regulate its use by instituting more stringent laws and holding nationwide awareness campaigns. [ABSTRACT FROM AUTHOR]

In 2012, our research with young men who have sex with men (YMSM) in Beirut showed high rates of recent condomless anal sex and low rates of recent HIV testing. In 2017, we collected data from YMSM to assess for temporal changes and sociodemographic correlates. Propensity score weighting was used to eliminate any sociodemographic differences between the 2012 (n = 164) and 2017 (n = 226) samples of YMSM (age 18-29) recruited with long-chain peer referral sampling. Regression analysis was used to examine sociodemographic correlates of recent condomless anal sex and HIV testing using the 2017 sample, and whether these behaviors differed between the samples. Compared to the 2012 sample, the 2017 sample was about half as likely to report any condomless anal sex in the past 3 months with partners whose HIV status was positive or unknown (14% vs. 23%; OR [95%CI] 0.56 [0.32, 0.98]), and nearly 2.5 times as likely to report HIV testing in the past 6 months (48% vs. 27%; OR [95%CI] 2.44 [1.46, 4.10]). In the 2017 sample, any recent condomless anal sex with partners whose HIV status was positive or unknown was associated with employment and Christian religious affiliation. Low income was the sole correlate of having recently tested for HIV. These findings suggest a temporal trend toward increased HIV protective behaviors among YMSM in Beirut over the past 5 years. Further inroads could be secured if HIV prevention programming targeted economic influences. [ABSTRACT FROM AUTHOR]

Guided by the minority stress model, we assessed depression and its relationship to structural and sexual minority-related stressors and social support in a sample of 226 young (age 18–29 years) men who have sex with men in Beirut, Lebanon. The sample was recruited with long-chain peer referrals and administered a survey that included the PHQ-9 measure of depression. Sixteen percent had current major depression based on our PHQ-9 criteria, and 33% reported any lifetime history of suicidal ideation (including 8% who had made an attempt); 69% had experienced any sexual minority-related discrimination in the past year. In bivariate analysis, structural (unemployment, no legal resident status) and sexual minority-related (greater number of types of discrimination experienced, greater discomfort with one's sexual orientation) stressors were associated with major depression, as was lower social support. Discomfort with one's sexual orientation was the only correlate of major depression when controlling for other stressors, social support and socio-demographics. These findings highlight a high level of depression, and the potential for community building and social solidarity for mitigating the effects of stressors based in personal security, internalized stigma, and discrimination. [ABSTRACT FROM AUTHOR]