A qualitative examination of barriers against effective medical education and practices related to breastfeeding promotion and support in Lebanon.

Background: Insufficient breastfeeding promotion and support by physicians contribute to suboptimal breastfeeding rates globally. Understanding setting-specific barriers against breastfeeding promotion and support from the perspective of medical students and addressing those that can be modified through undergraduate medical education may help improve learning outcomes, medical practice, and ultimately health outcomes associated with breastfeeding.Objectives: We selected the underserved and under-supported public medical school in Lebanon to explore psychosocial, institutional, and societal barriers hindering effective preventative medicine practices using breastfeeding promotion and support as an exemplar case.Methods: One-on-one semi-structured interviews, each lasting around 60 min, were conducted with medical interns (in Med III and Med IV) at their training hospitals. Interviews were voice-recorded, transcribed verbatim, coded, and analyzed thematically based on Theory of Planned Behavior.Results: Interns (n= 49; 96% response rate) completed the study. Five major themes emerged addressing barriers at various levels. At the health care system level at large, interns identified the predominant focus on pathophysiology and treatment rather than on disease prevention and health promotion as a barrier. At the level of trainees and their education experiences, interns reported limited and optional clerkship training in obstetrics/gynecology and in neonatology which contributes to their insufficient knowledge and low self-efficacy. Competing financial interests from infant formula companies and social pressures to promote infant formula were identified as two main barriers at the level of physicians and clinical practice.Conclusions: Our work using breastfeeding as an exemplary case highlights how undergraduate medical education and its learning outcomes and how medical practices and patient behavior are highly intertwined with psychosocial, institutional, and social drivers and constraints. Re-evaluating the success of undergraduate medical curricula in light of overcoming these constraints and not only based on meeting national accreditation and certification guidelines might prove helpful in improving medical education and ultimately clinical practice

A case study on breastfeeding education in Lebanon's public medical school: exploring the potential role of social networks in medical education.

BackgroundLimited knowledge, negative beliefs, and lack of sufficient breastfeeding promotion and support by physicians contribute to global suboptimal breastfeeding rates. Formal medical education is well-known to influence future physicians' knowledge, beliefs, and medical practice. However, less understood is the influence of social networks and processes on the exchange and diffusion of knowledge and practices related to breastfeeding.ObjectivesWe selected the underserved and under-supported public medical school in Lebanon to examine the social side of medical education. Our objectives were to assess knowledge, beliefs, and self-efficacy related to breastfeeding promotion and support among interns and residents. We also examined the social ecosystem surrounding these students concerning the exchange of breastfeeding knowledge.DesignAll data were collected during one study visit per participant. First, an interview-administered structured survey was used to assess beliefs, perceived knowledge, basic breastfeeding knowledge, and self-efficacy related to breastfeeding among n = 70 medical interns and residents. Then, social network data were collected during a semi-structured interview and analyzed using an ego-network approach. All interviews were voice-recorded, transcribed, coded, and thematically analyzed. Descriptive statistics were used to analyze quantitative survey and social network results.ResultsAlthough interns and residents had positive beliefs about breastfeeding benefits, they had limited knowledge and low self-efficacy related to the psychosocial and clinical aspects of breastfeeding promotion and support. They did not seem to have a well-connected professional network around breastfeeding knowledge and practices. Several tended to rely on their informal/non-professional network, such as their mothers, partners, and sisters, for knowledge and practice.ConclusionsOur work using breastfeeding as an exemplary case suggests there is a role for better attending to the beliefs of medical students as well as to the social side of medical education. Future studies can use social network theory to help identify and address influences on medical education outcomes

A case study on breastfeeding education in Lebanon’s public medical school: exploring the potential role of social networks in medical education

Background: Limited knowledge, negative beliefs, and lack of sufficient breastfeeding promotion and support by physicians contribute to global suboptimal breastfeeding rates. Formal medical education is well-known to influence future physicians’ knowledge, beliefs, and medical practice. However, less understood is the influence of social networks and processes on the exchange and diffusion of knowledge and practices related to breastfeeding. Objectives: We selected the underserved and under-supported public medical school in Lebanon to examine the social side of medical education. Our objectives were to assess knowledge, beliefs, and self-efficacy related to breastfeeding promotion and support among interns and residents. We also examined the social ecosystem surrounding these students concerning the exchange of breastfeeding knowledge. Design: All data were collected during one study visit per participant. First, an interview-administered structured survey was used to assess beliefs, perceived knowledge, basic breastfeeding knowledge, and self-efficacy related to breastfeeding among n = 70 medical interns and residents. Then, social network data were collected during a semi-structured interview and analyzed using an ego-network approach. All interviews were voice-recorded, transcribed, coded, and thematically analyzed. Descriptive statistics were used to analyze quantitative survey and social network results. Results: Although interns and residents had positive beliefs about breastfeeding benefits, they had limited knowledge and low self-efficacy related to the psychosocial and clinical aspects of breastfeeding promotion and support. They did not seem to have a well-connected professional network around breastfeeding knowledge and practices. Several tended to rely on their informal/non-professional network, such as their mothers, partners, and sisters, for knowledge and practice. Conclusions: Our work using breastfeeding as an exemplary case suggests there is a role for better attending to the beliefs of medical students as well as to the social side of medical education. Future studies can use social network theory to help identify and address influences on medical education outcomes

Intestinal presentation of non-Hodgkin lymphoma: Case report

Background: MEITL (monomorphic epitheliotropic intestinal T-cell lymphoma) is a rare primary intestinal T-cell lymphoma associated with high mortality rate. Being intestinal this implies difficult diagnostic workup and management. Case: We present a case of 59-year-old male presented with abdominal pain and found to have 15 × 11 cm mass in the right iliac fossa. Decision for surgical excision was retained and the Pathological examination determined monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL) with CD30 positive immune-histochemical profile. Conclusion: MEITL is a rare entity which retains challenging diagnosis and management as well as variable immune-histochemical profile. In the absence of clear guidelines for the management of intestinal manifestation of lymphoma, surgical approach may have its indications.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Spatio-temporal variability of the phytoplankton biomass in the Levantine basin between 2002 and 2015 using MODIS products

The Levantine basin in the Eastern Mediterranean Sea is subject to spatial and seasonal variations in primary production and physical-chemical properties both on a short and long-term basis. In this study, the monthly means of daily MODIS product images were averaged between 2002 and 2015, and used to characterize the phytoplankton blooms in different bioregions of the Levantine basin. The selected products were the sea surface temperature (SST), the chlorophyll-a concentration (Chl-a), the diffuse attenuation coefficient for downwelling irradiance at 490 nm (Kd_490) and the colored dissolved organic matter index (CDOM_index). Our results showed that phytoplankton blooms were spatially and temporally variable. They occurred in late autumn at the Nile Delta, in early spring and late summer at the eastern coastline, and in spring at the northeastern coastline. The northern coastline and the open water had a common bloom occurring in winter. The Nile Delta was found to be the most productive area of the Levantine basin showing high Chl-a. Kd_490 and Chl-a present a parallel co-variation indicating a dominance of Case 1 waters in the Levantine basin. The CDOM_index shows a phase shift with the Chl-a fluctuation. A strong inverse correlation was observed between both Chl-a and CDOM_index with SST, connoting an indirect relation represented by a depression of CDOM in summer by photobleaching, and a suppression of the chlorophyll-a concentration due to water stratification, together with nutrient stress. An overestimation of the Chl-a values had been signaled by the use of the CDOM_index, suggesting a correction plan in a latter study

Epidemiology and clinical characteristics of viral infections in hospitalized children and adolescents with cancer in Lebanon.

BackgroundViral infections in children and adolescents with malignancy are commonly encountered and have a significant impact on morbidity and mortality. Studies and epidemiological data regarding viral infections in children with cancer in developing countries are lacking. This retrospective cohort study aims to assess the burden of viral infections in children and adolescents with cancer, by assessing prevalence, risk factors, as well as morbidity and mortality of common viruses over a period of 8 years.Methods and findingsMedical records of cancer patients treated at the Children Cancer Center of Lebanon were reviewed and 155 participants under the age of 21 were identified with at least one documented viral infection during the period from July 2009 to November 2017. This subset included 136 participants with active malignancy and 19 participants with a history of cancer who underwent hematopoietic stem cell transplantation [HSCT] and were in remission; the latter group was analyzed separately. Information regarding participant characteristics, hospital course, and complications were obtained. Associations between viral infections and certain factors were assessed. In the cohort, 64% were male, 81% were Lebanese. In participants with active malignancy, 90% received chemotherapy in the 6 months preceding the viral infection episode, 11% received radiotherapy. 51% of participants were neutropenic at the time of viral detection, and 77% were lymphopenic. 17% experienced a bacterial co-infection, and 3 experienced a viral co-infection. Among 162 viral infection episodes, clinically diagnosed skin infections, mainly herpes simplex virus type 1 and varicella-zoster virus, were the most common [44% of cases]. These were followed by laboratory-proven systemic herpes infections: cytomegalovirus [14%] and Epstein-Barr virus [6%]. Respiratory viruses: influenza and respiratory syncytial virus, accounted for 9% and 4%, respectively, whereas rotavirus represented 11% and BK virus represented 3% of cases. Acute lymphocytic leukemia was the most prevalent neoplasia [57%]. Fever was the most common presenting symptom [55%] and febrile neutropenia was the reason for admission in 24% of cases. The mean length of stay was significantly longer in participants with cytomegalovirus infections and significantly lower in rotavirus infection. Admission to the ICU occurred in 9%, complications in 8%, and mortality in 5%. Participants with viral infections post-HSCT were noted to have a significantly longer length of hospital stay compared to non-HSCT participants, with no other significant differences in clinical course and outcome. The study was limited by its retrospective nature and by the late introduction and underuse of multiplex PCR panels, which may have led to underdiagnosis of viral infections.ConclusionsViral infections were prevalent in our sample of cancer patients and may have contributed to morbidity and mortality. Newly available viral diagnostics are likely to vastly increase the number and scope of detectable viral infections in this population. Prospective studies using multiplex PCR technology with systematic testing of patients will be more helpful in defining the burden of viral infections. Furthermore, efforts at antimicrobial stewardship would benefit from the identification of viral causes of infection and limit the unnecessary use of antibiotics in the pediatric cancer population