Stroke in Lebanon : prevalence, Risk Factors, and Disease Management in Hospitals

Les Accidents Vasculaires Cérébraux (AVC) sont un groupe de maladies à morbi-mortalité élevée, classés parmi les causes les plus communes de décès et de handicap acquis dans le monde. Ainsi, leur épidémiologie jouerait un rôle crucial dans la diminution de leur impact sur la population. Les pays en voie de développement sont aujourd'hui les plus responsables de l'augmentation de la fréquence de la maladie, vu que la sensibilisation des gens et l'amélioration de la prise en charge dans les pays développés a permis de contrôler à un certain degré l'incidence et la mortalité de la maladie dans ces pays. Au Liban, un pays en voie de développement du Moyen Orient, les études épidémiologiques concernant les AVC sont relativement rares, malgré que nécessaires. En effet, le pays confronte le problème de vieillissement de sa population et des taux très élevés de tabagisme, et à un moindre degré d'obésité, hypertension et diabète, comparés aux autres pays. Dans ce contexte, il fallait initier ce travail qui surligne les grands titres de l'épidémiologie des AVC au Liban. Deux études ont été conduites, l'une communautaire transversale pour estimer la prévalence des AVC et la deuxième hospitalière rétrospective pour évaluer d'une part la prévalence des sous-types et leur association aux facteurs de risque et, d'une autre part, la prise en charge précoce de la maladie. Malgré que les résultats obtenus soient peu généralisables, on pourrait dire que la prévalence estimée (5‰ [95% CI= 3.3-6.6‰]) serait liée à l'incidence élevée de la maladie (notamment des athéroscléroses des gros vaisseaux) plutôt qu'à une meilleure prise en charge des AVC en phase aiguë. Des campagnes de sensibilisation des gens au risque et symptômes des AVC surtout parmi les fumeurs aideraient à limiter l'incidence et la sévérité de la maladie. De plus, l'implantation d'unités neurovasculaires diminuerait le taux de mortalité à court terme et les handicaps à long terme.Stroke is a group of cerebrovascular diseases with high morbidity and mortality rates, classified among the most common causes of death and acquired disability worldwide. Thus, assessing its epidemiology may play a crucial role in reducing its impact on the population. Stroke late burden is attributable to developing countries mainly, as people in developed countries have a better access to optimal care and an increased awareness of stroke symtpoms and risk factors. However, in less developed countries, where population confronts the huge impact of urbanization and globalization with a great increase in the prevalence of cardiovascular risk factors, the incidence of stroke remains high. Lebanon, a developing country of the Middle East region, lacks epidemiological data on stroke burden. Moreover, he confronts the aging problem and very high rates of smoking, and to a lesser degree of obesity, hypertension and diabetes, compared to other countries. In this context, it was necessary to initiate this work to highlight some features of the disease epidemiology in the country. Two studies were conducted, the first one was a community-based cross-sectional study to assess stroke prevalence in the country, whereas the second one was a retrospective hospital-based study to assess stroke prevalence by subtypes and associations with risk factors, and to evaluate stroke acute management in hospitals. Despite that the obtained results were not generalizable, we could state the following: The estimated prevalence of stroke (5 ‰ [95% CI= 3.3-6.6‰]) may be linked to a high incidence of the disease (especially large artery atherosclerosis) rather than a better acute stroke care. Awareness campaigns on stroke risk and symptoms especially among smokers would help limit the incidence and severity of the disease, while the establishment of stroke units may reduce short-term mortality and long term disabilities

Evaluation of discharge instructions among hospitalized Lebanese patients

Background: Hospital readmissions are considered as the primary indicator of insufficient quality of care and are responsible of increasing annual medical costs by billions of dollars. Different factors tend to reduce readmissions, particularly instructions at discharge. Objectives: Our study objective was to evaluate discharge instructions given to hospitalized Lebanese patients and associated factors. Methods: Two hundred patients, aged between 21 and 79 years and admitted to the emergency department, were recruited from a Lebanese university hospital. Discharge instructions were evaluated by a face-to-face interview to fill a questionnaire with the patients immediately after their final contact with the physician or nurse in charge. We mainly focused on medications instructions and created two scores related to “instructions given” and “instructions appropriate” to later conduct bivariate analysis. Results: We found that discharge instructions were not completely given to all our study population. The degree of appropriateness fluctuated between 25% and 100%. The instructor in charge of giving discharge instructions had its significant influence on medication instructions given (p=0.014). In addition, the instructor and his experience influenced the degree of “appropriate instructions”. In fact, our study showed that despite being capable of giving good medication advice, nurses’ instructions were significantly less effective in comparison with physicians, fellows and residents. However, nurses gave 52% of the instructions, which questions the quality of those instructions. Conclusions: In conclusion, our observational study showed that in a Lebanese university hospital, patients’ understanding of discharge instructions is poor. Careful attention should be drawn to other hospitals as well and interventions should be considered to improve instructions quality and limit later complications and readmissions. The intervention of clinical pharmacists and their medication-related advice might be crucial in order to improve instructions’ quality

Prevalence of Lebanese stroke survivors: A comparative pilot study

Stroke is a leading cause of morbidity and mortality worldwide and its late burden has mainly been attributable to developing countries. Lebanon is one of these countries where epidemiological studies on stroke burden are scarce but necessary. Thus, the present study was conducted to assess the prevalence of stroke survivors among Lebanese inhabitants. A cross-sectional survey was carried out using randomly selected landline phone numbers on all governorates to retrieve data on stroke survivors and their sociodemographic characteristics. Results were then standardized over the Lebanese and the World Health Organization (WHO) world populations. A total of 6963 Lebanese inhabitants were included in the study; among these were 56 stroke survivors. This led to an adjusted stroke prevalence of 0.50% [95% confidence interval (CI) = 0.33–0.66%] and a world-standardized prevalence of 0.60% (95% CI = 0.42–0.78%). A significantly higher stroke prevalence was found among older age groups and more socioeconomically privileged areas. Overall, the study showed a relatively higher prevalence of stroke in this sample of Lebanese inhabitants when compared to other developing countries. However, larger community-based studies with a clinical assessment of stroke cases are needed to confirm our findings

Antibiotic dispensation by Lebanese pharmacists: A comparison of higher and lower socio-economic levels

Summary: Introduction: Indiscriminate use of antibiotics contributes to a global spread of antimicrobial resistance. Previous studies showed an excessive consumption of antibiotics purchased without medical prescription from community pharmacies, mainly in developing countries.There is a shortage of studies revealing the role of community pharmacists in the overuse of antibiotics. Our objective is to study the dispensing policy of non-medical prescription antibiotics in community pharmacies, assessing the possible influence of the socio-economic level of the area over this practice. Methods: A cross-sectional study was conducted between February and May 2011 among 100 pharmacists working in Beirut's pharmacies and its suburbs. Pharmacies were divided into 2 groups according to the socio-economic level of the population living in the pharmacy area. A self-administered questionnaire was filled by pharmacists. Results: Over-the-counter antibiotic availability existed in both higher and lower socio-economic areas: on the whole, 32% of antibiotics were dispensed without medical prescription, with higher frequency in lower socio-economic areas (p = 0.003). Dispensing injectable antibiotics without medical prescription was significantly higher in lower socio-economic areas (p = 0.021), as well as dispensing an association of 2 antibiotics without medical prescription (p = 0.001). Pharmacists working in lower socio-economic areas recommended more frequent antibiotics to children and the elderly (p < 0.001 and p = 0.004, respectively). Conclusion: Dispensing antibiotics without medical prescription in Beirut community pharmacies is a common practice, particularly in lower socioeconomic areas. This public health problem should be addressed at the social, educational, and legislative levels. Keywords: Dispensing antibiotics, Community pharmacist, Medical prescription, Socio-economic level, Lebano

Parents’ knowledge, attitude, and practices towards COVID-19 in children: A Lebanese cross-sectional study : Parents’ knowledge towards COVID-19 in children

Introduction: The Coronavirus disease 2019 (COVID-19) pandemic, a serious public health crisis, can affect all ages, even children. This study aimed to investigate the knowledge, attitude, and practices of parents living in Lebanon towards the COVID-19 in children. Methods: A cross-sectional online survey was conducted between June and July 2021, targeting parents living in Lebanon. The questionnaire was divided into 4 parts: socio-demographic, knowledge, attitude, and practices. A score was calculated to evaluate parents’ knowledge towards COVID-19 in children. Descriptive and bivariate analyses were conducted. Then, determinants of COVID-19 knowledge were assessed using multivariable linear regression. P&lt;0.05 was considered statistically significant. Results: A total of 429 parents were included. The mean knowledge score was 11.28 ± 2.19 out of 15. Knowledge was significantly lower among older and single parents, who don’t know if COVID-19 is a serious disease and if it will be successfully controlled, and higher among female parents. The majority of parents had a positive attitude and good practices towards COVID-19 in children, but 76.7% of them were worried about their child getting coronavirus. About 66.9% of parents expressed their willingness to vaccinate their kids when a vaccine would be available for them, and 66.2% answered that they are sending or willing to send their children to the school or the nursery. Conclusions: Parents’ knowledge about COVID-19 in children was good, but remains lower among older and single parents. Health authorities should conduct awareness campaigns to target specific groups of parents who lacked critical knowledge about COVID-19 in children

Authoritative parenting stimulates academic achievement, also partly via self-efficacy and intention towards getting good grades

BACKGROUND: The aim of this prospective study is to examine how parenting style relates to academic achievement of Lebanese adolescents and test the mediating effect of self-efficacy and intention towards getting good grades. Potential moderation by demographic factors (age, gender, school type, religion and parents’ education) was also examined. METHODS: Students (n = 345) from private and public schools in Mount Lebanon and Beirut area, aged between 15 and 18, participated in a two-wave longitudinal study and completed a self-administered questionnaire based on the I-Change Model assessing socio-demographics (age, gender, school type, parents’ education, family structure, religion), socio-cognitive factors (attitude, social norms, self-efficacy, intention), parenting styles and academic achievement. Adolescent were surveyed at two time points, six months apart. A multiple linear regression was carried out to identify baseline factors independently associated with academic achievement 6 months later. Moderation was examined using Hayes’s SPSS macro PROCESS. A serial mediation model was employed to test for the sequential mediating effect of self-efficacy and intention between parenting style and academic achievement. RESULTS: Authoritative parenting was prospectively associated with better academic achievement and higher self-efficacy and intention at 6 months follow up. In addition, self-efficacy and intention towards getting good grades were found to mediate the relationship of parenting style to academic achievement. Adolescents who perceive their parents as authoritative are more likely to develop high efficacy beliefs and higher intention and subsequently are more likely to achieve better in school compared to peers of neglectful parents. Socio-demographics did not moderate the effect of parenting on academic achievement. CONCLUSION: Authoritative parenting influenced both directly and indirectly the academic achievement of their children. Interventions aiming at improving academic performance of adolescents should also encompass positive parenting style strategies

Authoritative parenting stimulates academic achievement, also partly via self-efficacy and intention towards getting good grades

BACKGROUND: The aim of this prospective study is to examine how parenting style relates to academic achievement of Lebanese adolescents and test the mediating effect of self-efficacy and intention towards getting good grades. Potential moderation by demographic factors (age, gender, school type, religion and parents' education) was also examined. METHODS: Students (n = 345) from private and public schools in Mount Lebanon and Beirut area, aged between 15 and 18, participated in a two-wave longitudinal study and completed a self-administered questionnaire based on the I-Change Model assessing socio-demographics (age, gender, school type, parents' education, family structure, religion), socio-cognitive factors (attitude, social norms, self-efficacy, intention), parenting styles and academic achievement. Adolescent were surveyed at two time points, six months apart. A multiple linear regression was carried out to identify baseline factors independently associated with academic achievement 6 months later. Moderation was examined using Hayes's SPSS macro PROCESS. A serial mediation model was employed to test for the sequential mediating effect of self-efficacy and intention between parenting style and academic achievement. RESULTS: Authoritative parenting was prospectively associated with better academic achievement and higher self-efficacy and intention at 6 months follow up. In addition, self-efficacy and intention towards getting good grades were found to mediate the relationship of parenting style to academic achievement. Adolescents who perceive their parents as authoritative are more likely to develop high efficacy beliefs and higher intention and subsequently are more likely to achieve better in school compared to peers of neglectful parents. Socio-demographics did not moderate the effect of parenting on academic achievement. CONCLUSION: Authoritative parenting influenced both directly and indirectly the academic achievement of their children. Interventions aiming at improving academic performance of adolescents should also encompass positive parenting style strategies

Work fatigue among Lebanese community pharmacists: prevalence and correlates

Objective: To assess work fatigue and its associated factors among community pharmacists in Lebanon. Methods: This cross-sectional study was conducted between March and July 2018. A proportionate sample of 435 community pharmacists was selected from all regions of Lebanon. A standardized self-administered questionnaire, distributed by trained interviewers, was used to assess the studied variables. Results: The results showed that 50.12% of the pharmacists had emotional work fatigue [95%CI 0.454-0.549], 55.01% had mental work fatigue [95%CI 0.503-0.597], and 54.78% had physical work fatigue [95%CI 0.501-0.595]. Higher mental work fatigue was significantly associated with higher stress (Beta=0.185) and having a master’s degree compared to a bachelor’s degree (Beta=2.23). Higher emotional work fatigue was significantly associated with higher stress (Beta=0.219), working more than 40 hours compared to ≤ 16 hours (Beta=2.742), and having 6 months to less than 1 year of practice compared to less than 6 months (Beta=-5.238). Higher physical work fatigue was significantly associated with higher stress (Beta=0.169) and having better soft skills (Beta=-0.163). Conclusions: Work-related fatigue is high among community pharmacists and touches all aspects: physical, mental, and emotional. In our study, community pharmacists’ fatigue levels were associated with educational level, years of experience, working hours, stress, depression, and soft skills, while no relation was found with gender, age, position in the pharmacy, and economic status. Interventions are recommended to tackle this public health problem that affects pharmacists, and eventually, patients

Knowledge of pharmacists and parents towards antibiotic use in pediatrics: a cross-sectional study in Lebanon

Objectives: to assess the knowledge of both parents and community pharmacists regarding antibiotics use and resistance in pediatrics in Lebanon. Methods: A cross-sectional study was conducted between June and August 2017 in community pharmacies. A pre-established questionnaire targeting knowledge of parents and pharmacists regarding antibiotics use/misuse was carried out. An index of knowledge was computed to assess factors associated with good knowledge on antibiotics use/misuse. Results: The study showed that 28.7% of pharmacists did not know which factors may contribute to antimicrobial resistance. Concerning the misuse of antibiotics, pharmacists blamed at first parents (90.1%), at second level physicians (72.8%), and third themselves (59.4%). Furthermore, pharmacists believed that the socioeconomic problems of the country (86.1%), the level of resistance to the molecule of choice (80.8%), the lack of consultation time (71.2%) and the lack of national guidelines/recommendations (66.3%) might be additional factors contributing to antimicrobial resistance. In case of acute otitis media, the majority of pharmacists chose the correct treatment, dose and duration according to international guidelines; this was in contrast to the results obtained in case of pharyngitis. Female pharmacists had a significantly higher knowledge score compared to their male counterparts (ORa=2.51). Half of parents (42.6%) declared that antibiotics act against both viruses and bacteria, 55.9% still believe that the presence of fever requires the administration of antibiotics, 50% didn’t know the consequences of antibiotics misuse, 58.4% said that it is okay to give their child antibiotics without a physician's advice and/or based on a pharmacist’s recommendation, and 66.7% trusted the pharmacist in the antibiotic prescription. Parents with a university level of education or a master’s degree had significantly better knowledge compared to illiterate ones (ORa=9.04 and ORa=16.46, respectively). Conclusions: Based on the results obtained, it would be necessary to implement educational campaigns in order to increase awareness on antibiotics misuse and resistance in pediatrics