Seasonal variation of mercury concentration of ancient olive groves of Lebanon

This study investigates the seasonality of the mercury (Hg) concentration of olive tree foliage, an iconic tree of the Mediterranean basin. Hg concentrations of foliage, stems, soil surface, and litter were analyzed on a monthly basis in ancient olive trees growing in two groves in Lebanon, Bchaaleh and Kawkaba (1300 and 672 m a.s.l. respectively). A significantly lower concentration was registered in stems (∼7–9 ng g−1) in comparison to foliage (∼35–48 ng g−1) in both sites, with the highest foliage Hg concentration in late winter–early spring and the lowest in summer. It is noteworthy that olive fruits also have low Hg concentrations (∼7–11 ng g−1). The soil has the highest Hg content (∼62–129 ng g−1) likely inherited through the cumulated litter biomass (∼63–76 ng g−1). A good covariation observed between our foliage Hg time series analysis and those of atmospheric Hg concentrations available for southern Italy in the western Mediterranean basin confirms that mercury pollution can be studied through olive trees. Spring sampling is recommended if the objective is to assess the trees' susceptibility to Hg uptake. Our study draws an adequate baseline for the eastern Mediterranean and the region with similar climatic inventories on Hg vegetation uptake, in addition to being a baseline to new studies on olive trees in the Mediterranean to reconstruct regional Hg pollution concentrations in the past and present.</p

Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis

Abstract: Background: Syrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism. Method: A qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used. Results: Twenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria. Conclusion: Our study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, participants perceived that this practice was filling a gap in the formal health system and was helping to alleviate the burden of IHCWs and refugee health needs. In line with interviewees’ views, we recommend that policy decision makers within humanitarian agencies and the Government of Lebanon explore the possibilities for allowing temporary registration of displaced Syrian IHCW to benefit local host communities and refugee populations

Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown

Abstract Objectives: This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis. Design: Cross-sectional study (June–July 2020); phone survey (thirty items). Setting: Lebanon. Participants: Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households. Results: FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134–234 % and 185 % of DRI, respectively, P-values <0·001). Only 10–15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels. Conclusions: Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon

Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis.

BACKGROUND: Syrian healthcare workers (HCWs) are among those who fled the Syrian conflict only to face further social and economic challenges in host countries. In Lebanon, this population group cannot formally practice, yet many are believed to be operating informally. These activities remain poorly documented and misunderstood by the academic, policy and humanitarian communities. This study aims to understand mechanisms of informal provision of services, the facilitators and barriers for such practices and to present policy recommendations for building on this adaptive mechanism. METHOD: A qualitative descriptive study based on an in-depth interview approach with a sample of Syrian informal healthcare workers (IHCWs) residing in Lebanon was adopted. Known sponsor networks followed by snowball sampling approaches were used to recruit participants. Data collection occurred between September and December 2017. All interviews were audio-recorded, transcribed and translated into English. An inductive thematic analysis was used. RESULTS: Twenty-two participants were recruited. Motivational factors that led HCWs to practice informally were personal (e.g. source of income/livelihood), societal (cultural competency), and need to fulfill a gap in the formal health service sector. Being connected to a network of IHCWs facilitated initiation of the informal practice until eventually becoming part of a community of informal practice. The central challenge was the informal nature of their practice and its negative consequences. Most IHCWs were afraid of arrest by the government upon identification. Most interviewees indicated being discriminated against by host communities in the form of differential wages and tense interpersonal relationships. Almost all recommended a change in policy allowing them to practice formally under a temporary registration until their return to Syria. CONCLUSION: Our study confirmed the presence of IHCWs operating in Lebanon. Despite its informal nature, participants perceived that this practice was filling a gap in the formal health system and was helping to alleviate the burden of IHCWs and refugee health needs. In line with interviewees' views, we recommend that policy decision makers within humanitarian agencies and the Government of Lebanon explore the possibilities for allowing temporary registration of displaced Syrian IHCW to benefit local host communities and refugee populations

Effectiveness of behavioral interventions to reduce the intake of sugar-sweetened beverages in children and adolescents: a systematic review and meta-analysis.

Context: Consumption of sugar-sweetened beverages (SSBs) among children has been associated with adverse health outcomes. Numerous behavioral interventions aimed at reducing the intake of SSBs among children have been reported, yet evidence of their effectiveness is lacking. Objective: This systematic review explored the effectiveness of educational and behavioral interventions to reduce SSB intake and to influence health outcomes among children aged 4 to 16 years. Data Sources: Seven databases were searched for randomized controlled trials published prior to September 2016. Studies identified were screened for eligibility. Study Selection: Trials were included in the review if they met the PICOS (Population, Intervention, Comparison, Outcome, and Study design) criteria for inclusion of studies. Data Extraction: Data were extracted by 2 reviewers following Cochrane guidelines and using Review Manager software. Results: Of the 16 trials included, 12 were school based and 4 were community or home based. Only 3 trials provided data that could be pooled into a meta-analysis for evaluating change in SSB intake. Subgroup analyses showed a trend toward a significant reduction in SSB intake in participants in school-based interventions compared with control groups. Change in body mass index z scores was not statistically significant between groups. Conclusions: The quality of evidence from included trials was considered moderate, and the effectiveness of educational and behavioral interventions in reducing SSB intake was modest. Systematic Review Registration: PROSPERO registration number CRD42014004432

Water and Beverage Consumption among Children Aged 4–13 Years in Lebanon: Findings from a National Cross-Sectional Study

This study evaluates total water intake (TWI) from plain water, beverages and foods among Lebanese children and compares TWI to dietary reference intakes (DRIs). In a national cross-sectional survey, data on demographic, socioeconomic, anthropometric, and physical activity characteristics were obtained from 4 to 13-year-old children (n = 752). Food and beverage consumption patterns were assessed using a validated food-frequency questionnaire. TWI was estimated at 1651 mL/day, with beverages contributing 72% of the TWI compared to 28% from foods. Beverages with the highest contribution to TWI included plain water, fruit juice and soda. A significantly higher proportion of 9–13-year-old children failed to meet the DRIs compared to 4–8 years old (92%–98% vs. 74%). Gender differentials were observed with a significantly higher proportion of boys meeting the DRIs compared to girls. The water to energy ratio ranged between 0.84 and 0.87, which fell short of meeting the desirable recommendations. In addition, children from higher socioeconomic status had higher intakes of water from milk and bottled water, coupled with lower water intakes from sodas. The study findings show an alarming high proportion of Lebanese children failing to meet TWI recommendations, and call for culture-specific interventions to instill healthy fluid consumption patterns early in life

Perceived impact of community kitchens on the food security of Syrian refugees and kitchen workers in Lebanon: Qualitative evidence in a displacement context.

Community kitchens (CKs) have been recommended as public health strategies with social and nutritional health benefits for low-income participants and their families in different settings. The benefit of CKs in improving the food security status of participants in the context of conflict and displacement is less conclusive. This study aimed to qualitatively explore the impact of CKs on the food security status of community kitchen workers (CWs) and Syrian refugee (SR) families in Lebanon. An exploratory qualitative descriptive approach was adopted. Focus group discussions were conducted with 15 CWs and 49 SRs, and transcripts were analyzed thematically. Emerging themes included: motivation to join the CKs (CWs only), perception towards CKs, impact of these CKs, and their sustainability (both groups). Motivating factors for CWs included financial, internal and societal drivers, and the favorable type of work in kitchens. The perception towards CKs was overall positive among CWs and SR beneficiaries. Both groups reported the positive impact of CKs on their food security and financial status, which in turn affected positively their psychological health. At the social level, CWs indicated that the kitchen's friendly atmosphere increased social cohesion and companionship between Syrians and Lebanese within the kitchen. In addition, CWs reported increased sense of empathy towards SRs benefiting from the CK services. According to study participants, the positive impact of the CKs was almost completely reversed when their operation and services were interrupted for two months. Both CWs and SRs identified facilitators and barriers that can affect the sustainability of the kitchens, including financial and entrepreneurial skills. In conclusion, findings from this study highlight that CKs can be promising programs to improve the food security and livelihoods of participants, while also increasing social cohesion and integration of refugees within host communities in protracted crisis contexts

Data from: Perceived impact of community kitchens on the food security of Syrian refugees and kitchen workers in Lebanon: Qualitative evidence in a displacement context

Community kitchens (CKs) have been recommended as public health strategies with social and nutritional health benefits for low-income participants and their families in different settings. The benefit of CKs in improving the food security status of participants in the context of conflict and displacement is less conclusive. This study aimed to qualitatively explore the impact of CKs on the food security status of community kitchen workers (CWs) and Syrian refugee (SR) families in Lebanon. An exploratory qualitative descriptive approach was adopted. Focus group discussions were conducted with 15 CWs and 49 SRs, and transcripts were analyzed thematically. Emerging themes included: motivation to join the CKs (CWs only), perception towards CKs, impact of these CKs, and their sustainability (both groups). Motivating factors for CWs included financial, internal and societal drivers, and the favorable type of work in kitchens. The perception towards CKs was overall positive among CWs and SR beneficiaries. Both groups reported the positive impact of CKs on their food security and financial status, which in turn affected positively their psychological health. At the social level, CWs indicated that the kitchen’s friendly atmosphere increased social cohesion and companionship between Syrians and Lebanese within the kitchen. In addition, CWs reported increased sense of empathy towards SRs benefiting from the CK services. According to study participants, the positive impact of the CKs was almost completely reversed when their operation and services were interrupted for two months. Both CWs and SRs identified facilitators and barriers that can affect the sustainability of the kitchens, including financial and entrepreneurial skills. In conclusion, findings from this study highlight that CKs can be promising programs to improve the food security and livelihoods of participants, while also increasing social cohesion and integration of refugees within host communities in protracted crisis contexts

Household food insecurity is associated with a higher burden of obesity and risk of dietary inadequacies among mothers in Beirut, Lebanon

Abstract Background Mixed evidence exists with respect to the association between household food insecurity (HFIS) and obesity in low-to-middle income countries (LMICs), particularly among women. This study aimed to measure socioeconomic correlates of HFIS and explores its association with dietary intake and odds of obesity among mothers in Lebanon, a middle-income country undergoing nutrition transition. Methods A cross-sectional study was conducted among a representative sample of households (n = 378) in Beirut, Lebanon. Surveys were completed with mothers of children <18 years. HFIS was measured using a locally-validated, Arabic-translated Household Food Insecurity Access Scale (HFIAS). Dietary intake was assessed using the multiple pass 24-h recall method. Associations between HFIS (food vs food insecure) and socio-demographic characteristics were reported using crude and adjusted odds ratios. The odds of consuming <2/3rd Dietary Reference Intakes (DRIs) for nutrients among mothers from food secure and food insecure households were explored. In addition, logistic regression analyses were conducted to explore the association of HFIS with obesity (BMI ≥ 30 kg/m2) and at-risk waist circumference (WC ≥ 80 cm) among mothers. Results HFIS was found among 50% of study sample and was inversely associated with household income and mother’s educational level, even after adjusting for other socioeconomic variables (p < 0.01). Mothers in food insecure households reported consuming significantly less dairy products, fruits, and nuts yet more breads and sweets; and they had higher odds of consuming <2/3rd the DRI’s for key micronutrients (potassium, folate, and vitamin C) compared to secure ones. Adjusting for socioeconomic correlates, food insecure mothers had 1.73 odds of obesity (95% CI: 1.02–2.92) compared to food secure mothers. Conclusions High HFIS prevalence was reported among urban Lebanese households. Mothers from food insecure households had a high risk of dietary inadequacy and obesity. Adequate evidence-based public health strategies are needed to reduce the vulnerability of mothers to food insecurity in LMIC settings and alleviate their risk of a high burden of nutrient insecurity and obesity

Sustainable, Healthy and Affordable Diets for Children in Lebanon: A Call for Action in Dire Times

Achieving sustainable, healthy diets remains a global challenge to meet the sustainable development agenda by 2030. The purpose of this study is to derive optimal dietary recommendations for children that consider nutritional, environmental, and economic parameters of sustainability, using Lebanon as a case study. Data from the latest national food consumption survey conducted among Lebanese children were used. Optimized diets were derived using Optimeal, a software that produces similar patterns to the usual diet while considering nutrition constraints (energy, and macro/micronutrient needs), environmental footprints ((EFPs): water use, energy use, and greenhouse emissions), and cost. Three optimized diets were derived that meet the nutritional needs of children aged 4–8, 9–13, and 14–18 years, while considering EFPs and cost. Compared to the usual intake, optimized diets included higher intake of vegetables, legumes and dairy, and a decrease in saturated oils, processed meats, sugar, salty snacks, sweets, and sugar-sweetened beverages. Overall, the optimized diets decreased cost by 20% and reduced water use, energy use, and GHG emissions, by 20%, 11%, and 22%, respectively. The proposed models consider various constraints and provide sustainable solutions for decision makers within a country undergoing crises