Impact of Excess Body Weight on Health-Related Quality of Life Among Adults in Lebanon

The objective of this study is to evaluate the impact of excess body weight on Health-Related Quality of Life (HRQoL). A convenience sample of 320 adults was recruited from different health centers in Lebanon. Body mass index (kg/m2 ) was calculated based on measured weight and height. Participants were divided into three groups: normal-weight (18.5-24.9), overweight (25.0-29.9) and obese (≥30.0). HRQoL was assessed using the Short-Form health survey questionnaire (SF-36). The eight scales as well as the physical (PCS-36) and mental (MCS-36) component summary measures of the SF-36 were calculated and compared statistically among the three groups. The impact of Body Mass Index (BMI) on HRQoL was also examined through linear regressions, adjusting for sociodemographics, health behaviors and presence of chronic diseases. The results show that overweight and obese men reported reduced HRQoL on all physical scales, while overweight/obese women reported impairments on only two subscales: bodily pain and general health perceptions. PCS-36 showed lower scores in the obese and overweight subjects than the reference group. With regard to mental well-being, obese men and women displayed lower scores on vitality, social functioning and mental health subscales compared to the normalweight group. Additionally, MCS-36 showed lower scores in obese subjects. Results from linear regressions revealed significant negative correlations between BMI and both PCS-36 and MCS-36. In conclusion, overweight adults experience significantly worse physical HRQoL, while obese adults suffer from reduced physical and mental HRQoL. This highlights the importance of development and implementation of effective prevention strategies to improve HRQoL among adults with overweight and obesity

Prevalence of Body Dysmorphic Disorder (BDD) among the Lebanese University students: Associated risk factors and repercussion on mental health

Background: Body Dysmorphic Disorder (BDD) is a psychological illness characterized by persistent and intrusive preoccupation with an imagined or slight defect in appearance. For individuals with BDD, these perceived defects are significant and prominent, leading to emotional distress, depression, anxiety, and impairment in daily functioning. Despite its impact, no prior studies have explored the prevalence of BDD among Lebanese university students. Objectives: This study aimed to determine the prevalence of BDD and investigate its association with mental health status (depression and anxiety), religiosity, eating disorder risk, and self-esteem among Lebanese University students.  Methodology: A cross-sectional study was conducted in March 2020, involving students from the Lebanese University. Data were collected using the dysmorphic concern questionnaire (DCQ), Rosenberg self-esteem scale (RSE), religiosity scale, patient health questionnaire (PHQ-9), generalized anxiety disorder assessment (GAD-7), Eating Attitude test-26 scale (EAT-26). Results: A total of 6448 participants were enrolled in our study. The overall prevalence of BDD among university students was (6.4%).Our results showed that Lebanese students with BDD were more likely to have anxiety ORadj 1.3 (95% CI:1.2-1.7) p-value 0.001, depression ORadj 1.2 (95% C:1.15-1.5) p-value 0.007, and eating disorder (Bulimia & Food preoccupation ORadj 1.06 (95% CI:1.03-1.2) P-value 0.0, and oral control ORadj 1.09 (95% CI:1.05-1.1)  P-value < 0.001) compared to those with no BDD. We also found that students with BDD had Lower Self-esteem ORadj 0.88 (95%CI: 0.78-0.9) P-value <0.001), and less likely to be religious ORadj 0.88 (95%CI: 0.82-0.9) P-value 0.02) compared to those with no BDD. Conclusion: This pioneering study in Lebanon sheds light on the prevalence of BDD among Lebanese university students and its associated factors. BDD was found to be significantly linked to elevated levels of depression, anxiety, and eating disorders, along with lower levels of self-esteem and religiosity. These findings underscore the importance of early detection of BDD during adolescence and young adulthood, necessitating timely psychological intervention to prevent chronicity and complications. Moreover, promoting widespread awareness through various social media and public platforms is essential to address this psychological issue effectively

Pharmacists as immunizers in Lebanon: a national survey of community pharmacists' willingness and readiness to administer adult immunization

BACKGROUND: Since the focus of healthcare has shifted toward prevention, pharmacists were highly encouraged to expand their practice to include immunization services. Our study aimed to assess the knowledge, attitudes and beliefs of community-based Lebanese pharmacists, in addition to their willingness to expand their practice scope to include vaccine administration. METHODS: A cross-sectional study was conducted during the phase preceding the arrival of the COVID-19 vaccine in Lebanon between 1 and 31st December 2020. Using a stratified random sampling method, data were collected from Lebanese community pharmacists (CPs) through an online survey that included information on socio-demographic characteristics, clinical experience, willingness to administer vaccines, knowledge about vaccination, attitudes towards immunization, reasons supporting utilizing pharmacists as immunizers and the requested elements to incorporate immunization in pharmacists' practice scope. Multivariable analyses were performed to identify the factors associated with knowledge. RESULTS: A total of 412 community pharmacists participated in this survey. Of the total, 66.5% of the surveyed CPs are willing to administer vaccines. The majority of them (89.8%) had an overall good level. Out of all, 92.7% showed a positive overall attitude score toward immunization, 95.4% agreed that community pharmacists can play an important role in advertising and promoting vaccination. The main needed elements for implementing immunization services in pharmacies listed by participants were: support of health authorities (99.3%), statutory allowance (82.8%), patient demand (95.4%), pharmacist's interest (96.1%) and continuous education and training workshops on immunization. Older CPs (50 years and above) [aOR = 0.703, CI 95% (0.598-0.812)] and those working in Bekaa and North have lower knowledge score than their counterparts. High educational level [aOR = 1.891, CI 95% (1.598-2.019)], previous experience in immunization [aOR = 3.123, CI 95% (2.652-4.161)] and working in urban areas [aOR = 3.640, CI 95% (2.544-4.717)] were positively associated with a good knowledge level. CONCLUSION: Most of Lebanese community pharmacists are willing to offer immunizations. The expansion of the pharmacists practice scope to include provision of immunizations required a national plan that encompasses strengthening knowledge, training, certification for eligibility to administer vaccines, enhancing pharmacovigilance and statutory reform

PLoS One

Driving anger may vary across countries due to culture. This might affect driver behavior, which, in turn, impacts the driving outcomes. This study aims to investigate the relationship between socio-demographic variables, driving anger, and the self-reported aberrant behavior among Lebanese drivers and to determine which anger dimension is linked to driving behavior. A cross-sectional study was conducted among eligible Lebanese drivers from all Lebanese governorates. Data were collected using an anonymous Arabic self-reported questionnaire that included demographic information, driving-related variables, and two scales: the Driver Behavior Questionnaire (DBQ) and the Driver Anger Scale (DAS). Four hierarchical regressions were performed taking the DBQ subscales as the dependent variable and the DAS subscales as independent variables. Out of 1102 surveyed drivers, 68.4% were males, having a mean age of 34.6 ± 12.3 years and an average driving experience of 13.5 ± 10.8 years. DBQ, DAS, and their subscales showed good reliability. Older age and female gender were negatively associated with the tendency of committing aggressive violations. However, being a professional driver and increasing annual mileage were positively associated with a higher tendency to commit aggressive violations. In addition to these factors, a higher educational level was found associated with a lower risk of driver's involvement in traffic violations. However, increased driving experience was associated with a higher tendency to commit aggressive violations. Reported driving errors were also found positively associated with older age, increasing mileage, and being a professional driver. However, larger driving experience and higher education were found protectors from erroneous behavior. Hierarchical regression showed that anger prompted by hostile gesture, discourtesy, police presence, traffic obstruction, and slow driving were positively associated with aggressive violations. All the DAS subscales were found to be positively associated with ordinary violations. traffic obstruction was also found associated with a higher tendency of drivers to commit lapses, as well as anger, which originated from police presence and slow driving which were found also positively associated with errors. Driver anger dimensions were found positively associated with aberrant driver behavior. To overcome road anger, there is a need to train drivers on coping strategies to restrain aberrant driving behavior

Practice of non-pharmaceutical interventions against COVID-19 and reduction of the risk of influenza-like illness: a cross-sectional population-based study

INTRODUCTION: While the widespread implementation of the non-pharmaceutical interventions was intended to contain the COVID-19 pandemic, such measures could be also effective in limiting the spread of other respiratory infections. This study aimed to examine the association between the implementation of personal protective measures and the occurrence of influenza-like illnesses (ILI) in the general population. METHODS: An online retrospective cross-sectional observational study was conducted in April 2021 to assess cases of ILI among Lebanese adults aged 18 years and above, from all Lebanese governorates during the 2020-2021 flu season. Data were collected using a convenience sampling method. In addition to their socio-demographic information, participants were asked about their frequency of implementing personal protective measures and if they have experienced symptoms of ILI in the previous 6 months. The overall score of the personal protective measures was computed. Multivariable logistic regression was performed to examine the association between participants' level of adoption of personal protective measures against COVID-19 and the occurrence of ILI. RESULTS: Among the 1019 Lebanese adults participating in this study, 352 (34.54%) of them reported symptoms of ILI between October 2020 and March 2021. Lebanese adults who wore their facemasks frequently or always were less likely to suffer from symptoms of ILI than others who did not wear the mask (aOR = 0.452, 95% CI = 0.349-0.693, p < 0.001). Similarly, adults who adopt the following protective measures washing hands (aOR = 0.608, 95% CI = 0.524-0.922, p < 0.001), respecting cough etiquette (aOR = 0.763, 95% CI = 0.598-0.918, p < 0.001), disinfecting surface (aOR = 0.892, 95% CI = 0.632-0.911, p = 0.012), avoiding crowded places (aOR = 0.739, 95% CI = 0.688-0.903, p = 0.049), respecting physical distancing (aOR = 0.646, 95% CI = 0.482-0.833, p = 0.031) on a regular basis (frequently/always) were less likely to report symptoms of influenza-like illnesses when compared with those who did not adhere at all to these measures. CONCLUSION: Our study highlighted the potential of personal protective measures against COVID-19 in reducing the transmission of respiratory infections such as ILI. Such findings might be invested during influenza season, particularly among groups at high risk of developing severe complications. Exploring trends detected by the national severe acute respiratory infection surveillance system is recommended to confirm the utility of these measures

Has the COVID-19 pandemic changed the utilization and provision of essential health care services from 2019 to 2020 in the primary health care network in Lebanon? Results from a nationwide representative cross-sectional survey.

There is limited research soliciting the patient and staff perspectives on the overall effects of COVID-19 on the utilization and provision of primary care in Lebanon. The present study was part of a larger study on the overall effect of COVID-19 on both utilization and provision of essential health care services within the Lebanese primary health care network (PHCN). Here, we present the patient and staff perspectives on continuity of service provision, adherence to infection prevention and control measures, and the role of the PHCN in epidemic preparedness and response. We conducted a cross-sectional survey between June and July 2021 among patients who had received a health care service in 2019 or 2020 from registered primary healthcare centers (PHCs) in the network and among the respective PHC staff working during the same period. A total of 763 patients and 198 staff completed the surveys. Services were reported as interrupted by 15% of the total patients who used services either in 2020 only or in both 2019 and 2020. Access to chronic (67%) and acute medications (40%) were reported as the main interrupted services. Immunization also emerged as a foregone service in 2020. Among the staff, one third (33%) reported interruptions in the provision of services. Financial barriers rather than fear of COVID-19 were reported as main reasons for interruption. Both groups considered that the facilities implemented adequate infection prevention and control measures. They perceived that the PHCN maintained some essential healthcare services and that it should have played a bigger role in the response to the pandemic. There was a continuity in utilization and provision of services in the PHCN that was higher than expected, with non-communicable diseases and immunizations suffering more than other services

Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings.

In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting

Impact of safety-related dose reductions or discontinuations on sustained virologic response in HCV-infected patients: Results from the GUARD-C Cohort

BACKGROUND: Despite the introduction of direct-acting antiviral agents for chronic hepatitis C virus (HCV) infection, peginterferon alfa/ribavirin remains relevant in many resource-constrained settings. The non-randomized GUARD-C cohort investigated baseline predictors of safety-related dose reductions or discontinuations (sr-RD) and their impact on sustained virologic response (SVR) in patients receiving peginterferon alfa/ribavirin in routine practice. METHODS: A total of 3181 HCV-mono-infected treatment-naive patients were assigned to 24 or 48 weeks of peginterferon alfa/ribavirin by their physician. Patients were categorized by time-to-first sr-RD (Week 4/12). Detailed analyses of the impact of sr-RD on SVR24 (HCV RNA <50 IU/mL) were conducted in 951 Caucasian, noncirrhotic genotype (G)1 patients assigned to peginterferon alfa-2a/ribavirin for 48 weeks. The probability of SVR24 was identified by a baseline scoring system (range: 0-9 points) on which scores of 5 to 9 and <5 represent high and low probability of SVR24, respectively. RESULTS: SVR24 rates were 46.1% (754/1634), 77.1% (279/362), 68.0% (514/756), and 51.3% (203/396), respectively, in G1, 2, 3, and 4 patients. Overall, 16.9% and 21.8% patients experienced 651 sr-RD for peginterferon alfa and ribavirin, respectively. Among Caucasian noncirrhotic G1 patients: female sex, lower body mass index, pre-existing cardiovascular/pulmonary disease, and low hematological indices were prognostic factors of sr-RD; SVR24 was lower in patients with 651 vs. no sr-RD by Week 4 (37.9% vs. 54.4%; P = 0.0046) and Week 12 (41.7% vs. 55.3%; P = 0.0016); sr-RD by Week 4/12 significantly reduced SVR24 in patients with scores <5 but not 655. CONCLUSIONS: In conclusion, sr-RD to peginterferon alfa-2a/ribavirin significantly impacts on SVR24 rates in treatment-naive G1 noncirrhotic Caucasian patients. Baseline characteristics can help select patients with a high probability of SVR24 and a low probability of sr-RD with peginterferon alfa-2a/ribavirin

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020