Publications by authors named "Souheil Hallit"

217 Publications

Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population.

Perspect Psychiatr Care 2021 Apr 6. Epub 2021 Apr 6.

INSPECT-LB: National Institute of Public Health, Clinical Epidemiology and Toxicology, Beirut, Lebanon.

Purpose: To develop and validate a short version of the Beirut Distress Scale (BDS-22), the BDS-10, in the Lebanese population, and evaluate the association between psychological distress and other mental disorders.

Methods: A total of 2260 participants was enrolled in this cross-sectional study (January-July 2019).

Results: Items converged over a solution of two factors (Factor 1 = Mood, affect and cognitive symptoms; Factor 2 = Physical symptoms; total variance explained = 64.51%). A significantly high correlation was found between BDS-10 and BDS-22 (r = 0.963, p < 0.001). Higher depression, anxiety, and insomnia were significantly associated with higher stress (higher BDS-10 and BDS-22 scores).

Practice Implications: This new short tool is valid and reliable to screen for psychological distress, influencing mood and affect, and physical and cognitive functions.
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http://dx.doi.org/10.1111/ppc.12787DOI Listing
April 2021

Shedding Light on the Direct and Indirect Impact of the COVID-19 Pandemic on the Lebanese Radiographers or Radiologic Technologists: A Crisis within Crises.

Healthcare (Basel) 2021 Mar 23;9(3). Epub 2021 Mar 23.

Department of Radiologic Sciences, Faculty of Health Sciences, American University of Science and Technology (AUST), Beirut 1100, Lebanon.

With the novel coronavirus disease 2019 (COVID-19) pandemic, the need for radiologic procedures is increasing for the effective diagnosis and follow-up of pulmonary diseases. There is an immense load on the radiographers' shoulders to cope with all the challenges associated with the pandemic. However, amidst this crisis, Lebanese radiographers are also suffering from a socioeconomic crisis and record hyperinflation that have posed additional challenges. A cross-sectional study was conducted among registered Lebanese radiographers to assess the general, workplace conditions, health and safety, mental/psychologic, financial, and skill/knowledge development impacts. Despite applying an adapted safety protocol, institutions are neither providing free RT-PCR testing to their staff nor showing adequate support for infected staff members, thus causing distress about contracting the virus from the workplace. Aggravated by the deteriorating economic situation that affected the radiographers financially, they additionally suffer from severe occupational physical and mental burnout. Regardless of that, they used their free time during the lockdown for skill/knowledge development and have performed many recreational activities. This cross-sectional study highlighted the different ways the pandemic has impacted the radiographers: physically, psychologically, and financially. It aimed to shed light on what these frontline heroes are passing through in the midst of all these unprecedented crises.
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http://dx.doi.org/10.3390/healthcare9030362DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8005091PMC
March 2021

Drunkorexia and Emotion Regulation and Emotion Regulation Difficulties: The Mediating Effect of Disordered Eating Attitudes.

Int J Environ Res Public Health 2021 Mar 7;18(5). Epub 2021 Mar 7.

Institute of Psychology, University of Wroclaw, Dawida 1, 50-527 Wroclaw, Poland.

Drunorexia refers to food calorie intake restriction to prevent weight gain and the desire to enhance the more extensive intoxicating effects of alcohol. The present study aimed to investigate the association of drunkorexia with emotion regulation as well as emotion regulation difficulties across the Lebanese population, and assess disordered eating attitudes as a potential mediator of these relationships. The cross-sectional study enrolled participants ( = 258) from all Lebanese districts. The study was performed through an online survey based on a self-designed and structured questionnaire. The Drunkorexia Motives and Behaviors Scales (DMBS), the College Life Alcohol Salience Scale (CLASS), the Difficulties in Emotion Regulation Scale (DERS-16), the Emotion Regulation Questionnaire (ERQ) and the Eating Attitudes Test (EAT-26) were used in the present study. The results showed that higher EAT-26 total scores (more disordered eating attitudes) ( = 0.16) and higher DERS-16 total score ( = 0.30) were significantly associated with more drunkorexia motives. Also, higher EAT-26 total scores ( = 0.09) and higher DERS-16 total score ( = 0.17) were significantly associated with more drunkorexia behaviors. In addition, higher EAT-26 total scores ( = 0.10) and higher DERS-26 total score ( = 0.36) were significantly associated with more drunkorexia fails. Furthermore, higher EAT-26 total scores ( = 0.07), and higher DERS-16 total score ( = 0.37) were significantly associated with more drunkorexia during an alcohol consumption event. Higher EAT-26 total scores ( = 0.09), and higher DERS-16 total score ( = 0.22) were significantly associated with more post-drinking compensation. Higher EAT-26 total scores ( = 0.21), higher DERS-16 total scores ( = 0.65) and higher emotion regulation ( = 0.33) were significantly associated with higher CLASS scores. The results showed that EAT-26 total scores partially mediated the association between DERS-16 total score and drunkorexia motives (25.20%), between DERS-16 total score and drunkorexia behaviors (25.16%), between DERS-16 total score and drunkorexia fails (106.87%), between DERS-16 total score and drunkorexia during an alcohol consumption event (11.84%), between DERS-16 total score and post-drinking compensation (22.55%), between ERQ total score and college life alcohol salience (8.35%) and between DERS-16 total score and college life alcohol salience (20.14%). This study highlighted that only emotional regulation difficulties were associated with drunkorexia, whereas emotional regulation was not significantly associated with such behavior.
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http://dx.doi.org/10.3390/ijerph18052690DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7967414PMC
March 2021

Nutritional Status of Lebanese Hospitalized Patients With Chronic Disease: A Cross-Sectional Study.

Hosp Pharm 2021 Apr 9;56(2):102-108. Epub 2019 Aug 9.

Faculty of Pharmacy Lebanese University, Hadath, Lebanon.

In a hospitalized setting, malnutrition is known to increase patient's mortality and lower the quality of life; therefore, it is essential to detect such cases and intervene at the earliest possible. The goal of this study is to estimate the rate of malnutrition in hospitalized Lebanese patients, explore its association with different factors, and create a simple tool to detect patients at high risk of malnutrition. One hundred and fifty Lebanese hospitalized patients, suffering at least from one chronic disease, were randomly chosen from Centre Hospitalier Universitaire Notre Dame de Secours (CHU-NDS) hospital. The Mini Nutritional Assessment (MNA) score was used to assess nutritional status. A total of 34.7% of patients in our sample were at risk of malnutrition and 9.3% were malnourished. A higher risk of malnutrition was found in patients with a low body mass index, who were physically inactive or admitted to the hospital more than once in the past 6 months. The nutritional status was not associated with certain chronic diseases more than others. We designed a simple decision tree model based only on 3 questions to detect patients at high risk of malnutrition/malnourished. This tool has a sensitivity of 62% and a specificity of 77%. The prevalence found in our study was comparable with previous data. However, factors associated with poor nutritional status were somewhat different. Further studies are needed to validate our screening tool and to examine the effect of specific diseases on malnutrition on a larger scale.
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http://dx.doi.org/10.1177/0018578719867664DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958369PMC
April 2021

Surveillance of antimicrobial resistance in low- and middle-income countries: a scattered picture.

Antimicrob Resist Infect Control 2021 Mar 31;10(1):63. Epub 2021 Mar 31.

Department of Bactériologie-Hygiène, Centre Hospitalier Universitaire, Hôpital Purpan, 31330, Toulouse, France.

Data on comprehensive population-based surveillance of antimicrobial resistance is lacking. In low- and middle-income countries, the challenges are high due to weak laboratory capacity, poor health systems governance, lack of health information systems, and limited resources. Developing countries struggle with political and social dilemma, and bear a high health and economic burden of communicable diseases. Available data are fragmented and lack representativeness which limits their use to advice health policy makers and orientate the efficient allocation of funding and financial resources on programs to mitigate resistance. Low-quality data means soaring rates of antimicrobial resistance and the inability to track and map the spread of resistance, detect early outbreaks, and set national health policy to tackle resistance. Here, we review the barriers and limitations of conducting effective antimicrobial resistance surveillance, and we highlight multiple incremental approaches that may offer opportunities to strengthen population-based surveillance if tailored to the context of each country.
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http://dx.doi.org/10.1186/s13756-021-00931-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8011122PMC
March 2021

Factors associated with problematic internet use among a large sample of Lebanese adolescents.

BMC Pediatr 2021 Mar 29;21(1):148. Epub 2021 Mar 29.

INSPECT-LB (National Institute of Public Health, Clinical Epidemiology and Toxicology), Beirut, Lebanon.

Background: International literature clearly describes factors associated with problematic internet use, including substance dependence, online gambling, social impairment, and functional difficulties. Therefore, it was imperative to assess the extent to which young adolescents in Lebanese schools are affected by problematic internet use (PIU) and the factors associated with it. This large-scale Lebanese survey aims to evaluate the relationship between PIU, depression, and substance use, including alcohol consumption and nicotine use (cigarettes and waterpipe) among adolescents in Lebanese schools.

Methods: This cross-sectional study conducted between January and May 2019 assessed internet use through the Internet Addiction Test (IAT), with 'severe internet use' being the threshold for problematic internet use. It enrolled a total of 1810 adolescents aged 14 to 17 from 16 schools from all Lebanese Mohafazat.

Results: The majority of the participants had an average internet use 74.8% (95% Confidence Interval (CI): 0.72-0.76), 20.7% (95% CI: 0.18-0.22) had a frequent internet use, and 4.5% (95% CI: 0.03-0.05) had a severe internet use. Higher alcohol dependence (ß = 0.456, p < 0.001), higher depression (ß = 0.079, p = 0.001), and having separated parents vs. living together (ß = 0.136, p < 0.001) were significantly associated with higher IAT scores. Higher waterpipe dependence (ß = -0.218, p < 0.001) was significantly associated with lower IAT scores.

Conclusion: This study, the first and largest of its kind in the Middle East, showed that some psychiatric disorders, such as depression and substance use (smoking and alcohol), are associated with more problematic internet use among Lebanese adolescents. These results could serve as the first step for policymakers towards implementing early awareness campaigns to look at this problem more in-depth and come up with efficient actions to avoid it.
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http://dx.doi.org/10.1186/s12887-021-02624-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006342PMC
March 2021

Assessment of drug-prescribing perception and practice among dental care providers: a cross-sectional Lebanese study.

Pharm Pract (Granada) 2021 Jan-Mar;19(1):2234. Epub 2021 Mar 9.

PharmD, PhD. Laboratory of Pharmacology, Clinical Pharmacy and Drug Quality Control, Faculty of Pharmacy, Saint-Joseph University . Beirut ( Lebanon ).

Background: Dentists play an essential role in providing high-quality dental care, taking into consideration the clinical context and concomitant medications taken by the patients.

Objective: This study aimed to assess drug-prescribing perception and practices in addition to drug-related educational needs among Lebanese dentists; it also evaluated the need for interprofessional collaboration between dentists and pharmacists.

Methods: An exploratory cross-sectional study using an online questionnaire targeted a sample of dentists from all Lebanese districts. Participants gave their consent by accepting to complete the survey (ethics approval reference: USJ-2016-63). The questionnaire consisted of closed-ended questions exploring: 1) drug-prescribing perception, 2) drug-prescribing practice, and 3) collaboration with pharmacists regarding their respective roles in providing appropriate counseling to patients. Two indexes were created: the first evaluated self-confidence in prescribing medications, and the second assessed dentists' confidence in pharmacists. Logistic regressions were performed, taking each index as a dependent variable.

Results: A total of 137 dentists completed the survey (59% females; mean age: 42.17; SD: 13.78 years). The majority had a fair to good perceived knowledge in pharmacology and therapeutics (80.3%), only 30.7% reported to be sufficiently equipped to prescribe safely. Dentists exhibited particularly low perceived knowledge about prescribing in elderly patients, dosing, medication use in pregnancy, drug interactions, and adverse reactions. Dentists specialized in periodontics had the lowest odds of having self-confidence in prescribing drugs (aOR=0.25; p<0.001). Also, 64.3% declared that they routinely check a reference source before prescribing, and 78% relied on pharmaceutical companies and medical representatives to get information on medications. While 61% declared that pharmacists should provide oral care counseling, only half of them encouraged their patients to talk to their pharmacists about their medications. Only 15% considered that patients are getting enough counseling from the pharmacist, with a global confidence index below the median value, suggesting the need for more collaboration, especially with periodontists who exhibited the lowest confidence in pharmacists (aOR=0.45).

Conclusions: Lebanese dentists reported some lack of knowledge and confidence in prescribing practices. Education, training, and close collaboration between pharmacists and dentists are essential to overcome these problems and avoid potential harm to patients.
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http://dx.doi.org/10.18549/PharmPract.2021.1.2234DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7979316PMC
March 2021

Knowledge, attitudes and practices towards people living with HIV/AIDS in Lebanon.

PLoS One 2021 25;16(3):e0249025. Epub 2021 Mar 25.

INSPECT-LB: National Institute of Public Health, Clinical Epidemiology and Toxicology, Beirut, Lebanon.

Background: Up till today, studies carried in Lebanon have focused more on the prevalence of HIV and behaviors and quality of life of infected individuals, however, none of these studies discussed the degree of stigma towards these populations. Therefore, the aim of this study is to measure the rate of stigma in terms of knowledge, attitude and practice towards patients living with Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) (PLWHA) and examine the factors associated with this stigma.

Methods: A cross-sectional survey, enrolling 862 participants, was carried across the five governorates in Lebanon: Beirut, Mount Lebanon, North, South and Bekaa. The survey was a self-administered questionnaire which covered information about participants' general demographics, their knowledge, attitudes, practices and awareness towards HIV/AIDS in Lebanon., attitudes towards PLWHA, practices related to HIV/AIDS and awareness regarding HIV/AIDS situation in Lebanon.

Results: The response rate to the survey was 78.36% (862 participants). Being Muslim (Beta = -2.56) or Druze (Beta = -2.64) compared to Christians were significantly associated with lower knowledge towards HIV/AIDS, whereas having a secondary (Beta = 2.71) and a university (Beta = 3.04) levels of education compared to illiteracy and higher age (Beta = 0.05) were significantly associated with higher knowledge. Higher knowledge (Beta = 0.66) was significantly associated with better attitude, whereas higher age (Beta = -0.14) and being Muslim compared to Christian (Beta = -3.44) were significantly associated with worse attitude. Better attitude (Beta = 0.02) was significantly associated with better practice, whereas females compared to males (Beta = -0.39), having a secondary level of education compared to illiteracy (Beta = -0.88) and being Muslim compared to Christian (Beta = -0.32) were significantly associated with worse practice.

Conclusion: Our results stress the need for educational programs, advocacy campaigns and policies to help reduce HIV stigma. This will then help start developing interventions and strategies for a possible reduction in the stigmatization level.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0249025PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7993853PMC
March 2021

Physicians' attitudes on the implementation of an antimicrobial stewardship program in Lebanese hospitals.

Pharm Pract (Granada) 2021 Jan-Mar;19(1):2192. Epub 2021 Feb 16.

Faculty of Public Health, Lebanese University. Fanar (Lebanon).

Background: Misuse of antibiotics and antimicrobial resistance are global concerns. Antibiotic stewardship programs (ASP) are advocated to reduce pathogens resistance by ensuring appropriate antimicrobial use. Several factors affect the implementation of ASPs in hospitals. The size and types of care provided, as well as the complexity of antibiotic prescription, are all issues that are considered in designing an effective hospital-based program.

Objectives: To examine physicians' attitude on implementation of an antimicrobial stewardship program in Lebanese hospitals.

Methods: A descriptive cross-sectional survey was carried out using an online questionnaire. Survey items assessed ASP implementations, physicians' attitudes, usefulness of the tools, and barriers of implementation. The questionnaire was based on the Center for Disease Control core-elements.

Results: 158 physicians completed the survey with a response rate of 4%. Our results showed that the majority (66%) of physicians were familiar with the ASP concept. Most respondents reported a lack of regular educational programs (41%), as well as a lack of support from the medical staff (76%). This study demonstrated positive attitudes and support for ASP implementation. However, ASPs were reported as affecting physicians' autonomy by 34 % of the participants. Antibiotic rounds and prospective audit and feedback were rated as most useful interaction methods with the ASPs. A minimal support of the Ministry Of Public Health, as well as the absence of regulation and of national guidelines, were reported as barriers to ASPs. The shortage of Infectious Disease physicians was seen as a barrier by half of the respondents.

Conclusions: Physicians are supportive of ASP, with preference for interventions that provide information and education rather than restrictive ones. Additional research is needed on a larger sample of physicians.
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http://dx.doi.org/10.18549/PharmPract.2021.1.2192DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7939116PMC
February 2021

Violence Against Women During COVID-19 Pandemic.

J Interpers Violence 2021 Mar 8:886260521997953. Epub 2021 Mar 8.

INSPECT-LB: National Institute of Public Health, Clinical Epidemiology and Toxicology, Beirut, Lebanon.

The objectives of this study were to correlate several factors - including depression, anxiety, stress and self-esteem levels in both men and women - with the occurrence of domestic violence against women (VAW) during quarantine. This cross-sectional study was carried out in April 2020, in the midst of the COVID-19 pandemic when lockdown procedures were implemented; 86 married couples participated in this study amounting to 172 responses in total. A different questionnaire was set for women and men; the couple filled out their respective questionnaire simultaneously, but privately where one did not see the answers of the other. Inclusion criteria included married couples of all ages that are living together during the lockdown of COVID-19. The results of this study showed that a higher total abuse score was found in 39 females (45.3%; CI: 0.34 - 0.56). Being a Muslim female (Beta =24.80) and females having higher anxiety (Beta=0.97) were significantly associated with higher total abuse scores, whereas higher stress score in female (Beta=-0.61) was significantly associated with lower total abuse scores. In conclusion, this study focuses on VAW as a serious problem while demonstrating its further emergence during quarantine. This study also focused on the effects brought on by lockdown policies, including social and economic factors, and their implications in the increase of VAW during this pandemic.
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http://dx.doi.org/10.1177/0886260521997953DOI Listing
March 2021

Preconception exposure to over-the-counter medications and antibiotics and the risk of childhood asthma in Lebanon: A cross-sectional study.

Allergol Immunopathol (Madr) 2021 1;49(2):104-112. Epub 2021 Mar 1.

INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.

Objective: The aim of this study was to elucidate the relationship between the mother's use of over-the-counter (OTC) medications during pregnancy and asthma in Lebanese children.

Methods: A cross-sectional study was conducted on Lebanese students in both public and private schools, between January and September 2017, involving 1000 children aged between 4 and 17 years.

Results: The intake of any medication as an independent variable throughout pregnancy reveals that being in a public school compared to a private one (Beta = 0.344) and breastfeeding (Beta = 0.51) were highly associated with lower odds of asthma, while having a positive family of allergic rhinitis (Beta = 2.129) and the intake of any medication during pregnancy (Beta = 7.052) were highly associated with higher odds of asthma.A second logistic regression, taking as the dependent variable asthmatic versus healthy children and taking each OTC drug as an independent variable, showed that taking paracetamol once per week during pregnancy (Beta = 4.66) and proton pump inhibitors (PPIs) once per month (Beta = 3.498) compared to no intake were significantly correlated with higher probability of asthma.

Conclusion: Our findings showed that the intake of paracetamol, vitamin C, and PPIs during pregnancy is strongly correlated with asthma in the offspring. Since these factors are avoidable, it is necessary to raise awareness among healthcare professionals to reduce the prevalence of asthma in children.
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http://dx.doi.org/10.15586/aei.v49i2.46DOI Listing
March 2021

Monopolar electrocautery tip vs plasma ablation in tonsillotomy: A randomized case-control study comparing outcomes in pediatric population.

Int J Pediatr Otorhinolaryngol 2021 Apr 20;143:110655. Epub 2021 Feb 20.

Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Department of Otolaryngology Head and Neck Surgery, Eye and Ear International Hospital, Naccache, Lebanon. Electronic address:

Background: The objective of this study was to compare the low-priced monopolar electrocautery to the high-priced, worldwide used, plasma ablation in tonsillotomy among children aged between three and twelve years, suffering from obstructive breathing disorders (OBD), with respect to post-operative pain, bleeding and related morbidities.

Methods: A randomized case-control study was conducted in the Eye and Ear Hospital International- Lebanon. 103 children aged between three and twelve years suffering from OBD secondary to tonsillar hypertrophy were randomly assigned into two groups. Post-operative pain was evaluated using age-adequate validated scales: "FLACC-R" (Face, Legs, Activity, Cry, Consolability-Revised) for children aged less than five years, and "Wong Baker faces" for older children. Additional post-operative outcomes were evaluated using Pain-PROM (Patient reported Pain-Related Outcome Measures) and TAHSI (Tonsil and Adenoid Health Status Instrument) scales.

Results: Significantly, higher rates of patients who underwent tonsillotomy via plasma ablation technique used analgesics and had severe pain compared to the monopolar electrocautery group. A longer operative duration was significantly associated with higher pain scores, and the plasma ablation technique yielded significantly higher operative mean durations. 10 days post-operatively, a significantly higher percentage of children reported an overall high pain severity and more than expected overall pain when using the plasma ablation technique compared to the monopolar electrocautery one. Overall bleeding rates were similar. No difference was reported one month post-operatively.

Conclusion: When compared to plasma ablation, monopolar electrocautery, can provide the same efficiency in relieving OBD in healthy children, with equal overall bleeding rates, but significantly lower cost, operating time, pain scores and need for analgesics.
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http://dx.doi.org/10.1016/j.ijporl.2021.110655DOI Listing
April 2021

Clinical and Genetic factors associated with the Breast cancer-related Sleep Disorders: The "CAGE-Sleep" study- a cross-sectional study.

J Pain Symptom Manage 2021 Feb 22. Epub 2021 Feb 22.

Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Laboratoire de Pharmacologie, Pharmacie Clinique et Contrôle de Qualité des Médicaments, Saint-Joseph University, Beirut, Lebanon.

Context: Despite being among the most reported concerns in breast cancer patients, sleep disturbances are still poorly assessed and managed in routine clinical practice. Correctly evaluating these symptoms and understanding the underlying clinical and genetic factors would help medical teams develop an adequate treatment strategy for each patient.

Objectives: i. To explore the severity of insomnia as well as sleep quality in a sample of Lebanese women with breast cancer undergoing chemotherapy; ii. To examine the correlation between sociodemographic, clinical, psychiatric (anxiety and depression), genetic factors, and alterations in sleep patterns.

Methods: A cross-sectional study was carried out using the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) (December 2017-June 2019; Ethical reference number: CEHDF1016). All patients gave their written consent and were genotyped for several polymorphisms in CLOCK, CRY2, PER2, COMT, DRD2, OPRM1, and ABCB1 genes using Lightcycler®(Roche).

Results: Our sample included a total of 112 women. Almost half of the patients reported insomnia problems (with 20.5% moderate insomnia and 7.1% severe insomnia). Multivariable analyses taking the PSQI score as the dependent variable, showed that higher depression score and dyslipidemia (yes versus no) were significantly associated with higher PSQI scores (worse sleep quality), whereas having the DRD2 CT genotype versus CC and a higher chemotherapy cycle number were significantly associated with lower PSQI scores (better sleep quality). Depression was also significantly associated with higher ISI scores. When forcing all the genes in each model, the results remained the same except for depression that has been replaced by anxiety in the multivariable analysis.

Conclusion: Our study confirms the relationship between anxiety/depression, cycle number, dyslipidemia and DRD2 polymorphism with insomnia and highlights the importance of treating all associated factors to improve the overall QOL of patients.
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http://dx.doi.org/10.1016/j.jpainsymman.2021.02.022DOI Listing
February 2021

Association between problematic social media use and memory performance in a sample of Lebanese adults: the mediating effect of anxiety, depression, stress and insomnia.

Head Face Med 2021 Feb 23;17(1). Epub 2021 Feb 23.

Research and Psychology Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.

Background: Psychological factors such as depression, anxiety, stress and insomnia and problematic social media use are able to alter our memories and might have an impact on memory function and retrieval. More studies are needed to better understand the relationship between memory performance and mental health disorders, especially the ones that could be related to problematic social media use. The objective of this study was to evaluate any association between problematic social media use, depression, anxiety, stress, and insomnia vs memory performance among a representative sample of Lebanese people.

Methods: This cross-sectional study, conducted between January and May 2019, enrolled 466 community dwelling participants using a proportionate random sample from all Lebanese governorates. The questionnaire consisted of the following measures: the Memory Awareness Rating Scale (MARS) to assesses views of memory performance, the problematic social media use scale to measure the degree of addiction to social media, the Hamilton depression rating scale and Hamilton anxiety scale to assess depression and anxiety respectively, the Beirut Distress Scale to assess stress and the Lebanese Insomnia sale to assess insomnia. The data analysis was performed using the SPSS software version 25. A linear regression was conducted, taking the memory performance scale as the dependent variable. A mediation analysis was performed to test the effect of problematic social media use on memory performance mediated by depression, anxiety, stress and insomnia.

Results: Higher problematic social media use (Beta = - 0.21) and higher anxiety (Beta = - 0.25) were significantly associated with lower memory performance. The association between problematic social media use and memory performance was partially mediated by anxiety (21.19%) but not depression, stress or insomnia.

Conclusion: Concerning problematic social media use, a clear correlation was demonstrated in this study linking it to lower memory performances. Future studies should evaluate the possible mechanisms and methods for effective awareness especially towards the younger generation.
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http://dx.doi.org/10.1186/s13005-021-00260-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901207PMC
February 2021

Association between problematic social media use and memory performance in a sample of Lebanese adults: the mediating effect of anxiety, depression, stress and insomnia.

Head Face Med 2021 Feb 23;17(1). Epub 2021 Feb 23.

Research and Psychology Departments, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.

Background: Psychological factors such as depression, anxiety, stress and insomnia and problematic social media use are able to alter our memories and might have an impact on memory function and retrieval. More studies are needed to better understand the relationship between memory performance and mental health disorders, especially the ones that could be related to problematic social media use. The objective of this study was to evaluate any association between problematic social media use, depression, anxiety, stress, and insomnia vs memory performance among a representative sample of Lebanese people.

Methods: This cross-sectional study, conducted between January and May 2019, enrolled 466 community dwelling participants using a proportionate random sample from all Lebanese governorates. The questionnaire consisted of the following measures: the Memory Awareness Rating Scale (MARS) to assesses views of memory performance, the problematic social media use scale to measure the degree of addiction to social media, the Hamilton depression rating scale and Hamilton anxiety scale to assess depression and anxiety respectively, the Beirut Distress Scale to assess stress and the Lebanese Insomnia sale to assess insomnia. The data analysis was performed using the SPSS software version 25. A linear regression was conducted, taking the memory performance scale as the dependent variable. A mediation analysis was performed to test the effect of problematic social media use on memory performance mediated by depression, anxiety, stress and insomnia.

Results: Higher problematic social media use (Beta = - 0.21) and higher anxiety (Beta = - 0.25) were significantly associated with lower memory performance. The association between problematic social media use and memory performance was partially mediated by anxiety (21.19%) but not depression, stress or insomnia.

Conclusion: Concerning problematic social media use, a clear correlation was demonstrated in this study linking it to lower memory performances. Future studies should evaluate the possible mechanisms and methods for effective awareness especially towards the younger generation.
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http://dx.doi.org/10.1186/s13005-021-00260-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7901207PMC
February 2021

COVID-19 pandemic and mental health in Lebanon: a cross-sectional study.

Int J Psychiatry Clin Pract 2021 Feb 15:1-12. Epub 2021 Feb 15.

Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.

Objectives: To evaluate depression, stress, anxiety and obsessive-compulsive behaviours in the Lebanese population in response to COVID-19 pandemic.

Methods: This cross-sectional study was conducted between March and April 2020 on 386 participants randomly recruited from Lebanese general population.

Results: Following the evolution of the COVID-19 pandemic in Lebanon compared to was not significantly associated with higher stress, higher depression, lower obsessive-compulsive traits, higher anxiety. Moreover, higher compulsion (Beta = 0.092), having a university level of education (Beta = 0.573), intermediate income (Beta = 1.889), following the evolution of the COVID-19 pandemic in Lebanon all of the time (Beta = 7.064), most of the time (Beta = 5.592), sometimes (Beta = 4.235) and little of the time (Beta = 7.676) were significantly associated with a higher hygienic prevention practices score. Higher age (Beta = -0.051), being a male (Beta = -1.432), higher depression (Beta = -0.083) and practicing religion some of the time (Beta = -0.826) were significantly associated with a lower hygienic prevention practices score.

Conclusion: This study found a strong interrelationship between psychological stress, depression, anxiety and obsessive-compulsive traits during the COVID-19 pandemic and identified the most vulnerable sub-groups in the Lebanese population. Additional measures should be deployed by health authorities in Lebanon and worldwide to face the impact of COVID-19 pandemic on mental health. Key points Following the evolution of the COVID-19 pandemic in Lebanon compared to not was significantly associated with higher stress, higher depression, lower obsessive-compulsive disorder, higher anxiety. Higher compulsion, having a university level of education, following the evolution of the COVID-19 pandemic in Lebanon were significantly associated with a higher hygienic prevention practices score. Higher depression, male gender, and practicing religion some of the time were significantly associated with a lower hygienic prevention practices score. Additional measures should be deployed by health authorities in Lebanon and worldwide to face the impact of COVID-19 pandemic on mental health.
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http://dx.doi.org/10.1080/13651501.2021.1879159DOI Listing
February 2021

Orthorexia nervosa and its association with alexithymia, emotion dysregulation and disordered eating attitudes among Lebanese adults.

Eat Weight Disord 2021 Feb 11. Epub 2021 Feb 11.

Institute of Psychology, University of Wroclaw, Wroclaw, Poland.

Objective: This study aims to explore whether orthorexia nervosa, like other eating disorders, is associated with difficulties identifying, describing, and regulating one's own emotions among a sample of Lebanese adults.

Methods: A cross-sectional study was conducted during October 2020, during the lockdown period imposed by the government for the COVID-19 pandemic. All participants above 18 years of age were allowed to participate in this study. A total of 787 Lebanese adults out of 920 (85.54%) completed an online survey including Arabic versions of the ORTO-R measure of orthorexia, the Toronto Alexithymia Scale, the Difficulty in Emotion Regulation Scale, and the Eating Attitudes Test.

Results: After making sure that all norms are verified, hierarchical linear regressions were conducted to evaluate the association between disordered eating attitudes (EAT scores) and ON (model 1), and after controlling for difficulties in emotion regulation (DERS score) (model 2). Model 1 accounted for 15.1% of the variance of ON (adj. R = 0.151, F(1, 786) = 140.06, p < 0.001) and showed that higher levels of disordered eating (higher EAT scores) (β = 0.15) were significantly associated with more ON tendencies and behaviors. When adding the DERS total score to the model, Model 2 was a much better fit with 17.7% of the variance of ON (adj. R = 0.177, F(2, 786) = 84.44, p < 0.001), with higher levels of emotion dysregulation (higher DERS scores) (β = 0.06) and more disordered eating attitudes (higher EAT scores) (β = 0.13) were associated with higher levels of ON (Table 5).

Conclusion: The present research suggests that people with high ON tendencies experience troubles recognizing, regulating, and describing their emotions, similarly to other disordered eating.

Level Of Evidence: 5.
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http://dx.doi.org/10.1007/s40519-021-01112-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7877311PMC
February 2021

Adaptation of the Young Adults' Cigarette Dependence (YACD) Scale for the development and validation of the Adolescent Cigarette Dependence Scale (ACDS).

Environ Sci Pollut Res Int 2021 Feb 4. Epub 2021 Feb 4.

INSPECT-LB: Institut National de Santé Publique, Épidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.

Vulnerable adolescents may lose control over cigarette use within a day or two after smoking their first cigarette, as nicotine dependence (ND) symptoms may appear before actual daily smoking and usually occur at low levels of daily smoking. Moreover, smoking can cause illnesses and promote other types of substance abuse. Therefore, it was deemed essential to adapt the Young Adults' Cigarette Dependence (YACD) Scale to develop and validate the Adolescent Cigarette Dependence Scale (ACDS) in Lebanese adolescents and evaluate whether cumulative cigarette smoking is associated with nicotine dependence and symptoms of dependence. A cross-sectional study was carried out between August and September 2020, during the partial sanitary lockdown imposed by the government to limit COVID-19, coinciding with the summer holidays for most Lebanese. The total sample consisted of 564 community-dwelling adolescents aged 13 to 18. A factor analysis was performed using a varimax rotation. The Kaiser-Meyer-Olkin (KMO) measurement of sampling adequacy and Bartlett's sphericity test were appropriate. The factors retained corresponded to Eigenvalues > 1. Cronbach's alpha value represented the internal consistency of the scale. The Hooked on Nicotine Checklist (HONC) was used to screen for dependence symptoms. All items of the YACD were extracted, except for items 4 (smoking to concentrate at work) and 18 (smoking as a habit), which yielded a three-factor solution (factor 1 = smoking patterns; factor 2 = positive and negative reinforcements; factor 3 = smoking cessation) with Eigenvalues > 1 (variance explained = 56.18%; KMO = 0.784; Bartlett's sphericity test p < 0.001; α = 0.875). The newly generated scale was termed Adolescent Cigarette Dependence Scale (ACDS) and consisted of 19 items. Higher ACDS scores (higher cigarette dependence) were significantly associated with higher HONC scores (higher symptoms of dependence) (rho = 0.647; p < 0.001). Having deceased (B = 8.54) or divorced (B = 4.26) parents and higher cumulative cigarette smoking (B = 0.29) were significantly associated with higher ACDS scores. Higher cumulative cigarette smoking (B = 0.05) was significantly associated with higher HONC scores due to cigarettes. This study could validate a new tool to evaluate nicotine dependence among Lebanese adolescents, the Adolescent Cigarette Dependence Scale (ACDS). This version adapted from the Young Adults' Cigarette Dependence (YACD) Scale is reliable and valuable and correlates well with other scales, such as the HONC. However, further studies are necessary to improve this instrument, adding new questions useful for the diagnosis and evaluation of cigarette dependence.
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http://dx.doi.org/10.1007/s11356-021-12667-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7861582PMC
February 2021

Hygiene hypothesis: association between hygiene and asthma among preschool children in Lebanon.

Allergol Immunopathol (Madr) 2021 2;49(1):135-145. Epub 2021 Jan 2.

Institut National de Santé Publique (INSPECT-LB), Epidémiologie Clinique et Toxicologie - Liban, Beirut, Lebanon.

Objectives: To validate a scale to assess the hygiene hypothesis and the association between hygiene and asthma among Lebanese preschool children aged 3-5 years.

Methods: This cross-sectional study, conducted between November 2018 and March 2019, enrolled 515 preschool children. Asthma and potential risk factors, including hygiene, were assessed using a standardized questionnaire. A specific hygiene hypothesis scale has been generated and validated for this purpose.

Results: The hygiene hypothesis scale items converged over a solution of nine factors that had an Eigenvalue over 1, explaining a total of 65.86% of the variance. An acceptable Cronbach's alpha value was recorded for the hygiene hypothesis scale (0.696). Variables correlated with higher odds of asthma were male gender (ORa = 0.41 for females), living near a prairie sprayed with pesticides (ORa = 3.09), having a heating system in the bedroom compared to the sitting room (ORa = 9.97), attending kindergarten (ORa = 2.80), having a mother who smokes waterpipe compared to not smoking (ORa = 3.34), having a mother with a history of asthma (ORa = 5.50), and having respiratory infections (ORa = 14.72). However, the hygiene hypothesis score was not associated with higher odds of asthma (p = 0.881).

Conclusions: The current results suggested that neither home cleaning nor personal cleanliness was correlated with asthma in preschool children. Larger prospective studies that measure the intensity and duration of exposure to each toxicant are suggested to better assess the hygiene hypothesis items and their association with asthma.
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http://dx.doi.org/10.15586/aei.v49i1.41DOI Listing
January 2021

Prevalence of asthma, its correlates, and validation of the Pre-School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon.

Allergol Immunopathol (Madr) 2021 2;49(1):40-49. Epub 2021 Jan 2.

INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban, Beirut, Lebanon.

Objectives: The Asthma Risk Factor Scale (ARFS) is used to screen for asthma in Lebanese preschool children (aged 3-16 years). The study objective was to describe factors associated with asthma, confirm ARFS score validity among Lebanese preschool children, and develop a risk score for asthma diagnosis in this age group (Pre-School Asthma Risk Factor Scale [PS-ARFS]).

Methods: A cross-sectional study enrolled 515 preschool children (November 2018 and March 2019). The ARFS is a 15-item tool that assesses children's environmental exposure, parental history of asthma, and dietary habits.

Results: The percentage of asthmatic children was 8.2%. Higher odds of asthma in children were associated with living near a prairie sprayed with pesticides (odds ratio [OR] = 2.33), playing outdoors (OR = 2.89), having a heater in the bedroom (OR = 10.73), attending a nursery (OR = 2.91), having a mother who smokes cigarettes (OR = 3.35) or water pipe (OR = 2.46), a sister with a history of seasonal allergy (OR = 6.81), and a parental history (mother and father) of asthma (OR = 6.15 and OR = 9.83, respectively). Higher ARFS scores (OR = 1.144) were associated with higher odds of asthma. Accordingly, the PS-ARFS was created according to the following formula: ARFS score + (playing outdoor × 2.4) + (heating system in the bedroom × 12.9) + (having attended a nursery × 2.5) (area under the curve = 0.908 [0.860-0.957]; P < 0.001); at value: 14.20, Se = 84.3% and Sp = 90.9%.

Conclusion: PS-ARFS is suggested for screening of asthma in preschool children in an epidemiological setting and in the absence of spirometry.
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http://dx.doi.org/10.15586/aei.v49i1.25DOI Listing
January 2021

Prevalence of asthma, its correlates, and validation of the Pre-School Asthma Risk Factors Scale (PS-ARFS) among preschool children in Lebanon.

Allergol Immunopathol (Madr) 2021 2;49(1):40-49. Epub 2021 Jan 2.

INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban, Beirut, Lebanon.

Objectives: The Asthma Risk Factor Scale (ARFS) is used to screen for asthma in Lebanese preschool children (aged 3-16 years). The study objective was to describe factors associated with asthma, confirm ARFS score validity among Lebanese preschool children, and develop a risk score for asthma diagnosis in this age group (Pre-School Asthma Risk Factor Scale [PS-ARFS]).

Methods: A cross-sectional study enrolled 515 preschool children (November 2018 and March 2019). The ARFS is a 15-item tool that assesses children's environmental exposure, parental history of asthma, and dietary habits.

Results: The percentage of asthmatic children was 8.2%. Higher odds of asthma in children were associated with living near a prairie sprayed with pesticides (odds ratio [OR] = 2.33), playing outdoors (OR = 2.89), having a heater in the bedroom (OR = 10.73), attending a nursery (OR = 2.91), having a mother who smokes cigarettes (OR = 3.35) or water pipe (OR = 2.46), a sister with a history of seasonal allergy (OR = 6.81), and a parental history (mother and father) of asthma (OR = 6.15 and OR = 9.83, respectively). Higher ARFS scores (OR = 1.144) were associated with higher odds of asthma. Accordingly, the PS-ARFS was created according to the following formula: ARFS score + (playing outdoor × 2.4) + (heating system in the bedroom × 12.9) + (having attended a nursery × 2.5) (area under the curve = 0.908 [0.860-0.957]; P < 0.001); at value: 14.20, Se = 84.3% and Sp = 90.9%.

Conclusion: PS-ARFS is suggested for screening of asthma in preschool children in an epidemiological setting and in the absence of spirometry.
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http://dx.doi.org/10.15586/aei.v49i1.25DOI Listing
January 2021

Economic Burden of Urinary Tract Infections From Antibiotic-Resistant Escherichia coli Among Hospitalized Adult Patients in Lebanon: A Prospective Cohort Study.

Value Health Reg Issues 2021 Jan 22;24:38-46. Epub 2021 Jan 22.

Quality and Safety Department, Nabatieh Governmental Hospital, Nabatieh, Lebanon.

Objectives: The rising incidence of urinary tract infections (UTIs) attributable to Escherichia coli resistant isolates is becoming a serious public health concern. Although global rates of infection vary considerably by region, the growing prevalence of this uropathogen has been associated with a high economic burden and health strain. This study aims: (1) to estimate the differences in clinical and economic outcomes between 2 groups of adult hospitalized patients with UTIs from E. coli resistant and susceptible bacteria and (2) to investigate drivers of this cost from a payer's perspective.

Methods: A prospective multicenter cohort study was conducted in 10 hospitals in Lebanon. The cost analysis followed a bottom-up microcosting approach; a linear regression was constructed to evaluate the predictors of hospitalization costs and a Cox proportional hazards model was used to estimate the impact of resistance on length of stay (LOS) and in-hospital mortality.

Results: Out of 467 inpatients, 250 cases were because of resistant E. coli isolates. Results showed that patients with resistant uropathogens had 29% higher mean total hospitalization costs ($3429 vs $2651; P = .004), and an extended median LOS (6 days vs 5 days; P = .020) compared with susceptible cohorts. The selection of resistant bacteria and the Charlson comorbidity index predicted higher total hospitalization costs and in-hospital mortality.

Conclusion: In an era of increased pressure for cost containment, this study showed the burden of treating UTIs resulting from resistant bacteria. The results can inform cost-effectiveness analyses that intend to evaluate the benefit of a national action plan aimed at decreasing the impact of antibiotic resistance.
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http://dx.doi.org/10.1016/j.vhri.2020.01.006DOI Listing
January 2021

Relationships between inappropriate eating habits and problematic alcohol use, cigarette and waterpipe dependence among male adolescents in Lebanon.

BMC Public Health 2021 Jan 15;21(1):140. Epub 2021 Jan 15.

INSPECT-LB: Institut National de Santé Publique, Epidemiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.

Background: it is important to investigate the relationship between disordered eating in male adolescents and smoking and alcohol consumption as they are risk factors to other diseases as well. For example, high levels of alcohol accompanied by the acidic damage and nutritional deficit exhibited in people with disordered eating habits - due to induced vomiting - has been shown to increase risk of esophageal cancer. Considering the very few studies done on disordered eating prevailing in males and the prevalence of smoking and drinking habits, our study aims to investigate the correlation between inappropriate eating habits and one's dependence on cigarettes, waterpipes, and alcohol all the while focusing on male adolescents.

Methods: This was a cross-sectional observational study that enrolled 389 male students (13-17 years of age) drawn from five Lebanese schools between October and December 2019.

Results: The MANCOVA analysis was performed taking the addiction scales as the dependent variables and the EAT-26 score as an independent variable, adjusting for the covariates (age, BMI and household crowding index). Higher EAT-26 scores (more inappropriate eating attitudes) were significantly associated with higher waterpipe dependence (B = 0.11; CI 0.06-0.17) and more problematic alcohol use (B = 0.08; CI 0.04-0.12), but not cigarette dependence.

Conclusions: This study revealed an association between inappropriate eating and increased drinking and smoking the waterpipe, but not cigarettes. The manifestation of inappropriate eating habits was found to be significant among male adolescents; in the literature, this is also true for female adolescents. In Lebanon, the engagement of adolescents in alcohol drinking and waterpipe smoking is frequent as they are accessible due to the lack of law enforcement and supervision in the country. In addition, while this study found an association between inappropriate eating habits and dependency on smoking and drinking, further investigation should be done on the role of one's psychology in their exhibition of disordered eating as means to prevent the manifestation of these habits.
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http://dx.doi.org/10.1186/s12889-021-10184-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7809860PMC
January 2021

Food neophobia in Lebanese children: scale validation and correlates.

Public Health Nutr 2021 Jan 12:1-9. Epub 2021 Jan 12.

Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.

Objective: To validate the Food Neophobia Scale (FNS) and determine factors associated with the presence of food neophobia (FN) in a sample of Lebanese children.

Design: Cross-sectional study conducted between July and December 2019.

Setting: All Lebanese governorates.

Participants: Parents of Lebanese children aged 2 to 10 years.

Results: Out of 850 questionnaires, 194 were excluded. The mean age of children was 5·34 ± 2·20 years (50·8 % females); 238 (36·4 %) had low neophobia scores (≤37), whereas 219 (33·5 %) and 197 (30·1 %) had, respectively, moderate (between 38 and 41) and severe neophobia scores (≥42). All items of the FNS were extracted except item 8 and yielded a two-factor solution with Eigenvalues > 1 (variance explained = 51·64 %; Kaiser-Meyer-Olkin (KMO) test = 0·746; Bartlett's sphericity test P < 0·001; αCronbach = 0·739). Children who refused initially to eat vegetables (β = 5·51), fish (β = 4·57), fruits (β = 4·75) or eggs (β = 2·99) and higher parents' instrumental feeding scores (β = 0·3) were significantly associated with higher neophobia scores, whereas higher parents' encouragement scores (β = -0·21) were significantly associated with lower neophobia scores in children.

Conclusion: FN is common in children. Neophobic children tend to have lower variety in their diets. One of the ways to lower the levels of neophobia is the use of encouragement by the parents. In contrast, offering a reward to children for them to eat a certain food was associated with more signs of avoidance. More studies should be conducted to evaluate awareness levels concerning FN.
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http://dx.doi.org/10.1017/S1368980021000082DOI Listing
January 2021

Rapid tranquillisation in a psychiatric emergency hospital in Lebanon: TREC-Lebanon - a pragmatic randomised controlled trial of intramuscular haloperidol and promethazine intramuscular haloperidol, promethazine and chlorpromazine.

Psychol Med 2021 Jan 6:1-9. Epub 2021 Jan 6.

Institute of Mental Health, University of Nottingham, Nottingham, Nottinghamshire, UK.

Background: Agitated patients constitute 10% of all emergency psychiatric treatment. Management guidelines, the preferred treatment of clinicians differ in opinion and practice. In Lebanon, the use of the triple therapy haloperidol plus promethazine plus chlorpromazine (HPC) is frequently used but no studies involving this combination exists.

Method: A pragmatic randomised open trial (September 2018-July 2019) in the Lebanese Psychiatric Hospital of the Cross in Beirut Lebanon involving 100 people requiring urgent intramuscular sedation due to aggressive behaviour were given intramuscular chlorpromazine 100 mg plus haloperidol 5 mg plus promethazine 25 mg (HPC) or intramuscular haloperidol 5 mg plus promethazine 25 mg.

Results: Primary outcome data were available for 94 (94%) people. People allocated to the haloperidol plus promethazine (HP) group showed no clear difference at 20 min compared with patients allocated to the HPC group [relative risk (RR) 0.84, 95% confidence interval (CI) 0.47-1.50].

Conclusions: Neither intervention consistently impacted the outcome of 'calm', or 'asleep' and had no discernible effect on the use of restraints, use of additional drugs or recurrence. If clinicians are faced with uncertainty on which of the two intervention combinations to use, the simpler HP is much more widely tested and the addition of chlorpromazine adds no clear benefit with a risk of additional adverse effects.
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http://dx.doi.org/10.1017/S0033291720004869DOI Listing
January 2021

The Prevalence of Orthorexia Nervosa in Polish and Lebanese Adults and Its Relationship with Sociodemographic Variables and BMI Ranges: A Cross-Cultural Perspective.

Nutrients 2020 Dec 17;12(12). Epub 2020 Dec 17.

Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.

The prevalence of orthorexia nervosa (ON) appears to be increasing, and more research into its cross-cultural aspects is required to provide culturally appropriate psychological treatment. Until now, there has been relatively little research published about ON across cultures. Therefore, the objectives of the present study were to determine: (1) the prevalence of ON in Polish and Lebanese adults and (2) the association between ON and sociodemographic variables and Body Mass Index (BMI) in two culturally different samples. One thousand two hundred and sixty-two adults participated in the present study ( = 743 adults; = 519 adults). The Düsseldorf Orthorexia Scale and the Eating Habits Questionnaire were used in the present study. Information about age, sex, anthropometry, and marital status was obtained from all participants as well. The Polish sample had an ON prevalence rate of 2.6%, while the Lebanese sample had an ON prevalence rate of 8.4%. No significant correlation was found between ON and age in both samples. A statistically significant difference was found between marital status and country on ON, with the highest mean score seen among Lebanese singles. In Lebanon, having a low of BMI ≤ 25 kg/m compared to a high BMI was significantly associated with lower ON tendencies, while this association was not significant among Polish participants. This study was the second to focus on the prevalence of ON in Western and non-Western countries and its association with sociodemographic characteristics and BMI ranges. Knowledge about ON and its correlates in diverse populations may inform the design of culturally tailored behavior change interventions and the development of culturally appropriate tools in various groups to improve their dietary patterns.
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http://dx.doi.org/10.3390/nu12123865DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767210PMC
December 2020

Arabic version of the Hayling sentence completion test: scale validation, normative data and factors associated with executive functions in a sample of the Lebanese adults.

Head Face Med 2020 Dec 11;16(1):36. Epub 2020 Dec 11.

Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.

Background: This study was conducted for several reasons, primarily because of the lack of an Arabic version of the HSCT that could be beneficial in our clinical practice. Another reason is the need to find potential relationships between various factors with executive functions, especially problematic mobile phone use as suggested by many previous studies, since smartphones have become, nowadays, a daily companion of people from all generations. Thus, it is important to conduct this study in Lebanon to be adapted to the ideas, customs and social behavior of the Lebanese citizens. Hence, the objectives of the current study are to use the Arabic version of the HSCT in healthy community-dwelling Arabic-speaking adults in Lebanon, to check its validity compared to other versions of the test, as well as to identify risk factors that might affect the executive functions in these adults.

Methods: Between August-December 2019, 350 participants were randomly selected. The Arabic version of the HSCT, divided into automatic and inhibition conditions, was used; in each condition, participants' response-time and number of errors committed were recorded.

Results: None of the scale items was removed. For the automatic condition, response-time items converged over one factor (α = 0.905) and number of errors converged over seven factors (α = 0.334). For the inhibition condition, response-time converged over one factor (α = 0.943) and number of errors converged over four factors (α = 0.728). Using electricity as a heating method inside the house was significantly associated with a lower response-time, whereas higher problematic mobile phone use was associated with higher response-time. Using wood as a heating system inside the house and higher problematic mobile phone use were associated with higher number of errors, while using Arabian incense (bakhour) inside the house was associated with lower number of errors.

Conclusion: We were able to set normative data for the HSCT Arabic version for use in the Lebanese population. Problematic mobile phone use was associated with lower inhibitory control in terms of response-time and errors number.
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http://dx.doi.org/10.1186/s13005-020-00251-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7730776PMC
December 2020

Video gaming addiction and its association with memory, attention and learning skills in Lebanese children.

Child Adolesc Psychiatry Ment Health 2020 Dec 12;14(1):46. Epub 2020 Dec 12.

Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.

Background: Examining whether any association exists between addiction to video games and cognitive abilities in children could inform ongoing prevention and management of any possible harm. The objective of this study was to investigate the associations between addiction to video games, and memory, attention and learning abilities among a sample of Lebanese school children.

Methods: This cross-sectional study, conducted between January and May 2019, enrolled 566 school children aged between 9 and 13 years. Three private schools were chosen conveniently for this study. Students were randomly chosen from the list given by the school administration. The students' parents are those who responded to the questionnaire.

Results: The results showed that higher addiction to video gaming salience was significantly associated with worse episodic memory, problem solving, basic reading skills, written expression skills and worse clinical attention. Higher addiction to video gaming tolerance were significantly associated with worse novel problem solving and worse attention. Higher addiction to video gaming withdrawal were significantly associated with worse attention, factual memory, attention, processing speed, visual spatial organization, sustained sequential processing, working memory, novel problem solving and worse written expression skills.

Conclusion: The results suggest a correlation between addiction to video games and worse memory, attention, as well as cognitive and academic abilities among school children. Those findings indicate the need for more extensive research, and serve to highlight vital next steps needed in future papers, such as identifying predicting factors that could aid in early detection of video gaming addiction in children.
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http://dx.doi.org/10.1186/s13034-020-00353-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733285PMC
December 2020

Prescription and dispensing guidelines in Lebanon: initiative of the Order of Pharmacists of Lebanon.

J Pharm Policy Pract 2020 Nov 6;13(1):70. Epub 2020 Nov 6.

INSPECT-LB, Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie-Liban, Beirut, Lebanon.

Background: In Lebanon, difficulties in accessing medications are due to two main barriers, mainly: high cost and the lack of medication safety, related to poor-quality (irrational) prescription and use. The objective of this work is to suggest guidelines to implement a unified medical prescription in Lebanon. These guidelines are expected to promote medication safety and decrease pharmaceutical expenditures in the Lebanese context.

Methods: The Order of Pharmacists of Lebanon (OPL) developed a comprehensive set of guidelines for physicians and pharmacists, including a detailed workflow process to improve the use of the unified medical prescription. The guidelines were presented to the Lebanese Ministry of Public Health (MOPH).

Results: The project covered prescription guidelines to physicians (handwritten and electronic-prescriptions), and medication dispensing and generic substitution guidelines to pharmacists. Prescription guidelines included all required information about both the prescribing physician and the patient with the maximum of details, comprehensibility, and caution regarding specific populations/co-morbidities/co-prescriptions. Dispensing guidelines included details for safe and appropriate treatment dispensing, pearls for medications' counseling and generic substitution, as well as specific consideration for at-risk populations or those with concomitant medications and co-morbidities. Finally, a suggested workflow clarified the process for improving the unified medical prescription.

Conclusions: The implementation of the guidelines should now be formally evaluated, to assess if they achieve the aims to reduce prescribing and dispensing errors, to improve the quality of medicines' prescription and use, the patient care, and the interaction between all stakeholders.
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http://dx.doi.org/10.1186/s40545-020-00273-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644285PMC
November 2020

A case report of thyroid-associated Orbitopathy with elevated TPO antibodies.

BMC Endocr Disord 2020 Nov 27;20(1):176. Epub 2020 Nov 27.

Bahman Hospital, Beirut, Lebanon.

Background: Thyroid associated orbitopathy (TAO) is defined as an immune mediated inflammatory process affecting the extraocular muscles, connective and adipose tissue of uncertain etiopathogenesis. TAO are classically described in Grave's disease (GD) however it may occur in euthyroid and hypothyroid patients. Those patients usually test positive for Thyroid Stimulating Hormone receptor antibodies (TRAb). For instance, only few cases of severe Hashimoto's thyroiditis (HT) associated orbitopathy with negative TRAb are reported to date.

Case Presentation: Herewith we report a rare case of a middle-aged female who presented with bilateral progressive upper and lower palpebral edema and a unilateral marked proptosis associated with asthenia, headache and decrease in visual acuity. Biological investigation was notable for high levels of anti-thyroid peroxidase antibodies (Anti-TPO) in an otherwise euthyroid patient with negative TRAb. Orbital Magnetic resonance imaging revealed edema of the extraocular muscles and inflammation of periorbital soft tissue. The patient received a treatment with intravenous methylprednisolone followed by oral treatment with prednisone. This regimen was both effective and safe with minimal metabolic side effects in our patient.

Conclusion: Minor ocular manifestations of HT are common; however, severe sight threatening ophtalmopathy in the absence of TRAb is rare. Multiple differential diagnosis should be considered and investigated before diagnosing this rare entity. Management of similar cases is currently based on reports and no clear guidelines have been elaborated, corticosteroids is the mainstream of treatment with a potential benefit of selenium supplementation in mild to moderate cases.
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http://dx.doi.org/10.1186/s12902-020-00658-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7693503PMC
November 2020