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Rita Georges Nohra,1– 3 Taghrid Chaaban,1,4 Hala Sacre,3 Pascale Salameh,3,5– 7 Zeina Aoun Bacha,8 Beatrice Le Bon Chami,9 Fadi Abou Rizk,10 Paul Makhlouf,11 Monique Rothan-Tondeur1,12 1Chaire Recherche Sciences Infirmières, Laboratoire Educations et Promotion de la santé, LEPS, Université Sorbonne Paris Nord, Villetaneuse, France; 2Faculty of Public Health, Lebanese University, Fanar, Lebanon; 3Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban, INSPECT-LB, Beirut, Lebanon; 4Faculty of Public Health, Islamic University of Lebanon, Khaldeh - Beirut, Lebanon; 5School of Medicine, Lebanese Amerian University, Byblos, Lebanon; 6Department of Research, Faculty of Pharmacy, Lebanese University, Hadat, Lebanon; 7Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, 2417, Cyprus; 8Department of Pulmonary Disease,Faculty of Medicine, Saint Joseph University, Beirut, Lebanon; 9Department of Pulmonary Disease, Maritime Hospital, Jbeil, Lebanon; 10Department of Pulmonary Disease, American University Medical Center Rizk Hospital, Beirut, Lebanon; 11Department of Pulmonary Disease, Notre Dame du Liban Hospital, Jounieh, Lebanon; 12Chaire Recherche Sciences Infirmières, AP-HP, Paris, FranceCorrespondence: Rita Georges Nohra, Université Sorbonne Paris Nord, Chaire Recherche Sciences Infirmières, Laboratoire Educations et Promotion de la santé, LEPS, 74 Rue Marcel Cachin, Villetaneuse, 93000, France, Tel +961 76 144 873 ; +33 7 67 23 36 34, Email Ritag.nohra@gmail.comPurpose: The objective of this study was to investigate the feasibility and pretest the effectiveness of an educational and telemonitoring program in a sample of Lebanese COPD patients to inform the design of a randomized study.Patients and Methods: This study recruited a convenient sample of 15 patients from the pulmonology departments of four hospitals. Validated questionnaires were adapted to meet the context of this study

Purpose. - This study aimed to evaluate the relationship between factors related to COVID-19 confinement (i.e., fear of COVID-19, anxiety, anger, boredom, eating disorders, and duration of confinement) and weight perception in a sample of the Lebanese population. Methods. - A cross-sectional web-based survey carried out at a one-time point between April 3 and 18, 2020, enrolled 407 participants. Due to the imposed lockdown, respondents self-reported their weight and height. One dichotomized question (positive/negative) assessed the perception of weight change (yes = change perception, and no = no change perception). The variation in BMI was calculated by subtracting the estimated weight during confinement from the estimated weight before. Results. - No significant variation in BMI was detected before and during the confinement (p = 0.40), while a perceived weight change was found in 212 (52.1%) participants. The regression analysis showed that higher fear of COVID-19 score (ORa = 0.96) and higher self-reported weight change (ORa = 0.47) were associated with lower weight change perception. However, longer confinement duration (ORa = 1.07), higher anxiety (ORa = 1.05), and high eating concerns (ORa = 1.81) were associated with higher weight change perception. Conclusion. - Our results revealed that both the fear of COVID-19 and self-reported weight change were negatively associated with weight change perception, while higher anxiety and a longer duration of confinement correlated with a higher weight change perception. Further studies are necessary to confirm our findings.

Background : Pharmacists possess a unique and complex body of knowledge, skills, attitudes, and behaviors necessary to enable them to optimize health outcomes. Pharmacy organizations publish routinely updated versions of professional competenc ies that help pharmacy schools integrate advances into their curricula. In Lebanon, no national framework for pharmacy education is officia lly adopted yet. In 2017, the Official Pharmacists’ Association in Lebanon [OPL - Order of Pharmacists of Lebanon] t ook the initiative to develop a pharmacy core competency framework. Objective : The primary objective of this survey was to evaluate graduates' perceptions of pharmacy - related competencies “taught” across Lebanese pharmacy schools/faculties, based on the s uggested Lebanese Pharmacy Competencies Framework. This study also explored the association between graduates' demographics, university attributes, and self - assessed competency performance. Methods : A cross - sectional study involving pharmacists who gradua ted from Lebanese universities was performed through a 40 - minute online questionnaire distributed over social media platforms and groups of pharmacists. Results : Pharmacists perceived their competence as moderate upon graduation, the lowest scores being i n fundamental knowledge and medicine supply; the highest reported scores were in personal skills and safe/rational use of medicines. Moreover, female s, younger graduates, PharmD holders, and pharmacists working in hospitals/clinical settings and academia h ad the highest perception of their competencies. Pharmacists in the public sector and medical laboratory directors had the lowest perception of competence . Conclusions : When comparing the taught curriculum to the suggested Lebanese Pharmacy Competency Fra mework, all domains need to be improved to optimize the perception, education, and practice of pharmacists. It is essential to emphasize fundamental knowledge, medicines supply, and public health competen

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

Background Quarantine/confinement is an effective measure to face the Coronavirus disease 2019 (COVID-19). Consequently, in response to this stressful situation, people confined to their homes may change their everyday eating behavior. Therefore, the primary objective of this study is to evaluate the association between quarantine/confinement stressors and eating behavior during the COVID-19 outbreak. The secondary objective is to compare the association of quarantine/confinement stressors and diet behavior between two groups of participants, those attending diet clinics and those not (general population). Method A cross-sectional web-based online survey carried out between April 3 and 18, 2020, enrolled 407 participants from the Lebanese population. Eating Disorder Examination - Questionnaire (EDE-Q) were used to measure the behavioral features of eating disorders. Results More than half of the sample (53.0%) abide by the home quarantine/confinement, 95.4% were living with someone in the quarantine/confinement, and 39.6% continued to work from home. Higher fear of COVID-19 was found in 182 (44.8%) participants, higher boredom in 200 (49.2%) participants, higher anger in 187 (46.3%), and higher anxiety in 197 (48.5%) participants. Higher fear of COVID-19 (Beta = 0.02), higher BMI (Beta = 0.05), and physical activity (Beta = 1.04) were significantly associated with a higher restraint score. Higher anxiety, higher fear of COVID-19, higher BMI, practicing physical exercise, and a higher number of adults living in the quarantine/confinement were significantly associated with higher shape and weight concerns. Conclusion Our results showed that the fear of COVID-19 was correlated with more eating restraint, weight, and shape concerns in the whole sample, but more specifically in the dietitian clients group. Public health control measures are needed to reduce the detrimental effects of psychological distress associated with quarantine/confinement on eating behaviors during

Background Quarantine/confinement is an effective measure to face the Coronavirus disease 2019 (COVID-19). Consequently, in response to this stressful situation, people confined to their homes may change their everyday eating behavior. Therefore, the primary objective of this study is to evaluate the association between quarantine/confinement stressors and eating behavior during the COVID-19 outbreak. The secondary objective is to compare the association of quarantine/confinement stressors and diet behavior between two groups of participants, those attending diet clinics and those not (general population). Method A cross-sectional web-based online survey carried out between April 3 and 18, 2020, enrolled 407 participants from the Lebanese population. Eating Disorder Examination - Questionnaire (EDE-Q) were used to measure the behavioral features of eating disorders. Results More than half of the sample (53.0%) abide by the home quarantine/confinement, 95.4% were living with someone in the quarantine/confinement, and 39.6% continued to work from home. Higher fear of COVID-19 was found in 182 (44.8%) participants, higher boredom in 200 (49.2%) participants, higher anger in 187 (46.3%), and higher anxiety in 197 (48.5%) participants. Higher fear of COVID-19 (Beta = 0.02), higher BMI (Beta = 0.05), and physical activity (Beta = 1.04) were significantly associated with a higher restraint score. Higher anxiety, higher fear of COVID-19, higher BMI, practicing physical exercise, and a higher number of adults living in the quarantine/confinement were significantly associated with higher shape and weight concerns. Conclusion Our results showed that the fear of COVID-19 was correlated with more eating restraint, weight, and shape concerns in the whole sample, but more specifically in the dietitian clients group. Public health control measures are needed to reduce the detrimental effects of psychological distress associated with quarantine/confinement on eating behaviors during

Background Quarantine/confinement is an effective measure to face the Coronavirus disease 2019 (COVID-19). Consequently, in response to this stressful situation, people confined to their homes may change their everyday eating behavior. Therefore, the primary objective of this study is to evaluate the association between quarantine/confinement stressors and eating behavior during the COVID-19 outbreak. The secondary objective is to compare the association of quarantine/confinement stressors and diet behavior between two groups of participants, those attending diet clinics and those not (general population). Method A cross-sectional web-based online survey carried out between April 3 and 18, 2020, enrolled 407 participants from the Lebanese population. Eating Disorder Examination - Questionnaire (EDE-Q) were used to measure the behavioral features of eating disorders. Results More than half of the sample (53.0%) abide by the home quarantine/confinement, 95.4% were living with someone in the quarantine/confinement, and 39.6% continued to work from home. Higher fear of COVID-19 was found in 182 (44.8%) participants, higher boredom in 200 (49.2%) participants, higher anger in 187 (46.3%), and higher anxiety in 197 (48.5%) participants. Higher fear of COVID-19 (Beta = 0.02), higher BMI (Beta = 0.05), and physical activity (Beta = 1.04) were significantly associated with a higher restraint score. Higher anxiety, higher fear of COVID-19, higher BMI, practicing physical exercise, and a higher number of adults living in the quarantine/confinement were significantly associated with higher shape and weight concerns. Conclusion Our results showed that the fear of COVID-19 was correlated with more eating restraint, weight, and shape concerns in the whole sample, but more specifically in the dietitian clients group. Public health control measures are needed to reduce the detrimental effects of psychological distress associated with quarantine/confinement on eating behaviors during

Objective: This study aims to assess good pharmacy practice (GPP) aspects and compare GPP scores among community pharmacies in Lebanon, using a tool developed jointly by the International Pharmaceutical Federation (FIP) and the World Health Organization (WHO) to improve and maintain standards of pharmacy practice. Methods: Data collection was carried out between July and October 2018 by a team of 10 licensed inspectors who work at the Lebanese Order of Pharmacists (OPL) and visited community pharmacies across Lebanon. The questionnaire was adapted to the Lebanese context and included 109 questions organized under five sections: socio-demographics, Indicator A (data management and data recording), Indicator B (services and health promotion), Indicator C (dispensing, preparation and administration of medicines), and Indicator D (storage and facilities). The value of 75% was considered as the cutoff point for adherence to indicators. Results: Out of 276 pharmacies visited, a total of 250 (90.58%) pharmacists participated in the study with one pharmacist being interviewed in every pharmacy. Results showed that 18.8% of pharmacists were generally adherents to GPP guidelines (scores above the 75% cutoff): 23.3% were adherent to indicator A, 21.6% to indicator B, 14.8% to indicator C and 13.2% to indicator D. Moreover, comparison of GPP scores across geographical regions revealed a higher adherence among community pharmacists working in the Beirut region compared to the North region, the South region, Mount Lebanon, and the Bekaa. Conclusions: Our study shows that community pharmacists in Lebanon do not fulfill GPP criteria set by FIP/WHO, and that this poor adherence is a trend across the country’s geographical regions. Therefore, efforts should be made to raise awareness among pharmacists about the necessity to adhere to GPP guidelines and standards, and train them and support them appropriately to reach that goal. This is the first indicator-based comprehensive pilot as

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

Background Quarantine/confinement is an effective measure to face the Coronavirus disease 2019 (COVID-19). Consequently, in response to this stressful situation, people confined to their homes may change their everyday eating behavior. Therefore, the primary objective of this study is to evaluate the association between quarantine/confinement stressors and eating behavior during the COVID-19 outbreak. The secondary objective is to compare the association of quarantine/confinement stressors and diet behavior between two groups of participants, those attending diet clinics and those not (general population). Method A cross-sectional web-based online survey carried out between April 3 and 18, 2020, enrolled 407 participants from the Lebanese population. Eating Disorder Examination - Questionnaire (EDE-Q) were used to measure the behavioral features of eating disorders. Results More than half of the sample (53.0%) abide by the home quarantine/confinement, 95.4% were living with someone in the quarantine/confinement, and 39.6% continued to work from home. Higher fear of COVID-19 was found in 182 (44.8%) participants, higher boredom in 200 (49.2%) participants, higher anger in 187 (46.3%), and higher anxiety in 197 (48.5%) participants. Higher fear of COVID-19 (Beta = 0.02), higher BMI (Beta = 0.05), and physical activity (Beta = 1.04) were significantly associated with a higher restraint score. Higher anxiety, higher fear of COVID-19, higher BMI, practicing physical exercise, and a higher number of adults living in the quarantine/confinement were significantly associated with higher shape and weight concerns. Conclusion Our results showed that the fear of COVID-19 was correlated with more eating restraint, weight, and shape concerns in the whole sample, but more specifically in the dietitian clients group. Public health control measures are needed to reduce the detrimental effects of psychological distress associated with quarantine/confinement on eating behaviors during

Background Quarantine/confinement is an effective measure to face the Coronavirus disease 2019 (COVID-19). Consequently, in response to this stressful situation, people confined to their homes may change their everyday eating behavior. Therefore, the primary objective of this study is to evaluate the association between quarantine/confinement stressors and eating behavior during the COVID-19 outbreak. The secondary objective is to compare the association of quarantine/confinement stressors and diet behavior between two groups of participants, those attending diet clinics and those not (general population). Method A cross-sectional web-based online survey carried out between April 3 and 18, 2020, enrolled 407 participants from the Lebanese population. Eating Disorder Examination - Questionnaire (EDE-Q) were used to measure the behavioral features of eating disorders. Results More than half of the sample (53.0%) abide by the home quarantine/confinement, 95.4% were living with someone in the quarantine/confinement, and 39.6% continued to work from home. Higher fear of COVID-19 was found in 182 (44.8%) participants, higher boredom in 200 (49.2%) participants, higher anger in 187 (46.3%), and higher anxiety in 197 (48.5%) participants. Higher fear of COVID-19 (Beta = 0.02), higher BMI (Beta = 0.05), and physical activity (Beta = 1.04) were significantly associated with a higher restraint score. Higher anxiety, higher fear of COVID-19, higher BMI, practicing physical exercise, and a higher number of adults living in the quarantine/confinement were significantly associated with higher shape and weight concerns. Conclusion Our results showed that the fear of COVID-19 was correlated with more eating restraint, weight, and shape concerns in the whole sample, but more specifically in the dietitian clients group. Public health control measures are needed to reduce the detrimental effects of psychological distress associated with quarantine/confinement on eating behaviors during

Objective: The objective of this study was to assess the quality of life and the factors associated with it among community pharmacists in Lebanon. Methods: This cross-sectional study was carried out between March and July 2018, enrolling 435 pharmacists, using a proportionate random sample of community pharmacies from all districts of Lebanon. The validated Arabic translation of the Short-Form 12 (SF12v2) was used to derive 2 summary scores: physical and mental component summaries (PCS and MCS). Results: Lebanese community pharmacists scored a mean PCS-12 and MCS-12 of 48.9 (SD 7.1) and 48.8 (SD 8.5), respectively. Higher age (Beta= -0.08), having a PhD degree (Beta= -4.54), higher depression score (Beta= -0.25), higher emotional work fatigue (Beta= -0.13) and higher physical work fatigue (Beta=-0.14) were significantly associated with lower physical QoL (lower PCS-12 scores). Increased stress (Beta= -0.17), higher insomnia (Beta= -0.21), higher depression (Beta= -0.2) and working for over 40 hours per week (Beta= -0.2) were significantly associated with lower mental QoL (lower mental MCS-12 scores). Conclusions: Our research has found a strong correlation between quality of life and psychological factors, including stress, burnout, insomnia, and depression among community pharmacists.

Background: In Lebanon, mandatory continuing education (CE) for pharmacists was implemented in January 2014. Objective: The objectives of this study are to assess 1) the overall adherence to the mandatory CE program, 2) pharmacists’ preferences related to CE, and 3) barriers to adherence to CE. Methods: By the end of October 2017, an evaluation of pharmacists’ participation in the mandatory CE program was conducted using electronic reports available in the Learning Management System (LMS). Descriptive results were presented as frequencies and percentages. In addition, a cross-sectional survey was conducted among pharmacists to better understand their preferences and barriers to their participation to the CE program. Finally, a focus group was organized with pharmacists who did not start their CE. Results: Out of all registered pharmacists in Lebanon, 68.30% started their CE and 25.6% already achieved their required credits. Among pharmacists enrolled in the CE system, the majority (69%) used the online courses at least once. Moreover, CE enrolment was similar among old and young pharmacists except for those newly registered. The majority of pharmacists preferred clinical and pharmacological topics, followed by preventive medicine and transferable skills. Barriers to engaging in CE were mainly work and family obligations, lack of interest, lack of time, and difficulties in commuting and technology use. Conclusion: Although results of the present study are similar to those in developing countries, the resistance to change is higher. The Lebanese Pharmacists Association [Ordre des Pharmaciens du Liban] should develop strategies to motivate and enroll more pharmacists in the CE system, based on the barriers and preferences cited in the results, while continuing to offer high quality and cost-favorable CE programs to Lebanese pharmacists.

Background: The increase in medication use and expansion of the pharmaceutical industry has led to an increase in hazards, errors and adverse events associated with medication use. In Lebanon, medication safety reporting by pharmacists is lacking due to the absence of an official reporting system. Objective: The objective of the Order of Pharmacists of Lebanon (OPL) was to engage pharmacists in reporting the adverse drug reactions by creating an efficient tool for this purpose. Methods: The scientific committee at the OPL worked on designing a reporting tool for adverse drug reactions (ADRs). Results: An electronic platform was created, and several training sessions were conducted for professionals who would be involved in helping community or hospital pharmacists in launching the platform. The form was tuned based on the findings of the Community pharmacists, hospital pharmacists and the general population questionnaires about medication safety culture, to fit the needs of the practice and to be comprehensive and aligned with international validated standards. Conclusion: Pilot testing is ongoing and regular continuing education sessions and sensitization campaigns are planned, in parallel to the official launching of the project in collaboration with the MOPH. This program has important implications in terms of public health, since knowledge and attitudes are viewed as potentially modifiable factors and their improvement is expected to decrease underreporting; the OPL is also hoping to improve the patient safety culture in Lebanon.

Background Studies showed that pharmacists have little experience with adverse drug reactions (ADRs) reporting due to insufficient knowledge of the concept of ADR and pharmacovigilance (PV). There is an urge to assess hospital pharmacists' knowledge in medication safety practices. Objective To evaluate the knowledge, attitude, and practice, among hospital pharmacists in Lebanon concerning ADRs and PV concepts. Methods A cross‐sectional study, conducted between March and July 2016, enrolled 187 hospital pharmacists in all Lebanese districts. Results Concerning knowledge, 60.8% of the pharmacists said that ADR is an injury caused by appropriate and suboptimal care, while 74.6% of them said it can be preventable and nonpreventable. Moreover, 47.5% of them defined PV as being the study that detects, assesses, understands, and prevents adverse effects. Furthermore, 55.1% believed that PV concerns drug, herbal, medical devices, and vaccine problems. Concerning attitude, 61% of the pharmacists said they do not support direct ADR reporting by the patient. Of them, 78.6% confessed that ADR reporting is a professional obligation to them while 88.2% admitted that it is time‐consuming with no outcome. When it comes to practice, 64.2% had been trained to report ADRs. Only 20.8% and 24.2% confessed reporting ADRs more than once a week, respectively. More than half (54.5%) said that they report the ADR to the patient's prescriber. Conclusion Lebanese hospital pharmacists have little knowledge about the concept and process of PV and spontaneous ADRs reporting system. However, these pharmacists have positive attitudes, but very little practice with reporting systems. Educational programs are urgently needed to emphasize the role and responsibility of pharmacists in PV practices and to raise awareness towards ADR reporting process.