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Background: The economic crisis imposed changes to afford necessities like food, housing, and healthcare, leading to a decline in the physical and mental health of the population. Objectives: This study assessed the impact of the economic crisis on Lebanese adults' health-related Quality of Life (QoL) and the predictors of lower scores. Methods: A cross-sectional study targeted 561 adults using a uniform questionnaire for data collection and a Short Form 8-item survey. Results: The sample comprised 77.9% females and 22.1% males. More than half of the sample reported a decrease in their income compared to the period before the crisis, and most participants reported that the economic turmoil highly impacted their access to healthcare services (63.0%), medication (51.5%), and food (56.5%) in addition to other necessities. Participants had lower Mental Component (MC) than Physical Component (PC) scores (55.5 and 69.0, respectively). Those highly impacted by the economic crisis in accessing medication had 1.76 times higher odds of lower PC scores than others (OR 1.76, 95% CI: 1.07–3.21). As regards the impact of the economic crisis on the MC scores, significantly higher odds of a lower MC score were noted among those highly impacted by the economic crisis in terms of access to medication (OR 2.12, 95% CI: 1.14–3.95), to food (OR 1.79, 95% CI: 1.1.12–2.87), and encountering water shortage (OR 1.65, 95% CI: 1.01–2.71). Conclusion: Lebanese adults' QoL suffered physically and psychologically amid the economic crisis. The study underscores the need for accessible and affordable essential healthcare services and necessities. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess (i) the health-related Quality of Life (QoL) of medical students in Lebanon, (ii) its association with their general characteristics, and (iii) to investigate the combined effects of the predictors affecting the quality of life of students. Methods: An observational cross-sectional study was performed over three months, targeting 401 medical students from six universities. The 36-item Short Form survey was used to quantify the different QoL scores. Results: The physical component (PC) domains had higher scores than the mental component (MC) ones (70.2 vs. 55.9). Students aged 30 years or less had higher scores in all the PC domains than older students (70.9 vs. 59.3; p<0.010) but comparable scores in the MC domains (55.6 vs. 59.8; p>0.050). Single students had a significantly higher role-emotional score (63.5 vs. 49.0; p<0.050), and those studying in public universities had greater general health scores (57.7 vs. 53.7; p<0.050). Younger age significantly increased most of the health-related PC scores, and having chronic diseases decreased all the QoL scores except the mental health score. Conclusion: The QoL of medical students was negatively affected during the pandemic, particularly their mental health. Informed educational and health decisions are required to minimize this impact on their academic performance. [ABSTRACT FROM AUTHOR]

Generic drug substitution is a common practice in healthcare systems worldwide to promote cost-saving treatments while maintaining therapeutic effectiveness. Several factors influence this substitution, including regulatory policies, safety and efficacy considerations, patient and physician preferences, and market dynamics. This review comprehensively analyzes how these factors interact and influence generic drug substitution in healthcare settings and across various therapeutic classes and highlight the importance of balancing cost-saving measures with maintaining patient safety and therapeutic efficacy. Policies and guidelines established by health authorities in each country influence the approval, interchangeability, and substitution of generic drugs. Bioequivalence and therapeutic equivalence are critical factors, particularly in drugs with narrow therapeutic indexes. Moreover, physicians' acceptance and willingness to prescribe generic drugs, as well as patient acceptance and compliance with generic drug use, play a vital role in promoting generic substitution. [ABSTRACT FROM AUTHOR]

Background: Pharmacists are crucial in lowering pharmaceutical expenditures by substituting brand-name drugs for generic drugs. They are expected to understand the principles and practices of generic drug substitution for high-quality patient care. Some key areas of knowledge include bioequivalence and therapeutic equivalence, regulatory requirements, drug interchangeability, and adequate patient counseling. Objectives: This study aims to assess the knowledge, perception, and practice of generic drug substitution among pharmacists in Lebanon following the crises and the factors affecting the prescription and selection of generic drugs. Methods: A pilot descriptive cross-sectional study targeting 80 Lebanese pharmacists was conducted over 2 months (September-October 2022), in which data were collected using a uniform survey. Results: Overall, pharmacists had a good knowledge of generic drugs in terms of active ingredients (97.5%), pharmaceutical form (85.0%), lower cost (88.7%), bioequivalence to the brand before (95.0%), and therapeutic equivalence. Nevertheless, 22.5% reported that generic drugs are less safe than brands, and 22.5% said they cause side effects or did not know. Among the possible factors that influence the prescription of generic drugs, 35.0% of pharmacists reported that the financial situation of the patient is among the least important factors, while the lack of possible alternatives (45.0%) and the difference in prices (40.0%) were the most important ones. The price of different generics on the market was among the most important factors (36.3%) affecting the selection of generic drugs, followed by the patient's. preference (26.3%). Only 11.2% considered the information given by pharmaceutical firms could affect their choice, and 10.0% considered the presence or not of excipients with known effects in the formulation. Conclusion: Most pharmacists in Lebanon were familiar with generic drugs and supported generic drug substitution. Factors affecting generic drug use and prescription should be further explored to clarify misconceptions and reduce possible adverse events. [ABSTRACT FROM AUTHOR]

Generic Drugs are copies of small chemical drugs identical to their reference drug by dose, form, safety, strength, mode of administration, quality, performance, and intended purpose. They have been on the market for a long time and have abbreviated pathways to be approved. Their development is more simple and more affordable than their reference counterpart, which makes them widely used by patients. More recently, biosimilars were introduced to the market with strict regulations. They are highly similar to large, complex molecules, known as biological drugs, in terms of quality characteristics, biological activity, safety, and efficacy. Their development is complex and expensive, where clinical trials are necessary. Even though generic drugs and biosimilars are both copies of a reference drug, they differ in many aspects. Misconceptions or misinformation among healthcare stakeholders could have limited their use. Therefore, this short review aims to compare generic drugs and biosimilars in terms of characteristics, development, regulation, and interchangeability with brand drugs. Findings from this report can help clarify misconceptions and promote their use. [ABSTRACT FROM AUTHOR]

Introduction: The Coronavirus disease of 2019 (COVID-19) pandemic has imposed several challenges leading to the shortage of medications due to the disruption of their supply chains. Among others, patients using psychotropics encountered difficulties finding their medication despite the efforts of investing in local production. Encouraging patients to use generic drugs can be an effective strategy to ensure sustainable access to medication. Objectives: This study aimed to describe the consumption of psychotropic medications during the COVID-19 pandemic and the willingness together with the reasons for using generic drugs. It also assessed the association between generic drugs and the general characteristics of the patients. Design: A cross-sectional study was performed over a period of 4 months (July–October 2021) targeting 128 patients using psychotropic drugs. Results: The sample included more women than men with a mean age of 38 years. Antidepressants were the psychotropic medications mostly consumed followed by anti-anxiety medications. Almost 13% of the patients started using psychotropics either through self-prescription or a friend's advice and 73.4% used generic drugs. Fear of dependence, unavailability of the brand drug, and pharmacist's recommendation were the main reported reasons for using generic drugs. Conclusion: During the COVID-19 pandemic, the consumption of psychotropics increased due to new prescriptions and self-medication. No differences were noted between using generics and the characteristics of the patients in contrast to previous studies which support the implementation of generic prescription and substitution policies. [ABSTRACT FROM AUTHOR]

Background: migraine can negatively affect students' health, well-being, and physical, mental, and cognitive functions. Aims: This study aims to (i) compare the health-related QoL of students with and without migraines, (ii) assess the association between higher QoL scores and the general characteristics of the students, and (iii) evaluate the predictors of higher QoL. Methods: A cross-sectional study was conducted over four months between November 2019 and April 2020, targeting 1095 students from the public university campus faculties. Data were collected using a validated tool (SF-8) through face-to-face interviews performed by four pharmacy students. Results: Cases had significantly lower scores in all the physical domains compared to controls, with an overall total score of 62.0 (16.7) compared to 73.1 (18.4) (p<0.001). Similarly, lower overall scores for the mental domains were noted for cases (61.3 (16.7)). Caffeine consumption affected mental scores, where 71.9% of non-consumers had significantly higher scores than others (54.5%; p=0.015). Moreover, the higher the academic satisfaction, the better the QoL, with 61.2% of students who reported high satisfaction having higher scores in the mental domains compared to only 34.2% of those reporting low academic satisfaction (p=0.008). On the other hand, 62.6% of male students without migraine had significantly higher PC scores than females (48.2%; p<0.001), and those in their last academic years had substantially higher PC scores compared to those in their first two years (p=0.004). Cigarette and waterpipe smokers had lower PC scores among controls (p=0.042 and 0.012, respectively), and around 60% of those practicing sports had higher PC and MC scores (p<0.001). Conclusion: Migraine adversely affected students on both physical and psychological aspects, translated by lower QoL scores. The predictors of a better QoL should be considered when developing treatment plans and supporting those affected by this condition. [ABSTRACT FROM AUTHOR]

Background: Patients with multiple sclerosis (MS) report lower health-related quality of life (HRQoL) than other chronic disease populations. This study aims to identify risk factors of relapsing or remitting multiple sclerosis (RRMS) and assess its impact on HRQoL in Lebanese MS patients. Patients and methods: A three-month case-control study was performed among 75 RRMS case patients recruited from two clinics in Beirut and 225 controls from the general population. Results: Heavy cigarette smoking, moderate and heavy water pipe smoking, vitamin D deficiency, cardiovascular disease, and psychological disorders were significantly associated with RRMS. Linear regression showed that the multiple sclerosis international quality of life global index significantly decreased with the number of relapses, the incomplete recovery between relapses, and the psychological disorder. Higher-income and physical activity had a positive effect on quality of life (QoL). Conclusions: Findings of this study highlighted the risk factors of RRMS, which can be used for informed decision-making and targeted awareness campaigns. Other factors affecting the HRQoL of MS patients should be considered to improve their experience throughout and after treatment. [ABSTRACT FROM AUTHOR]

Introduction: Energy drinks (EDs) are caffeinated drinks marketed as energy and performance boosters and commonly used by athletes worldwide. They are widely used among youth and university students, with limited research about their consumption among physically active persons. Objectives: This study aims to assess ED consumption among physically active persons in Lebanon, the association between ED use and the participants' general characteristics, and to explore the predictors of ED use among them. Methods: An observational cross-sectional study was conducted over three months, targeting 384 physically active persons from 8 gyms across Lebanon. Results: The prevalence of ED consumption was 49.2%, namely to boost energy (68.2%) and stimulate awakeness (19.3%). Around 20% used EDs during workouts, and 15.8% used them before it. Females had 59% lower odds of ED consumption than males (OR 0.41, 95% CI 0.19-0.89), while older participants had 4.74 times higher odds of ED use (OR 4.74, 95% CI 1.16-19.3). Waterpipe smokers and alcohol consumption had 3.68 and 2.28 times higher odds of ED use than non-users. Among other sports, those doing weightlifting had significantly higher odds of ED consumption than others (OR 2.61, 95% CI 1.30-5.25). Conclusion: The predictors of ED consumption should be considered for better-informed decisions and effective awareness campaigns. [ABSTRACT FROM AUTHOR]

Objective: This study aims to compare all-cause mortality and other hospital outcomes of hospitalized coronavirus disease of 2019 patients using corticosteroids. Materials and methods: A comparative cross-sectional study was performed over three months by collecting data from patients' medical charts. Results: The sample included 129 patients with type 2 diabetes (T2D) and 293 patients without diabetes, with more men than women in both groups. Patients with T2D were older, namely, those aged more than 70 years (54.3%) with the majority having abnormal glucose levels on admission (76.1%) and at discharge (76.9%). As a primary outcome, higher all-cause mortality was reported among patients without diabetes having more than two comorbidities (38.2%) compared to those with two or single comorbidities (21.0% and 13.9% respectively; p = 0.009). It significantly increased if patients without diabetes had abnormal glucose levels at admission (51.7%; p < 0.001) and discharge (44.7%; p < 0.001) compared to those with normal levels. Critical cases had higher all-cause mortality compared to less severe cases in patients with T2D (58.8%; p < 0.001) and without diabetes (61.0%; p < 0.001). Among secondary outcomes, a higher length of stay in the hospital was noted among patients with T2D (8.4 vs. 7.3 days; p = 0.015), in addition to a significantly higher number of ventilator-free days (2.7 vs. 1.6 days; p = 0.039). Conclusions: Although the treatment with corticosteroids was comparable between patients with and without T2D, hospital outcomes varied between the groups. Findings from this study can help provide additional clinical support for patients with T2D to allow better in-hospital management of COVID-19 cases. [ABSTRACT FROM AUTHOR]

The use of generic medicines facilitate access to treatment and reduce the overall health cost. Policies promoting generic substitution take into account many components such as quality and efficacy considering health stakeholders including physicians and pharmacists and identifying factors impacting generics prescription. The current study aimed to assess the association between the perception of physicians towards generics with their sex and age and their willingness to switch to generics after initial treatment. Furthermore, it aimed to evaluate the predictors for switching brands to generics after initial treatment and perceiving the exclusivity to perform this substitution. Prescription of generics to lower medical cost was more common among younger physicians compared to those 50 years and older. Interestingly, physicians aged 40 and above were more prone to prescribe generics to patients without medical coverage, while compared to physicians younger than 30 years of age. Age was significantly associated with switching initial treatment to generics, which was 2.46 times higher for physicians older than 50 years compared to those younger than 30 years. In addition, physicians practicing more than 20 years were about 1,5 times more accepting the substitution by pharmacists after initial treatment by brand while compared to physicians practicing for less than 10 years. Strategies to increase generic substitution and promoting its acceptance among physicians should take into consideration the different significant predictors. However, Further research is required to explore more factors, predicting prescription of generics in Lebanon, such as visits by medical representatives, regulations of the hospital that the physician is practicing, which are also proven to have high influence on the prescription practice of generics. [ABSTRACT FROM AUTHOR]

The implementation of continuing education programs for pharmacists in Lebanon is emerging and needs to be further developed and strengthened to fill the gaps between knowledge acquisition and its application in the workplace. This study examined the perceptions of pharmacist preferences for and barriers to access programs. A crosssectional descriptive study was undertaken with a convenience sample of 142 pharmacists who were surveyed in their workplace. Almost 83.1% of pharmacists reported their day-to-day workplace experiences were the best way to learn. The high cost (50%) and time away from work (37.8%) were the main barriers to continuing education. Pharmacists reported a mean satisfaction of 5.8 (sd = 2.2)/10 with programs suggesting a need for routine needs assessments and adaptation of programs to better meet their learning needs. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The unified medical prescription was implemented as a policy to decrease the overall health expenditures and increase the use of generic drugs. The main objective of this study was to evaluate the perception of Lebanese physicians towards the unified medical Prescription and its impact on the overall generic prescription. Additionally, an overview was assessed concerning the type of drugs that physicians tend more to accept to be substituted to generic alternatives. METHODS: A cross-sectional descriptive study was conducted in Lebanon over a period of three months targeting physicians in their private clinics or in various hospitals using a survey as an instrument. RESULTS: Our findings demonstrated that more than the half of respondents (56.6%) believed that the unified medical prescription preserves the exclusivity for physicians to choose the medication while only 39.5% of physicians think that the unified medical prescription encouraged generic prescription and almost 42% admitted that the unified medical prescription lowers the medical cost for the patient. DISCUSSION: Despite that this new medical form of prescription is a high achievement for the Lebanese Ministry Of Public Health, this last should make essential actions: coordinating the generic drug substitution policy and monitoring its implementation over time and achievement of goals; establishing appropriate pricing system and medicines prices and controlling the interactions between physicians, pharmacists, and pharmaceutical industries; ensure their full commitment; and update the national list of substitutable generic drugs. CONCLUSION: The main objective of the unified medical prescription is to decrease the pharmaceutical expenditure and to provide access to medications for patients with lower socio-economic status. Lebanese physicians reported that this tool did not achieve its goal yet but have an impact on lowering the medical cost for patients and promoting generic prescription. [ABSTRACT FROM AUTHOR]

Generic substitutions practice is increasingly encouraged by health authorities. The use of cheaper generic drugs is often promoted as a measure to reduce the health care expenditure on pharmaceutical products, and save money to patients as well as governments. The current study aimed to explore the knowledge, perception, and attitude of physicians toward generic medicines in Lebanon and potential barriers to generic use and finally their confidence in the Lebanese pharmacist in the whole healthcare sector. A random sample of 385 physicians was recruited from different regions across Lebanon either by visiting their private clinics or in different hospitals. Among the respondents, 115 (29.9%) reported that they prefer to prescribe generic medicines over the innovator product and 258 (68.3%) reported that a generic medicine has the same therapeutic effect as the brand medicine. However, 181 (47.9%) respondents reported that a generic medicine should have the same active ingredient as the branded medicine and 357 (94.4%) reported that they do not have same excipients. When asked about their trust in the pharmacist in the health care system, almost 229 (59.5%) of respondents reported distrust. The majority of the physicians who participated in this survey indicated a low generic medicine prescription rate. They preferred to use and prescribe brand medicines. This phenomenon was observed in all of the age groups and was independent of their year, their place of graduation and experience but directly depends on the type of certificate. [ABSTRACT FROM AUTHOR]

Objective: To evaluate factors affecting adherence to oral antidiabetic treatment in the Lebanese population and to develop the Diabetes Medication Adherence Scale (DMAS) based on these factors. Methods: A cross‐sectional study was conducted on a sample of Lebanese diabetic patients. Data were collected using a structured questionnaire. The level of adherence was measured using the Lebanese Medication Adherence Scale (LMAS‐14). Bivariate analyses and multivariable analysis was done using SPSS. Psychometric evaluation of DMAS included an assessment of internal consistency, factor analysis, evaluation of sensitivity and specificity. Criterion‐related validity was assessed by comparison with LMAS‐14 measure of adherence. Key findings: A total of 500 patients were recruited. 39.2% were adherent to treatment. Long working hours, increased number of oral antidiabetic medication per day, drug discontinuation when travelling, longer duration of diabetes and treatment burden were among factors that decreased adherence. While understanding the treatment regimen, following up physician recommendations and following up the recommended diet contributed to good medication adherence. The final 7‐item scale (DMAS) had a good internal consistency (Cronbach's α = 0.612) and a good correlation and agreement with LMAS‐14 (Spearman's rho = 0.699, Cohen's kappa = 0.566). Patients with high DMAS scores were significantly more likely to have controlled glycaemia (P < 0.05). Sensitivity and specificity reached 70.39% and 51.47%, respectively. Conclusion: Adherence to oral antidiabetic treatment is suboptimal in Lebanon. The DMAS is a reliable instrument for assessing adherence and predicting poor glycaemic control in clinical practice, but requires further validation in other populations. [ABSTRACT FROM AUTHOR]

Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Eastern Mediterranean Health Journal is the property of World Health Organization and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Diabetes type 2 is considered one of the main public health concerns. Lack of adherence to treatment leads to poor therapeutic outcome, poor glycemic control, and high risk for developing diabetes complications. Objectives: The aim of this study is to evaluate adherence to oral antidiabetic medication in Diabetes type 2 Lebanese patients, and to evaluate factors leading to low adherence. Methods: A cross-sectional study was conducted in outpatients endocrinology clinics of two hospitals and four private clinics located in Beirut-Lebanon. Data was collected using a well-structured questionnaire by trained pharmacists. Adherence level was measured by the Lebanese Medication Adherence Scale (LMAS-14). Bivariate and multivariate analyses were conducted using SPSS version 20. Results: Overall, 245 patients were included in the study with the majority being females (54.3%) and obese (47.8%). Only 29% of the participants had controlled glycemia (HbA1c <7%) with 31.8% of subjects had high adherence to their medication compared to 68.2% with low adherence. Increased working hours/day was associated with a decrease in adherence to oral antidiabetic medication (OR=0.31; 95% CI 0.11:0.88; p=0.029). Other factors significantly associated with decreased adherence to treatment were forgetfulness, high drug costs, complex treatment regimens, experiencing side effects, and perception of treatment inefficacy. Postponing physician office visits also decreased the probability of being adherent to oral antidiabetic medication (OR=0.36; 95% CI 0.15:0.86; p=0.022). Skipping or doubling the dose in case of hypo/hyperglycemia and the sensation of treatment burden also decreased medication adherence (OR=0.09; 95% CI 0.02:0.34; p=0.001, and OR=0.04; 95% CI 0.01:0.13; p<0.001 respectively). Conclusions: Adherence to oral antidiabetic medication is low for Lebanese patients, which leads to a poor glycemic control and increases the diabetes complications. Intervention programs including patient education strategies are essential to improve medication adherence. [ABSTRACT FROM AUTHOR]

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

Copyright of Pharmacy Practice (1886-3655) is the property of Centro de Investigaciones y Publicaciones Farmaceuticas S.L. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Low back pain (LBP) is a widespread musculoskeletal disorder worldwide. It causes disability that influence work performance in individuals. The aim of this study was to evaluate the prevalence and risk factors of LBP in the middle-aged office workers in the Lebanese Population. In this observational, cross-sectional study performed in 2013, overall, 250 office workers aged between 20 and 64 years from different Lebanese companies and banks filled out a questionnaire containing various predictor individual and occupational factors. Our results show that 112 (44.8%) of the recruited population suffer from back pain. Females are the most affected (68%) versus males (32%) (P=0.023). The logistic regression showed that LBP was positively associated with backbone crookedness (P=0.003), knee pain (P<0.001), wrist pain (P=0.002), contractions (P=0.014), numbness (P=0.009), previous treatment for back pain (P<0.001), doctor consultation (P=0.029), household work for 3-6 hours (P=0.001), maintaining same posture for > 5 hours (P=0.024), fear of changing job (P=0.036) and higher BMI (P=0.005). However, use of ergonomic chair, job advancement satisfaction, making radiography was negatively associated with LBP with P value=0.072, 0.022, 0.005 respectively. LBP has an important prevalence among office worker in Lebanon. This study might help to estimate low back problems in office workers and emphasize healthy lifestyle, ergonomic measurement and holding educational programs. [ABSTRACT FROM AUTHOR]

Introduction: Smoking is known to have physiological effects on biological systems. The purpose of this study is to evaluate acute and chronic effects on pulmonary functions and cardiovascular indices of waterpipe (WP) smoking in real life circumstances. Methods: Three groups were included in the study: non-smokers ( N = 42), WP smokers ( N = 42) and cigarette smokers ( N = 48). A questionnaire was completed for each participant, in addition to pulmonary function [forced expiratory volume at 1 s (FEV1), 6 s (FEV6), percentage of FEV1/FEV6], and cardiovascular [diastolic blood pressure (DBP), systolic blood pressure (SBP) and heart rate (HR)] measures, taken before and after smoking. Results: Mean values of FEV1, FEV6, FEV1/FEV6, DBP and SBP in WP and cigarette smokers were very close. However, WP smoking significantly increased HR compared to cigarette smokers ( p = 0.007); duration of smoking, age at first WP and quantity of smoking affected pulmonary function and cardiovascular values. In the subgroup of WP smokers, DBP was acutely increased by a larger WP size ( p = 0.011), while the FEV6 was acutely increased by a smaller WP size ( p = 0.045). Conclusion: WP smoking affected the cardiovascular system more than cigarette smoking, while it had similar effects on pulmonary function. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are serious fall injuries that often result in long-term functional impairment and increased mortality. As the population ages, the number of hip fractures is likely to increase worldwide. The main objective of this pilot study was to evaluate the risk factors of hip fracture among the older adults in the Lebanese population. Methods: This pilot epidemiological, prospective, and case-control study was performed in 6 hospitals in Great Beirut and South Lebanon. Subjects who met the inclusion criteria filled out a questionnaire consisting on the socio- demographic characteristics, health status, drugs intake and cigarette smoking. Results: Overall, 195 subjects were recruited, with 65 cases of hip fracture and 130 controls all aged over 50 yr. Females represented around two third of the studied population. The logistic regression, using adjusted odds ratio (ORa), showed a significant relationship between hip fracture and chronic diseases (ORa=3.02; 95% CI: 1.63, 6.66), antihypertensive drugs intake (ORa=2.72; 95% CI: 1.56, 6.42), fall (ORa=2.79; 95% CI: 1.82, 7.06) previous fracture (ORa=3.80; 95% CI: 1.57, 9.23) and family history of fracture (ORa=4.82; 95% CI: 2.29, 10.86). Besides, smoking increased the risk of hip fracture (ORa=2.55; 95% CI: 1.96, 5.80). Having a bow was associated with the highest risk for hip fracture (ORa=5.18; 95% CI: 2.30, 12.24). Conclusions: Elderly people in Lebanon are exposed to many risk factors contributing to hip fracture. Our finding has implication in geriatric health improvement by preventing hip fracture in the Lebanese population. [ABSTRACT FROM AUTHOR]

Background: Malnutrition represents an important issue in older adults; unfortunately, there is lack of data concerning this topic in Lebanon. This paper aims to provide a description of nutri-tional status and its correlates in older adults living in long stay institutions situated in Beirut. Methods: This cross-sectional study was conducted in three long stay institutions in Beirut in 2012. The study population was composed of people aged 65 years and above, having a score of Folstein Mini Mental State Examination (MMSE) greater than 14 and without renal failure requiring dialysis. Subjects meeting inclusion criteria filled out a questionnaire consisting of nutri-tional status scale (Mini Nutritional Assessment: MNA) and several other parts (demographic, self-assessment of the state health, smoking and alcohol, physical dependence, quality of life, frailty, depression, social isolation and loneliness). Data were entered and analyzed using the statistical software SPSS (Statistical Package for Social Sciences), version 17.0 (Chicago, IL, USA). Results: Among 111 older adults (55 men and 56 women), 14 (12.6%) were malnourished, 54 (48.7%) were at risk of malnutrition and 43 (38.7%) had an adequate nutritional status. Multivari-ate analysis showed that physical exercise, depression, frailty and cognitive function were inde-pendent correlates of nutritional status of older adults. This model explained 42.2% (adjusted R2=0.422) of the older adults nutritional status variability. Conclusion: We found a moderate percentage of malnutrition in older adults living in long stay institutions situated in Beirut, and the correlates of malnutrition in older adults were low physical exercise, depression, frailty and low cognitive function. [ABSTRACT FROM AUTHOR]

Background: The harmful effects of medication and licit substance use during pregnancy may potentially constitute a major public health concern. Our study aims to assess risky exposure of Lebanese pregnant women to drugs, tobacco, caffeine, and alcohol, and to determine their effect on postnatal outcomes. Methods: Women at term were addressed after delivery in five university hospitals of Beirut and Mount Lebanon between February and June 2012. A standardized questionnaire was administered to them. Moreover, medical files of both mothers and their respective newborns were checked to confirm information given by mothers, and to assess the health outcome of the babies. Results: Among the interviewed 350 women, active and passive smoking of tobacco (cigarette or water pipe), and consumption of category C, D, and X drugs were common during pregnancy in Lebanon; they were shown to negatively affect the neonatal outcome in multivariate analyses: they significantly decreased Apgar scores and increased the risk of underweight and medical complications of babies (P < 0.05). Conclusion: Our study demonstrated that Lebanese women were exposed during pregnancy to multiple medications and licit substances that affected the neonates' health. Our findings have implications for clinical obstetric practice and prevention programs in Lebanon. Efforts should be made to decrease exposure to harmful substances during pregnancy. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a significant public health concern. The clinical response to statins is variable among sepsis patients. Objective: The aim of the study was to determinate the effect of statin-treatment on mortality in Lebanese patients with sepsis. Methods: A retrospective multicenter study on Lebanese patients with sepsis between January 2008 and March 2012 was conducted. Patients with a primary diagnosis of sepsis admitted to the intensive care unit of two tertiary care hospitals in Beirut were included. Patients who continued to receive statin therapy for dyslipidemia during the hospital course were included in the statin treatment group. The control group consisted of patients not taking statin. Demographic characteristics, clinical signs, standard laboratory test and treatment received were compared between these two groups using univariate analysis. Logistic regression and survival analysis were performed by SPSS. Results: Three hundred fifty one Lebanese patients were included (age: 71.33 SD=14.97 years; Male: 56%). Among them, 30% took a statin at the doses recommended for dyslipidemia. The comparison of the two groups showed that in the statin treatment group: The mean serum level of C-reactive protein at the time of sepsis was significantly decreased (P=0.050), the length-stay at ICU significantly increased (P=0.047) and mortality significantly reduced (P<0.001). Results were confirmed by logistic regression, particularly for mortality. In the Cox regression analysis, hypothermia and shock were significantly associated with high mortality while statin treatment decreased mortality (hazard ratio = 0.540; 95% CI: 0.302-0.964; P=0.037). Conclusion: At usual doses for dyslipidemia, statin treatment decreased incidence of mortality related to sepsis and improved the survival in this Lebanese septic population. Large randomized controlled clinical trials must be realized to give conclusive results about the potential beneficial effect of statins in sepsis. [ABSTRACT FROM AUTHOR]

Background: Adverse drug events (ADE) occur frequently during treatment with vitamin K antagonists (AVK) and contribute to increase hemorrhagic risks. A retrospective study was conducted over a period of 2 years. Patients treated with Methods: AVK and admitted to the emergency room of a tertiary care hospital in Beirut were included. The aim of the study was to identify ADE characterized by a high international normalized ratio (INR) and to determine the predictive factors responsible for these events. Statistical analysis was performed with the SPSS statistical package. Results: We included 148 patients. Sixty-seven patients (47.3%) with an INR above the therapeutic range were identiied as cases. The control group consisted of 81 patients (54.7%) with an INR within the therapeutic range. Hemorrhagic complications were observed in 53.7% of cases versus 6.2% of controls (P< 0.0001). No significant difference was noticed between cases and controls regarding the indication and the dose of AVK. Patients aged over 75 years were more likely to present an INR above the therapeutic range (58.2%, P = 0.049). Recent infection was present in 40.3% of cases versus 6.2% of controls (P< 0.0001) and hypoalbuminemia in 37.3% of cases versus 6.1% of controls (P< 0.0001). Treatment with antibiotics, amiodarone, and anti-inlammatory drugs were also factors of imbalance (P < 0.0001). Conclusion: Many factors may be associated with ADE related to AVK. Monitoring of INR and its stabilization in the therapeutic range are important for preventing these events. [ABSTRACT FROM AUTHOR]