The aftermath of 'Beirutshima': the role of nursing quantum leadership in primary health care centers

Background: The healthcare system in Lebanon faced unprecedented challenges following the COVID-19 pandemic and the devastating beirut blast on August 4th, 2020. The aftermath highlighted the system's vulnerability, corruption, and incapacity to provide essential services, leading to an urgent need for leadership transformation within primary healthcare centers (PHCs).Methods: This qualitative cross-sectional study assessed the quantum leadership skills of nurses in 30 PHCs within a 5-kilometer radius of the blast site. Data were collected six months post-blast using a self-administered questionnaire based on a binary outcome scale of agreement and disagreement, analyzed with IBM SPSS-19 software to evaluate the potential for leadership improvement.Results: The findings indicate a significant correlation between quantum leadership skills and the operational effectiveness of PHCs, particularly those managed by the Ministry of Public Health, which exhibited superior quantum leadership skills compared to others.Conclusions: The study underscores the necessity for a new leadership paradigm rooted in quantum theory to navigate the healthcare system through crises effectively. A quantum leader, characterized by heightened organizational consciousness and energy, is pivotal for ensuring a seamless transition towards recovery and resilience, ultimately fostering a breakthrough in the face of systemic breakdowns.

Psychometric properties of an Arabic translation of the short entrapment scale in a non-clinical sample of young adults

Background Entrapment is the feeling of wanting to leave an unbearable situation but believing that there are no options to do so. An Arabic entrapment Scale will assist healthcare professionals in the region in the prevention of suicide as the tool is tailored to the specific sociocultural context, which would enhance entrapment detection. Objective In the current study, we aim to evaluate the psychometric properties of a translated Arabic version of the Entrapment Scale Short Form (E-SF). Methods Three hundred eighty-nine Lebanese citizens were enrolled in this cross-sectional study. Results The mean age of participants was 23.03 years (SD = 2.93), 69.4% being women. To examine the factor structure of the entrapment scale, we used an exploratory-to-confirmatory factor analysis (EFA-to-CFA) strategy. EFA and CFA results indicated that the fit of the unidimensional model of the Arabic Entrapment Scale (A-ES) was generally acceptable. Composite reliability of scores was adequate in the total sample (ω = .87). All indices suggested that configural, metric, and scalar invariance was supported across genders. Entrapment was positively and significantly correlated with suicidal ideation, alcohol use disorder, psychological distress, and orthorexia nervosa, suggesting convergent and divergent validity. Conclusion The A-ES was found to be a valid and reliable tool to assess the degree of entrapment in Lebanese young adults. The A-ES will assist healthcare professionals in the region in the prevention of suicide as the tool is tailored to the specific sociocultural context, which would enhance entrapment detection. (AU)

Characteristics of Polyps in Lebanese population

Background: The objectiv e of this study is to describe the characteristics of the polyps in the Lebanese population and evaluate dysplasia and its relation to the polyps’ locations. Methods: A retrospectiv e descriptiv e study was conducted at the Department of the National Institute of Pathology in Lebanon and comprised a biopsy of colonic polyps or resected polyps from patients from 2007 to 2009. We collected demogr aphic data and polyps’ characteristics. Then, we divided patients according to age sex, location, and histology . Results: With 2298 polyps in 1470 patients, the mean age was 57.45 with 68% aged more than 50yo. 75.6% have one polyp and multiple polyps are more commonly found in older patients (> 50 years). More than 20 % of polyps are found in the recto-sig moid area. In the right colon, people older than 50 years were more likely to have polyps (19%) compared to those < 30 years (8.3%) (p < 0.05). In the rectum, people < 30 years were more likely to have polyps compared to those > 50 years (p < 0.01). Concerning histology , tubular adenoma is the most common type and is more prevalent in the left colon. Hyperplastic polyps are mainly found in the recto-sigmoid area and mainly in the age group 30-50 in contrast to adenomatous polyps found over 50yo. Adenocarcinomas and/or degener ative polyps were founded in 5.9% of our population. Conclusion: This study gives valuable information on colorectal polyps in the Lebanese population regarding age, sex, dominant histology and anatomic location. We noted a male predominance and mainly above 50 years old. The majority had single polyps, and>50% of polyps were localized in the rectosigmoid. Adenomatous polyps were the most common type.

Ressentimento e os sofrimentos identitários de um jovem xiita / The resentment and Identity Suffering of a Shiite Youth under the bombings in southern Lebanon committed by Israel in 2006 / Resentimiento y los sufrimientos identitarios de un joven chiita / Le ressentiment et la souffrance identitaire d'un jeune chiite sous les bombardements perpétrés par Israël en 2006 dans le sud du Liban

O artigo procura exemplificar o grau de traumatismo sofrido por um jovem nos bombardeios cometidos por Israel em 2006, no sul do Líbano, contra a comunidade xiita. O registro faz parte de 20 histórias de vida colhidas em pesquisas de campo realizadas em cidades afetadas, e pretende-se que exemplifique os efeitos desses eventos na comunidade. Depois de décadas, os integrantes do grupo etno-confessional participam de uma conjuntura nacional de enfrentamentos mortíferos entre suas comunidades. Do outro lado da fronteira, Israel volta a atacá-los. Esse contexto, que os situa em duas frentes de perigo, torna constantes os eventos catastróficos em sua história recente. São analisadas as disposições psíquicas do jovem e o papel da identificação grupal no enfrentamento das situações catastróficas. Será sublinhada a produção do ódio a partir do traumatismo sofrido, para analisar, na conclusão, seu papel na resiliência psíquica e na dinâmica identitária.

The article seeks to exemplify the degree of trauma suffered by a young man in the bombing of the Shiite community committed by Israel in southern Lebanon in 2006. This record is part of twenty life histories collected from field surveys conducted in affected cities, and it is intended to exemplify the effects of these events in the community. The ethno-confessional group participates in a national conjuncture of deadly clashes between their communities, after decades. Across the border, Israel attacks them again. This context that places them in danger, make catastrophic events constant in their recent history. The psychic conditions of the young person and the role of the group identification in the confrontation with the catastrophic situations are analyzed. The surge of hatred from trauma will be highlighted, in order to analyze in conclusion, its role in psychic resilience and in their identity dynamics.

El articulo trata de ejemplificar el grado de traumatismo sufrido por un joven en los bombardeos contra la comunidad chií cometidos por Israel en el sur del Líbano en 2006. Este registro forma parte de veinte historias de vida recogidas a partir de investigaciones de campo realizadas en ciudades afectadas, y se pretende que ejemplifique los efectos de estos eventos en la comunidad. El grupo etno confesional participa después de décadas de una coyuntura nacional de enfrentamientos mortíferos entre sus comunidades. Al otro lado de la frontera, Israel vuelve a atacarlos nuevamente. Este contexto que los sitúa en dos frentes de peligro, vuelve constantes los acontecimientos catastróficos en su historia reciente. Se analizan las disposiciones psíquicas del joven y el papel de la identificación grupal en el enfrentamiento con las situaciones catastróficas. Se subrayará la producción del odio a partir del traumatismo sufrido, para analizar en la conclusión su papel en la resiliencia psíquica y en su dinámica identitaria.

L'article cherche à illustrer le degré de traumatisme subi par un jeune homme lors des bombardements contre la communauté chiite commis par Israël dans le sud du Liban en 2006. Ce registre fait partie de vingt histoires de vie recueillies lors de recherches sur le terrain, menées dans les villes touchées, dans le but d'expliquer les effets de ces événements sur la communauté. Depuis des décennies, les membres du groupe ethno-confessionnel participent d'une conjoncture nationale d'affrontements meurtriers entre leurs communautés. De l'autre côté de la frontière, Israël les attaque à nouveau. Ce contexte qui les place sur deux fronts de danger rend constants les événements catastrophiques dans leur histoire récente. On analyse les dispositions psychiques du jeune et le rôle de l'identification du groupe dans la défense contre les situations catastrophiques. Ce sera souligné la production de la haine à partir du traumatisme subi, pour analyser, dans la conclusion, son rôle dans la résilience psychique et dans sa dynamique identitaire.

Nasopharyngeal linguatulosis or halzoun syndrome: clinical diagnosis and treatment

SUMMARY Halzoun syndrome, also known as nasopharyngeal linguatulosis, is a rare entity that is mostly prevalent in Eastern Mediterranean countries. The consumption of raw ovine liver and lymph nodes infested with Linguatula serrata nymphs remains a major cause of the nasopharyngeal symptoms and discomfort associated with the disease. Halzoun syndrome is a clinical diagnosis based on history and presentation. Treatment of this disease is still debated; however, our experience reveals that alcohol gargle can be a good option. Proper counselling on the hazards of eating raw liver in endemic areas is needed. Moreover, physicians should be aware of the sequence of events in the disease in order not to delay or miss the diagnosis. This communication presents a rare Lebanese case of Halzoun syndrome that offers medical implications in the clinical diagnosis and treatment of the nasopharyngeal symptoms of this syndrome, with a review of the literature.

RESUMO Esta comunicação apresenta um caso libanês raro de síndrome de Halzoun que oferece implicações médicas no diagnóstico clínico e no tratamento dos sintomas nasofaríngeos desta síndrome, com uma revisão da literatura. A síndrome de Halzoun, também conhecida como linguatulose nasofaríngea, é uma entidade rara predominante nos países do Mediterrâneo Oriental. O consumo de linfonodos ovinos e linfáticos ovinos infestados com ninfas Linguatula serrata continua a ser uma das principais causas dos sintomas nasofaríngeos e do desconforto associado à doença. A síndrome de Halzoun é um diagnóstico clínico baseado na história e na apresentação. O tratamento dessa doença ainda é debatido; no entanto, nossos resultados revelam que o gargarismo de álcool pode ser uma boa opção. É necessário um aconselhamento adequado sobre os perigos de comer fígado cru em áreas endêmicas. Além disso, os médicos devem estar cientes da sequência de eventos na doença, a fim de não atrasar ou perder o diagnóstico.

Dental caries and fluorosis among children in Lebanon

The purpose of this study is to assess caries and enamel fluorosis in a sample of 1433 children aged 6–8, 12, and 15 years from 48 schools in 6 regions of Lebanon, selected by probability proportional to size. Methods: Children were examined according to the World Health Organization criteria. Results: Our results showed a mean of decayed, missing, and filled teeth (DMFT) of 0.6 (dft of 5.15), 3.42, and 5.44 corresponding respectively to the groups of 6–8-, 12-, and 15-year-old children. In the same groups, the percentage of DMFT = 0 for the 6–8-year-old category was 74%, the 12-year-old category was 20.9%, and for the 15-year-old category was 9.7%; Ten (2.1%) 12 year olds had moderate and one (0.2%) severe scores; these children had been born in other countries. Conclusions: Survey results confirm the need to implement nationwide dental caries prevention measures. Since water fluoridation is not feasible, salt fluoridation would be the alternative.

Surveillance Study of Acute Gastroenteritis Etiologies in Hospitalized Children in South Lebanon (SAGE study) / 대한소아소화기영양학회지

PURPOSE: Acute gastroenteritis (AGE) is a major cause of morbidity and remains a major cause of hospitalization. Following the Syrian refugee crisis and insufficient clean water in the region, this study reviews the etiological and epidemiological data in Lebanon. METHODS: We prospectively analyzed demographic, clinical and routine laboratory data of 198 children from the age of 1 month to 10 years old who were admitted with the diagnosis of AGE to a private tertiary care hospital located in the district of Nabatieh in south Lebanon. RESULTS: Males had a higher incidence of AGE (57.1%). Pathogens were detected in 57.6% (n=114) of admitted patients, among them single pathogens were found in 51.0% (n=101) of cases that consisted of: Entamoeba histolytica 26.3% (n=52), rotavirus 18.7% (n=37), adenovirus 6.1% (n=12) and mixed co-pathogens found in 6.6% (n=13). Breast-fed children were significantly less prone to rotavirus (p=0.041). Moreover, children who had received the rotavirus vaccine were significantly less prone to rotavirus (p=0.032). CONCLUSION: Our findings highlight the high prevalence of E. histolytica infection as the major cause of pediatric gastroenteritis in hospitalized children, during the summer period likely reflecting the insanitary water supplies and lack of hygiene. Moreover the 42.4% of unidentified causative pathogens should prompt us to widen our diagnostic laboratory arsenal by adopting new diagnostic technologies.

Do trauma individual ao trauma coletivo. Os Xiitas do sul do Líbano e os bombardeios israelenses 2006 / From individual trauma to collective trauma. The Shi'ites of southern Lebanon and the Israeli bombing 2006 / Del trauma individual al trauma colectivo. Los chiitas del sur del Líbano y el bombardeo israelí 2006

O artigo é uma síntese das pesquisas de campo realizadas com a comunidade xiita do sul do Líbano em 2008. Procurou-se averiguar a conexão e superposição do trauma individual ao trauma coletivo na luta de resistência à invasão das forças israelenses a suas terras. O grupo étno-confessional participa depois de décadas de uma conjuntura nacional de enfrentamentos mortíferos entre suas comunidades. De outro lado da fronteira, há Israel, o inimigo que depois de submeter sua região por vinte anos, volta a atacá-los em 2006. Foram registradas vinte entrevistas com indivíduos de ambos os sexos, cujas questões abertas objetivaram suas histórias de vida. A análise de conteúdo do material permitiu sua separação em três grupos. Os depoimentos de seus representantes coloca em relevo o grau de afetação provocado pelos eventos. Averiguamos as disposições psíquicas desses sujeitos que vivem constantemente situações de stress e de eventos traumáticos. Observamos o papel da identificação grupal à mensagem de seus mitos fundadores e como fator de reforço egoico no enfrentamento a esse real catastrófico.

This article is a synthesis of field studies carried out in the Shiite community in South Lebanon in 2008. The aim of this study was to investigate the connection and superposition of the individual trauma over the collective trauma in the struggle and resistance against the invasion of Israeli forces in their lands. This ethnic confessional group has for decades been involved in a series of nationwide deadly struggles within their communities. On the other side of the border lies Israel, the enemy that after subjugating their region for twenty years, attacked them again in 2006. We then studied the psychological conditions of these subjects that constantly undergo traumatic and stressful situations. We observed how this group identifies with the message of their forefathers and myths and how it strengthens their egos on facing this catastrophic reality.

El presente artículo es una síntesis de las investigaciones de campo realizadas con la comunidad chiita del sur del Líbano en 2008. El objetivo fue investigar la conexión y la superposición del trauma individual al trauma colectivo durante la lucha de resistencia a la invasión de las fuerzas israelíes a sus tierras. Este grupo étnico-confesional participa, después de décadas, de una coyuntura nacional de enfrentamientos mortales entre sus comunidades. Del otro lado de la frontera está Israel, el enemigo que después de haber ocupado la región por veinte años, vuelve a atacarlos en 2006. Se realizaron veinte entrevistas a través de preguntas abiertas a individuos de ambos sexos, con la finalidad de estudiar sus historias de vida. El análisis de contenido del material permitió separarlo en tres grupos. Los testimonios de sus representantes colocan en evidencia el grado en que estos acontecimientos los afectaron. Se investigó las estructuraciones psíquicas de estos individuos que viven constantemente situaciones de estrés y hechos traumáticos. Fue observado, igualmente, el papel de la identificación del grupo en relación al mensaje de sus mitos fundadores y de qué forma estos actúan como factor de refuerzo del ego en el enfrentamiento a esa realidad catastrófica.

Itinerário de um pesquisador-interveniente posto à prova em seus próprios desafios de identidade: uma intervenção num estabelecimento escolar no Líbano / Itinerary of a researcher-stakeholder tested in his own identity challenges: an intervation in a Lebanese school / Trayectoria de un investigador-interviniente puesto a prueba en sus propios retos de identidad: intervención en una escuela en Líbano

Neste artigo, apoiando-se em certos elementos de uma intervenção realizada, ao longo de três anos (2012-2015) em um estabelecimento escolar libanês, o autor deseja analisar, em retrospectiva, seu posicionamento de pesquisador-interveniente ligado à evolução de suas questões de identidade, tanto no aspeto intrapsíquico quanto no profissional. Primeiramente, o autor apresentará algumas características do cenário escolar libanês.

Based on certain elements of a three-year (2012-2015) intervention at a Lebanese school, in this study the author wishes to analyze in retrospect his researcher-stakeholder position linked to the evolution of his identity issues, both in the intrapsychic and professional aspects. The author will present at first some characteristics of the Lebanese school scene.

Con base en determinados aspectos de una intervención llevada a cabo en una escuela en Líbano durante tres años, 2012 a 2015, en este texto el autor pretende analizar retrospectivamente su postura como investigador-interviniente desde la evolución de sus cuestionamientos sobre identidad, tanto en el ámbito intrapsíquico cuanto en el ámbito profesional. En primer lugar, el autor presentará algunas características del escenario escolar libanés.

Antibiotic Use, Cost, and Consumption in Tertiary Hospitals in Lebanon: A Comparative Study Before and After an Implementation of Antibiotic-Restriction Program (ARP).

Aims: To compare the antibiotic use, cost, and consumption before and after an implementation of an antibiotic-restriction program (ARP) in governmental hospitals setting in Lebanon. Study Design: A retrospective cohort study on hospitalized patients who were prescribed antibiotics prior to, and after the application of the ARP, was conducted over a three month period, between March 2013 and June 2013. Methodology: The studied population included patients on antibiotic therapy. The sample size that was enrolled was equal to 612 patients prior to ARP and 606 patients after ARP. Results: The average age of the patients was 34.6±23.5 years, 55.6% of whom were females, and 79.2% had no comorbidity. Respiratory diseases, and gynecological surgeries motivated the antibiotics prescriptions. The physicians prescribed combinations of intravenous antibiotics in 91% of the cases. The most frequently ordered antibiotics were second, third- generation cephalosporins, and penicillin derivatives. After ARP, the rate of restricted antibiotic use decreased by 11% (P<.0001), while the use of gentamicin increased with a potential for increased rates of nephrotoxicity and ototoxicity; Prior to and after the ARP, a microbiological exam was done in 12.6% of cases, and 67.3% of the cases of prescribed antibiotics were sensitive. The expenditure of all, and restricted antibiotics decreased by 22.3% and 9% respectively. The cost savings were US$ 8099 per month. The compliance with the ARP by prescribers was very high (>90%). Conclusion: The ARP reduces the amount of antibiotic usage, cuts down the healthcare expenditure, and may prevent a higher prevalence of some resistant bacterial strains; it is, therefore, in the interest of policymakers to propose an antimicrobial stewardship program based on mHealth system that allows patients, and healthcare providers an on-line and mobile consultation.

Nutritional education for management of osteodystrophy (NEMO) trial: Design and patient characteristics, Lebanon

This study aims to determine the effect of a trained dedicated dietitian on clinical outcomes among Lebanese hemodialysis (HD) patients: and thus demonstrate a viable developing country model. This paper describes the study protocol and baseline data. The study was a multicenter randomized controlled trial with parallel-group design involving 12 HD units: assigned to cluster A (n = 6) or B (n = 6). A total of 570 patients met the inclusion criteria. Patients in cluster A were randomly assigned as per dialysis shift to the following: Dedicated Dietitian (DD) (n = 133) and Existing Practice (EP) (n = 138) protocols. Cluster B patients (n = 299) received Trained Hospital Dietitian (THD) protocol. Dietitians of the DD and THD groups were trained by the research team on Kidney Disease Outcomes Quality Initiative nutrition guidelines. DD protocol included: individualized nutrition education for 2 hours/month/HD patient for 6 months focusing on renal osteodystrophy and using the Trans-theoretical theory for behavioral change. EP protocol included nutrition education given to patients by hospital dietitians who were blinded to the study. The THD protocol included nutrition education to patients given by hospital dietitian as per the training received but within hospital responsibilities, with no set educational protocol or tools. Baseline data revealed that 40% of patients were hyperphosphatemics (> 5.5 mg/dl) with low dietary adherence and knowledge of dietary P restriction in addition to inadequate daily protein intake (58.86%+/- 33.87% of needs) yet adequate dietary P intake (795.52 +/- 366.94 mg/day). Quality of life (QOL) ranged from 48-75% of full health. Baseline differences between the 3 groups revealed significant differences in serum P, malnutrition status, adherence to diet and P chelators and in 2 factors of the QOL: physical and social functioning. The data show room for improvement in the nutritional status of the patients. The NEMO trial may be able to demonstrate a better nutritional management of HD patients.

Growth response of Lebanon cedar (Cedrus libani ) plantations to thinning intensity in Western Turkey.

This paper presents the growth response of 25 yr old Lebanon cedar (Cedrus libani A. Rich.) plantation to thinnings of different intensities in Isparta in western Turkey. The thinning intensity was measured by using the residual basal area (%) as parameter. In spring of 2005, three treatments were tested; light, moderate and heavy thinning with respectively 10, 25 and 35% of basal area removed. The statistical design of the experiment was a randomized incomplete block with two blocks and three treatments. Variables such as diameter at breast height (diameter) and height were measured. Growth rate ratios of diameter in moderately thinned and heavily thinned stands were 1.02 and 1.03, respectively. Basal area growth rates in moderately thinned and heavily thinned plots were 0.93 and 1.05, respectively. The largest values for the mean tree were observed with the heaviest thinning treatment. Absolute diameter increment was positively correlated with initial diameter in all plots. Relative diameter growth was negatively correlated with initial diameter. Growth rate interpretations were supported by analysis of variance using Duncan’s test of range multiple. The results obtained show significant differences between treatments for tree height growth, for the two inventories carried out (2005, 2008). However, diameter, basal area and volume were no found between treatments for tree.

Brincadeira e amizade: lembranças de imigrantes libaneses vivendo no Brasil / Play and friendship: memories of lebanese immigrants living in Brazil

presente artigo investigou as lembranças de imigrantes libaneses vivendo no Brasil sobre suas amizades e brincadeiras na infância, vivida no Líbano, e as de amizades e brincadeiras da infância de seus filhos, no Brasil. Quatro imigrantes libaneses vivendo na Grande Vitória, Espírito Santo, foram entrevistados. Os relatos foram transcritos e analisados de acordo com categorias previamente estabelecidas: (a) amigos de infância no Líbano; (b) amigos da infância dos filhos no Brasil; (c) brincadeiras da infância no Líbano; (d) brincadeiras da infância dos filhos no Brasil; (e) percepção de diferenças culturais entre o brincar e a amizade nos dois países em diferentes momentos históricos. Os dados foram discutidos à luz da obra de Robert Hinde. Pode-se concluir que, apesar das semelhanças em alguns aspectos das amizades e das brincadeiras, diferenças culturais estão presentes na estrutura da rede de amigos e no conteúdo dos relacionamentos.

This article investigated the memories of Lebanese immigrants living in Brazil about friendships and play habits in their childhood in Lebanon, and about friendships and play habits of their children in Brazil. Four Lebanese immigrants living in Metropolitan Vitoria, Espirito Santo, were interviewed. The reports were transcribed and analyzed according to previously established categories: (a) childhood friendships in Lebanon, (b) childhood friendships of their children in Brazil, (c) childhood play habits in Lebanon, (d) childhood play habits of their children in Brazil, (e) perception of cultural differences between play and friendship in the two countries in different historical moments. The data were discussed in light of Robert Hinde's work. It was concluded that, despite the similarities in some aspects of friendships and play, cultural differences were present in the structure of friendship network and in the relationship content. hips and play, cultural differences were present in the structure of friends network and in the relationship content.