Menstrual abnormalities post-COVID vaccination: a cross-sectional study on adult Lebanese women.

BACKGROUND: In the year 2020, the coronavirus pandemic invaded the world. Since then, specialized companies began to compete, producing many vaccines. Coronavirus vaccines have different adverse events. Menstrual disorders have been noticed as a common complaint post-vaccination. AIM: Our study fills an important gap by evaluating the relationship between coronavirus vaccines and menstrual disorders. METHODS: This is a cross-sectional study between 20 September 2021, and 1 October 2021, using an online survey. The questionnaire consisted of 36 questions divided into 4 sections: demographics, COVID-19 exposure and vaccination, hormonal background, and details about the menstrual cycle. Sample t-test, ANOVA test, chi-square, and McNemar test were used in bivariate analysis. RESULTS: This study includes 505 Lebanese adult women vaccinated against COVID-19. After vaccination, the number of women having heavy bleeding or light bleeding increased (p = 0.02 and p < 0.001, respectively). The number of women having regular cycles decreased after taking the vaccine (p < 0.001). Irregularity in the cycle post-vaccination was associated with worse PMS symptoms (p = 0.036). Women using hormonal contraception method or using any hormonal therapy had higher menstrual irregularity rates (p = 0.002 and p = 0.043, respectively). Concerning vaccine adverse events, those who had headaches had a higher rate of irregularity (p = 0.041). Those having PCOS, osteoporosis, or blood coagulation disorders had higher irregularity rate (p < 0.001 and p = 0.005, respectively). CONCLUSION: Vaccine adverse events may include specific menstrual irregularities. Moreover, some hormonal medications and diseases are associated with the alteration of the menstrual cycle. This study helps in predicting vaccines' menstrual adverse events, especially in a specific population prone to menstrual disorders.

A cross-sectional study of knowledge, attitude, behaviour and preventive measures for COVID-19 infection in Lebanon.

Background: The World Health Organization has often reiterated its recommendations for the prevention of COVID-19, however, the success of these measures largely depends on public knowledge and attitudes. Aims: This study assessed the relationship between knowledge, attitude, behaviour and preventive measures for COVID-19 infection in a Lebanese population. Methods: This cross-sectional study was conducted between September and October 2020 using the snowball sampling technique and an online self-administered questionnaire. The questionnaire had 4 parts targeting sociodemographic characteristics; medical history; knowledge, attitude and practices (preventive measures and behaviours related to COVID-19); and mental health variables such as psychological distress. Two models were derived using multivariable binomial logistic regression to optimize the picture of COVID-19 correlates. Results: Our sample comprised 1119 adults. Being older, female, a regular alcohol consumer, waterpipe smoker, having low level of education, low family income, and having contact with a COVID-19 patient correlated with increased odds of ever having been diagnosed with COVID-19. Participants who had ever been diagnosed with COVID-19 had a significantly better knowledge and a higher risky practice scale [adjusted odds ratio (ORa) = 1.49; 95% CI 1.27-1.74; P < 0.001; and ORa = 1.04; 95% CI 1.01-1.08; P = 0.024, respectively]. Conclusion: The most important predictors of COVID-19 infection appear to be generally well-known among the general population, however, their knowledge and adherence to preventive measures should be continuously re-evaluated. This study highlights the need for greater awareness to improve precautionary behaviours among the public.

Knowledge and attitude towards monkeypox among the Lebanese population and their attitude towards vaccination.

Introduction: Monkeypox is a currently re-emerging disease in the world and several cases have been detected in Lebanon. For this reason, an assessment of the knowledge and attitude of the Lebanese population towards monkeypox and smallpox or monkeypox vaccines had to be done. Methods: A cross-sectional study was conducted using a questionnaire developed from previous literature among a sample of Lebanese residents. It recorded the sociodemographic characteristics and comorbidities of the participants and analyzed the patterns of knowledge and attitudes in Lebanon. Results: Among 493 participants, it was found that there is a generally low knowledge of and an average attitude toward monkeypox. However, knowledge is better with higher educational levels, COVID-19 vaccination, and residency in the south of Lebanon and poorer with marriage and residency in Beirut. Attitude is better in females but poorer with higher educational levels. Several other effectors have been devised too. As for vaccination, taking the smallpox vaccine as a proactive measure is predicted with previous COVID-19 vaccination and better attitude but not in the residents of the north of Lebanon and married Lebanese residents. Higher educational levels and a better attitude were positive predictions of taking the monkeypox vaccine whenever it is developed. Conclusion: This study revealed low level of knowledge and attitude towards monkeypox and its vaccines, which can be a rich resource when proactive measures are developed.

Smartphone addiction and personality traits among Lebanese adults: the mediating role of self-esteem.

Smartphone usage in Lebanon is increasing constantly. Lebanese population especially university students were described to be at a higher risk of smartphone addiction compared to the general population. To our knowledge there has been no study in the literature that investigated the mediating effect of self-esteem when assessing personality traits and smartphone addiction in young adults. The aim of our study was to assess factors associated with smartphone addiction and investigate the mediating role of self-esteem in the association between smartphone addiction and personality traits. A cross-sectional study was carried out between August and September 2020, during the lockdown period imposed by the government for the COVID-19 pandemic and that coincides with the summer season vacation for most Lebanese, using a sample of community-dwelling participants aged 18 to 29 years. The snowball technique was followed for participants' recruitment. The results showed that the mean age of the participants was 22.25 ± 2.87 years, with 70.9% females. The results showed that 216 (46.9%) of the participants had smartphone addiction. Higher negative emotionality (Beta = 0.17) was significantly associated with more smartphone addiction, whereas higher self-esteem (Beta = -0.37) and household crowding index (Beta = -1.58) were significantly associated with less smartphone addiction. Self-esteem mediated the association between negative emotionality and smartphone addiction. Lebanese young adults were found to be at a high risk of smartphone addiction. These results might serve as a first step towards implementing preventive measures to reduce smartphone addiction. Improving face to face communication, as well as setting specific time for cell phone usage might help reduce the development of addictive behaviors.

Actualités épidémiologiques des troubles neuropsychiatriques dans un pays en crise structurelle : le cas du Liban

Introduction Avant 2022, le Liban était classé comme pays à revenu intermédiaire supérieur, l'âge de la population était croissant, et les maladies chroniques (dont les troubles neuropsychiatriques tel que l'AVC, l'épilepsie, la schizophrénie, la dépression et l'anxiété) y sont aussi prévalentes que dans les pays avancés (sinon plus). Dès 2020, le Liban connaissait une crise économique et sociale, aggravée par la pandémie COVID-19 et l'explosion accidentelle dans le port de Beyrouth, entraînant une déliquescence du système de santé, jusqu'alors considéré comme l'un des meilleurs du Moyen Orient. Actuellement, le secteur médicamenteux souffre de pénuries sévères, ce qui risque d'entraîner des complications significatives. L'objectif de cette présentation et de montrer l'état des lieux des maladies neuropsychiatriques au Liban, dans le contexte de crise actuelle sans précédent. Méthodes Une revue de la littérature a été menée, visant à évaluer les études épidémiologiques sur les maladies neuropsychiatriques au Liban de 2012–2022. Résultats La majorité des études publiées durant la période de la crise Libanaise, étaient des études transversales menées en ligne ou des études cliniques ;si la prévalence des maladies neuropsychiatriques était difficile à évaluer en raison des méthodes utilisées, les corrélats et facteurs de risque ont été identifiés. Le niveau socioéconomique contemporain affecte non seulement l'incidence de la maladie, mais également la qualité de la prise en charge. De fait, la crise économique a augmenté le stress, et a affecté l'état des patients au Liban, avec une nette augmentation du risque de complication lié au manque d'adhérence au traitement (les patients ayant des difficultés à accéder aux médicaments : pénurie, prix exorbitants, falsification) et la disparition de la couverture assurance médicale. Conclusion Le fardeau des maladies neuropsychiatriques au Liban s'est accentué dans le contexte contemporain du pays ;la prévention primaire y est de première importance, vu que la prise en charge de ces maladies devient de plus en plus difficile et coûteuse.

The association of management and leadership competencies with work satisfaction among pharmacists in Lebanon.

BACKGROUND: Pharmacists are at the core of the healthcare system and are the most accessible healthcare professionals. Their new roles involve leadership skills, among others. Work satisfaction of pharmacists might affect the quality of the services they provide. Hence, the primary objective of this study was to evaluate the management/leadership skills and work satisfaction of pharmacists and working pharmacy students. The secondary objective was to establish the relationship between management/leadership competencies and work satisfaction. METHODS: This cross-sectional study enrolled 415 Lebanese pharmacists and fifth-year pharmacy students (undergraduates) working in different pharmacy sectors across Lebanon from August 2021 through October 2021 using the snowball sampling technique and validated tools to assess management/leadership competencies and work satisfaction. RESULTS: Management/leadership competencies were significantly correlated with work satisfaction (B = 0.288) and inversely associated with being engaged/married (B = - 2.825) and living outside Beirut or Mount Lebanon (B = - 1.873). Pharmacy students did not significantly differ in their leadership/management level from graduate pharmacists. Work satisfaction was significantly associated with management/leadership competencies (B = 0.062) and inversely related to education level (B = - 0.644). CONCLUSIONS: Pharmacists' work satisfaction and management/leadership competencies are interrelated, although the level of satisfaction seemed lower than the declared level of competencies. These concepts are differentially affected by personal and work-related characteristics. More efforts should be exerted to improve both the satisfaction and management/leadership competencies of pharmacists in Lebanon.

Disease-Modifying Therapies, Outcomes, Risk Factors and Severity of COVID-19 in Multiple Sclerosis: A MENACTRIMS Registry Based Study

Background Multiple sclerosis (MS) patients have been considered a higher-risk population for COVID-19 due to the high prevalence of disability and disease-modifying therapy use;however, there is little data in our Middle East and North Africa region (MENA) identifying clinical characteristics of MS associated with worse COVID-19 outcomes. Material(s) and Method(s) This a nationwide, multicenter, retrospective cohort study conducted between March 2020 and February 2021 and included MS patients with a suspected or confirmed COVID-19. Using data collected from the MENACTRIMS registry and local COVID-19 registries, the association of patient demographics, MS disease characteristics, and use of disease-modifying therapies with outcomes and severity of COVID-19 illness were evaluated by multivariate logistic models. Results A total of 600 MS patients with suspected (n=58) or confirmed (n=542) COVID-19 (mean age: 36.4 ± 10.16 years;414 (69%) females;mean disease duration: 8.3± 6.6 years) were analyzed. Seventy-three patients (12.2%) had a COVID-19 severity score of 3 or more, and 15 patients (2.5%) died of COVID-19. The median EDSS was 2.0 (range, 0-9.5), and 559 patients (93.2%) were receiving disease-modifying therapy (DMT). There was a higher proportion of patients with a COVID-19 severity score of 3 or more among patients treated with DMTs relative to untreated patients (82.9% vs 17.1%;P < .001), from whom the majority (n=117;19.7%) were maintained on anti-CD20 therapies such as ocrelizumab and rituximab. Comorbidities mainly hypertension and cardiovascular diseases, progressive MS, disease duration, and EDSS were associated with severe or worse COVID-19 disease outcome. Multivariate logistic regression analysis showed that older age (odds ratio per 10 years, 1.5 [95%CI, 1.1-2.0]), male gender (OR, 2.1 [95%CI. 1.2-3.8]), obesity (OR, 2.8 [95%CI, 1.3-5.8]), and treatment ocrelizumab/rituximab (OR for ocrelizumab, 4.6 [95%CI. 1.2-17.7], OR for rituximab, 14.1 [95%CI, 4.8-41.3]) or off-label immunosuppressive medications such as azathioprine or mycophenolate mofetil (OR, 8.8 [95%CI. 1.7-44.0]) were risk factors for moderate to severe COVID-19 requiring hospitalization. Surprisingly, smoking and diabetes were not identified as risk factors for severe COVID-19 disease in our cohort. Conclusion In this registry-based cohort study of patients with MS, age, sex, EDSS, obesity, progressive MS were independent risk factors for severe COVID-19. Moreover, there was an association found between exposure to anti-CD20 DMTs and COVID-19 severity. Knowledge of these risk factors may help improve the clinical management of MS patients with COVID-19 infection.

Cognitive function in recovered COVID-19 Lebanese patients with schizophrenia.

INTRODUCTION: It remains unclear whether COVID-19 which is an infectious disease caused by the SARS-CoV-2 virus is associated with the deterioration of cognitive function among patients with schizophrenia. This study aimed to evaluate changes in cognitive function before and after COVID-19 and associated factors among patients with schizophrenia at the Psychiatric Hospital of the Cross (HPC). METHODS: A prospective cohort study was conducted among 95 patients with schizophrenia followed from mid-2019 until June 2021 at the Psychiatric Hospital of the Cross (HPC). This cohort was divided into a group diagnosed with COVID-19 (n = 71) and another not diagnosed with COVID-19 (n = 24). The questionnaire included the Brief Assessment of Cognition in Schizophrenia (BACS), Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale for Schizophrenia (CDSS), and Activities of Daily Living (ADL). RESULTS: The repeated-measures ANOVA showed no significant effect of time and the interaction between time and being diagnosed or not with COVID-19 on cognition. However, being diagnosed or not with COVID-19 had a significant effect on global cognitive function (p = 0.046), verbal memory (p = 0.046), and working memory (p = 0.047). The interaction between being diagnosed with COVID-19 and cognitive impairment at baseline was significantly associated with a higher cognitive deficit (Beta = 0.81; p = 0.005). Clinical symptoms, autonomy, and depression were not associated with the cognition (p > 0.05 for all). CONCLUSION: COVID-19 disease affected global cognition and memory: patients diagnosed with COVID-19 had more deficits in these domains than those without COVID-19. Further studies are necessary to clarify the variation of cognitive function among schizophrenic patients with COVID-19.

Social media medical misinformation: impact on mental health and vaccination decision among university students.

BACKGROUND: The COVID-19 pandemic highlighted the need of social media as a medium for gathering health-related information. Simultaneously, a slew of false information, primarily about COVID-19's origin, dissemination, prevention, treatment, and fatality surfaced, making it difficult to distinguish fake from genuine material. However, the possible effects on mental health and the extent to which this influences our decisions, particularly regarding vaccination, are unknown. AIM: The purpose of this questionnaire-based cross-sectional study was to examine Lebanese University students' perceptions of social media influence during the COVID-19 pandemic, as well as to measure the impact of misinformation on respondents' mental health and vaccination decisions. METHODS: In total, 440 students took part and were asked to complete an online survey that included questions on social media trust, the "general health questionnaire index" (GHQ-12), and a scale measuring "attitude towards vaccination". RESULTS: Our data demonstrated a low frequency of mental health disorders among Lebanese University students, which was correlated to frequent social media exposure during the COVID-19 pandemic. These findings suggested that students are more aware of misinformation and had lower rates of despair and anxiety than the general population. Furthermore, Facebook use was associated with worse attitude and behaviour towards vaccination (p = 0.001), but a better mental health. Twitter had the inverse effect (p = 0.002). CONCLUSION: It is a necessity to use social media correctly in health-related topics, to push governments and platforms towards making decisions about false and invalidated posts.

Clinical and laboratory factors associated with mortality among hospitalized patients with COVID-19 infection in Lebanon: A multicenter study.

BACKGROUND: With the dire economic situation in Lebanon, many of the basic resources of the hospitals needed to help fight COVID-19 infections are not available. In this paper, we studied the possible factors associated with increased mortality in a sample of Lebanese adults enrolled in three hospitals. METHOD: In this retrospective cohort study, we analyzed data from 416 adults hospitalized in three institutions for a COVID-19 infection, from the opening of the COVID unit until their closure (period extending from March 2020 to June 2021). We used multivariate analyses to assess potential factors associated with COVID-19 mortality: gender, age, the presence of underlying medical conditions, and some medication taken during hospitalization. RESULTS: Using variables related to baseline characteristics entered as independent variables, acute kidney injury (aOR = 4.057) and older age (aOR = 1.053) were associated with a higher probability of death. After adjusting baseline characteristics and factors related to admission entered as independent variables, enoxaparin intake (aOR = 0.435) was significantly associated with a lower probability of death, whereas old age (aOR = 1.049) and ventilation (aOR = 1.2) were significantly associated with higher odds of death. When all variables that showed significance in bivariate analysis were entered, old age (aOR = 1.243) and highest PaCO2 during hospitalization (aOR = 1.192) were significantly associated with higher mortality. With a weak effect, atrial fibrillation, COPD, and higher leucocyte counts on admission were significantly associated with higher odds of death. CONCLUSION: These findings could help us prevent severe diseases in patients with several comorbidities and adjust therapeutic care to improve future outcomes. More studies should compare the outcome of different COVID-19 strains as well as the impact of vaccination on those with multiple comorbidities, especially on the mortality rate culminating from disease complications.

Author Reply

We wish to thank the commentators for their time and effort in providing valuable feedback to our study. The main purpose of our study was to evaluate the willingness to pay (WTP) for a coronavirus vaccine and its associated determinants in Lebanon.

Boredom Proneness, Loneliness, and Smartphone Addiction Among Lebanese Young Adults: The Mediating Role of Depression, Anxiety, and Stress.

Objective: To evaluate the association between boredom proneness, loneliness, and smartphone addiction among Lebanese young adults and examine the mediating role of depression, anxiety, and stress in this association.Methods: This cross-sectional study was conducted between August and September 2020 during the lockdown period of the coronavirus disease 2019 pandemic. An online survey was completed by 461 young adults aged 18 to 29 years.Results: The results showed that 66 of 134 males (49.3%, scores ≥ 31) and 143 of 327 females (43.7%, scores ≥ 33) had smartphone addiction. Smartphone addiction was significantly associated with higher boredom proneness (P < .001), anxiety (P = .012), and loneliness (P = .025). Anxiety mediated the association between boredom proneness and smartphone addiction and between loneliness and smartphone addiction, whereas depression and stress did not mediate the association between boredom/loneliness and smartphone addiction.Conclusions: Smartphone addiction is highly associated with psychological disorders, and screening strategies are needed to minimize addiction. This study emphasizes the importance of investigating the relation between smartphone addiction and psychological disorders.

The role of pharmacists in providing immunization to the general population: Are Lebanese pharmacists ready for this role?

Background: Vaccination rates remain suboptimal in multiple areas around the world in spite of evidence that immunization is one of the most effective interventions for precluding morbidity and mortality. Non-traditional vaccine providers are proposed to augment immunization coverage. Pharmacists can have multiple vital roles to educate, facilitate and immunize against vaccine-preventable diseases. Limited data are available around the expertise and practices of Lebanese pharmacists in providing immunization services. Objective: This study aimed to determine predictors that are associated with vaccine administration by pharmacists in Lebanon, and to assess experiences and practices in providing immunization. Methods: This is a cross-sectional study that included pharmacists from all over Lebanon. A web-based self-administered validated questionnaire was adapted with permission. A snowball sampling technique was used to collect data through an electronic self-administered questionnaire between March and June 2021. The web-link to the survey was also shared by the Order of Pharmacists of Lebanon with all registered pharmacists to gather a sample from different districts all over Lebanon. Results: A total of 315 pharmacists were included. A significant positive association was found between completion of an immunization training program (ORa = 2.085, [95%CI 1.006:4.322], P = 0.048), full-time pharmacists (ORa = 2.504, [95%CI 1.156:5.426], P = 0.02), 1 to 4 years of practice experience (ORa = 3.855, [95%CI 1.849:8.039], P < 0.0001), geographic area of practice (ORa = 3.201, [95%CI 1.242:8.249], P = 0.016;ORa = 5.373, [95%CI 1.859:15.530], P = 0.002 for Beirut and Mount Lebanon respectively), educating the public about immunization (ORa = 3.012, [95%CI 1.281:7.083], P = 0.011);and vaccine administration. Conclusion: The study highlights the need for additional immunization training programs to pharmacists to expand their ability and role as immunizers. It also provides intuition for policy makers to upgrade legislation relating to pharmacy continuing education and immunization training in order to enable pharmacists to have a greater role in direct vaccination.

Public views of community pharmacy services during the COVID-19 pandemic: a national survey.

OBJECTIVE: To assess public opinion about community pharmacy services in Lebanon during the COVID-19 pandemic. METHOD: A cross-sectional study using an online questionnaire was conducted between April and August of 2021. A link was shared randomly among the Lebanese population using WhatsApp and Facebook. Public perceptions were explored within 3 different indicators: general services (B) dispensing (C), and storage (D). Chi-square, Student's test and ANOVA tests were used. p < 0.05 was considered statistically significant. RESULTS: Out of 491 responses, only 9.6% scored above the 75th percentile (19.3% for the general services, 2.4% for dispensing indicator and 12.6% for storage indicator). The main concerns focused on lack of medication and reduced opening hours; however, 67.1% of respondents preferred consulting the community pharmacist instead of visiting primary health care centers, doctor's private clinic and hospitals. Higher mean values of indicators B, C and in the overall indicator were significantly found in the presence of a pharmacist compared to the support pharmacy workforce. CONCLUSION: The overall public perception was inadequate. Significant difference in terms of quality of services was detected in the presence and absence of a community pharmacist during the crisis. It is recommended that the Order of Pharmacist of Lebanon (OPL) and the Ministry of Public Health (MOPH) undergo further steps mainly to enforce the laws concerning dispensing and storage indicators, improve the services in terms of extending the opening hours, ensure the availability of medicines and increase public awareness.

Financial Wellbeing and Quality of Life Among a Sample of the Lebanese Population: The Mediating Effect of Food Insecurity

Background Lebanon is undergoing multiple overlapping crises, affecting the food security, financial well-being, and quality of life (QOL) of its residents. Objective The primary objective was to assess the food insecurity (FI) status of a sample of the Lebanese population. The second objective was to explore factors related to QOL parameters and evaluate the mediating effect of food security between financial well-being and QOL. Methods The study was cross-sectional and enrolled 412 participants recruited online using the snowball sampling technique. The survey included questions related to sociodemographic and economic characteristics of Lebanese households and validated scales to assess FI, QOL measures, financial well-being, and fear of COVID-19. Results Almost 43% of the study participants reported being food insecure, with 31% experiencing mild FI, 10% moderate FI, and 1.5% severe FI. Compared to food-insecure participants, food secure participants had a significantly higher income (58.5% vs. 39.2%, p < 0.001), a university education level (96.6% vs. 88.1%, p = 0.002), an average perceived financial status (83.9% vs. 65.9%), higher financial well-being scores (5.14 vs. 3.19, p < 0.001), and lower crowding index (0.94 ± 0.4 vs. 1.09, p = 0.002). Multivariate analysis showed that FI was not associated with physical (Beta = −1.48, 95% CI: −3.10;0.13) and mental (Beta = −1.46, 95% CI −3.68;0.75) QOL, after adjusting for other demographic and socioeconomic correlates. This association remained non-significant when introducing the financial well-being variable to the model. Mediation analyses showed that the FI variable mediated the association between financial well-being and physical QOL (Beta = 0.19, 95% CI: 0.02;0.36), but not the mental QOL (Beta = −0.02, 95% CI: −0.20;0.14). Conclusion Food insecurity was prevalent in our study sample, and it mediated the association between financial well-being and physical, but not mental, QOL parameters. These findings call for evidence-based policies and programs to help improve the food security and well-being of Lebanese households amidst these unprecedented circumstances.

Phubbing among Lebanese young adults: Scale validation and association with mental health (depression, anxiety, and stress).

Mobile phones use has not been without several social and psychological problems, specifically during the fast spread of the COVID-19 infection, which imposed strict restrictions and isolation. This research principal aims were to (1) confirm the validity of the Generic Scale of Phubbing in Arabic (GSP), and (2) evaluate the association between phubbing and mental health (depression, anxiety and stress). A first cross-sectional study enrolled 203 participants to confirm the factor structure of the phubbing scale among Lebanese young adults. A confirmatory factor analysis (CFA) was carried out on the whole sample using SPSS AMOS v.24 to confirm the four-factor structure of the GSP. The root mean square error of approximation (RMSEA) statistic, the comparative fit index (CFI) and the Tucker Lewis Index (TLI) were used to evaluate the goodness-of-fit of the model. RMSEA values ≤0.08 and ≤ 0.10 indicate a good and acceptable fit respectively. CFI and TLI values ≥0.90 indicate good model fit. A second cross-sectional study enrolled 461 respondents (18-29 years old) to conduct the multivariable analysis. The fit indices values were as follows: χ2/df = 181.74/84 = 2.16, TLI = .92, CFI = .94 and RMSEA = .076 [95% CI .061-.091] respectively, indicating an excellent fit of the model. The results of the multiple linear regression using the ENTER model, when taking the phubbing score as the dependent variable, showed that female gender (ß = 0.11; t(454) = 2.50; p = .013), more stress (ß = 0.27; t(454) = 3.94; p < .001), more anxiety (ß = 0.30; t(454) = 4.24; p < .001), and older age (ß = 0.28; t(454) = 6.12; p < .001) were positively correlated with higher phubbing, or higher household crowding index (ß = -0.15; t(454) = -3.62; p < .001) was significantly correlated with less phubbing. The results of this study were able to confirm the validity of the Arabic version of the GSP scale. This will allow Lebanese clinicians to use this validated tool to screen for the presence of the phubbing phenomenon within this age group. We propose finding possible correlation between phubbing and others factors (such as obsession and loneliness) and validating this scale in other Arabic-speaking countries.

Managing endothelial dysfunction in COVID-19 with statins, beta blockers, nicorandil, and oral supplements: A pilot, double-blind, placebo-controlled, randomized clinical trial.

Coronavirus disease 2019 (COVID-19) is associated with endothelial dysfunction. Pharmacologically targeting the different mechanisms of endothelial dysfunction may improve clinical outcomes and lead to reduced morbidity and mortality. In this pilot, double-blind, placebo-controlled, randomized clinical trial, we assigned patients who were admitted to the hospital with mild, moderate, or severe COVID-19 infection to receive, on top of optimal medical therapy, either an endothelial protocol consisting of (Nicorandil, L-arginine, folate, Nebivolol, and atorvastatin) or placebo for up to 14 days. The primary outcome was time to recovery, measured by an eight category ordinal scale and defined by the time to being discharged from the hospital or hospitalized for infection-control or other nonmedical reasons. Secondary outcomes included the composite outcome of intensive care unit (ICU) admission or the need for mechanical ventilation, all-cause mortality, and the occurrence of side effects. Of 42 randomized patients, 37 were included in the primary analysis. The mean age of the patients was 57 years; the mean body mass index of study participants was 29.14. History of hypertension was present in 27% of the patients, obesity in 45%, and diabetes mellitus in 21.6%. The median (interquartile range) time to recovery was not significantly different between the endothelial protocol group (6 [4-12] days) and the placebo group (6 [5-8] days; p value = 0.854). Furthermore, there were no statistically significant differences in the need for mechanical ventilation or ICU admission, all-cause mortality, or the occurrence of side effects between the endothelial protocol group and the placebo group. Among patients hospitalized with mild, moderate, or severe COVID-19 infection, targeting endothelial dysfunction by administering Nicorandil, L-arginine, Folate, Nebivolol, and Atorvastatin on top of optimal medical therapy did not decrease time to recovery. Based on this study's findings, targeting endothelial dysfunction did not result in a clinically significant improvement in outcome and, as such, larger trials targeting this pathway are not recommended.

The Combined Outcomes of the COVID-19 Pandemic and a Collapsing Economy on Mental Well-Being: A Cross-Sectional Study.

Objective: This study aimed to examine the outcomes of COVID-19 and a collapsing economy on the mental well-being (MWB) of the general Lebanese population. Methods: A cross-sectional study was conducted online in May 2020 and enrolled 502 adults. Results: Mental well-being had a mean of 14.80 (14.37; 15.24). A lower MWB was associated with female gender (beta=-1.533 [-2.324; -0.743]), university education (beta=-2.119 [-3.353;-0.885]), fear of COVID-19 (beta=-0.131 [-0.199; -0.063]), fear of poverty (beta=-0.232 [-0.402;-0.063]), verbal violence at home (beta=-3.464 [-5.137; -1.790]), and chronic disease (beta=-1.307 [-2.283; -0.330]). Better family satisfaction (beta=0.380 [0.235; 0.525]) and better financial situation (beta=0.029 [0.003; 0.055]) were significantly correlated with better MWB. In the subsample of workers/looking for a job, additional factors affected MWB: physical exercise (beta =1.318 [0.370; 2.265]) was associated with better QOL, while being a previous waterpipe smoker, being self-employed before the crisis (beta=-1.22 [-2.208;-0.231]), working from home since the economic crisis (-1.853 [-3.692; -0.013]), and worrying about the long-term effects of the crisis on one's employment status (beta=-0.433 [-0.650; -0.216]) were associated lower MWB. It is noteworthy that closure of the institution yielded a borderline result (B = -1.2; p = .094), while the fear of COVID-19 was not significantly associated with MWB (B = -0.054; p =0.192). Conclusion: This study showed that, during the pandemic, economic and other factors, directly or indirectly related to COVID-19, significantly affected quality of life. The fear of COVID-19 and fear of poverty mainly impacted the MWB of the general population. However, the fear of COVID-19 lost its significance among workers, who reported that factors negatively affecting their MWB are directly related to their employment and the already collapsing economy in Lebanon.

Factors related to pregnancy status and unwanted pregnancy among lebanese women during the COVID-19 lockdown: a cross-sectional study.

BACKGROUND: Home confinement and lockdowns have created challenges and vulnerabilities, causing relevant changes in sexual health and couple stability, particularly in women. The objective of this study was to evaluate the socio-economic and psychological factors related to current pregnancy status and unwanted pregnancy among Lebanese women during the COVID-19 lockdown. METHODS: A cross-sectional online study conducted between June 8 and August 1, 2020, enrolled 369 Lebanese women using the snowball technique for data collection. All married women between 18 and 51, with access to the internet and currently living with their partners, were eligible to participate. Current pregnancy status and unwanted pregnancy were assessed using binary questions. The SPSS software 25 was used for data analysis, and multivariable analysis was performed, taking the pregnancy status and unwanted pregnancy as the dependent variables. The statistical significance was set at a p-value < 0.05. RESULTS: Our results showed that 11.1% of women were pregnant, of whom 22.0% reported unwanted pregnancies. Having children (ORa = 0.183) and taking contraceptives (ORa = 0.231) were significantly associated with a reduced chance of becoming pregnant. Higher psychological violence would negatively affect pregnancy, but the association was not significant (p = 0.065). Regular visits to the physician for routine checks were also linked to a decreased risk of unwanted pregnancy (ORa = 0.053). Higher psychological violence would affect unwanted pregnancy; however, the association was insignificant (p = 0.056). CONCLUSION: The study findings showed that having children and taking contraceptives are associated with a reduced pregnancy. Additionally, psychological violence was found to be related to current pregnancy status and unplanned pregnancy. During a pandemic, vulnerable women should be identified and given adequate care, knowledge, and awareness regarding their reproductive health.

Effect of Screen Time on Physical and Mental Health and Eating Habits During COVID-19 Lockdown in Lebanon.

OBJECTIVE: This study aimed to explore whether screen time and the screen type impacted various health aspects of children, including physical activity (PA), sleep quality, and eating habits. Additionally, we investigated whether children's eating behavior while using electronic devices affects their physical and mental health. METHODS: We conducted an online survey asking for screen use (duration, type, and purpose), PA, eating habits, sleep problems, and level of depression. The participants were children between the ages of 3 and 7 years, and the survey was answered by the participants' parents from March 3 to March 20, 2021. RESULTS: A screen time of ≥2 h in children was associated with various clinical characteristics, such as body mass index (BMI), sleep problems, depression, decreased PA, and unusual eating habits. Children's food eating behavior while using electronic devices was predicted by a total screen time ≥2 h, smartphone screen time ≥2 h, sleep problems, owning electronic devices, and eating unhealthy food. CONCLUSION: There was an interplay among children's PAs, eating behaviors, depression, sleep problems, and screen time in this pandemic era. Therefore, guiding children on the correct use of electronic devices and helping them eat healthy are paramount during this COVID-19 pandemic.