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.

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.

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.

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.

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.

Challenges and perspective of cancer patients during the COVID-19 pandemic and the Lebanese financial crisis: a multicentric cross-sectional study.

Lebanese cancer patients are facing a war on two fronts, between the COVID-19 pandemic and one of the most severe financial crises globally in recent times. This multicentric cross-sectional study was conducted, aiming to analyse challenges and perspective of this particularly vulnerable population. A questionnaire was prepared to assess socio-demographic data, challenges faced during the pandemic, perspectives concerning cancer and COVID-19, a scale was also validated to assess knowledge level regarding COVID-19 in this population. Patients were interviewed in chemotherapy units from four different private and public hospitals in Lebanon during December 2020 and March-June 2021. In total, 272 patients were interviewed (median age, 57 years, range, 22-90 years). Concerning salary during the pandemic, it changed negatively (45.6%), or did not change (7.7%), while 46.7% of participants did not work. Some challenges such as transportation problems (39%), inability to reach their physician by phone (16.9%), deferral of chemotherapy dates (31.6%), difficulty finding chemotherapy medications (49.6%) were more likely to be reported by patients receiving chemotherapy in public compared to private hospitals (p < 0.01 for each). Other challenges include not being able to find non-cancer-related medications (71.3%), this challenge being increased when comparing December 2020 with March-June 2021 (p < 0.02). Using a multivariate analysis, the best predictor for increased knowledge about COVID-19 was higher levels of education (p < 0.001). In conclusion, this study shows that cancer patients in Lebanon are facing many challenges that complicate different aspects of health. Perspective and challenges of these patients must be taken into consideration in order to deliver better care to our patients in these unprecedented times.

Should samples be weighted to decrease selection bias in online surveys during the COVID-19 pandemic? Data from seven datasets.

BACKGROUND: Online surveys have triggered a heated debate regarding their scientific validity. Many authors have adopted weighting methods to enhance the quality of online survey findings, while others did not find an advantage for this method. This work aims to compare weighted and unweighted association measures after adjustment over potential confounding, taking into account dataset properties such as the initial gap between the population and the selected sample, the sample size, and the variable types. METHODS: This study assessed seven datasets collected between 2019 and 2021 during the COVID-19 pandemic through online cross-sectional surveys using the snowball sampling technique. Weighting methods were applied to adjust the online sample over sociodemographic features of the target population. RESULTS: Despite varying age and gender gaps between weighted and unweighted samples, strong similarities were found for dependent and independent variables. When applied on the same datasets, the regression analysis results showed a high relative difference between methods for some variables, while a low difference was found for others. In terms of absolute impact, the highest impact on the association measure was related to the sample size, followed by the age gap, the gender gap, and finally, the significance of the association between weighted age and the dependent variable. CONCLUSION: The results of this analysis of online surveys indicate that weighting methods should be used cautiously, as weighting did not affect the results in some databases, while it did in others. Further research is necessary to define situations in which weighting would be beneficial.

Antibiotic Discovery and Resistance: The Chase and the Race.

The history of antimicrobial resistance (AMR) evolution and the diversity of the environmental resistome indicate that AMR is an ancient natural phenomenon. Acquired resistance is a public health concern influenced by the anthropogenic use of antibiotics, leading to the selection of resistant genes. Data show that AMR is spreading globally at different rates, outpacing all efforts to mitigate this crisis. The search for new antibiotic classes is one of the key strategies in the fight against AMR. Since the 1980s, newly marketed antibiotics were either modifications or improvements of known molecules. The World Health Organization (WHO) describes the current pipeline as bleak, and warns about the scarcity of new leads. A quantitative and qualitative analysis of the pre-clinical and clinical pipeline indicates that few antibiotics may reach the market in a few years, predominantly not those that fit the innovative requirements to tackle the challenging spread of AMR. Diversity and innovation are the mainstays to cope with the rapid evolution of AMR. The discovery and development of antibiotics must address resistance to old and novel antibiotics. Here, we review the history and challenges of antibiotics discovery and describe different innovative new leads mechanisms expected to replenish the pipeline, while maintaining a promising possibility to shift the chase and the race between the spread of AMR, preserving antibiotic effectiveness, and meeting innovative leads requirements.

Willingness to Pay for a Coronavirus Vaccine and Its Associated Determinants in Lebanon.

OBJECTIVES: This study aimed to investigate the willingness to pay (WTP) for a hypothetical vaccine and its associated determinants among the Lebanese general population during one of the peak episodes during the coronavirus disease 2019 (COVID-19) pandemic in Lebanon. METHODS: An online survey was developed and delivered to the Lebanese general population. The questionnaire included the participants' sociodemographic characteristics, financial situation, attitude toward vaccination, and WTP for the hypothetical vaccine. The study was based on the contingent valuation method. RESULTS: Among 500 individuals solicited, 352 individuals agreed to participate (participation rate = 70.4%); among them, 66% were between 18 and 45 years old, and 54% were women. Notably, 78.1% of the respondents were ready to pay for this hypothetical vaccine even if the vaccine will not be covered. The maximum WTP of the Lebanese population was approximately $60 ± $66 (range $3-$500) after excluding extreme values in the sensitivity analysis and ranged between $3 and $500. WTP was associated with the severity of COVID-19 (P<.001), the education level (P=.001), and the place to live during the lockdown (P=.045). There was an association between family income and WTP (P=.004) with a weak correlation. CONCLUSIONS: The WTP was comparable with other studies and highly associated with the level of education, the household income, living in the city during the lockdown, and the perceived severity of COVID-19. These findings can help in understanding COVID-19 vaccination acceptance and WTP in Lebanon.

Factors related to autonomy among Lebanese women: a web-based cross-sectional study.

BACKGROUND: Autonomy involves making independent decisions and creating lasting and equitable power relationships within families. Many factors, dependent on both the woman and her partner, can influence self-dependence, and subsequent decision-making, exerting a protective or triggering effect on its development. Therefore, the primary objective of the study was to assess autonomy in a sample of Lebanese women. The secondary objective was to evaluate the association between socioeconomic status, psychological factors, and autonomy. METHODS: A web based cross-sectional online study was conducted between June 8 and August 1, 2020. The questionnaire developed on Google Forms was distributed through social media and WhatsApp groups, using the snowball technique. The Women's Autonomy Index (WAI) was created using three items adapted from a previous study. In addition, the Composite Abuse Scale Revised-Short Form (CASR-SF) was used to assess three domains of abuse: physical, sexual, and psychological. The Perceived stress scale short version to measure stress perception, the Lebanese Anxiety Scale to measure anxiety and the Patient Health Questionnaire (PHQ-9) to assess depression. The Statistical Package for the Social Sciences (SPSS) software version 25 was used for data analysis. Linear regressions were performed, taking the Women's Autonomy Index as the dependent variable. RESULTS: The sample consisted of 369 Lebanese women. University education level (beta = 1.263), alcohol consumption (beta = 0.586), intermediate income level (beta = 0.702), high income (beta = 0.911), employment (beta = 0.559), and older age (beta = 0.033) were significantly associated with higher WAI. Living in South Lebanon (beta = - 0.668) and being Druze (beta = - 323) were associated with lower WAI. Significantly higher mean scores of anxiety and perceived stress were found among women with low autonomy. CONCLUSION: In Lebanon, the autonomy of women depends on several personal and partner-related characteristics (education, socioeconomic status, age), in addition to the cultural (geographic and religious) environment. Furthermore, low autonomy is associated with higher perceived stress and anxiety and probable depression and domestic abuse.

Stigma toward people with COVID-19 among the Lebanese population: a cross-sectional study of correlates and mediating effects.

INTRODUCTION: Stigma develops during outbreaks such as the COVID-19 pandemic due to the human fear that arises from the anxiety about a disease of an unknown etiology, with the associated detrimental consequences on both the individual and society. This study was conducted to assess if knowledge about COVID-19, attitude, practice and behavior regarding preventive measures against COVID-19, fear, and anxiety towards COVID-19 will affect the level of stigma and evaluate the mediating effect of fear, anxiety, and diagnosis of COVID-19 on stigma. METHODS: A cross-sectional online survey conducted between December 20, 2020, and January 05, 2021, enrolled 405 participants recruited from the Lebanese population. Two scales were created and adapted to the Lebanese context to measure the current stigma (stigma discrimination scale, self-stigma scale) toward COVID-19. RESULTS: More than half of the sample had moderate to severe stigma discrimination (62%) and self-stigma (65.9%). The multivariable analysis showed that higher fear of COVID-19 scale (Beta = .143) was significantly associated with a higher stigma discrimination scale. Whereas, higher knowledge score (Beta = -.153) was significantly associated with a lower stigma discrimination scale. Fear of COVID-19, anxiety from COVID-19, being diagnosed with COVID-19, and having a family member with COVID-19 partially mediated the association between knowledge and stigma discrimination scale. No mediation effect of fear and anxiety scale was found between the knowledge and self-stigma score. CONCLUSION: Our main findings indicate that a considerable proportion of the Lebanese population has stigma discrimination behaviors toward COVID-19 patients and that those who were infected with the virus experienced COVID-19-related stigmatization.

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.

Smartphone Screen Time Among University Students in Lebanon and Its Association With Insomnia, Bedtime Procrastination, and Body Mass Index During the COVID-19 Pandemic: A Cross-Sectional Study.

OBJECTIVE: We aimed to investigate the association of increased smartphone screen time with insomnia, bedtime procrastination, depression, anxiety, body mass index (BMI), and physical activity during the coronavirus disease of 2019 (COVID-19) pandemic. METHODS: An online survey was performed for university students from all regions of Lebanon during the lockdown. The survey included questionnaires about smartphone screen time, diet, physical activity, psychological symptoms, and bedtime procrastination. We defined 6 hours of smartphone use as critical based on a survey done in United States. RESULTS: Among female students, smartphone use duration, physical activity levels, BMI, depression, anxiety, and insomnia severity were significantly higher than in male. When we stratified participants based on 6 hours of smartphone use, females, unhealthy food consumption, insomnia, anxiety, depression, and bedtime procrastination were significantly higher in the group with ≥6 hours of smartphone use. When we divided based on 7 hours, physical activity and body weight also differed between the two groups. Logistic regression analysis revealed that female, overweight, insomnia, and bedtime procrastination were significant predictors of a phone screen time of 7 hours. CONCLUSION: Our findings suggest that adults should be more cautious and responsible when using smartphones and be more concerned about the health-related risks.

Combined anticoagulant and antiplatelet therapy is associated with an improved outcome in hospitalised patients with COVID-19: a propensity matched cohort study.

BACKGROUND: COVID-19 is a respiratory disease that results in a prothrombotic state manifesting as thrombotic, microthrombotic and thromboembolic events. As a result, several antithrombotic modalities have been implicated in the treatment of this disease. This study aimed to identify if therapeutic anticoagulation (TAC) or concurrent use of antiplatelet and anticoagulants was associated with an improved outcome in this patient population. METHODS: A retrospective observational cohort study of adult patients admitted to a single university hospital for COVID-19 infection was performed. The primary outcome was a composite of in-hospital mortality, intensive care unit (ICU) admission or the need for mechanical ventilation. The secondary outcomes were each of the components of the primary outcome, in-hospital mortality, ICU admission, or the need for mechanical ventilation. RESULTS: 242 patients were included in the study and divided into four subgroups: Therapeutic anticoagulation (TAC), prophylactic anticoagulation+antiplatelet (PACAP), TAC+antiplatelet (TACAP) and prophylactic anticoagulation (PAC) which was the reference for comparison. Multivariable Cox regression analysis and propensity matching were done and showed when compared with PAC, TACAP and TAC were associated with less in-hospital all-cause mortality with an adjusted HR (aHR) of 0.113 (95% CI 0.028 to 0.449) and 0.126 (95% CI 0.028 to 0.528), respectively. The number needed to treat in both subgroups was 11. Furthermore, PACAP was associated with a reduced risk of invasive mechanical ventilation with an aHR of 0.07 (95% CI 0.014 to 0.351). However, the was no statistically significant difference in the occurrence of major or minor bleeds, ICU admission or the composite outcome of in-hospital mortality, ICU admission or the need for mechanical ventilation. CONCLUSION: The use of combined anticoagulant and antiplatelet agents or TAC alone in hospitalised patients with COVID-19 was associated with a better outcome in comparison to PAC alone without an increase in the risk of major and minor bleeds. Sufficiently powered randomised controlled trials are needed to further evaluate the safety and efficacy of combining antiplatelet and anticoagulants agents or using TAC in the management of patients with COVID-19 infection.

A cross-sectional study of COVID-19-related bullying in a sample of Lebanese adults: scale validation, correlates, and mediating effect of fear and anxiety.

BACKGROUND: The COVID-19 pandemic has led to prolonged exposure to stress and anxiety, raising concerns about a large spectrum of psychological side effects. The primary objective of the study was to validate the COVID-19 Bullying Scale (CBS-11). The second objective was to explore factors associated with COVID-19-related bullying and evaluate the mediating effect of fear and anxiety between knowledge and COVID-19-related bullying. METHODS: A cross-sectional online survey conducted between December 20, 2020, and January 5, 2021, recruited 405 Lebanese adults using a snowball sampling technique. The CBS-11, an 11-item tool specifically created for this study, was used to measure bullying behaviors towards COVID-19 patients. RESULTS: All items of the CBS-11 converged over a 1-factor solution with an eigenvalue over 1, accounting for a variance of 75.16%. The scale has a high Cronbach's alpha (.974), indicating excellent reliability. A positive correlation was found between the COVID-19 bullying scale and fear, anxiety, and stigma discrimination. The logistic regression showed that higher fear of COVID-19 (ORa = 1.04), a positive attitude toward COVID-19 preventive measures and hygiene recommendations (ORa = 1.18), higher stigma discrimination scores (ORa = 1.09), and having a health professional family member (ORa = 2.42) were significantly associated with bullying. CONCLUSION: Our main findings showed that the CBS-11 could be an efficient tool to measure bullying behaviors toward COVID-19 patients. Stigma discrimination and fear from COVID-19 were associated with higher bullying attitudes. Future prospective studies are needed to understand better the factors related to bullying among adults during a pandemic, such as COVID-19.