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Healthcare institutions have commonly reported exposure of employees, particularly nurses, to high levels of occupational violence. Despite such evidence in the Middle East Region, there is a dearth of national studies that have systematically investigated this phenomenon. This study investigates the prevalence, characteristics, consequences and factors associated with nurses' exposure to occupational violence in Lebanon. A cross-sectional design was utilized to survey a nationally representative sample of 915 nurses registered with the Order of Nurses in Lebanon. Stratified random sampling by governorate was utilized. Individually-mailed questionnaires collected information on exposure to violence, degree of burnout and demographic/professional background. The main outcome variables were exposure to verbal abuse (never, 1-3, 4-9 and 10+ times) and physical violence (never, ever) over the past 12-months. Descriptive statistics were used to estimate prevalence of violence. Multivariable, binomial and multinomial regression models were carried out to investigate the correlates of exposure to verbal abuse and physical violence, respectively. Response rate was 64.8%. Over the last year, prevalence of nurses' exposure to verbal abuse was 62%, (CI: 58-65%) and physical violence was 10%, (CI: 8-13%). Among respondents, 31.7% of nurses indicated likelihood to quit their jobs and 22.3% were undetermined. Furthermore, 54.1% reported high levels of emotional exhaustion and 28.8% reported high levels of depersonalization. Compared to nurses with no exposure to verbal abuse, nurses reporting high exposure had high levels of emotional exhaustion (OR:6.4; CI:1.76-23.32), depersonalization (OR:6.8; CI: 3-15) and intention to quit job (OR:3.9; CI: 1.8-8.3). They further reported absence of anti-violence policies at their institutions (OR: 3; CI: 1.5-6.3). Nurses that were ever exposed to physical violence were more likely to be males (OR: 2.2; CI: 1.1-4.3), working day and night shifts (OR: 2.8; CI: 1.4-5.5) and subject to ten or more incidents of verbal abuse per year (OR: 46.7; CI: 10.1-214). An alarming two-thirds of respondents reported exposure to verbal abuse which was found to be a significant predictor of the three subscales of burnout, intention to quit and exposure to physical violence. The prevalence of exposure to physical violence is disconcerting due to its severe consequences. Policy and decision-makers are urged to use study findings for policy and practice interventions to create safe work environments conducive to nurses' productivity and retention.

Background Burnout in health system pharmacists has been studied in several countries. To date, no data exists on burnout among healthsystem pharmacists in Lebanon. This study aimed to determine the prevalance of burnout, identify factors and describe coping strategies related to burnout among healthsystem pharmacists in Lebanon. Methods A cross-sectional study utilizing the Maslach Burnout Inventory- Human Services Survey for Medical Personnel (MBI-HSS (MP))was conducted in Lebanon. A convenience sample of hospital pharmacists in Mount Lebanon and Beirut area filled a paper-based survey in person or via a phone interview. Burnout was defined as having an emotional exhaustion score ≥ 27 and/or depersonalization score ≥ 10. To identify factors associated with burnout, the survey also contained questions on socio-demographic characteristics, professional status, hospital characteristics, professional stressors and professional satisfaction. Participants were also asked about their coping strategies. To adjust for potential confounding, a multivariable logistic regression was used to estimate the adjusted odds ratios of factors and coping strategies associated with burnout. The authors also evaluated burnout according to the broader definition, emotional exhaustion score ≥ 27 or depersonalization score ≥ 10 or low personal accomplishment ≤ 33. Results Of the 153 health system pharmacists who were contacted, 115 filled the survey (response rate of 75.1%). The overall burnout prevalence reported was n = 50 (43.5%) and was largely driven by high emotional exhaustion n = 41(36.9%). Following multivariate logistic regression, seven factors were associated with increased burnout: older age, B.S. in Pharmacy degree, involvement in student training, no involvement in procurement, divided attention at work, overall dissatisfaction with career, dissatisfaction to neutrality with balance between professional and personal life. Low personal accomplishment was noted in n = 55 (49.5%). The main coping strategies identified were holidays, leisure, hobbies, sports activities, and relaxation. There was no association between the coping strategies used and burnout. The prevalence of burnout according to the broader definition was n = 77 (67%). The factors associated with the broader definition of burnout were older age, overall dissatisfaction with career and dissatisfaction with work life balance. Conclusion Approximately n = 50(43.5%)of health system pharmacists in Lebanon may be at risk for burnout. If using broader definitions incorporating all three subscales of the (MBI-HSS (MP)), the prevalence of burnout was n = 77(67%). This study highlights the need to advocate for pratice reforms to improve the low personal acoomplishment and recommends strategies to mitigate burnout. Further research to assess the current prevalence of burnout and evaluate effective interventions in alleviating burnout amongst health system pharmacists is needed.

Background Since the outbreak of the Syrian war in 2011, close to 6 million Syrian refugees have escaped to Syria’s neighbouring countries, including Lebanon. Evidence suggests rising levels of mental health disorders among Syrian refugee populations. Yet, to the best of our knowledge, large-scale studies addressing the mental health of adult Syrian refugees in Lebanon are lacking. We examined the prevalence of depression symptoms, which represent a common and debilitating mental health disorder among Syrian refugee populations in Lebanon, along with their sociodemographic and clinical correlates. Methods A cross-sectional survey design was conducted as part of a collaborative project-“Sijilli”- led by the Global Health Institute at the American University of Beirut (Beirut, Lebanon) across 4 informal tented settlements for refugees (Beirut, Bekaa, North, South) in Lebanon among adult Syrian refugees (≥18), over a period extending from 2018 to 2020. The survey inquired about participants’ sociodemographic and clinical characteristics, and screened participants for symptoms of depression through sequential methodology using the Patient Health Questionnaire (PHQ-2 and PHQ-9). Results A total of 3255 adult Syrian refugees were enrolled in the study. Of those refugees, 46.73% ( n  = 1521) screened positive on the PHQ-2 and were therefore eligible to complete the PHQ-9. In the entire sample ( n  = 3255), the prevalence of moderate to severe depression symptoms (PHQ-2 ≥ 2 and then PHQ-9 ≥ 10) was 22% ( n  = 706). Further analyses indicate that being ≥45 years of age (OR 1.61, 95% CI 1.13–2.30), a woman (OR 1.34, 95% CI 1.06–1.70), widowed (OR 2.88, 95% CI 1.31–6.32), reporting a neurological (OR 1.73, 95% CI 1.15–2.60) or a mental health condition (OR 3.98, 95% CI 1.76–8.97) are major risk factors for depression. Conclusion Our study suggests that an estimated one in four Syrian refugees in Lebanon shows moderate to severe depression symptoms, and our findings have important public health and clinical implications on refugee health. There is a need to enhance screening efforts, to improve access and referral to mental health services, and to improve post-migration factors among Syrian refugees in Lebanon.

Cornflakes are a popular and convenient breakfast cereal made from corn and widely consumed worldwide, including in Lebanon. However, they are susceptible to mycotoxin contamination, which can have harmful effects on human health. Our study evaluated the occurrence of five mycotoxins (AFB1, OTA, FUM, ZEA, DON) levels in packed cornflakes marketed in Lebanon. A market screening identified 35 different cornflake stock-keeping units (SKU) in the Lebanese market, originating from 10 different brands and having different tastes and shapes. SKUs were collected and tested for five mycotoxins in triplicates using enzyme-linked immunosorbent assay technique. The results showed the presence of the five mycotoxins in the samples. The average levels of AFB1, OTA, ZEA and FUM among positive samples (above limit of detection) were 1.58, 1.2, 15.1 and 774.1 μg/kg, respectively, and were below the EU limits. On the other hand, the average level of DON was 1206.7 μg/kg, exceeding the EU limit. Furthermore, out of the positive samples, 60%, 17%, 9%, 14%, and 6% exceeded the EU limits for DON, OTA, AFB1, FUM, and ZEA, respectively. Notably, SKUs made in Lebanon had significantly ( p  < 0.05) higher levels of AFB1 and FUM. The packing size of the cornflakes had no significant ( p  > 0.05) effect on the levels of the five mycotoxins detected in the samples. AFB1, FUM and ZEA levels differed significantly among SKUs ( p  > 0.05). Considering these findings, further studies should be conducted to assess the exposure to mycotoxins from the consumption of cornflakes in Lebanon, especially among children.

Background The use of potentially inappropriate medications (PIMs) may pose more risks than benefits to patients and is a major factor contributing to the likelihood of serious adverse drug reactions and negative health outcomes among older patients. Methods A retrospective chart review was conducted in a tertiary care center in USA where home medications of the older patients were reviewed and analyzed upon hospital admission over three months, from March till May 2016. Inclusion criteria were age of 65 years and above, history of cardiovascular disease, and admission to the cardiology service. The aim of our study was to determine the frequency and factors associated with PIMs, by applying the updated Beers 2015 criteria. Results A total of 404 patients were included in the study and were taking a total of 4669 medications at home, an average of 11.6 ± 4.5 medications per patient. The proportion of PIMS was 20% of all medications reported, with an average of 2.4 PIM per patient, and 87.4% of patients were receiving at least one PIM. Significant association was found between use of PIMs and number of home medications, female gender, and number and types of comorbidities. Comorbidities associated with more PIMs were heart failure, atrial fibrillation/flutter, history of falls/fractures, cerebrovascular accident, and depression. The most commonly prescribed PIMs were: drugs that may exacerbate or cause syndrome of inappropriate antidiuretic hormone secretion or hyponatremia (29.7%), scheduled use of proton pump inhibitors (PPIs) > 8 weeks in non-high-risk patients (11.3%), and benzodiazepines (8.1%). Conclusions A high prevalence of PIMs in older patients with cardiovascular disease was observed. Provider education and detailed assessment of medication lists upon hospital admission by multidisciplinary teams can help in preventing the use of PIMs.

This study aimed to assess health literacy (HL) levels among inpatients and evaluate its association with health-related quality of life (HRQoL), antibiotic use and knowledge, health services need, adverse drug events (ADEs), and sociodemographic factors. The cross-sectional study was conducted at a major teaching hospital from October 2022 to April 2023, recruiting 135 inpatients aged 18 and older. Data were collected through face-to-face interviews using validated questionnaires including the HLS-EU-Q16 for HL and EQ-5D-5 L for HRQoL assessment. Results showed sufficient HL among 64.4% of the participants, which was associated with gender, marital status, and occupation. Patients with sufficient HL demonstrated higher HRQoL measures and better antibiotic knowledge. Those with insufficient HL were more likely to engage in risky medication practices and hold misconceptions about antibiotic use. No significant link was found between HL and healthcare utilization or ADEs. The findings underscore HL’s critical impact on inpatient healthcare outcomes. By integrating HL assessment into clinical practice and implementing targeted educational initiatives, particularly on antibiotic use, healthcare providers can empower patients to make informed decisions and enhance health outcomes.

Owning pets offers various potential health benefits; however, it can be associated with gastrointestinal illnesses due to poor food safety knowledge and practices. This study aimed to evaluate the level of food safety knowledge and practices among pet owners in Lebanon, exploring the association between their knowledge/practices and socio-demographic characteristics. The participants included 300 pet owners, representing various genders, ages, educational levels, educational backgrounds, and incomes. They completed a questionnaire of 72 food handling practices and knowledge questions related to preparation, cross-contamination, storage and hygiene. In parallel, 300 non-pet owners with comparable sociodemographic characteristics to pet owners (control group) completed the questionnaire. On average, food safety knowledge scores were 62.1 ± 14.9% and 58.7 ± 15.5% among pet and non-pet owners, respectively, and the difference was significant ( p  = 0.05). On the other hand, mean food safety practice scores were 41.3 ± 14.8% and 40.4 ± 15.3% among pet and non-pet owners, respectively, and the difference was not significant ( p  = 0.41). In the food safety knowledge part, non-pet owners who were young, high income, university graduate, and from health-related majors scored significantly ( p  < 0.05) higher, while among pet-owners, only participants with a university degree and from health-related majors scored significantly ( p  < 0.05) higher, in terms of knowledge. On the other hand, In the food safety practices part, non-pet owners who were young, high income, and university graduates scored significantly ( p  < 0.05) higher, while among pet-owners, only young and high-income participants scored significantly ( p  < 0.05) higher. These results highlight the need for ongoing educational initiatives to improve food safety practices among both pet owners in Lebanon. The study suggests that targeted educational programs should be developed, considering specific socio-demographic characteristics, to enhance overall food safety awareness and practices among the population.

Tea is among the oldest and most-known beverages around the world, and it has many flavors and types. Tea can be easily contaminated in any of its production steps, especially with mycotoxins that are produced particularly in humid and warm environments. This study aims to examine the level of ochratoxin A (OTA) and total aflatoxin (AF) contamination in black and green tea sold in Lebanon, evaluate its safety compared to international standards, and assess the effect of different variables on the levels of OTA and AFs. For this, the Lebanese market was screened and all tea brands (n = 37; 24 black and 13 green) were collected twice. The Enzyme-Linked Immunoassay (ELISA) method was used to determine OTA and AFs in the samples. AFs and OTA were detected in 28 (75.7%) and 31 (88.6%) samples, respectively. The average of AFs in the positive (above detection limit: 1.75 μg/kg) samples was 2.66 ± 0.15 μg/kg, while the average of OTA in the positive (above detection limit: 1.6 μg/kg) samples was 3.74 ± 0.72 μg/kg. The mean AFs in black and green tea were 2.65 ± 0.55 and 2.54 ± 0.40 μg/kg, respectively, while for OTA, the mean levels were 3.67 ± 0.96 and 3.46 ± 1.09 μg/kg in black and green tea samples, respectively. Four brands (10.8%) contained total aflatoxin levels above the EU limit (4 μg/kg). As for OTA, all samples had OTA levels below the Chinese limit (5 μg/kg). No significant association (p > 0.05) was found between OTA and tea type, level of packaging, country of origin, country of packing, and country of distribution. However, AF contamination was significantly (p < 0.05) higher in unpacked tea, and in brands where the country of origin, packing, and distributor was in Asia. The results showed that the tea brands in Lebanon are relatively safe in terms of AFs and OTA.

Background Developing a patient safety culture was one of the recommendations made by the Institute of Medicine to assist hospitals in improving patient safety. In recent years, a multitude of evidence, mostly originating from developed countries, has been published on patient safety culture. One of the first efforts to assess the culture of safety in the Eastern Mediterranean Region was by El-Jardali et al. (2010) in Lebanon. The study entitled \"The Current State of Patient Safety Culture: a study at baseline\" assessed the culture of safety in Lebanese hospitals. Based on study findings, the objective of this paper is to explore the association between patient safety culture predictors and outcomes, taking into consideration respondent and hospital characteristics. In addition, it will examine the correlation between patient safety culture composites. Methods Sixty-eight hospitals and 6,807 respondents participated in the study. The study which adopted a cross sectional research design utilized an Arabic-translated version of the Hospital Survey on Patient Safety Culture (HSOPSC). The HSOPSC measures 12 patient safety composites. Two of the composites, in addition to a patient safety grade and the number of events reported, represented the four outcome variables. Bivariate and mixed model regression analyses were used to examine the association between the patient safety culture predictors and outcomes. Results Significant correlations were observed among all patient safety culture composites but with differences in the strength of the correlation. Generalized Estimating Equations for the patient safety composite scores and respondent and hospital characteristics against the patient safety grade and the number of events reported revealed significant correlations. Significant correlations were also observed by linear mixed models of the same variables against the frequency of events reported and the overall perception of safety. Conclusion Event reporting, communication, patient safety leadership and management, staffing, and accreditation were identified as major patient safety culture predictors. Investing in practices that tackle these issues and prioritizing patient safety is essential in Lebanese hospitals in order to improve patient safety. In addition, further research is needed to understand the association between patient safety culture and clinical outcomes.

Background In recent years there has been a substantial increase in the use of over-the-counter (OTC) products around the world. While they are assumed to be safe by consumers, they can potentially lead to adverse effects and drug interactions particularly in older adults. Methods We assessed the patterns of OTC products used by older adults admitted to the cardiology service in a tertiary care medical center in the USA over a three month period. We conducted a retrospective chart review where older adults with cardiovascular diseases (CVD) who were taking at least one OTC product at home were included. Results Out of 404 patients who were admitted to the cardiology service, 281 (69.6%) were taking OTC products. Patients were taking a total of 659 OTC products; mean of 2.35 ± 1.57 and the range varied from 1 to 9 products. The most commonly used products were vitamins (37.3%), followed by laxatives (17%), minerals (13.6%), stomach acid reducers (9%), and analgesics (3.6%). OTC users were found to be suffering from more comorbidities and received more prescription medications as compared to non-users. Gender and age did not have an impact on the use of OTC products while patients with atrial fibrillation, sleep apnea and gastro-esophageal reflux disease were more likely to use OTC products. Conclusion Use of OTC products is quite frequent in older adults with CVD in our study. Clinicians should ask about OTC product usage and counsel patients about the risks and benefits associated with their use.