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Background: Community-acquired pneumonia (CAP) remains a significant cause of hospitalization and mortality globally. Optimizing clinical outcomes in CAP depends heavily on timely, appropriate empiric antibiotic therapy. However, limited data from low- and middle-income countries hinder effective stewardship efforts. The study aims to assess clinical outcomes among hospitalized CAP patients in Lebanon and identify key factors associated with deterioration or death, with particular emphasis on the role of guideline concordant empiric antibiotic prescribing. Methods: A cross-sectional study was conducted in five tertiary hospitals across Lebanon between January and June 2024. Adult patients admitted with CAP were included. Demographic, clinical, laboratory, microbiological, and treatment data were extracted. Antibiotic regimens were evaluated for adherence to national CAP guidelines. Multivariable logistic regression was used to identify predictors of poor clinical outcomes, defined as ICU admission or in-hospital death. Results: Inappropriate antibiotic selection (aOR=18.81, p< 0.001) and dosing (aOR=1.78, p=0.027) were significantly associated with poor outcomes. Additional predictors included advanced age, congestive heart failure, coronary artery disease, elevated WBC, and CURB-65 scores ≥ 3. Conversely, patients with classical CAP presentations (e.g., wheezing, rales) were more likely to experience favorable outcomes. Conclusion: Inappropriate empiric antibiotic prescribing significantly worsens clinical outcomes in hospitalized CAP patients. These findings underscore the urgent need for strengthening antimicrobial stewardship programs, implementing clinical decision support tools, and reinforcing physician education to promote adherence to national guidelines and improve patient safety.

Background The International Physical Actvity Questionnaire (IPAQ) is a validated tool for physical activity assessment used in many countries however no Arabic version of the long-form of this questionnaire exists to this date. Hence, the aim of this study was to cross-culturally adapt and validate an Arabic version of the long International Physical Activity Questionnaire (AIPAQ) equivalent to the French version (F-IPAQ) in a Lebanese population. Methods The guidelines for cross-cultural adaptation provided by the World Health Organization and the International Physical Activity Questionnaire committee were followed. One hundred fifty-nine students and staff members from Saint Joseph University of Beirut were randomly recruited to participate in the study. Items of the A-IPAQ were compared to those from the F-IPAQ for concurrent validity using Spearman’s correlation coefficient. Content validity of the questionnaire was assessed using factor analysis for the A-IPAQ’s items. The physical activity indicators derived from the A-IPAQ were compared with the body mass index (BMI) of the participants for construct validity. The instrument was also evaluated for internal consistency reliability using Cronbach’s alpha and Intraclass Correlation Coefficient (ICC). Finally, thirty-one participants were asked to complete the A-IPAQ on two occasions three weeks apart to examine its test–retest reliability. Bland-Altman analyses were performed to evaluate the extent of agreement between the two versions of the questionnaire and its repeated administrations. Results A high correlation was observed between answers of the F-IPAQ and those of the A-IPAQ, with Spearman’s correlation coefficients ranging from 0.91 to 1.00 ( p  < 0.05). Bland-Altman analysis showed a high level of agreement between the two versions with all values scattered around the mean for total physical activity (mean difference = 5.3 min/week, 95% limits of agreement = −145.2 to 155.8). Negative correlations were observed between MET values and BMI, independent of age, gender or university campus. The A-IPAQ showed a high internal consistency reliability with Cronbach’s alpha ranging from 0.769–1.00 ( p  < 0.001) and intraclass correlation coefficient (ICC) ranging from 0.625–0.999 ( p  < 0.001), except for a moderate agreement with the moderate garden/yard activity (alpha = 0.682; ICC = 0.518; p  < 0.001). The A-IPAQ had moderate-to-good test-retest reliability for most of its items (ICC ranging from 0.66–0.96; p  < 0.001) and the Bland-Altman analysis showed a satisfactory agreement between the two administrations of the A-IPAQ for total physical activity (mean difference = 99.8 min/week, 95% limits of agreement = −1105.3; 1304.9) and total vigorous and moderate physical activity (mean difference = −29.7 min/week, 95% limits of agreement = −777.6; 718.2). Conclusion The modified Arabic version of the IPAQ showed acceptable validity and reliability for the assessment of physical activity among Lebanese adults. More studies are necessary in the future to assess its validity compared to a gold-standard criterion measure.

The Traffic Locus of Control scale (T-LOC) serves as a measure of drivers’ personality attributes, providing insights into their perceptions of potential causes of road traffic crashes (RTCs). This study meticulously evaluated the psychometric properties of the Arabic version of T-LOC (T-LOC-A) among Lebanese drivers. Additionally, the study aimed to explore associations between the T-LOC scale and various driving variables, including driver behavior, accident involvement, and traffic offenses. A cross-sectional study was conducted among Lebanese drivers using a face-to-face approach. The validation of the Arabic version of T-LOC (T-LOC-A) occurred through a two-stage process: translating and culturally adapting T-LOC in the first stage, and testing its psychometric properties in the second stage. Data were collected using a comprehensive self-reported questionnaire in Arabic, covering demographic and travel-related variables, risk involvement, and measures such as the Driver Behavior Questionnaire (DBQ) and T-LOC. Exploratory factor analysis and confirmatory factor analysis were performed to scrutinize the factorial structure of T-LOC. Pearson correlation and chi-square tests were used for continuous and categorical variables, respectively. Two logistic regression analyses were executed to probe associations between T-LOC and involvement in road traffic crashes (RTCs) and T-LOC subscales with the occurrence of traffic offenses. The study included 568 drivers, predominantly male (69%) and aged between 30 and 49 years (42.1%). The findings revealed that T-LOC-A exhibited robust psychometric properties, with excellent reliabilities (α = 0.85) and adherence to the original four-factor structure, encompassing self (α = 0.88), other drivers (α = 0.91), vehicle/environment (α = 0.86), and fate (α = 0.66). The multidimensional structure was statistically supported by favorable fit indices. Gender differences revealed men attributing responsibility to other drivers, while women leaned towards fate and luck beliefs. Regarding driver behavior, the \"other drivers\" and self-dimensions of T-LOC-A correlated positively with aggressive violations. The fate dimension showed positive associations with aggressive violations and lapses. The \"other drivers\" subscale correlated positively with errors, and the vehicle/environment subscale with lapses. External T-LOC factors were positively associated with accident involvement, while the \"LOC self\" factor emerged as a protective element. In terms of traffic offenses, \"LOC fate\" displayed a positive association, while the \"LOC self\" factor showed a protective effect. In conclusion, the Arabic T-LOC is a reliable and valuable instrument, suggesting potential improvements in driving safety by addressing drivers’ locus of control perceptions.

Background Patients with psychosis frequently use a variety of psychotropic medicines, many of which have anticholinergic effects that can impair cognition. Therefore, this study aimed to evaluate whether there is an association between medications used for neuropsychological disorders/symptoms and cognition in patients with schizophrenia, focusing on their anticholinergic load and antipsychotic doses. Study design A cross-sectional study between July 2019 and Mars 2020 at the Psychiatric Hospital of the Cross-Lebanon enrolled 120 inpatients diagnosed with schizophrenia. The total anticholinergic burden was calculated based on the Anticholinergic Drug Scale (ADS), and the chlorpromazine equivalent dose was calculated using the Andreasen method to assess the relative antipsychotic dose. Also, the objective cognition was assessed using the Brief Assessment of Cognition in Schizophrenia (BACS) tool. Study results. A significantly higher BACS total score ( r  = -0.33, p  < 0.001), higher verbal memory ( r  = -0.26, p  = 0.004), higher working memory ( r  = -0.20, p  = 0.03), higher motor speed ( r  = -0.36, p  < 0.001), and higher attention and speed of information processing ( r  = -0.27, p  = 0.003) were significantly associated with lower chlorpromazine equivalent dose. Higher ADS (Standardized Beta (SB) = -.22; p  = .028), higher chlorpromazine equivalent dose (SB = -.30; p  = .001), and taking mood stabilizer medications (SB = -.24; p  = .004) were significantly associated with lower cognition. Conclusion This study confirms that the cognitive functions of chronic patients with schizophrenia may be affected by medications and their anticholinergic burden. More studies are needed to explain the role of cholinergic neurotransmission and general neurochemical mechanisms in the cognitive impairment of patients with schizophrenia.

Background The Lebanese population has undergone several conflicts and were the most afflicted by shelling and chaos during the civil war from 1975 to 1990, or even by displacement, bereavement, emigration, family separations, not to mention the economic crises that have hit the country since 2019 under which young adults are still succumbing. Our study aims to validate the Lebanese Anxiety Scale and assess correlates of anxiety among Lebanese adolescents. Methods A cross-sectional study was carried between January and May 2019, using a proportionate random sampling of schools from all five Lebanese governorates, among which 1810 adolescents aged 14 to 17 years. Results All LAS items remained in the model and formed one factor solution that explained 61.38% of the total variance (KMO = 0.873; p Bartlett test  < 0.001), with an excellent Cronbach’s alpha of 0.93. Higher neglect (B = 0.38), insomnia (B = 0.21) and child psychological abuse (B = 0.08) were significantly associated with more anxiety. Those results were considered adjusted overall sociodemographic variables since the latter had no statistically significant association with anxiety. Conclusion The study confirmed the association between anxiety and some variables such as psychological child abuse, neglect, and insomnia and emphasized the correlation between anxiety and these factors. Further, the LAS appears to be a short, valid and efficient tool for assessing anxiety among Lebanese adolescents. Further studies need to be carried to evaluate whether the LAS-10 gives a similar diagnosis to psychiatrists.

Instrumental activities of daily living (IADL) refer to activities necessary for independent living, emphasizing community-related tasks. The literature has limited measurement tools that address autonomous living in contemporary communities. Consequently, our study aimed to develop, cross-culturally adapt, and evaluate the psychometric properties of a recently updated IADL scale called the Autonomy in Daily Functioning-Contemporary Scale (ADF-CS). Additionally, it sought to examine the level of agreement between informant reports and self-reports on the ADF-CS. Following translation and cross-cultural adaptation, a first cross-sectional study was carried out among 544 family caregivers of community-dwelling older adults to assess the psychometric properties of the ADF-CS. The internal consistency of the scale was evaluated via Cronbach's alpha. Content and convergent validity, factorial analysis-including confirmatory factor analysis (CFA) and exploratory factor analysis (EFA)-and known group validity were also assessed. A second cross-sectional study involving 44 paired caregivers and care recipients was conducted to examine the level of agreement in responses to the ADF-CS scale between caregivers and older adults. Response agreement was evaluated through intraclass and Cohen's kappa correlation coefficients. The internal consistency of the ADF-CS and its factors was high (Cronbach's alpha between 0.83 and 0.90). The robust positive correlation between the total ADF-CS score and the ADL score supported the convergent validity of the ADF-CS Arabic version. Moreover, the statistically significant variations in ADF-CS mean scores among various age groups and some chronic disease groups supported the scale's known group validity. The EFA of the ADF-CS yielded a two-factor solution with an eigenvalue exceeding 1, explaining 63.13% of the variance. The CFA demonstrated that all the items in each component fit well with their intended constructs. Additionally, the intraclass and kappa correlation coefficient results were excellent, indicating robust agreement in the responses of caregivers and their respective older adults. The Arabic version of the ADF-CS is a reliable and valid informant-reported measure for assessing IADL in older adults living in a contemporary community.

Background Salameh et al. developed the Lebanese Waterpipe Dependence Scale (LWDS-11) that assesses nicotine dependence among adult waterpipe smokers. In view of the high waterpipe use among Lebanese youth and other neighboring countries, it was deemed necessary to check the psychometric properties of the LWDS-11, originally adapted to the Lebanese population, to measure nicotine dependence among adolescents. Methods Two cross-sectional investigations were conducted; Study 1 (January and May 2019) enrolled a total of 449 students who were exclusive waterpipe smokers; this sample was used to conduct the exploratory factor analysis. Study 2 enrolled another sample composed of 243 waterpipe smoking adolescents. This sample was independent from the first one and was used to conduct the confirmatory analysis. Results The results also showed that 312 (69.5%) [95% CI 0.652–0.738] had high waterpipe dependence (scores of ≥10). Results of the factor analysis in sample 1 showed that all LWDS-11 items were extracted following the factor analysis. Items converged over a solution of one factor; total variance explained = 70.45%, α Cronbach  = 0.96). The results of the confirmatory factor analysis were as follows: the Maximum Likelihood Chi-Square = 129.58 and Degrees of Freedom = 45, which gave a χ 2 /df = 2.88. For non-centrality fit indices, the Steiger-Lind Root Mean Square Error of Approximation (RMSEA) was 0.08 [0.071–0.106]. Moreover, the Comparative Fit Index (CFI) value was 0.77. Conclusion The preliminary results suggest that the LWDS-11 has good psychometric properties to measure waterpipe dependence among adolescents. We hope this tool would serve the benefit of research and epidemiology.

Data on comprehensive population-based surveillance of antimicrobial resistance is lacking. In low- and middle-income countries, the challenges are high due to weak laboratory capacity, poor health systems governance, lack of health information systems, and limited resources. Developing countries struggle with political and social dilemma, and bear a high health and economic burden of communicable diseases. Available data are fragmented and lack representativeness which limits their use to advice health policy makers and orientate the efficient allocation of funding and financial resources on programs to mitigate resistance. Low-quality data means soaring rates of antimicrobial resistance and the inability to track and map the spread of resistance, detect early outbreaks, and set national health policy to tackle resistance. Here, we review the barriers and limitations of conducting effective antimicrobial resistance surveillance, and we highlight multiple incremental approaches that may offer opportunities to strengthen population-based surveillance if tailored to the context of each country.

Several tools have been developed to assess insight, which can be measured using either clinician-rated or self-reported tools, each with advantages and limitations. The VAGUS Insight into Psychosis clinician-rated (VAGUS-CR) and the VAGUS self-report (VAGUS-SR) scales are brief clinician-rated and self-report measures assessing several dimensions of insight. This study aimed to translate, adapt, and validate the VAGUS scale in Arabic for use among Arabic-speaking psychotic populations. A cross-sectional study was conducted between June and July 2025 at the Psychiatric Hospital of the Cross, Lebanon. The study included 121 inpatients diagnosed with schizophrenia disorder, including a small number with schizoaffective disorder. The VAGUS Insight Scale was used to assess different dimensions of insight through the clinician-rated version and the self-report version. A principal component analysis revealed a one-factor construct for the VAGUS-CR explaining 47.96% of the total variance (Cronbach’s α = 0.668). For the VAGUS-SR, a three-factor structure was identified, accounting for 54.55% of the variance (Cronbach’s α for the total VAGUS-SR scale = 0.636). Test–retest reliability for the VAGUS-SR was good (ICC = 0.920, p  < 0.001). For the VAGUS-CR, the total score displayed good test–retest reliability (ICC = 0.896, p  < 0.001). The inter-rater reliability of the VAGUS-CR total score reached excellent agreement (ICC = 0.854, p  < 0.001). Convergent validity showed moderate positive correlations between VAGUS-SR, VAGUS-CR, and BIS total scores. The VAGUS-SR and VAGUS-CR are brief and valid tools for assessing insight in Arabic-speaking patients with schizophrenia. Their value is particularly notable given the scarcity of such tools within the Arabic population.

Background Quarantine/confinement is an effective measure to face the Coronavirus disease 2019 (COVID-19). Consequently, in response to this stressful situation, people confined to their homes may change their everyday eating behavior. Therefore, the primary objective of this study is to evaluate the association between quarantine/confinement stressors and eating behavior during the COVID-19 outbreak. The secondary objective is to compare the association of quarantine/confinement stressors and diet behavior between two groups of participants, those attending diet clinics and those not (general population). Method A cross-sectional web-based online survey carried out between April 3 and 18, 2020, enrolled 407 participants from the Lebanese population. Eating Disorder Examination – Questionnaire (EDE-Q) were used to measure the behavioral features of eating disorders. Results More than half of the sample (53.0%) abide by the home quarantine/confinement, 95.4% were living with someone in the quarantine/confinement, and 39.6% continued to work from home. Higher fear of COVID-19 was found in 182 (44.8%) participants, higher boredom in 200 (49.2%) participants, higher anger in 187 (46.3%), and higher anxiety in 197 (48.5%) participants. Higher fear of COVID-19 (Beta = 0.02), higher BMI (Beta = 0.05), and physical activity (Beta = 1.04) were significantly associated with a higher restraint score. Higher anxiety, higher fear of COVID-19, higher BMI, practicing physical exercise, and a higher number of adults living in the quarantine/confinement were significantly associated with higher shape and weight concerns. Conclusion Our results showed that the fear of COVID-19 was correlated with more eating restraint, weight, and shape concerns in the whole sample, but more specifically in the dietitian clients group. Public health control measures are needed to reduce the detrimental effects of psychological distress associated with quarantine/confinement on eating behaviors during the COVID-19 outbreak.