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Background Non-communicable diseases (NCD) present an increasing global health challenge, particularly for settings affected by fragility where access to care may be disrupted, and where high-quality continuous care delivery is difficult to achieve. This study documents the complex dynamics of NCD prevention and management in the fragile setting of rural Beqaa, Lebanon. Methods Participatory system dynamics methods were used, including 30 semi-structured interviews and three Group Model Building (GMB) workshops. Participants included health care providers offering NCD care, and Lebanese host- and Syrian refugees community members affected by NCDs. Results Participants across all groups articulated a shared complex understanding of both the structural and direct determinants behind NCD onset. Lebanese and Syrian community members further identified several barriers to health seeking, including restrictions in health coverage, limited availability of services in the Beqaa and perceptions of poor-quality care. Health providers and community members described a health system overtly focused on disease control and overwhelmed by delivery of care to people living with NCD across both communities. Conclusion Participants across all groups agreed on the need for health promotion and primary prevention activities and identified priority interventions in these areas.

Purpose We aimed to describe the level of agreement between patients and physicians on the ratings of daily functioning and pain in a cohort of sarcoma patients and assess how (dis)agreement and its change over time predicted patient-reported outcomes in survivorship. Method We performed secondary analysis of longitudinal data from a sarcoma-specialty clinic in Montreal, Canada. Demographics, clinical characteristics and patient-physician agreement were summarized descriptively. Linear mixed models were used to assess the effects of time, baseline agreement, change in agreement over time, interaction of time and change in agreement and 12-month daily functioning, quality of life, and fatigue. Results Data were available for 806 patients (57.7% male, x̄ = 53.3 years) who completed at least one questionnaire. Patient-physician disagreement was common on the level of function (43.4%) and pain (45.7%). Baseline physician-patient agreement was associated with better 12-month outcomes. Improvement in agreement on function over time was significantly associated with daily functioning ( F (2, 212) = 3.18, p  = 0.043) and quality of life ( F (2, 212) = 3.17, p  < 0.044). The pattern was similar though less pronounced for the agreement on pain. Conclusions Our study offers novel insights into the importance of patient-physician agreement and communication’s role in long-term patient-reported outcomes in sarcoma. Implications for Cancer Survivors The results emphasize the importance of mutual understanding of symptoms and patients’ needs and suggest that further consultation in cases of discordance of ratings and opinions might be beneficial for optimal survivorship.

Breastfeeding is the ultimate food source for infants and it is highly valuable for both mothers and children’s health. The WHO recommends exclusive breastfeeding (EBF) until six months postpartum. In Lebanon, the EBF rates until six months postpartum are amongst the lowest worldwide, and the factors affecting EBF have been rarely investigated. A systematic review to determine the associations between socio-cultural-demographic factors and EBF at six months postpartum in middle-income countries was conducted. The review has shown that the most frequently reported determinant of EBF was maternal employment, followed by maternal education and maternal age. This study was the first in Lebanon to explore the association between certain demographic, social and cultural factors with EBF for the six months postpartum of mothers residing across Lebanon. The study employed social media to recruit 593 mothers to complete an online questionnaire. Data analysis consisted of bivariate analysis and multivariate logistic regressions. The findings show that EBF until six months postpartum is not associated with the housekeeper presence, positively associated with having a prenatal plan to breastfeed, the mother disagreeing that free formula samples should be distributed to the mothers after delivery at the hospital, having the baby’s crib kept by the mother’s bed side at the hospital, not being offered a free formula sample at the hospital, the mother’s partner perceiving breastfeeding as very important, not having the mother’s father living in the same household besides the partner and children when the child was between zero and six months and being non-Lebanese. It is the first study conducted in low and middle-income countries to explore the maternal attitudes and opinions regarding feeding practices and their association with EBF until six months. This study shows that ensuring appropriate systems, services and support for mothers, while applying the social-ecological model, should be a priority for the stakeholders to improve maternal and child health.

The study objectives were to measure the concentrations of albumin, prealbumin and transferrin in amniotic fluid (AF), and to establish if these concentrations were associated with infant birth weight (BW). At St Mary's Hospital (Montreal, Quebec), 294 AF samples were collected from mothers undergoing routine amniocentesis (12-19 weeks gestation). Exclusion criteria included subjects having gestational diabetes, multiple births or fetal genetic abnormalities. AF samples were analyzed by capillary electrophoresis (CE) at 190 nm. Analysis of variance and multiple linear regressions were performed. AF prealbumin could not be detected by CE. However, ANCOVA showed that transferrin was different among BW categories. Multiple regressions showed the parameter estimates for transferrin and albumin were negative, but neither was associated with BW in our study population. In contrast, transferrin was negatively associated with BW in our LBW infants. Our study shows that 2nd trimester AF transferrin may emerge as a biomarker for poor in-utero growth.