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Oesophageal aspergillosis is a rare occurrence primarily documented in hematologic malignancies, and only rarely occurring among patients with solid tumours. In this case report, we present the unique case of an 81-year-old Lebanese man who had a remarkable medical history, including four solid tumours. The patient sought medical attention due to dysphagia and weight loss, prompting a gastroscopic examination that revealed a necrotic abscess at the oesophagogastric junction. Initial treatment with fluconazole and esomeprazole was administered, but the recurrence of similar symptoms led to a repeat gastroscopy, unveiling a diagnosis of Aspergillus oesophagitis. Intravenous voriconazole was promptly initiated; however, the patient developed a significant pericardial effusion and expired, with Aspergillus species identified in the pericardial fluid prior to patient expiring. This exceptional case emphasizes the importance of considering oesophageal aspergillosis in cancer patients who present with refractory symptoms such as epigastric pain, dysphagia, nausea, and vomiting, despite symptomatic treatment. Our findings underscore the need for increased awareness and the inclusion of gastrointestinal endoscopy as part of the diagnostic approach for this rare but potentially life-threatening condition.

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BACKGROUND: Mental health and psychosocial support (MHPSS) is increasingly considered vital for addressing the needs of displaced communities. The mental health of young people in Lebanon, including members of the host community and refugees, has been severely affected by multiple crises. Physical activity (PA) is an effective means for enhancing mental health, but evidence of PA's impact on mental health among forcibly displaced populations is still emerging and often varies widely across studies. METHOD: In this waitlist-controlled study, we examined the effectiveness of an 8-week psychosocial bouldering group intervention offered by the nonprofit organization ClimbAID on psychological well-being, distress, self-efficacy, and social cohesion in a group of mostly Syrian refugee adolescents residing in the Bekaa Valley, Lebanon. The intervention consisted of 8 sessions and took place once a week for 2 h in a group of up to 12 adolescents with 2 trained facilitators and up to 2 volunteers, supervised by a climbing instructor and a social worker. Multilevel analyses were performed for all outcomes. RESULTS: 233 people were included in the study. The dropout rate was approximately 33%. The IG improved significantly more than the waitlist group in terms of overall mental well-being and psychological distress. Group allocation was a significant predictor of improvements in mental well-being and psychological distress and showed a trend toward predicting self-efficacy. There was no positive impact of the intervention on social cohesion. CONCLUSIONS: Even in complex humanitarian settings of forced displacement, a psychosocial bouldering intervention reduces psychological distress and increases well-being in a mixed group of host and refugee youth in Bekaa, Lebanon. TRIAL REGISTRATION: Prospectively registered with ISRCTN 13005983, registered April 1st, 2022.

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OBJECTIVE: Healthcare workers are continuously exposed to challenging environments, making them liable for poor mental health. The COVID-19 pandemic exacerbated this problem, however available data in Lebanon is scarce. We conducted this investigation to provide comprehensive evidence on the mental health of Lebanese healthcare workers. METHODS: In this systematic review, we analyzed 3957 workers reported in 15 cross-sectional studies (10 during and five before the pandemic), identified after searching four databases. Examined mental health problems included depression, anxiety, stress, posttraumatic stress disorder (PTSD), and poor sleep quality. STATA software was used to pool the prevalence across studies. Subgroup analyses were performed based on the pandemic status, severity of mental health problems, and healthcare worker type. Gender and marital status were analyzed as potential risk factors. The methodological quality of all included studies was good as per the National Institute of Health risk of bias tool. RESULTS: Anxiety, depression, stress, PTSD, insomnia, and poor sleep quality were reported in 50%, 52%, 50%, 35%, 45%, and 41% of the population, respectively. Most cases had mild anxiety (40%), mild depression (45%), but severe stress (27%). Depression and anxiety were highest among pharmacists (69% and 56%) and nurses (49% and 45%), respectively. Compared to the pre-pandemic period, depression (36% vs. 62%) and anxiety (30% vs. 56%) rates were higher during the pandemic, while stress levels were lower (62% vs. 45%). Both gender and marital status were insignificant predictors of depression, anxiety, stress, or PTSD. CONCLUSIONS: Depression, anxiety, posttraumatic stress, insomnia, and poor sleep quality are experienced by approximately one in every two Lebanese healthcare workers. The rate of depression and anxiety almost doubled during the pandemic with higher rates among pharmacists and nurses than physicians and residents. Both gender and marital status were deemed insignificant predictors of reported mental health problems.

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BACKGROUND: Sexual and reproductive empowerment (SRE) is an important determinant of women's and girls' health yet measuring it is complex due to cultural and domain-specific variations. This study describes the process of adapting an SRE scale consisting of four domains (self-efficacy; future orientation; social support; and safety) and testing its psychometric properties among Arabic speaking adolescent girls in Lebanon. METHODS: An SRE scale developed in a Western context was adapted in four steps: (1) reviewing the scale and selecting culturally appropriate domains for translation to standard Arabic; (2) conducting cognitive interviews with 30 11-17-year-old adolescent girls in Lebanon; (3) administering the scale to 339 refugee adolescent girls who participated in an early marriage intervention; and (4) conducting confirmatory factor analysis (CFA) on the data to assess the scale's psychometric properties. RESULTS: The original model for the 13-item, four-domain adapted scale demonstrated poor fit in CFA. After iteratively removing two items, scale properties were improved, albeit were not optimal. The validity and reliability results for the self-efficacy domain were acceptable. Cognitive interview data revealed that Arab adolescent girls understood self-efficacy in relational terms, recognizing that autonomous decision-making is not necessarily favored but is influenced by parents and family. CONCLUSIONS: This study presents an effort to customize an SRE scale for use in studies on the health of adolescent girls in an Arab cultural context. Findings from cognitive interviews highlight the importance of taking into consideration relationality in adolescent sexual and reproductive decision-making. The self-efficacy domain in the adapted scale demonstrates acceptable psychometric properties and is recommended for use in health studies to capture SRE.

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Background: Medication non-adherence is a significant barrier to optimal treatment goals. The study explores the association between subjective well-being (SWB) and medication adherence among Lebanese individuals with multiple chronic diseases and identifies additional factors that may influence adherence in this population. Methods: An exploratory, cross-sectional study was conducted for three months at six community pharmacies. Adherence was assessed using the Adherence to Refills and Medication Scale Arabic Lebanese Version (ARMS-A). The SWB was measured using the Arabic Scale of Happiness (ASH), Love of Life Scale (LLS), Arab Hope Scale (AHS), and Satisfaction with Life Scale (SWLS). Spearmen's Rho correlation analyzed the association between ARMS-A and SWB constructs. Binary logistic regression identified predictors of adherence among individuals with chronic diseases and on multiple chronic medications. Results: Of 400 participants, 106 (26.5 %) with a 95 % CI, 0.22-0.31, were adherent. Lower medication adherence (reflected in higher ARMS-A scores) was associated with lower SWB (p = 0.01). Multivariate analysis showed that lower education (OR = 2.21, 95 % CI, 1.01-4.81), lack of a specific diet (OR = 1.64, 95 % CI, 1.01-2.69), and frequent hospital and/or emergency visits (OR = 3.29, 95 % CI, 1.75-6.17 for 2 visits; OR = 2.71, 95 % CI, 1.43-5.14 for ≥3 visits) significantly increased the odds of non-adherence to chronic treatment. However, higher income (OR = 0.06, 95 % CI, 0.01-0.38), healthcare provider occupation (OR = 0.42, 95 % CI, 0.21-0.48), and having diabetes mellitus (OR = 0.59, 95 % CI, 0.36-0.96) correlated with better adherence. Conclusion: A significant portion of participants failed to adhere to their prescribed chronic medications, influenced by multicomplex socioeconomic, psychological, and health-related factors. These findings demonstrate the need for culturally-tailored, pharmacist-led interventions to improve medication adherence and overall health outcomes.

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Aim: To determine the frequency and possible associated dietary and environmental factors of functional constipation (FC) among children in Lebanon followed at a single pediatric health system. Method: A prospective cross-sectional study was conducted in all pediatrics clinics at the American University of Beirut Medical Center (AUBMC). Children aged 2-7 years presenting for a well-child visit were recruited. Data relating to the child's bowel habits and other history items were obtained from parental questionnaires. Results: The mean age of the 172 recruited participants was 4.94 years with 56.4% being males. FC was present in 32.6% of the participants. Although there was no difference in the frequency of FC based on age and gender, the peak frequency of FC was at 5 years. The daily frequency of withholding stools was 64.3%, and 46.6% of the children with FC always experienced straining while stooling for the past 2 months. Decreased physical activity and diet were not significantly associated with FC. Conclusion: The present study shows that 32.6% of children aged 2-7 years in Lebanon suffer from constipation while only 51.7% of the recruited children's physicians inquire about the child's bowel movement during the well check visit. These numbers highlight the need to raise more awareness among pediatricians on the need to screen for constipation during clinic visits as a standard of care practice.

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Background: Conflict in Syria since 2011 led to over one million Syrians fleeing to Lebanon, predominantly from economically disadvantaged areas with low literacy and high child marriage rates. Over 90% live in extreme poverty, in informal tented settlements with minimal access to education, healthcare or employment. Displacement and poverty have further increased early marriages and unplanned pregnancies, and curtailed access to sexual and reproductive healthcare (SRH) in the Bekaa valley. This is exacerbated by increasing rates of sexual and gender-based violence (SGBV), intimate partner violence and domestic violence. Study design: We aimed to explore SRH beliefs and practices and teach on key SRH topics through focus group discussions (FGD) and questionnaires, co-designed with Syrian practitioners, conducted with Syrian men and women. FGD were recorded, transcribed and thematically analysed. Questionnaires collected demographics and explored SRH beliefs and practices. Findings: 24 FGD with 203 participants, 72.4% female and 27.6% men. 90.1% participants were married with an average age-gap of 6.3 years between partners. Teenage marriage rates were 55.6% for women, and 47.4% delivered their first child before the age of 20. 43.6% participants were not using any contraception. Findings demonstrate the impacts of SRH cultural norms and changes due to displacement, financial crisis, and increased exposure to technology and NGOs. Conclusions: SRH is multifaceted and contested, requiring systemic improvements in access to care, employment and education. This small but important proof-of-concept study demonstrates the possibility of engaging men and women in SRH discussion; paramount to empowering communities and challenging intergenerational SGBV.

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Over the past few years, point-of-care ultrasound (POCUS) has emerged as a critical diagnostic tool in emergency medicine, providing real-time imaging at the bedside. This study aims to assess POCUS knowledge and competency among medical residents in Lebanon, identify possible gaps and deficiencies in their training, and recommend guidelines for further improvement of the curriculum in Lebanese medical schools and residency programs. Our study reveals that 58.3% (N=119) of resident doctors from multiple specialties in Lebanon have only basic knowledge about POCUS, 19.6% (N=40) have no knowledge, and only 21.6% (N=44) have sufficient knowledge to perform diagnostic studies on a routine basis. Lebanese medical residents currently possess suboptimal POCUS knowledge and proficiency due to disparities in training and educational obstacles. To address this, residency programs should focus on standardized POCUS training, simulation-based learning, and faculty development. This approach will help ensure residents gain the necessary skills to use POCUS effectively in clinical practice.

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BACKGROUND: With the increasing number of protracted refugee crises globally, it is essential to ensure strong national health information systems (HIS) in displacement settings that include refugee-sensitive data and disaggregation by refugee status. This multi-country study aims to assess the degree of integration of refugee health data into national HIS in Jordan, Lebanon, and Uganda and identify the strengths and weaknesses of their national HIS in terms of collecting and reporting on refugee-related health indicators. METHODS: The study employs a comparative country analysis approach using a three-phase framework. The first phase involved reviewing 4120 indicators compiled from global health organizations, followed by a multi-stage refinement process, resulting in 45 indicators distributed across five themes. The second phase consisted of selecting relevant criteria from the literature, including data sources, annual reporting, disaggregation by refugee status, refugee population adjustments, accuracy, and consistency. The third phase involved assessing data availability and quality of the selected indicators against these criteria. RESULTS: Our analysis uncovered significant challenges in assessing the health status of refugees in Jordan, Lebanon, and Uganda, primarily stemming from limitations in the available health data and indicators. Specifically, we identified significant issues including incomplete local data collection with reliance on international data sources, fragmented data collection from various entities leading to discrepancies, and a lack of distinction between refugees and host populations in most indicators. These limitations hinder accurate comparisons and analyses. In light of these findings, a set of actionable recommendations was proposed to guide policymakers in the three countries to improve the integration of refugee health data into their national HIS ultimately enhancing refugees' well-being and access to healthcare services. CONCLUSION: The current status of refugee-related health data in Jordan, Lebanon, and Uganda indicates the need for improved data collection and reporting practices, disaggregation by refugee status and better integration of refugee health data into national HIS to capture the health status and needs of refugees in host countries. Key improvement strategies include establishing a centralized authority for consistent and efficient data management, fostering transparent and inclusive data governance, and strengthening workforce capacity to manage refugee health data effectively.

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Shocks effects are under-theorised in the growing literature on health system resilience. Existing work has focused on the effects of single shocks on discrete elements within the health system, typically at national level. Using qualitative system dynamics, we explored how effects of multiple shocks interacted across system levels and combined with existing vulnerabilities to produce effects on essential health services delivery, through the prism of a case study on childhood vaccination in Lebanon. Lebanon has experienced a series of shocks in recent years, including large-scale refugee arrivals from neighbouring Syria, the COVID-19 pandemic and a political-economic crisis. We developed a causal loop diagram (CLD) to explore the effects of each shock individually, and in combination. The CLD was developed and validated using qualitative data from interviews with 38 stakeholders working in Lebanon's vaccination delivery system, in roles ranging from national level policy to facility-level service delivery, conducted between February 2020 and January 2022. We found that each of the shocks had different effects on service demand- and supply-side dynamics. These effects cascaded from national through to local levels. Both Syrian refugee movement and the COVID-19 pandemic primarily exposed vulnerabilities in service demand, mainly through slowly emerging knock-on effects on vaccination uptake behaviour among host communities, and fear of contracting infection in crowded health facilities respectively. The economic crisis exposed wider system vulnerabilities, including demand for vaccination as household income collapsed, and supply-side effects such as reduced clinic time for vaccination, declining workforce retention, and reduced availability of viable vaccine doses, among others. Finally, important pathways of interaction between shocks were identified, particularly affecting the balance between demand for vaccination through publicly supported facilities and private clinics. Future research should incorporate dynamic approaches to identifying within-system vulnerabilities and their potential impacts under different scenarios, as a precursor to improved resilience measurement, system preparedness, and intervention targeting.

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Drawing on institutional historical records, interviews and student theses, this article charts the intersection of hospital acquired illness, the emergence of antimicrobial resistance (AMR), environments of armed conflict, and larger questions of social governance in the specific case of the American University of Beirut Medical Center (AUBMC) in Lebanon. Taking a methodological cue from approaches in contemporary scientific work that understand non-clinical settings as a fundamental aspect of the history and development of AMR, we treat the hospital as not just nested in a set of social and environmental contexts, but frequently housing within itself elements of social and environmental history. AMR in Lebanon differs in important ways from the settings in which global protocols for infection control or rubrics for risk factor identification for resistant nosocomial outbreaks were originally generated. While such differences are all too often depicted as failures of low and middle-income countries (LMIC) to maintain universal standards, the historical question before us is quite the reverse: how have the putatively universal rubrics of AMR and hospital infection control failed to take account of social and environmental conditions that clearly matter deeply in the evolution and spread of resistance? Focusing on conditions of war as an organized chaos in which social, environmental and clinical factors shift dramatically, on the social and political topography of patient transfer, and on a missing "meso" level of AMR surveillance between the local and global settings, we show how a multisectoral One Health approach to AMR could be enriched by an answering multisectoral methodology in history, particularly one that unsettles a canonical focus on the story of AMR in the Euro-American context.

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Background: Dietary supplements (DS) use among Lebanese patients with type 2 diabetes mellitus (T2DM) increased widely due to the country's economic and financial situation. This study was conducted (1) to estimate the prevalence of DS use among persons with T2DM amid the escalating economic crisis in Lebanon; (2) to explore the knowledge, attitude, and practice (KAP) of DS use; and (3) to determine any significant association between socio-economic and socio-demographic factors and the use of DS modality. Methods: A cross-sectional study was conducted during the worst episode of the economic crisis between October and April 2022 on 460 adult patients with T2DM of both sexes. Patients were interviewed using a pre-tested questionnaire. Results: Almost 4 out of 10 patients with T2DM in our study were found to be using DS, where 27.6% take multivitamins frequently. One-third of the participants agreed that nutritional supplements are necessary to control diabetes symptoms and complications. Around 41.1% of the participants complained about hypoglycemia and used DS to control their blood sugar levels (56.4%), while the rest used it to improve their health (35.5%) and control their diet (2.2%). The predictors of DS usage were the patient's level of education [OR=3.9, CI=1.5-10, p=0.003), self-monitoring of blood sugars (OR=4.9, CI=1.68-14.6; p=0.004) and reading the nutrition label [OR=59.3, CI=6.3-55.8, p=0.000]. Conclusion: This study estimated the prevalence of DS use and abuse, among persons with diabetes type II and found three significant predictors of DS use among patients with T2DM. Public health experts should encourage healthy discussions and awareness with their patients to comprehend their views regarding DS use.

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Background: Strong familial bonds are crucial to building resilience among youth exposed to traumatic events in socially adverse environments. Exploring parental experiences in the aftermath of adolescents' traumatic exposure in these settings would help tailor early interventions.Objective: We qualitatively explored experiences and perceived needs among parents of teenagers aged 11-16 years who were exposed in the last three months to a potentially traumatic event in Beirut, Lebanon.Method: We purposively sampled 28 parents of 24 adolescents meeting the inclusion criteria. Semi-structured interviews were conducted, and thematic analysis was applied combined with a grounded theory approach.Results: The most frequent traumatic event was direct exposure to the violent clashes that happened in Beirut on 14 October 2021. Parents identified that the recent event exacerbated pre-existing mental health difficulties caused by cumulative stress. They were reminded of their own war experiences and tended to reject the 'sick role' associated with trauma. A majority of participants viewed resilience as a fixed trait characteristic of the Lebanese and avoided communication with their children about traumatic memories, while a significant minority criticised resilience as a myth that added pressure on them and had more open communication about trauma. Parenting styles oscillated between controlling behaviours, warmth, and avoidance, which impacted the family dynamic. Despite adversity, most parents tried to cope through social connectedness, humour, and living day by day.Conclusions: Our findings hold implications for contextual adaptations of early posttraumatic interventions aimed at strengthening family support, such as addressing parental mental health; increasing awareness among first-line responders on parents' potential representations of trauma and resilience; addressing the issue of controlling parenting; and including a component in psychoeducation on traumatic stress that validates the impact of daily stressors on mental health while avoiding direct labelling. Further research is needed to validate the impact of these domains.

Parents of adolescents recently exposed to trauma in Beirut endure cumulative stress and recall war memories.Some parents see resilience as innate, and others criticise it as a myth.Early interventions should target parental mental health and conceptions on trauma and resilience.

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Lebanon is a country in the Middle East that had been witnessing nutrition transition to a westernized diet high in trans fats (TFs) and saturated fatty acids (TFAs) that had been linked to cardiovascular diseases and many other health issues. This study examines TF-related awareness, knowledge, and self-reported behaviors among a sample of Lebanese adults aged between 18 and 64 years, as well as their association with sociodemographic factors and anthropometric measurements. Using a multicomponent questionnaire, a cross-sectional study was conducted online, across all Lebanese regions based on a convenience sampling method (n = 401). Factors associated with TF-related awareness, knowledge, and behaviors were examined by multivariate linear regression analysis. The study highlighted specific gaps in TF-related awareness, knowledge, and behavioral practices as well as differences by sociodemographic factors. Most of the participants (36%) had heard of partly hydrogenated oils (PHOs) rather than TFs (49%). A higher proportion of respondents (54%) said they understood a little about TFs, the majority had inadequate knowledge about the foods that contain TFs, and 44% said they would not give up eating their favorite snack even if they knew it contains TFs. Overall, consumers' awareness and knowledge about TFs are rather low and the majority had fair behavioral practices. In addition, being a woman and having higher education level were significantly associated with higher levels of TFs awareness, knowledge, and behavior scores. Higher behavior scores were shown in older participants, married, and those who had part-time jobs, whereas having higher income and normal weight were significantly associated with higher awareness scores. These findings offer valuable insight into TF-related awareness, knowledge, and behaviors in a sample of Lebanese adults and provide key information that could spur the development of evidence-based TFs reduction interventions specific to the Middle East.

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BACKGROUND: Influenza represents a significant global health burden for individuals and society. This study assessed the burden of medically attended influenza at a tertiary medical center in Lebanon to describe the demographics, risk factors, and outcomes prior to the COVID-19 pandemic. METHODS: This was a retrospective review of patients who tested positive for the influenza virus during three seasons between July 1, 2016 to June 30, 2019, at the American University of Beirut Medical Center. RESULTS: A total of 2049 patients who tested positive for influenza were analyzed. Influenza A accounted for 79.6 % of cases, and influenza B for 19.7 %, with influenza activity starting in October/November and peaking in December/January. Older age above 65 years (AOR=3.584), obesity (AOR=2.183), and chronic conditions such as chronic lung diseases (AOR=1.832), and bacterial co-infection (AOR= 2.834) were found to be independent risk factors for developing complications. Viral co-infection increased the likelihood of death tenfold. Vaccinated patients had a shorter mean hospital stay duration and a lower intensive care unit admission rate. CONCLUSION: The burden of medically attended influenza at our tertiary medical center in Lebanon prior to the COVID-19 pandemic was high. Vaccination decreased the likelihood of complications leading to intensive care unit admission in patients at risk.

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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.

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In 2023, the Faculty of Dental Medicine, Saint Joseph University of Beirut (USJ) celebrated its 100th anniversary, marking a century of unwavering commitment to academic excellence. This milestone offers a valuable opportunity to navigate the history and evolution of dentistry in Lebanon, from its ancient roots in Phoenicia to its modern developments. It chronicles the transformative journey of dentistry while recognizing the key role played against all odds by the Society of Jesus and Saint Joseph University of Beirut in fostering the growth of dentistry as a distinct medical discipline.

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Background: The Lebanese ongoing crisis has exposed big challenges for the education system, including low teachers' salaries and their desire to leave their jobs. Identifying key contributing factors to teacher turnover intention may help policymakers develop and implement appropriate and informed retention strategies aiming at preserving the struggling Lebanese educational system and saving costs. The present study aimed to examine the mediating role of three potential factors, i.e. job satisfaction, work-related fatigue, and psychological distress, and the moderating role of employment sector, in the relationship between economic pressure and turnover intention among teachers who work in Lebanon during the economic crisis. Methods: We carried-out a cross-sectional, web-based study targeting a nationally-representative sample of Lebanese teachers (N = 3779, mean age = 38.33 years, 86.7 % females). Results: The results of mediation analyses showed that physical/emotional/mental work fatigue, psychological distress and job satisfaction mediated the relationship between perceived economic pressure and turnover intentions among Lebanese teachers. Economic pressure was significantly associated with higher work fatigue, more distress, less job satisfaction and more turnover intentions. Also, more work fatigue, higher distress levels and less job satisfaction were significantly associated with higher turnover intentions. Finally, more economic pressure was significantly associated with more turnover intentions. On the other hand, the moderating effect of teachers' sector of employment (Private versus Public) was not significant. Conclusion: This is among the first studies to link economic pressure, job satisfaction, work fatigue, psychological distress and turnover intentions in the teachers' psychology literature. This is also the first study on this topic in Lebanon, a country that offers a unique context and opportunity to understand the link between teachers' economic pressure and turnover intentions. The results expand on past research by showing that work-related fatigue, job satisfaction and psychological distress are three factors that underline the cross-sectional relationship between economic pressure and teachers' turnover intention. This implies that further attention of policy makers and school officials should be paid to enhance job satisfaction, decrease work fatigue and prevent psychological distress in order to retain and attract teachers at schools in Lebanon.

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OBJECTIVE: This study aims to identify the association between adherence to healthy eating, using the Lebanese Mediterranean Diet Scale (LMDS), and cardiovascular risk factors in the Lebanese population. MATERIALS AND METHODS: A cross-sectional study using a multistage cluster sample was conducted in Lebanon. Sociodemographic characteristics were collected through structured interviews and self-administered questionnaires. The LMDS assessed dietary habits. The associations between diabetes, dyslipidemia, and cardiovascular disease were investigated using stratification analysis. RESULTS: The study included 2048 people (mean age: 41.54 ± 17.09 years). Higher adherence to the Mediterranean diet was associated with older age (Beta = 0.175, p < 0.001), being female (Beta = 0.085, p = 0.001), being married (Beta = 0.054, p = 0.047), participating in regular physical activity (Beta = 0.142, p < 0.001), and having cardiovascular disease (Beta = 0.115, p < 0.001) and diabetes (Beta = 0.055, p = 0.043). Adherence was, however, negatively associated with being a smoker (Beta = -0.083, p = 0.002), a previous smoker (Beta = -0.059, p = 0.026), and having higher distress levels (Beta = -0.079, p = 0.002). Stratification analysis by diabetes, dyslipidemia, and cardiovascular disease (CVD) consistently demonstrated these associations. CONCLUSIONS: These findings suggest that demographic and health factors influence the Lebanese population's adherence to the Mediterranean diet. Older age, female gender, married status, physical activity, CVD, and diabetes were all found to be associated with adherence to the Mediterranean diet in the Lebanese population. In contrast, smoking and distress were inversely associated with it.

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BACKGROUND: Acknowledging the increasing worry over climate change and its psychological effects, the aim of this research is to clarify the dynamics between religiosity, climate anxiety and death anxiety, seeking to figure out the way religiosity mitigates the psychological effects of existential anxieties and climate related anxiety. METHODS: Using Google Forms, a questionnaire was developed and disseminated through a variety of messaging platforms, such as WhatsApp, Instagram, and Facebook Messenger. Through a snowball sampling technique, 763 participants were recruited in this cross-sectional during September 2023. RESULTS: The subsequent variables were adjusted in the moderation analysis: age, gender, and place of living. The results suggested that religiosity levels moderated the association between climate anxiety and death anxiety (Beta = 0.02, t = 1.97, p = .05, 95% CI 0.001, 0.035). At low, moderate, and high levels of religiosity, higher climate anxiety was significantly associated with more death anxiety. In addition, at low levels of climate anxiety, individuals with higher levels of religiosity (22.66) had more decreased levels of death anxiety compared to those with lower levels of religiosity (11.99). As climate anxiety levels increase, inverted patterns can be observed, with highly religious individuals showing higher levels of death anxiety than those with lower levels of religiosity. Overall, the relationship between climate anxiety and death anxiety was found to be weakest at low levels of religiosity and strongest at high levels of religiosity. CONCLUSION: Our findings suggest a possible beneficial effect of high religiosity at low levels of climate anxiety. This effect is reversed as climate anxiety starts to increase. Therefore, clinicians and policy-makers should bear in mind these complex interactions when designing strategies to mitigate mental health problems in the context of climate crisis.

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