North Lebanon Research Articles

Nomads of the Void: Unpacking the Enigmatic Lives and Survival of Syrian Dom Refugee Women in North Lebanon

Nomads of the Void: Unpacking the Enigmatic Lives and Survival of Syrian Dom Refugee Women in North Lebanon

A Cross-Sectional Study Revealed a Low Prevalence of SARS-CoV-2 Infection among Asymptomatic University Students in Tripoli, North Lebanon.

This study aimed to investigate the SARS-CoV-2 infection prevalence among >18-year-old students in the Faculty of Public Health and Faculty of Sciences at the Lebanese University in Tripoli, Northern Lebanon, in June 2023 and to characterize the circulating Omicron subvariants. Out of 357 participants, only 2 (0.56%) tested positive by qPCR, corresponding to 0.61% (2/326) of asymptomatic students. One case tested positive with a qPCR targeting the Omicron BA.2 variant. These findings indicate a low incidence at that time and emphasize the interest of SARS-CoV-2 surveillance among students.

Appraising the Role of Strategic Control in Financial Performance: The Mediating Effect of the Resource Allocation Process—The Case of the Ministry of Finance–North Lebanon

This paper aims to appraise the influence of strategic control tactics on financial performance. The goal is to examine the mediating effect of the resource allocation process on the relationship between financial performance and five strategic control tactics. A quantitative hypothetico-deductive methodology was used in this study. A basic random sample of the Ministry of Finance–North Lebanon’s workforce was used to conduct an electronic questionnaire. A total of 232 valid responses were collected. Two statistical analysis methods, an exploratory and a confirmatory factor analysis, were implemented. The sample adequacy was confirmed by a KMO value higher than 0.7 before instigating the principal component analysis (PCA). The latter kept more than 60% of the initial data while structuring the data. The findings of the KMO and Barlett tests supported the adoption of PCA. The correlation matrix confirmed a statistically significant relationship between resource allocation, financial success, and strategic control techniques. The structural equation model (SEM) validated the linear correlations and statistical significance between the variables. The hypotheses were examined. Results confirmed that the model satisfactorily fits the data. The RMSEA is below the 0.05 threshold. The incremental indices are higher than 0.9. Results confirmed that the resource allocation process mediates the relationship between preventive control, operational control, special alert control, implementation control, and financial performance.

Salmonella Prevalence and antibiotic resistance profile in raw poultry meat sold in North Lebanon: Insights from the COVID-19 pandemic and economic crisis

Salmonella-related foodborne illness is a significant public health concern, with the primary source of human infection being animal-based food products, particularly chicken meat. Lebanon is currently experiencing a dual crisis: the COVID-19 pandemic and an unprecedented economic crisis, which has resulted in substantial challenges to the public health system and food safety. This study aims to assess the prevalence and antibiotic resistance profile of Salmonella in raw poultry meat sold in North Lebanon during this dual crisis. A cross-sectional study was carried out between May 2021 and April 2022 across six different districts in North Lebanon. A total of 288 whole, unprocessed chickens were examined. The isolation and identification of Salmonella isolates were done based on cultural and biochemical properties. All isolates were subjected to antimicrobial susceptibility testing and phenotypic assays for Extended-Spectrum Beta-lactamase (ESBL) detection. The prevalence of Salmonella in raw poultry meat purchased in North Lebanon reached 18.05 % (52/288). The dry season and chilled chicken were significantly associated with an increased risk of Salmonella contamination (P < 0.05). Additionally, 34.61 % of the isolates were potential ESBL producers, and 57.69 % exhibited multidrug resistance (MDR). This study highlights the existence of MDR in chicken meat in North Lebanon, posing a potential health risk if undercooked chicken meat is consumed. This emphasizes the importance of the implementation of preventive strategies and hygienic procedures throughout the food chain to reduce the risk of Salmonella spp. contamination in chicken meats and its potential transmission to humans.

Climate Change Impacts on Maritime Resources in Lebanon Using Satellites Imagery, Chekka Case Study

This paper aims to explore the impact of climate change on underwater and coastal sites over the past few decades, with a specific focus on the Chekka area in North Lebanon. Given its rich maritime archaeology potential, this region has become a focal point, especially with the ongoing developments posing a threat to cultural resources. Detecting climate changes necessitates extensive measurements from various sources globally, including land stations, ships, and satellite imagery. In this study, we concentrate on changes in sea surface temperature (SST) over the last 20 to 40 years. The analysis heavily relies on satellite imagery, with a primary focus on Landsat 8, equipped with two bands of the thermal infrared sensor (TIRS), and Landsat 7, which carries the Enhanced Thematic Mapper Plus (ETM+) sensor, and also Landsat 5 TM. Utilizing QGIS for the calculation of SST, our findings reveal a noteworthy increase of 1° in sea surface temperature over the past two decades. This observation underscores the significance of ongoing climate change and its potential repercussions for the underwater and coastal cultural heritage in the Chekka area and its suburbs.

Evaluation of SARS-CoV-2 anti-Spike antibody levels and breakthrough infection risk among vaccinated adults in North Lebanon.

Since March 2020, the COVID-19 pandemic has swiftly propagated, triggering a competitive race among medical firms to forge vaccines that thwart the infection. Lebanon initiated its vaccination campaign on February 14, 2021. Despite numerous studies conducted to elucidate the characteristics of immune responses elicited by vaccination, the topic remains unclear. Here, we aimed to track the progression of anti-spike SARS-CoV-2 antibody titers at two-time points (T1: shortly after the second vaccination dose, T2: six months later) within a cohort of 201 adults who received Pfizer-BioNTech (BNT162b2), AstraZeneca, or Sputnik V vaccines in North Lebanon. Blood specimens were obtained from participants, and antibody titers against SARS-CoV-2 were quantified through the Elecsys-Anti-SARS-CoV-2 S assay (Roche Diagnostics, Switzerland). We used univariate analysis and multivariable logistic regression models to predict determinants influencing the decline in immune response and the occurrence of breakthrough infections among vaccinated patients. Among the 201 participants, 141 exhibited unchanging levels of antibody titers between the two sample collections, 55 displayed waning antibody titers, and only five participants demonstrated heightened antibody levels. Notably, age emerged as the sole variable significantly linked to the waning immune response. Moreover, the BNT162b2 vaccine exhibited significantly higher efficacy concerning the occurrence of breakthrough infections when compared with the AstraZeneca vaccine. Overall, our study reflected the immune status of a sample of vaccinated adults in North Lebanon. Further studies on a larger scale are needed at the national level to follow the immune response after vaccination, especially after the addition of the third vaccination dose.

Salvia josetta (Nepetoideae; Lamiaceae), a new species from Lebanon

Salvia josetta, a new species of Lamiaceae, is described and illustrated. The species was discovered in 2018 from the district of Danniye, North Lebanon. We collected samples each year and prepared herbarium specimens. By comparing our samples with the already known taxa in the genus Salvia, through morphological descriptions and herbarium specimens, we established that they belong to a species new to science. This new species grows in openings within pine woodlands on brown soil developed from limestone and sandy bedrocks. Following the guidelines and criteria of the International Union for the Conservation of Nature (IUCN), it is assessed as critically endangered, based on its limited distribution area (0.02 km²) and the threats impacting the site where it was found, namely illegal logging, forest fires, and quarrying. The morphological characters are compared with two similar species, Salvia fayruziana from Lebanon and Salvia veneris from Cyprus.

Genetic diversity of grapevine landraces grown in a traditional vineyard in North Lebanon

Genetic diversity of grapevine landraces grown in a traditional vineyard in North Lebanon

Implementing and evaluating integrated care models for non-communicable diseases in fragile and humanitarian settings

In this commentary, we advocate for the wider implementation of integrated care models for NCDs within humanitarian preparedness, response, and resilience efforts. Since experience and evidence on integrated NCD care in humanitarian settings is limited, we discuss potential benefits, key lessons learned from other settings, and lessons from the integration of other conditions that may be useful for stakeholders considering an integrated model of NCD care. We also introduce our ongoing project in North Lebanon as a case example currently undergoing parallel tracks of program implementation and process evaluation that aims to strengthen the evidence base on implementing an integrated NCD care model in a crisis setting.

The “In-Between” Development and Heritage

Batroun is a historic Mediterranean coastal city in North Lebanon and exemplar for long-term impact of haphazard urban expansion on (in-)tangible heritage. The long-term development of transport infrastructure has contributed to Batroun’s contemporary urban structure and the weak connections between its entities and with the sea. As a result, Batroun’s old town is gradually disconnecting from the coastline and inland developments, and its traditional socioeconomic practices are declining. This has triggered negative spatial, social and economic outcomes on the town’s public spaces and identity.This paper, therefore, seeks to evaluate the impact of infrastructural development on the social, economic, and spatial aspects of the historic town of Batroun. It investigates the opportunities that arise from the city’s cultural heritage landscape and how these opportunities inform revitalising the lost socio-economic values and identity of the old town. For this purpose, field observations were conducted to investigate Batroun’s urban and spatial setting. Also, Interviews were conducted with stakeholders, experts and local communities in order to define problems and their impact on (in-)tangible heritage from top-down and bottom-up perspectives. By mapping findings, this research assesses the consequences of a developed transport infrastructure on everyday life and the town’s historic built environment.The heritage of Batroun has been seen as a barrier to the city’s development, and the regeneration of the old town has largely focused on the preservation of tangible dimensions, ignoring the contribution of intangible heritage settings to the revival of the old town and its socio-economic practices. Understanding Batroun’s heritage capacities and contemporary social values can facilitate the way for local stakeholders and communities to inform the revitalisation process. Thus, inclusive and collaborative approaches and new tools of inclusion can improve heritage-informed regeneration strategies and help define appropriate infrastructure for a resilient development of the historic built environment.

Genomic analysis of Shigella isolates from Lebanon reveals marked genetic diversity and antimicrobial resistance.

In this study, we characterized 54 clinical isolates of Shigella collected in North Lebanon between 2009 and 2017 through phenotypic and genomic analyses. The most prevalent serogroup was S. sonnei, accounting for 46.3 % (25/54) of the isolates, followed by S. flexneri (27.8 %, 15/54), S. boydii (18.5 %, 10/54) and S. dysenteriae (7.4 %, 4/54). Only three isolates were pan-susceptible, and 87 % (47/54) of the isolates had multidrug resistance phenotypes. Notably, 27.8 % (15/54) of the isolates were resistant to third-generation cephalosporins (3GCs) and 77.8 % (42/54) were resistant to nalidixic acid. 3GC resistance was mediated by the extended-spectrum beta-lactamase genes bla CTX-M-15 and bla CTX-M-3, which were present on various plasmids. Quinolone resistance was conferred by single point mutations in the gyrA DNA gyrase gene, leading to GyrA S83L, GyrA D87Y or GyrA S83A amino acid substitutions. This is the first study, to our knowledge, to provide genomic insights into the serotypes of Shigella circulating in Lebanon and the various antimicrobial resistance determinants carried by these strains.

Emergence of Extended-Spectrum Cephalosporin- and Colistin-Resistant Enterobacterales in Otherwise Healthy University Students.

Resistance to last resort antibiotics has been increasing, particularly in low- and middle-income countries such as Lebanon, which has well established challenges in antimicrobial stewardship and other public health and environmental issues. However, data on the emergence of antibiotic resistance in the community in Lebanon are limited. In this study, we assessed resistance to last resort antibiotics in the fecal samples of 111 otherwise healthy university students in north Lebanon. The results showed that 47.7% of the samples harbored extended-spectrum cephalosporin-resistant isolates, while 2.7% of the samples yielded colistin-resistant isolates. Furthermore, molecular analyses showed that the β-lactamase gene group, blaCTX-M-1 group, was detected in the majority (93%) of screened extended-spectrum β-lactamase isolates. In addition, the colistin-resistant Escherichia coli isolates carried mcr-1, including the novel mcr-1.26 variant, which was previously reported in clinical samples as well as in domesticated animals and the environment in Lebanon. Taken together, these findings highlight the occurrence of resistance to important antibiotics in the community, perhaps suggesting diffuse sources, including clinical and environmental settings, and multiple factors driving the spread of multidrug-resistant bacteria and resistance determinants. There is a pressing need for comprehensive antimicrobial stewardship programs and the implementation of evidence-based practices in clinical and community settings to mitigate the increasing spread of antimicrobial resistance.

Recent Data Characterizing the Prevalence and Resistance Patterns of FimH-producing Uropathogenic Escherichia coli Isolated from Patients with Urinary Tract Infections in North Lebanon

Background: The adhesin gene (FimH) of uropathogenic Escherichia coli (UPEC) plays a critical role in mediating the first contact of UPEC bacterial strains with uroepithelial cells, leading to colonization and invasion of host cells. Objectives: This study aimed to determine the prevalence of FimH in UPEC strains isolated from patients with urinary tract infections (UTIs) in North Lebanon and characterize the resistance profile of UPEC isolates. Methods: A total of 881 urine samples were collected from UTI-symptomatic patients admitted to different hospitals and laboratories in North Lebanon. Seventy UPEC isolates were identified and transferred to the Biomedical Laboratory of Beirut Arab University (BAU) for further analysis. All UPEC isolates were subjected to antimicrobial susceptibility testing, phenotypic assays for ESBL detection, and PCR to detect the FimH gene. Results: The prevalence of UTIs reached 42% (370/881), with UPEC representing 19% (70/370) of the detected uropathogens. The highest and the lowest resistance among UPEC isolates were reported against Ampicillin (80%; 56/70) and carbapenem (0%; 0/70), respectively. A high prevalence of MDR (68%; 48/70) and ESBL (64%; 45/70) was reported. Molecular analysis revealed that most of the tested UPEC (98.6%; 69/70) harbored the FimH gene. A significant correlation was found between FimH and the antimicrobial resistance properties of UPEC (P &lt; 0.05). Conclusions: This study highlighted the high prevalence of the FimH adhesin gene among UPEC isolates, revealing its crucial role in enhancing the resistance of these bacteria to antimicrobial agents.

Healthcare workers’ experiences of workplace violence: a qualitative study in Lebanon

BackgroundThe COVID-19 pandemic has brought unprecedented challenges to healthcare workers (HCWs) around the world. The healthcare system in Lebanon was already under pressure due to economic instability and political unrest before the pandemic. This study aims to explore the impact of COVID-19 and the economic crisis on HCWs’ experiences of workplace violence in Lebanon.MethodsA qualitative research design with an inductive approach was employed to gather data on workplace violence through Focus Group Discussions (FGDs) from HCWs in Tripoli Governmental Hospital (TGH), a governmental hospital in North Lebanon. Participants were recruited through purposive sampling. The interviews were conducted in Arabic, recorded, transcribed, and translated into English. Thematic analysis was used to analyze the data.ResultsA total of 27 employees at the hospital participated in the six FGDs, of which 15 females and 12 males. The analysis identified four main themes: (1) Types of violence, (2) Events witnessed, (3) Staff reactions to violence, and (4) Causes of violence. According to the interviews conducted, all the staff members, whether they had experienced or witnessed violent behavior, reported that such incidents occurred frequently, ranging from verbal abuse to physical assault, and sometimes even involving the use of weapons. The study findings suggest that several factors contribute to the prevalence of violence in TGH, including patients’ financial status, cultural beliefs, and lack of medical knowledge. The hospital’s location in an area with a culture of nepotism and favoritism further exacerbates the issue. The staff’s collective response to dealing with violence is either to submit to the aggressor’s demands or to remove themselves from the situation by running away. Participants reported an increase in workplace violence during the COVID-19 pandemic and the exacerbated economic crisis in Lebanon and the pandemic.ConclusionInterventions at different levels, such as logistical, policy, and education interventions, can help prevent and address workplace violence. Community-level interventions, such as raising awareness and engaging with non-state armed groups, are also essential to promoting a culture of respect and zero tolerance for violence.

Determinants of health-related quality of life among adolescents: The role of the Mediterranean diet

BackgroundA number of physical, emotional, cognitive and psychological changes shape the adolescence phase, which may influence health and well-being. Therefore, it is important to develop healthy eating habits that will persist into adulthood. ObjectiveThis study was conducted in order to investigate in depth the association between components of the Mediterranean diet (MD) and health-related quality of life (HRQoL), along with its different subscales, among Lebanese adolescent students attending schools in Tripoli, North Lebanon. MethodsA cross-sectional survey was undertaken among 798 teenagers aged 11 to 18. All responded to a questionnaire that evaluated their HRQoL, sociodemographic characteristics and adherence to the Mediterranean diet. ResultsThe results of the study revealed that only 15.9% of the students had a high adherence to the MD. With regard to the components of the MD associated with the HRQoL, it was revealed that fruit intake by the students (once daily) was associated with a better general well-being (P = 0.047). In addition, fish consumption (two to three times per week) and daily intake of a dairy product for breakfast were positively associated with the total KIDSCREEN score (P < 0.001 and P = 0.003, respectively). Finally, skipping breakfast was correlated with a poorer general well-being (P = 0.013). ConclusionOur results suggest a strong correlation between MD adherence and HRQoL in Lebanese adolescents. However, future studies are warranted in order to strengthen the evidence of this association.

Is banking and finance education producing sector-relevant personnel? Stakeholders’ psychological perceptions toward employment

While many studies have examined factors affecting graduate employability, few have examined the effects of stakeholders’ psychological perceptions. Uncovering the moderating effects of employability skills and experience becomes critical. This study examines the psychological perceptions of graduate programs, graduate employability modelling, interpersonal competencies, and the employability skills and experience required to produce sector-relevant personnel for the banking sector. Using structural equation modelling, we examine the relationships between the subject variables. 453 students and 33 lecturers were surveyed, and data sheets from a skills inventory were given to a random sample of 23 bank human resource managers in North Lebanon. The findings support the theory of beneficial interaction effects between interpersonal competencies and graduate employability.

The effect of work environment conditions on the performance of workers in Lebanese private hospitals during the Lebanese financial crisis: the case of private hospitals in North Lebanon

يهدف البحث إلى تحديد تأثير ظروف بيئة العمل على أداء العاملين في المستشفيات اللبنانية الخاصة في شمال لبنان خلال الأزمة المالية اللبنانية. تمت دراسة عينة مكونة من 95 موظف من مختلف المناصب في المستشفيات الخاصة في شمال لبنان (مستشفى الشمال مستشفى معوض مستشفى سيدة شمال لبنان). تم اختيار المنهج الوصفي التحليلي لهذا البحث. تم تحليل البيانات باستخدام برنامج الإحصاءSPSS، واستخدمت إحصائيات وصفية وتحليلية في عملية التحليل. أظهرت النتائج أنه يوجد أثر مباشر ذو دلالة إحصائية للظروف المادية والسلوكية لبيئة العمل على أداء العاملين في المستشفيات الخاصة في شمال لبنان خلال الأزمة المالية في لبنان.

Examining the Impact of Entrepreneurial Orientation on New Venture Performance in the Emerging Economy of Lebanon: A Moderated Mediation Analysis

Despite scholarly debates on the role of entrepreneurial orientation, its effect on new venture performance remains largely understudied, particularly in the context of emerging economies. Determining this association is crucial and has an important implication for scholars and managers of SMEs to increase performance. Therefore, using the resource-based view and upper-echelon theories, this study examines this link by considering the mediating role of opportunity exploitation and the moderating role of transformational leadership in the case of an emerging market in Lebanon. The resource-based view theory discusses the importance of intangible and tangible resources in obtaining a sustainable competitive edge. The upper-echelon theory also connects the attributes of firm performance and top employee management. To achieve this purpose, we conducted a comprehensive survey of 411 managers and owners, 346 of whom were men and 65 of whom were women, of SMEs in the top five provinces of North Lebanon, South Lebanon, Mount Lebanon, Beirut, and Bekaa, where the majority of SMEs are located. This study also collected the data in 2022 and performed moderated mediation analysis to probe this nexus. The empirical results show that entrepreneurial orientation has a positive direct and indirect (through opportunity exploitation) effect on new venture performance. Furthermore, it reveals that opportunity exploitation has a positive effect on new venture performance and partially mediates the entrepreneurial orientation–new venture performance nexus. Furthermore, the results highlight that transformational leadership moderates the direct entrepreneurial orientation–new venture performance nexus, and the positive relationship is stronger for managers (or owners) with higher-level transformational leadership. Moreover, the results reveal that transformational leadership moderates the indirect effect between entrepreneurial orientation and new venture performance through opportunity exploitation, and the extent of the indirect effect is enhanced for managers (or owners) with higher-level transformational leadership. The results are robust and have important policy implications. The current research offers crucial managerial implications for the management of SMEs by paying attention to significant drivers of entrepreneurial orientation and opportunity exploitation. The findings also suggest that entrepreneurs and managers of new ventures must transform their entrepreneurial strategic posture into opportunity exploitation behaviors by pinpointing market inefficiencies and consumer needs, launching novel products and services, and taking advantage of opportunities for new products to enter the market to maximize financial gain.

High frequency and molecular characterization of ESBL-producing Enterobacteriaceae isolated from wound infections in North Lebanon

ABSTRACT Background Extended-spectrum beta-lactamases producing Enterobacteriaceae (ESBL-PE) represent a major problem in wound infections. Here, we investigated the prevalence and molecular characterization of ESBL-PE associated with wound infections in North Lebanon. Research design and methods A total of 103 non-duplicated E. coli and K. pneumoniae strains isolated from 103 patients with wound infections, were collected from seven hospitals in North Lebanon. ESBL-producing isolates were detected using a double-disk synergy test. In addition, multiplex polymerase chain reaction (PCR) was used for the molecular detection of ESBLs genes. Results E. coli was the predominant bacteria (77.6%), followed by K. pneumoniae (22.3%). The overall prevalence of ESBL-PE was 49%, with a significantly higher rate among females and elderly patients. K. pneumoniae was the common MDR and ESBL-producer bacteria (86.95% and 52.17%) compared to E. coli (77.5% and 47.5%). Most of the isolated ESBL producers harbored multiple resistant genes (88%), where blaCTX-M was the most predominant gene (92%), followed by blaTEM (86%), blaSHV (64%), and blaOXA genes (28%). Conclusions This is the first data on the ESBL-PE prevalence associated with wound infections in Lebanon, showing the emergence of multidrug-resistant ESBL-PE, the dominance of multiple gene producers, and the widespread dissemination of blaCTX-M and blaTEM genes.

Food safety knowledge, attitudes and practices among restaurants’ food handlers in North Lebanon: Evaluation of the food safety training

This study was conducted to assess food safety knowledge, attitudes and practices among restaurant food handlers in North Lebanon and to determine what impact the food safety intervention had on the performance of workers. A structured questionnaire of 35 questions has been used to collect information on socio-demographic characteristics, knowledge, attitudes and practices for 110 food handlers randomly working in 38 food service establishments via face-to-face questioning interviews during three months. The intervention was made to a subgroup of 13 participants followed by a reassessment. The average percentage scores of all food handlers for knowledge, attitudes, and practices were 63.78%, 83.63% and 81%, respectively. For the 13 participants who received the intervention, a significant improvement was observed in their performance after the training (p ˂ 0.001).