System In Lebanon Research Articles

Knowledge, attitudes, and practices of cardiopulmonary rehabilitation among physiotherapists in Lebanon

BackgroundInsufficient physical activity is one of the leading mortality risks worldwide for cardiovascular and pulmonary diseases. Physiotherapists (PT) are core healthcare professionals who play a major role in the prevention of disease complications and in inspiring a healthy lifestyle. To identify challenges in the promotion of cardiopulmonary rehabilitation (CR) in Lebanon, a survey was conducted among PT and physiotherapy students. The aim was to assess the knowledge, attitudes, and practices of CR in Lebanon.ResultsThe response rate was 46.1% (N = 322). Results show that 24.5% of respondents have good to excellent knowledge about CR. More than 60% of the respondents indicate possible barriers to starting a CR program, and one of two respondents identify the absence of skills as a main barrier. Findings highlight the importance of the role of PT as a mediator to increase a healthy lifestyle among patients and to promote the prevention of cardiovascular diseases and pulmonary diseases in the country.Conclusions and recommendationsOur results support the evidence and clinical guidelines that PT play a major role by increasing the participation of patients in CR. A cost-effective CR program needs to be covered by the private and public system in Lebanon.

Maternal mortality in Lebanon: Increased vulnerability among Syrian refugees.

To compare the burden and causes of maternal deaths between Syrian and Lebanese women for the period of 2010-2018. A retrospective analysis was conducted of maternal deaths from the national notification system at the Ministry of Public Health in Lebanon during the period of 2010-2018. Maternal deaths among Syrian refugees and Lebanese citizens were compared based on cause of death, age of the woman, and nationality. Causes of maternal deaths were categorized as direct and indirect following WHO definitions. The maternal mortality ratio among the Syrian refugee women in Lebanon was higher than that of Lebanese women in the period 2010-2018, with its highest rate of 55.1 in 2017. Hemorrhage and indirect causes of maternal deaths are more common among Syrian refugee women whereas embolism and hypertension have higher proportions among Lebanese women. Maternal deaths within 48h after birth are more common among Syrian than Lebanese women. Syrian refugee women carry an increased risk for maternal mortality in Lebanon. Improving timely access and equitable provision of appropriate care should be a priority for the health system in Lebanon.

The toll of cascading crises on Lebanon's health workforce

The toll of cascading crises on Lebanon's health workforce

The Role of the Cedar Revolution in the Formation of the Collective Identity in Lebanon

The Lebanese lands, which hosted many different ethnic and religious identities under the Ottoman Empire's rule, could not bring together the plural and distinctive differences within it on common ground. The most crucial factor for the lack of common ground is the Mutasarrifate system established with the interference of France and other European states under the Ottoman rule in the country. The Mutasarrifate system's institutionalization and the building of administrative changes on this system in Lebanon's historical breaking moments brought the fragmented structure to the present day. As a result, this political system based on ethnic and religious differences prevented a Lebanese state citizen identity based on common rights and responsibilities. In the continuation and afterward of the demonstrations that started right after the assassination of former Prime Minister Rafiq Hariri in Lebanon in 2005, a broad social consensus ground could not be established. Considered as the reflection of color revolutions in the Middle East, the Cedar Revolution could not produce more democratic and inclusive results as claimed.

Lebanese Republic: between Political Confessionalism and Political Pragmatism

One of the most interesting phenomena, that were associated with the functioning of the Lebanese power structures, is the principle of consociative (consociational) democracy in the country. It is expressed in the form of political confessionalism. At the same time, the principles of the functioning of political system of Lebanon have experienced and continue to experience significant changes during the almost 80 years of the history of Lebanese Republic. The understanding of the nature and the definition of the stages of this evolution will allow us to get the understanding of the prospects for further political development of this country, which is important for a Middle East region.
 The author of the articles hares the opinion of the researchers who believe that Lebanon is gradually transforming from a consociational to a majority democracy. Already at the time of the formation of the Lebanese Republic on the basis of a confessional principle, a declarative recognition of the temporary nature of the using of this principle was announced. In 1990, the amendments made to the Lebanese constitution contained provisions that are creating real opportunities for the implementation of the course of the deconfessionalization. In 2005, a radically new political system of Lebanon was formed on the wave of the Cedar Revolution. Although in the basis, it retains a confessional aspect, however, at the same time it represents a confrontation between wopoly-confessional political blocs. This (2021) year, a very small, but real, anti-confessional opposition political bloc has formed on the wave of mass dissatisfaction with the existing political system in Lebanon. This block plans to take part in the parliamentary elections in 2022. At the same time, the use of a anti-confessional rhetoric is often practiced in the highest political circles of the country. This phenomenon testifies to the growth of the popularity of a above-stated rhetoric. Finally, the influence of the external factors often promotes the overcoming the interfaith barriers by local political elites.
 Today, a Lebanese society finds itself half way between a traditional political confessionalism and a non-confessional political pragmatism. This political modus vivendi can be defined as a pragmatic confessionalism.

Implementation of ERPS in Accounting within Lebanese Organizations: Motives and Barriers

ERPS (Enterprise Resources Planning System) is an information technology software that aims to aid organizations in their functions. According to many research the system proved its significance especially in the fields of accounting and financial management. However, this system in Lebanon has been less effective and less implemented. This research aims to identify the motives that make organizations implement ERPS and the reasons that render them not apply it. Accordingly, a mixed approach has been done. The methodology of the study used both quantitative and qualitative. The quantitative research used a questionnaire that addressed 150 employees who work with or are aware of ERPS in order to identify the barriers that made them not use it. For the qualitative research in-depth interviews were held with managers and supervisors to identify the motives that made them use ERPS. The findings of the study indicated that they use ERPS to manage financial resources, and report financial information effectively. The barriers to use it included lack of IT infrastructure, lack of training, and lack of IT support.

“It's Mainly the Fear of Getting Hurt”: Experiences of LGBT Individuals with the Healthcare System in Lebanon

LGBT people face significant discrimination, social pressures, and legal challenges in Lebanon, yet little is known about their experiences with the healthcare system. We conducted a secondary data analysis study using a qualitative descriptive design and data from the parent project, LebGuide (2016–2017). The data consisted of de-identified one-on-one interviews with 13 LGBT individuals and seven community-based organizations (CBOs). Data were analyzed using content analysis. Themes related to LGBT individuals’ healthcare experiences overlapped between the two groups of participants (LGBT participants and CBO participants) and centered around: anticipation of discrimination, experiences with healthcare providers, experiences with healthcare systems, transgender-specific experiences, and role of CBOs. This study highlights the need for LGBT-inclusive curricula in healthcare educational and training programs. Since most positive healthcare experiences reported by participants were at CBOs, it is important for CBOs to partner with healthcare institutions to introduce an LGBT-affirming culture into the healthcare workplace and the institutional culture of healthcare facilities and systems.

Using COVID-19 responses to help strengthen the mental health system in Lebanon.

This paper describes national-level mental health responses to COVID-19 in Lebanon. It then notes factors that have supported the mental health response, including how COVID-19 represents a window of opportunity to help strengthen the mental health system in Lebanon. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Beyond Religious Marriages: Civil Marriage, Civil Family Laws, and the Enhancement of Women’s Rights in Lebanon

The present text explores the current confessional system in Lebanon and the possibility of a radical change to a secular state that governs personal status codes under civil laws. In order to do that, it draws on the Tunisian experience with which it shares a common colonial, geographic, and religious experience. I also delve into the possible effects that this reform can have on women’s rights in Lebanon while analyzing how the current laws fuel the sectarian system and examine the obstacles of secular change in a sectarian country.

Chemical incident surveillance launch in Lebanon

Background: The International Health Regulations (2005) require that countries develop preparedness plans for chemical threats. Little information is available in Lebanon on chemical incidents. Therefore, there was a need to establish a chemical exposure surveillance system in Lebanon.

The Development and Negotiation of Frames During Non-sectarian Mobilizations in Lebanon

This paper explores the processes whereby organizers of non-sectarian mobilizations frame grievances against the sectarian system in Lebanon. While previous studies on non-sectarian mobilizations have mainly focused on explaining how the sectarian system in Lebanon constrains the outcomes of non-sectarian mobilizations, the paper draws attention to the agency of activists during the process of mobilizations. It analyzes framing processes in two cases: the Hirak, a protest movement which took place in the summer of 2015, and Beirut Madinati (Beirut My City), a list which competed in Beirut’s municipal elections in 2016.

Acute flaccid paralysis (AFP) surveillance system in Lebanon: a teaching case-study

Lebanon has been declared polio-free since 2002. In 2003, following an imported polio case, national campaigns succeeded to contain the virus with no further cases. Since 2013, the risk of poliovirus importation became concrete. Several risk factors linked to the Syrian crisis were illustrated including wild poliovirus type 1 outbreak in Syria in 2013-2014, huge Syrian population influx into Lebanon due to insecurity, and circulating vaccine-derived poliovirus type 2 (cVDPV2) outbreak in Syria in 2017. Hence, there is continuous need to enhance Acute Flaccid Paralysis (AFP) surveillance to timely detect any imported poliovirus for the implementation of needed response. The goal of the case study is to build the capacity of Field Epidemiology Training Program (FETP) residents and other health professionals in the area of AFP reporting and prepare health care staff to any polio importation into the country. This case study is can be administered in 2-3 hours.

Challenges of Media Ethics Education in Lebanon in the Midst of Political and Economic Pressure

The Lebanese media sector has played a pioneering role in the Arab world due to its free and diverse system. However, the lack of professional and ethical structures in journalistic practices can be attributed to political and economic pressures. Through both a quantitative and qualitative methodology, this study contributes to the complex boundaries of the Lebanese media landscape that make the gap between media ethics education and real-world pressures in need of sustained analysis. This research aims to explore the challenges media ethics education in Lebanon faces, along with the perceptions formed by media students about journalistic practices and the application of moral reasoning in the field. In addition, the study investigates whether media ethics courses prepare students for settling moral dilemmas in the professional arena. To address the multiple factors affecting ethics education, it is significant to understand the relationship between journalists and power, democratic norms, technological change, global community, and academic critiques. Survey and focus groups results indicated that the majority of students rated moral reasoning as important for their future media professions, and that the media ethics course prepares them for professional life. On the other hand, the majority believe that the corrupt system in Lebanon makes journalists resort to unethical practices which in turn compromise journalists’ credibility and integrity. Students consider that journalists have power as the so-called fourth estate, yet that power seems minimal when journalists lack the freedom to write facts without fear from editors and/or gatekeepers’ political views, economic pressure, and on-the-job demands, placing journalistic integrity again at stake.

Economic and environmental consequences of implementing an EU model for collecting and separating wastes system in Lebanon.

In this study, we examine the economic and environmental significance associated with the implementation of an EU waste-separated collection scheme in a developing context - Lebanon. Two scenarios, S1 and S2, representing different intensities of source segregation were analysed. In S1, the average source segregation intensity reached 25% and 13% for the Italian test area and Lebanese test area, respectively. In S2, source segregation intensity increased to 48% and 68% for the Italian and Lebanese test areas, respectively. Passing from S1 to S2 increased collection costs significantly, up to 44% with greater increases in the Italian test area where labour cost is higher. In both areas, environmental impacts decreased with greater source segregation intensity. Savings in the climate change impact and stratospheric ozone depletion potential were lower under the Lebanese test area in comparison with the Italian test area. In contrast, savings in freshwater eutrophication and acidification impact were lower for the Italian test area. The increase in the source segregation intensity resulted in maximum savings for the depletion of abiotic resources, 74% to 77% and 79% to 80% in a developing and developed context, respectively.

Riots in Beirut: Description of the Impact of a New Type of Mass Casualty Event on the Emergency System in Lebanon.

In the summer of 2015, Beirut experienced a garbage crisis that led to rioting. Riot control measures resulted in multiple casualties. This study examines injury patterns of riot victims presenting to the emergency department of a tertiary care center in a developing country. A retrospective study was conducted in the emergency department of the American University of Beirut Medical Center between August 22 and August 30, 2015. Patients seen in the emergency department with riot injuries were included. Patient characteristics, injuries, and resources utilized in the emergency department were analyzed. Ninety-five patients were identified. Most patients presented to the emergency department within a short time period. The mean age of the patients was 28.0 ± 8.7 years. Most (90.5%) of the patients were males and 92.6% were protestors. Emergency medical services were utilized by 41.0% of patients. Laceration was the most common presenting complaint (28.5%), and blunt trauma was the most common type of injury (50.5%). The head/face/neck was the most common injured body region (55.8%). Most patients did not require blood tests or procedures (91.6% and 61.0%, respectively), and 91.2% of patients were treated in the emergency department and discharged. One patient required intensive care unit admission and another was dead on arrival. Most patients had mild injuries on presentation. The emergency department experienced a high influx of patients. Complications and deaths can occur from seemingly nonlethal weapons used during riots and warrant effective prehospital and hospital disaster planning.

The Impact of the Syrian Refugee Crisis on Nurses and the Healthcare System in Lebanon: A Qualitative Exploratory Study.

To explore Lebanese nurses' perspectives on the impact of the protracted Syrian refugee (SR) crisis on nurses working in hospitals and primary healthcare centers in Lebanon. A qualitative research design drawing on a semistructured in-depth interview approach. We recruited participants through the Order of Nurses in Lebanon. We interviewed six primary healthcare nurses and six nursing directors working in regions with high concentration of SRs. We used the thematic inductive approach to analyze the data. Two themes emerged. In Theme I, nurses and nursing directors described the SR health profile as poor at baseline, and as the crisis was protracting the type of diseases shifted from acute to chronic with convoluted complications. As for determinants of health, SRs had poor health literacy and poor living conditions. In Theme II, nurses and nursing directors voiced the impact of the SR crisis on nurses, nursing practice, healthcare system, and host community. They cited fatigue, burnout, and depleted compassionate care at the individual level; rationing and stressed interpersonal relationships at the practice level; shortage in resources and poor performance at the healthcare system level; and a shift in the patient population that led the host community to seek health care elsewhere. Alternatively, more money was injected, and new services and clinical programs were introduced. Lebanese nurses bore a profound burden as a result of the SR crisis. Should this crisis be replicated in other contexts, the important lessons learned encompass (a) increasing access to care to refugees, coupled with an emergency plan to increase human health resources; (b) improving preparedness of nurses in handling priority health conditions; (c) documenting and reporting the challenges and resilience of health workers, especially nurses facing the crisis; and (d) engaging more nurses to be at the policy table. There is a need to prepare nurses for efficient response to crisis related to refugee health by increasing human resources and training them to be competent in delivering safe and high-quality care necessary to respond to the special healthcare needs of the refugees.

Gender Leadership and Excellence: The Case of Higher Education in Lebanon

This study aimed to explore the employment status of women in the higher educational sector and to uphold women’s productivity and commitment in executive positions of responsibility. Management tended to show preferential treatment for men in top management positions; hence, women were less engaged in the decision-making process. Women possess the potential to be transformative leaders in higher education institutions (HEI). The research purpose of this study was to speculate that some Lebanese educational institutions still practice discrimination and prefer men over women in executive positions, as well as to show that excellence in educational institutions is linked to women being in these executive positions. Currently, the higher education sector in Lebanon is under development as numerous educational developments are being implemented. The problem is that a peculiar attitude toward women in the HEI sector and specifically in top management positions still exists. In this study, the author explored women’s engagement at the top levels of higher education management and found that only 15 out of 65 Dean’s positions were filled by women and aimed to discover the factors behind the misrepresentation of women within the higher education system in Lebanon. In addition, the study found a positive relationship between the presence of women and the performance of HEIs. In this study, I aimed to focus on women’s engagement at the top management level and to emphasize the advantages of their skills and expertise, as well as to enhance the presence of women. The findings were significant and clear: There was misrepresentation, bias and stereotyping in HEIs. A clear strategic plan is needed to engage women in the decision-making process along with a well-designed incentive plan to achieve the required purpose. The aim of this study was to highlight this matter and to accentuate the benefit of women’s leadership roles in higher education in Lebanon. A qualitative strategy was used: Primary information was obtained from interviews with 12 chairpersons at six different schools. Data were gathered and analyzed to provide insightful results and recommendations.

Emergency Medical Services Utilization and Outcomes of Patients with ST-Elevation Myocardial Infarction in Lebanon

BackgroundArrival of patients with ST-elevation myocardial infarction (STEMI) by Emergency Medical Services (EMS) results in shorter reperfusion times and lower mortality in developed countries. ObjectivesThis study examines EMS use by STEMI patients in Lebanon and associated clinical outcomes. MethodsA retrospective observational study with chart review was carried out for STEMI patients arriving to the Emergency Department of a tertiary care center in Lebanon between January 1, 2013 and August 31, 2016. A descriptive analysis was done and followed by a bivariate analysis comparing two groups of patients (EMS vs. Non-EMS). ResultsA total of 280 patients were included in the study. They were mostly male (71.8%). Mean age was 65.1 years (95% confidence interval [CI] 63.4–66.9). Only 12.5% (95% CI 8.6–16.4) presented by EMS. Chest pain (81.1%) was the most common presenting symptom. Anterior myocardial infarction was the most common electrocardiogram (ECG) diagnosis (51.4%). Most patients were admitted (98.2%), and 72.0% of these patients were treated with primary percutaneous coronary intervention. Cardiogenic shock was the most frequent in-hospital complication (6.2%). The mortality rate was 7.1%. Mean door-to-ECG and door-to-balloon times were 10.8 (95% CI 7.1–14.4) min and 106.2 (95% CI 95.9–116.6) min, respectively. Patients’ characteristics, presenting symptoms, outcomes, and performance metrics were similar between the two groups. ConclusionEMS is underutilized by STEMI patients in Lebanon and is not associated with improvement in clinical outcomes. Medical oversight and quality initiatives focusing on outcomes of patients with timely sensitive emergencies are needed to advance the prehospital care system in Lebanon.

Impact of historic and future climate on spring recharge and discharge based on an integrated numerical modelling approach: Application on a snow-governed semi-arid karst catchment area

Flow in a karst system in Lebanon (Important water supply source; Assal Spring; discharge 0.2–2.5 m3/s yearly volume of 22–30 Mm3), which is dominated by snow and semi-arid conditions, was simulated using an integrated numerical model (Mike She, 2016). The calibrated model (Nash–Sutcliffe coefficient of 0.77) is based on high resolution input data (2014–2017) and detailed catchment characterization. A sensitivity analysis of individual climatic parameters shows that spring hydrograph characteristics are most sensitive to temperature.A forward simulation using the IPS_cm5 model with the RCP6.0 scenario for future climate change (Global Climate Models GCM; daily downscaled bias and altitude corrected time series for Lebanon 2020–2099) unravel that precipitation, recharge, and discharge have moderate to highly significant decreasing trends with time over the 21st century. Moreover, recession flowrates are expected to drop drastically starting in the year 2070 to 1 l/s with shortage periods reaching up to six months. The latter is due to a temperature rise of +1.5–2.5 °C and subsequent shrinking of snow cover by almost 100% (e.g., 2073–2074). Furthermore, this is accompanied by a decline in annual spring volume by 73% with respect to the current status, with real evapotranspiration consisting of up to 50% from total water budget (currently around 12–17% in 2014–2017). Moreover, decreasing snow accumulation and a more prominent flushing of precipitation event waters into fast preferential pathways will lead to peak spring discharges. This study allows decision makers to implement best informed practices for future water resources management especially for karst systems under semi-arid conditions in the regions.

Efficiency Analysis of Healthcare System in Lebanon Using Modified Data Envelopment Analysis

The inflow of refugees from Syria into Lebanon necessitates a robust and efficient healthcare system in Lebanon to withstand the growing demand for healthcare service. For this purpose, we evaluate the efficiency of healthcare system in Lebanon from 2000 through 2015 by applying a modified data envelopment analysis (DEA) model. We have selected four output variables: life expectancy at birth, maternal mortality ratio, infant mortality rate, and newly infected with HIV and two input variables: total health expenditure (% of GDP) and number of hospital beds. The findings of the paper show improvement in the efficiency of the healthcare system in Lebanon after the widespread of the health system reform in 2005. It also shows that reduction in health expenditure does not necessarily reduce efficiency if operational and technical aspect of the healthcare system is improved. The study infers that the healthcare system in Lebanon is capable of withstanding the increase in health demand provided further resources are made available and the existing technical and operational improvement are maintained.