Evidence-based models emphasizing on lifestyle behaviours for the treatment of drug use is still in its infancy. The development of multicomponent effective drug use intervention programs as part of ...health promotion is crucial to decrease risk of relapse. This study aims at exploring the lifestyle practices including dietary intake, physical activity and sleep of people who use drugs undergoing residential rehabilitation treatment in Lebanon with its perceived benefits and pitfalls. A purposive sample of 18 males and 9 females at different stages of recovery from drug use in rehabilitation centers participated in the qualitative discussions. The six phases thematic analysis revealed three themes: chaotic lifestyle, structuredlifestyle, benefits and pitfalls, and suggestions for making rehabilitation a better experience. Participants discussed their chaotic lifestyle during addiction with poor food intake, disrupted sleep and low physical activity moving to a more disciplined routine enforcing normality in lifestyle practices with social and professionlprofessional support. The early phases of treatment were marked with increased food intake and weight gain perceived as a health indicator and the sole divergent from drugs, moving towards more structured meals and efforts to lose weight in later stages. Lack of variety of Physical activity programs taking into consideration the motivational differences among the participants was also highlighted. Measures for improving rehabilitation services in terms of promoting healthy eating behaviours and environmental control were thoroughly addressed. These findings shed the light on the challenges faced in maintaining a healthy lifestyle in rehabilitation centers and the necessities of addressing them to improve the overall rehabilitation experience, prevent relapse and inform the development of future targeted intervention programs tackling all aspects of behavioural changes.
Food insecurity is a common public health problem in both developed and developing countries. This study aimed to profile food insecurity among university students in a developed country with stable ...economic circumstances (Germany) and a developing Mediterranean country undergoing a severe economic and financial crisis (Lebanon) and examine the associations between food insecurity and lifestyle behaviors (i.e., physical activity, sleep, and adherence to a healthy eating pattern, such as the Mediterranean diet), stress, and financial well-being.
This online cross-sectional study was conducted between September 2021 and March 2022. Subjects were recruited through social media platforms (Facebook, WhatsApp, Instagram, and personal email) and in-class announcements by several university professors of various majors and from different universities in Lebanon and Germany. The final sample included 547 participants (197 from Lebanon and 350 from Germany).
Our findings showed a higher food insecurity rate in Lebanon compared with Germany (59% versus 33%). In the bivariate analysis, food insecurity was associated with insomnia (r = 0.230; p < 0.001) and stress (r = 0.225; p = 0.001); German university students had higher physical activity (p < 0.001), better diet quality (p < 0.001), and lower adherence to the Mediterranean diet (p < 0001) than Lebanese students. In the multivariable analyses, more stress was related to insomnia (B = 0.178; p < 0.001), while financial well-being was not associated with any of the lifestyle behaviors. Physical activity, insomnia, and Mediterranean diet adherence were not associated with the country or food insecurity (p > 0.05); however, living in Germany was associated with better diet quality (B = -7.85; p < 0.001).
The high prevalence of food insecurity reported in this study is alarming, particularly among Lebanese students; German students had better diet quality and higher physical activity but worse adherence to the Mediterranean diet. Moreover, food insecurity was also associated with worse sleep and stress. Further studies are necessary to assess the role of food insecurity as a mediating factor between sociodemographic characteristics and lifestyle behaviors.
Metabolic syndrome (MetS) increases the risk of cardiovascular disease, with atherogenic dyslipidemia being a major contributing factor.
A systematic review was conducted following the Preferred ...Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to assess whether vitamin D supplementation (VDS) alleviates dyslipidemia in adults with MetS. Scientific databases (PUBMED, MEDLINE, CINAHL, EMBASE, Cochrane Library, ClinicalTrials.gov, International Clinical Trials Registry Platform) and the gray literature were searched for randomized controlled trials of VDS, reporting on blood lipids. A narrative review, meta-analyses, sensitivity analyses, and appraisal of the risk of bias and overall quality of evidence produced were conducted.
Seven studies were included, and four were meta-analyzed. The risk of bias was generally low, and the final quality of evidence was low or very low. VDS, whether in high or low dose, significantly increased endline vitamin D blood levels; did not affect total, low-density, high-density cholesterol levels, and novel lipid-related biomarkers; yet, significantly increased triglycerides (TG) levels compared with placebo (MD: 30.67 (95%CI: 4.89-56.45) mg/dL;
= 0.02 for low-dose VDS; and MD: 27.33 (95%CI: 2.06-52.59) mg/dL;
= 0.03 for high-dose VDS). Pertaining heterogeneity was high (I
= 86%; and I
= 51%, respectively), and some included studies had significantly higher baseline TG in the intervention arm. The sensitivity analyses revealed robust results.
VDS seems not to affect blood lipids in adults with MetS.
The evidence on the association between vitamin D and metabolic syndrome (MetS) is inconclusive. This was a cross-sectional study to explore the relationship between vitamin D serum levels and MetS ...in a sample of Lebanese adults (
= 230), free of diseases that affect vitamin D metabolism, recruited from an urban large university and neighboring community. MetS was diagnosed according to the International Diabetes Federation criteria. A logistic regression analysis was performed taking MetS as the dependent variable, and vitamin D was forced into the model as an independent variable. The covariates included sociodemographic, dietary, and lifestyle variables. The mean (SD) serum vitamin D was 17.53 (12.40) ng/mL, and the prevalence of MetS was 44.3%. Serum vitamin D was not associated with MetS (OR = 0.99 (95% CI: 0.96, 1.02),
< 0.757), whereas the male sex, compared with the female sex and older age, was associated with higher odds of having MetS (OR = 5.92 (95% CI: 2.44, 14.33),
< 0.001 and OR = 1.08 (95% CI: 1.04, 1.11),
< 0.001, respectively). This result adds to the controversy in this field. Future interventional studies are warranted to better understand the relationship between vitamin D and MetS and metabolic abnormalities.
Evidence of synergic health effects of co-supplementation with vitamin D and probiotics is emerging. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses PRISMA statement, ...scientific databases and the grey literature were searched, and a narrative review and risk of bias assessment were conducted. Seven randomized controlled trials were included, which had low risk of bias. Six studies were double-blind, and once single-blind, extended over 6-12 weeks, and included 50-105 participants. Conditions explored included schizophrenia, gestational diabetes, type 2 diabetes and coronary heart disease, polycystic ovarian syndrome, osteopenia, irritable bowel syndrome (IBS), and infantile colic. Supplementation frequency was daily or bi-monthly, with mainly vitamin D3, and
,
, and
. Comparators were placebo, vitamin D, lower vitamin D dose, and probiotics and lower vitamin D dose. The co-supplementation yielded greater health benefits than its comparators did in all studies except in one assessing IBS. Beneficial effects included decreased disease severity, improved mental health, metabolic parameters, mainly insulin sensitivity, dyslipidemia, inflammation, and antioxidative capacity, and lower use of healthcare. Co-supplementation of vitamin D and probiotics generated greater health benefits than its comparators did. More studies in other diseases and various populations are needed to confirm these findings and to elucidate the optimal form, composition, and frequency of this co-supplementation.
Substance use disorder compromises the nutritional status and the eating habits of drug users, often leading to malnutrition. Once referred for treatment, hyperphagia and poor lifestyle practices ...leading to weight gain are observed. This study aimed to examine the patterns and extent of weight change as well as the determinants of weight gain in a sample of drug users who were receiving treatment in Lebanon. A total of 172 male participants undergoing either rehabilitation or opioid substitution treatment (OST) were included. Multivariate regression analysis was applied to assess the effect of different variables on weight gain while adjusting for potentially confounding variables. Approximately two-thirds (65.1%) of the participants gained weight (OST: 54.3%, rehabilitation: 78.2%;
< 0.05). The mean weight gain was 5.9 kg and was mainly reported among participants in the underweight, normal, and overweight pre-treatment categories and accentuated in the rehabilitation group (OST: 2 kg, Rehabilitation: 10.6 kg). Around half of the participants moved from the normal weight category to the overweight and obese categories during treatment. Weight gain was negatively associated with the number of previous treatment attempts (Odds Ratio = 0.86; Confidence Interval: 0.74-0.99), duration of current treatment (Odds Ratio = 0.98; Confidence Interval: 0.96-0.99), and pre-treatment body mass index (BMI) (Odds Ratio = 0.88; Confidence Interval: 0.80-0.96). Investigating other nutrition and lifestyle practices, neither nutrition knowledge, food addiction, physical activity level, nor sleep quality were associated with weight gain. Treatment through drug use was associated with meaningful weight gain that might lead to health risk factors. Developing health promotion programs is crucial to enhance treatment and decrease the risk of relapse.
Background
Although the economic burden of multiple sclerosis (MS) in high-income countries (HICs) has been extensively studied, information on the costs of MS in low- and middle‐income countries ...(LMICs) remains scarce. Moreover, no review synthesizing and assessing the costs of MS in LMICs has yet been undertaken.
Objective
Our objective was to systematically identify and review the cost of illness (COI) of MS in LMICs to critically appraise the methodologies used, compare cost estimates across countries and by level of disease severity, and examine cost drivers.
Methods
We conducted a systematic literature search for original studies in English, French, and Dutch containing prevalence or incidence-based cost data of MS in LMICs. The search was conducted in MEDLINE (Ovid), PubMed, Embase (Ovid), Cochrane Library, National Health Service Economic Evaluation Database (NHS EED), Econlit, and CINAHL (EBSCO) on July 2020 without restrictions on publication date. Recommended and validated methods were used for data extraction and analysis to make the results of the COI studies comparable. Costs were adjusted to $US, year 2019 values, using the World Bank purchasing power parity and inflated using the consumer price index.
Results
A total of 14 studies were identified, all of which were conducted in upper-middle-income economies. Eight studies used a bottom-up approach for costing, and six used a top-down approach. Four studies used a societal perspective. The total annual cost per patient ranged between $US463 and 58,616. Costs varied across studies and countries, mainly because of differences regarding the inclusion of costs of disease-modifying therapies (DMTs), the range of cost items included, the methodological choices such as approaches used to estimate healthcare resource consumption, and the inclusion of informal care and productivity losses. Characteristics and methodologies of the included studies varied considerably, especially regarding the perspective adopted, cost data specification, and reporting of costs per severity levels. The total costs increased with greater disease severity. The cost ratios between different levels of MS severity within studies were relatively stable; costs were around 1–1.5 times higher for moderate versus mild MS and about two times higher for severe versus mild MS. MS drug costs were the main cost driver for less severe MS, whereas the proportion of direct non-medical costs and indirect costs increased with greater disease severity.
Conclusion
MS places a huge economic burden on healthcare systems and societies in LMICs. Methodological differences and substantial variations in terms of absolute costs were found between studies, which made comparison of studies challenging. However, the cost ratios across different levels of MS severity were similar, making comparisons between studies by disease severity feasible. Cost drivers were mainly DMTs and relapse treatments, and this was consistent across studies. Yet, the distribution of cost components varied with disease severity.
University students are particularly susceptible to mental health issues. The association between adherence to the Mediterranean Diet and mental health in this population remains inconclusive. To ...address this gap, we studied the association between adherence to the Mediterranean diet and mental health aspects: depression, anxiety, and stress, among a sample of university students in Lebanon.
This was a cross-sectional study using an online survey. The survey included the Patient Health Questionnaire-4 (PHQ-4) to evaluate symptoms of depression and anxiety, the Perceived Stress Score (PSS) to assess stress levels, and the Mediterranean Diet Adherence Screener (MEDAS) to measure adherence to the Mediterranean diet. Socio-demographic and lifestyle-related questions were also assessed. Descriptive, bivariate, and multivariate analyses were conducted.
200 students were included: 64 % being females, 58.5 % studying in private universities, and 69.5 % being seniors. The mean PHQ4-anxiety subscale was 3.61 (out of a total of 6) and 71.5 % of the sample met the criteria for anxiety diagnosis; the mean PHQ4-depression subscale was 4.04 (out of a total of 6) and 77 % of the sample met the criteria for depression diagnosis, and mean PSS was 21.18 (out of a total of 39). The mean MEDAS was 6.42 (out of a total of 14). There was a significant inverse association between MEDAS scores and anxiety (β=-0.110, 95 %CI: -0.196; -0.024) and between MEDAS and PSS (β=-0.327, 95 %CI: -0.546; -0.107). There was no association between MEDAS and depression.
We found poor mental health and low adherence to the Mediterranean Diet among university students. Higher adherence to the Mediterranean Diet was associated with lower anxiety and stress levels. Randomized trials are needed to confirm our findings.
Strategies to enhance knowledge of and adherence to dietary guidelines for management of hyperphosphatemia in hemodialysis patients have been studied extensively over the past decade. This review is ...the first to compile all of them (2003–2013) and conduct a meta‐analysis through calculation of effect size, with the aim of identifying the optimal nutrition education methods for effective management of hyperphosphatemia in hemodialysis patients. The following strategies were identified as being effective in changing dietary behavior: 1) use of self‐evaluation and self‐regulation techniques within educational tools, along with easy‐to‐apply skills; 2) individualized counseling by a renal dietitian provided just before the hemodialysis session; 3) high‐intensity education; and 4) long duration of interventions. Future studies should focus on conducting randomized controlled trials with powered samples to help generate stronger evidence.
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