Institut National de Santé Publique du Québec (INSPQ)

Entomopathogenic fungi engineered to express insect-specific neurotoxins have demonstrated potential as microbial control agents against malaria mosquitoes. Currently, the primary application method is via direct contact of spores with indoor resting mosquitoes. However, many malaria-transmitting mosquitoes feed and rest outdoors. To target these, we have developed an alternative application method that exploits the lethality of transgenic fungi as a sexually transmitted mosquito disease. This approach has both a wider interdisciplinary significance and important implications for preventing mosquito-borne diseases.

Background Lebanon has experienced a series of devastating crises that continue to have significant adverse effects on the mental health of parents and their children, especially those who are unemployed, burdened with debt or financial difficulties, and have pre-existing mental health conditions. Accordingly, this study aimed to assess the effect of financial insecurities on parents in Lebanon amid the multiple crises, and the impact of parents’ mental health on their children’s emotional and behavioral wellbeing. Methods A cross-sectional study including 589 parents in Lebanon was performed using convenience sampling of parents of any gender with children aged 4 to 18 from the five Lebanese governorates. The study collected the sociodemographic data of the participants and incorporated supplementary measures such as the Parental Stress Scale (PSS), Pediatric Symptom Checklist (PSC), and the InCharge Financial Distress/Financial Well-Being (IFDFW) scale. Statistical tests included bivariate analysis, ANOVA test, linear regression, and mediation analyses. Results A total of 589 parents, primarily mothers, participated in this study. Most children were males in elementary school. Bivariate analyses revealed that parents with non-Lebanese nationality, primary education, employment, or children in technical schools reported significantly higher PSS and PSC scores. Negative correlations were observed between the IFDFW scale and both PSS (r=-0.200, p < 0.001) and PSC scores (r=-0.086, p = 0.038), indicating lower stress and symptoms with improved financial well-being. Multivariable analysis showed that higher PSC scores, age, complementary education, and Lebanese nationality were associated with increased parental stress, while unemployment, lower age, and higher IFDFW were associated with reduced stress. Similarly, higher PSC scores were linked to increased parental stress, age, non-Lebanese nationality, and IFDFW, whereas university education, higher GPA, and residence outside Beirut/Mount Lebanon were associated with reduced PSC scores. Mediation analysis indicated that parental stress fully mediated the relationship between IFDFW and PSC scores, underscoring the impact of financial well-being on a child’s psychological symptoms via parental stress. Conclusions The study revealed significant financial distress and low financial well-being among participants amid Lebanon’s economic crisis, with a notable mediated association between financial well-being, parental stress, and child mental health symptoms. Parental stress was heightened among those with lower education levels, non-Lebanese nationality, and employment in low-wage jobs, with children from these families exhibiting elevated mental health symptoms. Additionally, regional factors and socioeconomic status played a role, as children in urbanized areas and technical schools reported higher distress. Targeted interventions are urgently recommended to alleviate financial and emotional burdens on families and ensure improved mental well-being for both parents and children.

As urbanisation continues to accelerate, urban green spaces are increasingly recognised as key elements for enhancing people's health and well‐being. However, most research has used vegetation metrics that may not capture the specific associations between different types of vegetation and different mental health outcomes. In this study, we investigate the cross‐sectional associations between residential vegetation exposure and individual well‐being in Montreal, Canada, using different vegetation and well‐being measures: The proportion of grass cover, tree cover, and average NDVI value within buffers of various radii (100–1000 m) were linked to each participant's residence (n = 1072, aged 18 years or older), while well‐being was assessed using subjective happiness, emotional well‐being, and personal well‐being scales. The associations were analysed using generalised additive regression models. Our findings show that more vegetation was linked to enhanced well‐being, although the effect sizes were relatively small. Irrespective of the buffer distance, the positive associations for grass and NDVI were more pronounced than those for trees, though these associations varied across the different well‐being outcome measures. We also observed that increasing tree coverage has a stronger positive effect on the well‐being of individuals who are dissatisfied with the current number of street trees. Synthesis and applications. Everyday exposure to nearby nature is associated with better self‐reported mental health, suggesting urban greening policies should focus on including more vegetation within built spaces, from individual street trees to small and large parks. Our study also highlights the importance of distinguishing between different types of vegetation (e.g. grass vs. trees) when studying the effects of vegetation on well‐being or other health‐related outcomes. Likewise, using different measures of well‐being may provide a more nuanced and comprehensive understanding of how vegetation impacts people's well‐being. Read the free Plain Language Summary for this article on the Journal blog.

Objectives This study identified profiles of outpatient physician follow-up care and other practice features, mostly after detection of incident mental disorders (MD), and associated these profiles with patient characteristics and subsequent adverse outcomes. Methods A cohort of 170,957 patients age 12 + with a new or recurrent MD detected in 2019-20 was investigated based on data from the Quebec Integrated Chronic Disease Surveillance System. Latent class analysis was performed to identify follow-up care profiles, mostly within one year of MD detection. Bivariate analyses tested associations between profiles and patient characteristics; logistic regressions examined relationships between profiles and adverse outcomes after one year. Results Five profiles were identified: Profiles 2 and 5 (64%) offered low mental health (MH) outpatient follow-up care, while the others dispensed higher MH follow-up care. Profiles differed in patient characteristics and related outcomes. Labelled “Follow-up care by usual psychiatrist”, Profile 1 (1% of sample) included younger patients with the most health and social issues. Profile 2 (50%), “Low MH follow-up care but high prior consultations for physical reasons”, mostly integrated older patients with chronic physical illnesses. Profile 3 (11%), “Follow-up care by general practitioners (GP) and psychiatrists”, referred to physicians other than the usual ones (e.g., walk-in practice) and encompassed patients with severe MD conditions. Profile 4 (23%), “High follow-up care by usual GP and prior consultations for physical reasons”, showed the typical characteristics of patients treated in primary care (more common MD, women, less materially and socially deprived). Profile 5 (15%), “Low MH follow-up care and prior consultations for physical reasons”, integrated more younger men, materially deprived patients, and with substance-related disorders (SRD) or co-occurring MD-SRD. More Profile 1 and 3 patients lived in university regions – those of Profile 4 were the least numerous in such regions. More Profile 5 patients lived in metropolitan and rural areas. Risk of death was higher in Profiles 5, 2, 3, and risk of frequent ED use and hospitalization higher in Profiles 1, 3, and 5 – patients with severe health and social issues. Conclusion The study confirmed the need to improve prompt, adequate and continuous follow-up care for patients with incident MD.

Bats play key roles in ecosystem functions and provide services to human populations. There is a need to protect bat populations and to mitigate the risks associated with pathogen spillover. Caves are key habitats for many bat species, which use them as roosting and breeding sites. Caves, bats and their guano also attract many other animals along trophic chains which might favor direct or indirect interspecies interactions. Two caves hosting colonies of insectivorous bats have been investigated in the Republic of Congo to characterize habitat sharing and interactions between bats, humans and animals. We set up a camera-trap monitoring protocol during 19 months at the entrance of and inside each cave. Our results demonstrated the richness and complexity of the species interactions around and within these caves. We identified and/or quantified mainly rodents, but also numerous categories of animals such as insects, birds, reptiles and carnivores using the caves. We investigated the temporal variation in the use of caves and the potential interactions between humans, wild animals and bat colonies. Our study contributes to the understanding of the interface and interactions, for the first time quantified, between cave-dwelling animal species, including humans. This knowledge is important to promote the conservation of cave ecosystems and better understand the ecology of infectious diseases.

University students are at a pivotal stage of shaping cancer risk factors. Little is known about their dietary behavior in Lebanon, a country heavily burdened by cancer. This cross-sectional study assessed the dietary knowledge of and adherence to cancer prevention guidelines among university students in Beirut, Lebanon. We hypothesized that students would exhibit low knowledge, poor diet quality, and that knowledge predicted diet quality. Dietary knowledge was explored using a dedicated questionnaire, with scores above the 60th percentile considered as Knowledgeable (Kn+), and those below as less knowledgeable (Kn-). Dietary adherence to cancer prevention guidelines and the predictors of the Alternative Healthy Eating Index (AHEI)- a measure of diet quality calculated using the Modified Mediterranean Prime Screen, were also examined. The sample included 300 participants (55% females, mean age: 20 years). The mean knowledge score was 49.5%. Over 50% of students were aware of the association between red and processed meat, sodium, fruits and vegetables, obesity, and cancer. Kn+ group had a higher intake of vegetables and a lower intake of meats and sweetened beverages. Increased knowledge (B = 0.78, 95%CI: 0.18,1.37) and high physical activity (B = 4.62, 95%CI: 1.66,7.59) were associated with elevated AHEI scores. A significant positive interaction was observed between knowledge and enrollment in a health-related major. University students’ dietary knowledge of and adherence to cancer prevention guidelines are suboptimal. Although higher knowledge predicts high-quality diets, the association was weak. Further studies should investigate the food systems influencing university students’ dietary intake of university students in Lebanon and identify effective interventions to enhance health behavior.

Gay, bisexual, and other men who have sex with men (GBM) are more likely to be diagnosed with HIV and other sexually transmitted infections (STIs) compared with the general population. Although newcomers generally experience a health advantage in Canada compared with non‐immigrants and more established immigrants (i.e., healthy immigrant effect), they also experience disparities in access to healthcare services. These disparities, in turn, may lead to unique vulnerabilities for the sexual health of GBM immigrants. We examined disparities in healthcare access, STI testing, and HIV pre‐exposure prophylaxis (PrEP) use among immigrant and non‐immigrant GBM. Using baseline data (collected between February 2017 and August 2019) from a multisite cohort study of GBM in Toronto, Vancouver, and Montreal ( n = 2449), we found that newcomer GBM (migrated ≤ 5 years prior) were less likely to report having a primary healthcare provider than non‐immigrants. This had a weak indirect effect in mediating both access to STI testing and the use of HIV PrEP. These disparities dissipated after controlling for migration precarity (e.g., refugees and those without permanent residency), suggesting that disparities in newcomer GBM healthcare access may, in part, be driven by the large number of newcomers with precarious migration statuses. Public Significance Statement : New immigrants tend to be less likely to have a primary healthcare provider or use other sexual health clinics, which can have adverse consequences for sexual health. This disparity appears to be largely concentrated among temporary foreign workers, international students, and refugees. Interventions should target policies that increase the number of primary healthcare providers, and address immigration policies that lead to fear of deportation due to one's health.

Background Availability of new vaccines for adults has increased interest in understanding Canada’s respiratory syncytial virus (RSV) burden in older adults and adults considered at high risk of severe infection. Objective To characterize the burden of RSV disease in Canada by joint analysis of the published literature and hospitalization data from a healthcare administrative database. Methods Electronic databases of published literature were searched to identify studies and systematic reviews reporting data on outpatient visits, hospitalizations, intensive care unit (ICU) admissions and deaths associated with RSV infection in adults. For the hospitalization data analysis, hospital discharge records were extracted from the Canadian Institute of Health Information Discharge Abstract Database for all patients admitted to an acute care facility for RSV infection defined by ICD-10 codes from 2010 to 2020 and 2021 to 2023. Results Overall, 26 studies, including seven systematic reviews, were identified and summarized. Evidence suggests that medically attended RSV respiratory tract infections (RTI) are frequently causing 4.7%–7.8% of symptomatic RTI in adults 60 years of age and older. Incidence of RSV RTI increases with age and presence of underlying medical conditions. This trend was consistently observed across all RSV clinical outcomes of interest. Patients who reside in long-term care or other chronic care facilities have a higher likelihood of severe clinical outcomes compared to patients with other living situations upon hospital admission. Approximately 10% of older adults hospitalized with RSV infection require ICU admission. Although data are limited, the case fatality ratio (CFR) among those admitted to hospital varies between 5% and 10%. Some evidence suggests that RSV burden may be close to the influenza burden in older adults. In general, the results from the Canadian hospitalization data support the rapid review findings. Rates of hospitalization, ICU admission and death associated with RSV all increased with age, with 16% of hospitalizations resulting in ICU admission and with an in-hospital CFR of 9%. Conclusion In adults, the burden of severe RSV outcomes in general increases with age and presence of comorbidities.

Background As the number of medications increases, the appropriateness of polypharmacy may become questionable due to the heightened risk of medication-related harm. Objectives (1) To investigate the relationship between the number of current medications used by older adults and three indicators of potentially inappropriate polypharmacy: (a) the mean number of potentially inappropriate medications (PIMs), (b) the average count of drug–drug interactions, and (c) the anticholinergic burden; (2) To characterize the population-based burden of potentially inappropriate polypharmacy by calculating the proportion of individuals with these indicators. Design We conducted a population-based observational study using the Quebec Integrated Chronic Disease Surveillance System. Methods We included all individuals over 65 years insured by the public drug plan on April 1st, 2022. For each individual, we calculated the number of current medications and the number of (a) PIMs (Beers 2019), (b) drug–drug interactions (Beers 2019), and (c) anticholinergic burden (Anticholinergic Cognitive Burden (ACB) scale). The association between the number of medications and these indicators was quantified using linear regression. Prevalence with 99% confidence intervals (CIs) was calculated. Results A total of 1,437,558 individuals (mean age: 75; 55% female) were included, taking an average of 4.9 medications (±4.1). For each additional medication, the mean number of PIMs, drug–drug interactions, and anticholinergic burden increased by 0.11, 0.04, and 0.17, respectively (p-trend <0.0001). Nearly half the population (45.5%; 99% CI: 45.5–45.5) had a regimen containing ⩾1 PIMs, ⩾1 drug–drug interaction, or an ACB ⩾3. Conclusion The strong association between the increasing number of medications and reduced polypharmacy quality underscores the importance of medication count beyond therapeutic indications. With widespread medication use, many older adults face quality issues.

Widespread vaccine acceptance is crucial, particularly with emerging infectious diseases like COVID-19. This study assesses COVID-19 vaccine willingness and its influencing factors among healthcare workers (HCWs) and non-HCWs in Lebanon. In November 2020, a web-based survey was conducted among Lebanese adults using snowball sampling. Participants completed an anonymous Arabic questionnaire covering sociodemographics, health status, vaccine intentions, and the Health Belief Model. Multivariable logistic regression was performed to identify factors associated with COVID-19 vaccine acceptance in HCWs and non-HCWs. Of 2802 participants, 51.5% intended to receive the COVID-19 vaccine. HCWs (65.8%) were more willing than non-HCWs (47%). Factors positively linked to acceptance included older age, marital status, urban residence, recent influenza vaccination, heightened susceptibility and benefit perception, concerns about vaccine access, and health authority recommendations. Conversely, vaccine refusal history, safety concerns, and side effect worries reduced intention. Among non-HCWs, female gender, religiosity, and manufacturer reliability concerns, negatively affected acceptance. Good knowledge, public vaccine intake, and self-motivation were positive factors. HCWs were unaffected by these factors. Addressing the concerns and misconceptions surrounding the COVID-19 vaccine, especially among non-HCWs, while promoting the benefits of vaccination, is essential to enhance COVID-19 vaccine acceptance in Lebanon to achieve broader immunization coverage and pandemic control. in the community.

Background Unintentional injury deaths in sport and recreation represent a significant public health concern. This study analysed coronial recommendations related to such deaths, focusing on case specifics and recurring themes from January 2006 to December 2019. Methods This mixed-methods study used data from the Bureau du coroner du Québec. Reports with recommendations were analysed by sex, age group, context, mechanism and activity. A four-phase thematic analysis was conducted to emphasise the developed themes and connect them with the existing literature. Results Of 1937 coronial reports reviewed, 13.3% (n=258) contained at least one recommendation, totalling 609 recommendations (31 per 100 activity-related deaths). Reports were more likely to contain at least one recommendation for women (20.3%, p=0.0004), paediatric populations (≤5 years: 30.3%, p<0.0001; 6–11 years: 29.3%, p=0.0003; 12–17 years: 27.6%, p<0.0001), and organised events (55.0%, p<0.0001), despite most deaths occurring among men, adults and during unstructured events. All-terrain vehicle and snowmobile activities showed significantly lower rates of reports with recommendations (8.1%, p=0.0008 and 8.6%, p=0.0044, respectively). Most frequently addressed themes were Development, inspection and modification of bicycle infrastructure for cycling and Lake and river safety measures for swimming. Conflict with other types of users was the top theme for land motorsports, while Personal flotation device use was the most common for navigation activities. Conclusions Patterns from reports with recommendations will be shared with the Bureau du Coroner du Québec to improve coronial practices. Integrating recurrent themes and recommendations with activity-specific risk factors will help identify critical patterns and inform preventive measures holistically.

Background University students, often unemployed and reliant on low-nutrition foods, are susceptible to food insecurity (FI) with potential physical and mental health challenges. This study explores FI and its impact on lifestyle behaviours among university students. Methods A cross-sectional web-based study was performed by sending an online questionnaire to university students in Lebanon, Cyprus, and Germany during the COVID-19 pandemic. Using validated measures, i.e., the Household Food Insecurity Access Scale, International Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, and Mediterranean Diet Adherence Screener, adjusted linear regression models were performed to assess the associations between country, FI and physical activity, sleep quality, and diet. Results In a convenience sample of 611 individuals (350 in Germany, 214 in Lebanon, and 47 in Cyprus) enrolled in the study, 547 provided complete response. 190 (34.7%) experienced FI, of whom 52 (9.5%) were severely food-insecure, with variation of FI prevalence between countries (18.9% in Germany, 14.9% in Cyprus, and 60.3% in Lebanon). Lifestyle behaviours also differed between participants from the three countries, with students in Germany exhibiting the highest physical activity level and the lowest adherence to the Mediterranean diet compared with Lebanon and Cyprus. On the other hand, participants from Lebanon and Cyprus had similar physical activity and diet behaviours. Concerning sleep, students in Cyprus showed the poorest quality. FI significantly correlated with reduced physical activity (beta − 0.171, 95% Confidence Interval (-0.313, -0.029)), but not with sleep or diet. The country of residence independently predicted lifestyle behaviours (p < 0.05). Conclusions This study suggests that FI impacts university students in countries of varying income levels, and the country of residence independently influences lifestyle behaviours. Larger-size studies are essential to confirm these findings and further explore FI’s impact on university students outside the context of the pandemic.

Introduction Non-specific neck pain (NSNP) causes a great deal of discomfort, impacting a person’s functionality and quality of life. This study aimed to determine the prevalence, activity limitations, and quality of life in patients with NSNP in Burundi. Patients and Methods This was a cross-sectional study with descriptive and analytical aims, covering the period from September 2023 to February 2024. It focused on NSNP patients received in three health facilities of Bujumbura. In addition to sociodemographic data, clinical data including pain, disability, psychological status and quality of life were collected. Results Most of patients (47.1%) were over 40 years old, with an average of 49.30 (13.30) years. The majority was female, married, employed, and had a university education. Most of them (64.70%) described their pain as moderate to severe, with a mean score of 6.20 (1.60) on the numerical scale. A minority had poor health-related quality of life (20.60%). The majority had mild to moderate disability in both the psychological (41.20%) and physical (55.90%) components. Pain location during the current episode had a statistically significant association with social aspects (p=0.049). Individuals with lower levels of education, a more sedentary lifestyle, and greater psychological distress are likely to experience increased activity limitations (p<0.05). Conclusion NSNP is a significant public health concern in Burundi, impacting individuals’ socio-professional lives and overall quality of life. Individuals with lower levels of education, a more sedentary lifestyle, and greater psychological distress are likely to experience increased activity limitations. The state of health was perceived as poor by 20.60% of the sample. The physical component of health status was more impaired than the mental component, and the majority of patients presented moderate to severe disabilities, highlighting the need for preventive and management measures to mitigate its impact on individuals and the healthcare system in Burundi.

Eight provinces and territories are currently experiencing syphilis outbreaks in Canada, with the national rate of infectious syphilis increasing significantly from 5.1 per 100,000 population in 2011 to 36.1 per 100,000 population in 2022. Neurosyphilis refers to infection of the central nervous system by Treponema pallidum, which may occur at any stage. It is to be expected that along with the syphilis outbreak, a concomitant rise in neurosyphilis cases will occur. It is important to note that Canadian national surveillance data on neurosyphilis is not currently published as it is inconsistently reported and often lumped in with secondary and tertiary syphilis rates. Future surveillance efforts must focus on properly identifying these cases to quantify the scope of the problem. This article summarizes Canadian Public Health Laboratory Network guidelines for neurosyphilis diagnosis.

The COVID-19 pandemic disrupted the seasonal transmission pattern of respiratory syncytial virus (RSV), challenging the launch of palivizumab immunization campaigns. This study explored the performance of the moving epidemic method (MEM) to guide the launch of such campaigns. Data were collected through a continuous RSV surveillance system (07/2013‒03/2022) in Québec, Canada. Two strategies were compared: (1) a “preestablished” approach according to which each annual campaign began on November 1 and ended upon the earliest week with an RSV positivity rate ≤ 10% after March 31; and (2) MEM, according to which each annual campaign began and ended upon meeting an epidemic threshold of RSV positivity. We estimated the proportion of RSV cases that would be covered depending on the approach used for each RSV epidemic. From seasons 2013–2014 through 2019–2020, RSV cases peaked between weeks 1 and 8, and all epidemic curves overlapped with an intraclass correlation coefficient (ICC) of 0.83. From 2013–2014 through 2019–2020, the epidemic periods determined by MEM and the preestablished approach covered similar proportions of RSV cases (MEM = 91.6%, preestablished = 90.7%) and had a similar duration (MEM = 21.3 weeks, preestablished = 21.7 weeks). With MEM, the 2021–2022 epidemic period started at week 29 and ended at week 51, covering 95.7% of cases. With the preestablished approach, the epidemic period started at week 44 and ended at week 8, covering 28.3% of cases. During normal RSV seasons, MEM is an effective alternative to the preestablished approach. However, MEM appears significantly more robust to disruptions of RSV’s seasonal pattern.

Objective: The study objectives were to test the hypothesis that childhood trauma moderates the associations between Early Maladaptive Schemas (EMS) and intimate partner violence (IPV) among women in the specific Lebanese patriarchal context. Methods: This is a cross-sectional study that was conducted on Lebanese women between September and December 2018; 1655 participants enrolled in this study were from all of Lebanon's governorates and were selected using an equitable representative sample. Results: The “Disconnection and Rejection” EMS domain showed the strongest correlations with both physical and non-physical IPV (r = .46 and r = .51, respectively) in our sample. Moderation analyses findings showed that at low, moderate and high levels of childhood trauma, greater endorsement of the “Disconnection and Rejection” schema domain was strongly linked to more severe physical and non-physical IPV. Furthermore, childhood trauma (only at high levels) emerged as a significant moderator in the link between the “Impaired autonomy and performance” domain and physical/non-physical IPV. High levels of childhood trauma significantly moderated the association between “Other directedness” and non-physical IPV. Finally, low levels of childhood trauma moderated the link between “Over-vigilance and Inhibition” and physical IPV. Conclusion: Given that EMS are known to be resistant to change, identifying childhood trauma as a moderator in the link between certain specific EMS and IPV can provide novel avenues for the prevention IPV and its long-lasting detrimental consequences. Childhood trauma can be regarded as a target for prevention and intervention, as it can assist in mitigating correlations between EMS and IPV occurrence.

Background/Objectives: During the pandemic, client-facing workers were perceived to be at greater risk of SARS-CoV-2 infection. This study investigated the risk factors for SARS-CoV-2 infection among a cohort of 304 retail workers in the Quebec City metropolitan area. Methods: After providing consent, participants were interviewed to gather information on demographic, socioeconomic, behavioural, and occupational variables. They were subsequently followed for up to five visits, scheduled every 12 ± 4 weeks. The study covered critical periods before and during the emergence of the Omicron variants and included retrospective reporting of COVID-19 symptoms and virus detection tests to capture the pandemic’s early stages. Results: During the observation period, 173 (57%) participants experienced a first episode of COVID-19. Serological evidence of recent infection was detected in 160 participants (53%), while 117 (38%) reported a positive virus detection test. In adjusted analyses, risk factors for infection included younger age, a diagnosis of lung disease, longer weekly working hours, more frequent social gatherings, and having received fewer than three doses of vaccine. Notably, the increased risk associated with younger age and longer working hours was observed only after the relaxation of public health measures in the spring of 2022. Conclusions: These data suggest that during the early years of the pandemic when strict public health measures were in place, retail work was not a significant risk factor for SARS-CoV-2 infection in Quebec City metropolitan area. These findings highlight the complex dynamics of COVID-19 transmission and the effectiveness of workplace protective measures.

Purpose Epilepsy, a prevalent chronic neurological disorder, is associated with misconceptions, negative attitudes, and stigma because of poor public knowledge and awareness. Therefore, the purpose of the current study was to assess the knowledge, awareness, and attitudes toward epilepsy and its associated factors among the Lebanese general population. Methods A cross-sectional study was conducted on Lebanese adults between October 2021 and June 2022 using an electronic structured self-administered questionnaire that was circulated online using the different social media platforms. Data related to participants’ demographic characteristics, knowledge, awareness, and attitude about epilepsy were measured. Eight items were included in the knowledge score that ranged between “0 and 16”, five items were included in the awareness score and ranged between 0 and 10. Likewise, the attitude score was calculated from 14 items and the score ranged between “0 and 28”. Data was analyzed using descriptive statistics, and logistic regression was employed to identify factors associated with knowledge and awareness of epilepsy. Results A total of 301 participants filled the questionnaire with a mean age of 28.68 and majority (66%) were females. The analyzed scores revealed that most of the participants (87.4%) had a good knowledge regarding epilepsy as a disease with mean of 10.2 (± 2.14), 70.1% had good awareness about epilepsy with mean of 6.3 (± 1.4), and 88% had good attitude toward patients with epilepsy with mean of 21.5 (± 6.2). Attending lecture about epilepsy was significantly associated with higher knowledge (OR 5.756, CI 95% 4.652–11.676, p < 0.001), better awareness (OR 4.936, CI 95% 3.062–10.566, p < 0.001) and attitude (OR 5.187, CI 95% 1.687–9.761, p < 0.014) toward the disease. Conclusion The findings of this study reflected an adequate knowledge and awareness, as well a positive attitude toward patients with epilepsy in Lebanon. However, there is a need for raising societal awareness and understanding of epilepsy to minimize the public misconceptions and reduce the stigma and discriminatory attitudes toward epileptic patients.

Introduction The Pregnancy and Newborn Diagnostic Assessment (PANDA) system is a mobile application designed to facilitate diagnosis and decision-making by healthcare staff in antenatal care (ANC). This study aimed to evaluate its effectiveness in improving the quality of ANC. Methods This randomised controlled trial implemented the PANDA system in two groups of health facilities (intervention and comparison groups) using a matched-pair method in the Koupéla health district, Burkina Faso. Six health centres were included in each group. We included pregnant women presenting with more than 20 weeks of amenorrhea during their first antenatal consultation, and we followed them up until their sixth week postpartum. The primary outcome was a binary variable derived from the ANC quality score, coded yes or no. Six components of ANC quality were identified: welcoming the woman, history taking and dietary habits, physical examination, obstetric examination, preventive care, and counselling and advice. We used Poisson regression with robust variance to compare the unadjusted and adjusted primary outcomes results between the two study arms. Results We included 319 and 272 women in the intervention and comparison groups, respectively. In the intervention group, 15.67% (50 out of 319) of the women had at least 75% of the total ANC quality score, compared to 6.25% (17 out of 272) in the comparison group. Adjusted results showed that women in the intervention group were 2.71 times more likely to have an excellent total ANC quality score than women in the comparison group (RR = 2.71; 95% CI [1.60–4.60]; p < .001). Conclusion Although the proportion of women with good ANC quality was low, this study showed that the PANDA system significantly improves the ANC quality. These results are vital because Burkina Faso has decided to use these computerised clinical decision support systems for maternal and child health.