The research, led by Tia El Kazzi of the Lebanese University with co-authors Nazek Mansour and Mirna N. Chahine, set out to measure knowledge, attitudes, and practices related to sunscreen use, sun-protective behavior, and skin cancer among the country’s medical trainees. The team surveyed 1,063 participants between April 29 and June 15, 2023, drawing respondents from all eight medical faculties in Lebanon: the seven private schools, the American University of Beirut, Beirut Arab University, the Lebanese American University, Saint George University of Beirut, Holy Spirit University of Kaslik, the University of Balamand, and Saint Joseph University, along with the public Lebanese University. Because the sample spanned every medical school in the country, the authors argue it offers an unusually broad picture of how Lebanon’s next generation of doctors approaches photoprotection.

Participants were recruited through an English-language online questionnaire distributed via WhatsApp and Instagram using snowball sampling, a technique in which early respondents forward the survey to their peers. The instrument was designed around established behavioral frameworks. Sun-protective behavior was assessed using the stages-of-change construct from the Transtheoretical Model, which classifies individuals along a continuum from not considering a behavior to maintaining it consistently. Attitudes were captured with two validated instruments: the Decisional Balance Scale, which weighs the perceived pros and cons of adopting sun protection, and the Self-Efficacy Scale, which measures confidence in one’s ability to perform protective behaviors across different situations. Knowledge of sunscreen and skin cancer was tested with dedicated items, and the team used multivariate linear regression to identify independent predictors of the three main outcome scores.

The headline numbers reveal a paradox. On one hand, 75.2 percent of participants said they used sunscreen, a figure that might seem encouraging at first glance. On the other hand, 78.6 percent reported having experienced a prior sunburn, the single best-documented behavioral risk factor for later melanoma and other skin cancers. In other words, the majority of these future doctors had already sustained the kind of acute ultraviolet injury that dermatologists warn the public about, despite knowing precisely how such injury occurs and how to prevent it. The authors describe this as a clear disconnect between knowledge and preventive behavior, one that persists even in a group with privileged access to medical education.

The quantitative scores reinforce that impression. Participants demonstrated moderate knowledge, averaging 53.23 percent with a standard deviation of 14.31. Decisional balance scores averaged 14.15 out of a possible 20, and self-efficacy scores averaged 26.39 out of 45, both indicating middling rather than strong attitudinal readiness. Notably, the three measures were positively correlated with one another, with correlation coefficients ranging from 0.219 to 0.547 and all reaching statistical significance at p less than 0.001. This interdependence matters theoretically: it suggests that knowing more about skin cancer, feeling more confident about sun protection, and perceiving greater benefits from it tend to travel together, forming a psychological cluster that could be targeted as a whole rather than piecemeal.

The regression models, which adjusted for multiple variables simultaneously, identified who scored highest on each dimension. Higher knowledge was independently associated with being further along in medical training, having experienced a prior sunburn, higher self-efficacy, higher household income, attendance at a private university, and being at an advanced stage of sunscreen adoption; this model explained 21.4 percent of the variance in knowledge scores. Higher decisional balance scores were linked to higher self-efficacy, sunscreen use, female gender, higher knowledge, and advanced behavioral stage, with the model accounting for 40.5 percent of the variance. Higher self-efficacy, in turn, was predicted by higher decisional balance, sunscreen use, and advanced behavioral stage, explaining 36.6 percent of the variance. The pattern is consistent: behavioral readiness, attitudinal confidence, and factual knowledge reinforce one another in a loop, and academic progression only partially breaks through.

Several of these predictors deserve closer attention. The association between higher academic year and greater knowledge is reassuring in one sense, since it suggests that medical education does incrementally deliver content about skin cancer and photoprotection. But the fact that knowledge remained only moderate even among senior trainees hints that this content is thin, fragmented, or delivered too late. The link between prior sunburn and higher knowledge is equally double-edged: it may reflect heightened awareness after a personal scare, but it also means that the educational system is being outpaced by ultraviolet exposure itself. Socioeconomic gradients, visible in the independent effects of household income and private university affiliation, point to structural inequities in access to both information and protective products, a reminder that sun safety is not only a matter of individual willpower.

The role of self-efficacy emerges as perhaps the most actionable finding. In behavioral science, self-efficacy, the belief that one can successfully carry out a behavior in real-world conditions, is often the strongest lever for change, because knowledge alone rarely translates into action. Here, self-efficacy was independently tied to both knowledge and decisional balance, and it clustered tightly with advanced stages of sunscreen adoption. Participants who believed they could apply sunscreen before class, reapply it during hospital shifts, or seek shade during long outdoor commitments were far more likely to actually do so. This suggests that interventions should go beyond lecturing about ultraviolet radiation and instead build practical confidence: rehearsing routines, addressing barriers specific to hospital life, and normalizing sun protection as part of professional identity.

The authors argue that the findings carry implications well beyond Lebanon. Medical students and residents occupy a dual role in skin cancer prevention: they are future counselors who will advise patients on sunscreen, protective clothing, and skin checks, and they are role models whose own behavior shapes what patients perceive as normal. A physician who preaches daily sunscreen but arrives at clinic sunburned undermines the message before saying a word. The study’s conclusion is that preventive competencies are strongly associated with academic progression, behavioral readiness, and self-efficacy, and that integrating structured, stage-specific sun protection education early in medical training could improve trainees’ own behaviors while strengthening their capacity to guide patients. Stage-specific means matching the intervention to where the learner sits on the Transtheoretical Model continuum, nudging precontemplators toward awareness and helping maintainers sustain their habits.

For a country with abundant sunshine and a Mediterranean climate, the stakes are concrete. Lebanon’s medical trainees will spend decades working under high ultraviolet conditions and treating a population similarly exposed. The study, which received no external funding and was approved by the Institutional Review Board of Al-Zahraa Hospital University Medical Center, offers a baseline that other countries in the region could replicate. Its core message is deceptively simple: knowing about skin cancer is not the same as preventing it, even for people trained to do exactly that. Closing that gap, the authors contend, requires embedding sun protection into the earliest years of medical curricula, treating it not as an optional dermatology footnote but as a core preventive skill that future physicians must first practice on themselves.

Subject of Research: Knowledge, attitudes, and practices regarding sunscreen use, sun protection, and skin cancer prevention among medical students and residents in Lebanon

Article Title: Knowledge, attitude, and practice towards sunscreen use, sun protective behavior, and skin cancer among Lebanese medical students and residents

Article References: El Kazzi, T., Mansour, N., & Chahine, M. N. (2026). Knowledge, attitude, and practice towards sunscreen use, sun protective behavior, and skin cancer among Lebanese medical students and residents. BMC Cancer. https://doi.org/10.1186/s12885-026-17074-z

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17074-z

Keywords: skin cancer, sunscreen, sun protection, medical students, residents, self-efficacy, Transtheoretical Model, melanoma, Lebanon, health behavior, cancer prevention, dermatology

The research team, led by Ayoub Alayoub and Samir Mustapha of the Department of Mechanical Engineering, together with Reinde Alhouri Alhomsi and Darine A. Salam, set out to test whether hyperspectral imaging could serve as a fast screening tool for soil contamination across Lebanon’s diverse agricultural landscapes. Hyperspectral imaging works by capturing reflected light from a sample across hundreds of narrow, contiguous wavelength bands, spanning the visible, near-infrared, and shortwave infrared regions of the electromagnetic spectrum. Where the human eye registers only a single color of soil, the hyperspectral sensor records a full spectral fingerprint, a curve of reflectance values that encodes information about the minerals, organic matter, moisture, and particle surfaces that light has interacted with on its way back to the detector.

The logic behind using such spectra to detect heavy metals is subtle, because nickel and cadmium themselves are not strong absorbers of light in these wavelength ranges. Instead, the metals influence the soil’s spectral signature indirectly, through their associations with clay minerals, iron oxides, organic matter, and other matrix components that do absorb light in characteristic ways. This indirect relationship is precisely why machine learning is required: algorithms such as partial least squares regression, support vector regression, neural networks, and convolutional neural networks can detect statistical correlations between subtle spectral features and metal concentrations that no simple linear rule could capture. The technique has precedent, with earlier studies using reflectance spectroscopy to estimate contamination after mining accidents and to map heavy metals from airborne platforms, but the Lebanese study adds a rigorous comparison of model families across contrasting soil textures.

The researchers worked with three agricultural soils from Lebanon, classified as clayey, silty, and sandy, deliberately chosen to represent the range of physical matrices that a field-deployed sensing system would encounter. Before any modeling, the team contaminated the soils with known levels of nickel and cadmium and recorded their hyperspectral images. Even at this early stage, the three soil groups told different optical stories. They exhibited distinct absorption features, different overall reflectance intensities, and different spectral shapes, a reminder that soil is not a generic brown medium but a complex optical material whose signature depends on texture, mineralogy, and surface chemistry.

Four modeling approaches were then trained to translate spectra into contamination predictions. Partial least squares regression served as the classical chemometric baseline, projecting the high-dimensional spectral data onto a small number of latent variables that maximize covariance with the metal concentrations. Support vector regression, a kernel-based method that fits a function within a tolerance margin while ignoring small errors, represented the machine learning tier. On the deep learning side, the team built artificial neural networks and convolutional neural networks, the latter designed to automatically extract local spectral patterns from the raw reflectance curves much as CNNs extract edges and textures from photographs. Across the board, support vector regression and convolutional neural networks emerged as the strongest performers.

The numbers reveal both the promise and the texture-dependence of the approach. For nickel contamination, support vector regression achieved coefficients of determination of 0.850 in clayey soil, 0.830 in silty soil, and 0.790 in sandy soil. For cadmium, the same model performed even better, reaching 0.930, 0.931, and 0.945 in the clayey, silty, and sandy soils respectively. The convolutional neural network matched or exceeded these figures in several cases, with values of 0.899 for nickel and 0.944 for cadmium in silty soil, and 0.872 and 0.938 in sandy soil. Notably, the clayey soil yielded its best nickel and cadmium predictions from the neural network model, which reached 0.930 and 0.950 respectively. Cadmium was consistently predicted more reliably than nickel across all soil groups and models, a pattern the authors highlight as one of the study’s key findings.

Crucially, the team did not stop at internal cross-validation. They validated the support vector regression and convolutional neural network models against newly contaminated soil samples that the models had never seen, and the models held up, maintaining coefficients of determination above 0.790 across all tested soils. This external validation step matters enormously in spectroscopic modeling, where overfit models can look spectacular on training data and fail embarrassingly in the field. The result suggests that, within a given soil type, the spectral-to-metal relationship is stable enough to support practical screening applications.

But the study also delivers a sobering caveat. When the trained models were transferred across soil types, asked to predict contamination in a soil texture different from the one they were calibrated on, performance collapsed. The support vector regression models dropped to coefficients of determination ranging from 0.107 to 0.242, and the convolutional neural network models fared little better, ranging from 0.110 to 0.260. In other words, a model calibrated on clayey soil was essentially useless on sandy soil, and vice versa. The authors attribute this to the distinct physicochemical properties of each soil matrix, which reshape the spectral signature in ways the models cannot generalize across, and they conclude that soil-specific or matrix-informed calibration models are needed. They also acknowledge a limitation: because only three soils were investigated and detailed mineralogical characterization was not performed, the specific contribution of individual soil characteristics to the transferability failure could not be isolated.

For Lebanon, a country whose agricultural soils face pressure from industrial activity, unregulated waste practices, and decades of environmental stress, the implications are tangible. Conventional heavy metal analysis relies on techniques such as atomic absorption spectroscopy and inductively coupled plasma mass spectrometry, which require sample collection, acid digestion, and laboratory time. A hyperspectral workflow, by contrast, could in principle screen many samples rapidly once calibrated for the local soil type, allowing regulators to prioritize the handful of samples that truly need confirmatory wet chemistry. The study was supported by the US-Middle East Partnership Initiative Tomorrow’s Leadership Graduate program at the American University of Beirut, and all of the analyzed data are included in the published article and its supplementary files, with additional data available on reasonable request.

The broader lesson extends well beyond Lebanon’s borders. Around the world, soil monitoring programs struggle with the cost of chemical analysis, and the dream of cheap, fast, spectroscopy-based contamination screening has been building for two decades. This study moves that dream forward by showing that deep learning can extract cadmium and nickel signals from hyperspectral images with accuracy rivaling traditional methods, while simultaneously delivering a warning that the field must take seriously: soil is heterogeneous, and a model trained on one matrix cannot be blindly deployed on another. The path forward, the authors suggest, lies in building calibration frameworks that explicitly account for soil matrix information, whether by calibrating per soil class or by incorporating physicochemical descriptors into the models themselves. Until then, the combination of hyperspectral imaging and artificial intelligence stands as a powerful but soil-aware tool, one that could transform how the world’s farmland is screened for the heavy metals that threaten both crops and the people who eat them.

Subject of Research: Prediction of nickel and cadmium contamination in Lebanese agricultural soils using hyperspectral imaging and machine learning models

Article Title: Prediction of Ni and Cd contamination in agricultural soils in Lebanon using hyperspectral imaging and artificial intelligence

Article References: Prediction of Ni and Cd contamination in agricultural soils in Lebanon using hyperspectral imaging and artificial intelligence. (n.d.). https://doi.org/10.1007/s11356-026-38271-0

Image Credits: AI Generated

DOI: 10.1007/s11356-026-38271-0

Keywords: hyperspectral imaging, heavy metal contamination, nickel, cadmium, agricultural soils, machine learning, support vector regression, convolutional neural networks, soil spectroscopy, Lebanon, soil calibration, environmental monitoring

The trial enrolled 114 women drawn from approximately 20 villages across the Chouf region, an area whose residents have contended with continuing economic instability, political unrest and environmental challenges in recent years. Researchers from Maharishi International University in Fairfield, Iowa, randomly assigned participants either to learn the Transcendental Meditation technique or to an active control group that received weekly videos on self-development and well-being. The use of an active control condition matters methodologically: rather than comparing meditators against people receiving nothing, the design allowed the team to compare the effects of learning the meditation technique against participation in another structured activity explicitly aimed at self-improvement, strengthening the case that the observed changes were attributable to the practice itself rather than to attention, expectation or the passage of time.

Participants in the meditation group were instructed to practice for 20 minutes twice a day, sitting comfortably with their eyes closed. Adherence proved remarkably high for a community-based trial. Sixty percent of the women reported practicing twice daily every day or most days, 18 percent practiced once a day, and 20 percent practiced irregularly. No harmful events related to participation were reported during the study period. The researchers say this combination of high adherence and an absence of adverse events is notable, particularly given that the participants were navigating daily lives shaped by chronic stressors rather than volunteering from a leisure-rich, low-stress population.

After three months, the meditation group outperformed the control group on all four outcome measures. Happiness showed the largest change of the four. Women practicing the technique reported increases in happiness at both the one-month and three-month assessments. The control group followed a different trajectory: a small improvement at one month, followed by a marked decrease at three months. The researchers suggest this divergence is meaningful because it indicates that the benefits of the meditation practice did not merely fade or plateau but appeared to consolidate over the study period, while the initial boost seen in the control condition reversed by the end of follow-up.

The statistical analysis also probed which factors were most closely tied to happiness. The team found that self-efficacy and perceived stress were both significantly related to happiness levels, and in their model self-efficacy emerged as the strongest predictor, followed by perceived stress. Together, the two variables accounted for 42 percent of the variance in happiness, a substantial share for psychological research of this kind. Self-efficacy, defined as a person’s perception of their ability to achieve desired results through their own actions, increased over the three months in the meditation group while decreasing in the control group. The researchers argue that this pairing of rising self-efficacy and falling perceived stress is particularly important because both variables were independently linked to happiness in their analysis, pointing to a plausible mechanism through which the practice may exert its effects.

Marie Loiselle, PhD, principal investigator and a researcher in the Department of Maharishi Vedic Science at Maharishi International University, emphasized the strength of the trial’s methods and the breadth of its results. She described the study as significant given its randomized controlled design and the statistically significant changes observed on every measure, noting that it is very encouraging because the women improved across several dimensions of psychological well-being at the same time. In her view, the results suggest that Transcendental Meditation may offer these women an additional way to cope with the significant pressures they face in daily life. Frederick Travis, PhD, who served as statistician and senior advisor on the study, highlighted the same two variables from a different angle. He said the improvements in self-efficacy and the reductions in perceived stress are particularly important because both were related to happiness in the analysis, adding that the findings provide a basis for further research into approaches that may help people cope with persistent environmental stress.

The choice of population was deliberate. The researchers note that women in Lebanon can face multiple, overlapping sources of stress, including economic instability, political unrest, environmental problems and gender inequality. Previous research has also identified cultural and social barriers that may discourage some people from seeking professional help for stress and related psychological difficulties, meaning that low-barrier, self-administered practices could fill a gap where conventional mental health services are difficult to access or socially stigmatized. The trial itself grew out of a community program: the researchers worked in collaboration with the Ladies Foundation for Pure Knowledge, which was nearing the end of a project to teach Transcendental Meditation to approximately 1,000 women in the Chouf region. The foundation approached the research team to investigate whether the practice was producing measurable benefits among the women learning it, turning an ongoing outreach effort into an opportunity for rigorous evaluation.

Susan Hamza, the foundation’s director, reflected on the scale of the response among participants in the broader teaching project. She said that so many of the participants told her their life had been transformed in many ways that words could not even begin to describe, and that those involved in realizing the project have her deep gratitude. Such testimonies are, by themselves, anecdotal, but the trial’s quantitative results give that community enthusiasm an empirical footing: the measured changes in happiness, resilience, self-efficacy and perceived stress among the 114 trial participants aligned with the direction of the reports coming out of the larger teaching program.

The study was approved by the Maharishi International University Research Institute Review Board and registered with the U.S. Clinical Trials Registry under identifier NCT05836129. Funding was provided by the Ladies Foundation of Pure Knowledge in Lebanon and by individual donors, and the authors reported no potential conflicts of interest. The research method was classified as a randomized controlled trial, and the subject population consisted of people rather than clinical samples recruited through hospitals, which the authors present as a strength when studying well-being in community settings.

The investigators are careful to frame the findings as a beginning rather than a conclusion. Of the 114 women who enrolled, 83 completed both posttests, and participants were followed for only three months, leaving open questions about durability and about whether the effects would hold in larger and more diverse samples. The team recommends future studies with six- or 12-month follow-up periods and larger populations in Lebanon and potentially elsewhere in the Middle East, where chronic, population-level stressors are common and scalable, low-cost interventions for psychological resilience are in short supply. If the results are confirmed, the researchers suggest, a technique that requires no equipment, no clinical setting and only 40 minutes a day could become a practical complement to existing efforts to support mental well-being in communities under sustained pressure. Transcendental Meditation itself is described by its practitioners as a simple, natural technique that does not involve concentration, control of the mind, contemplation or monitoring of thoughts or breathing, and that allows the active thinking mind to settle into a state of inner calm, characteristics that may help explain both the high adherence observed in the trial and the feasibility of extending the approach to other stressed populations.

Subject of Research: Effects of Transcendental Meditation on psychological well-being in rural Lebanese women

Article Title: Randomized trial finds Transcendental Meditation improves happiness, resilience and self-efficacy in rural Lebanese women

Article References: Randomized trial finds Transcendental Meditation improves happiness, resilience and self-efficacy in rural Lebanese women. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: Transcendental Meditation, randomized controlled trial, Lebanon, rural women, happiness, resilience, self-efficacy, perceived stress, mental health, Women's Health journal, Maharishi International University, psychological well-being

The study focuses specifically on the Maronite Church, one of the Eastern Catholic churches in full communion with Rome, and situates it within the West Syriac, or Antiochene, theological and liturgical tradition. This distinction matters technically. The broader Syriac Christian family includes several separate churches, notably the Syriac Catholic Church and the Syriac Orthodox Church, each with its own hierarchical structures and institutional life. Antaby acknowledges this shared Syriac heritage but deliberately narrows the analysis to the Maronite Church, examining its theological framework, its liturgical practice, its spiritual patrimony, and its pastoral methods. The term Maronite–Syriac, as the author clarifies, is not an umbrella label for all Syriac-tradition churches but a description of the Maronite Church understood within its own Syriac inheritance.

That inheritance is substantial and historically deep. Syriac Christianity produced a distinctive spiritual and intellectual culture centered on poetic theology, exemplified by figures such as Saint Ephrem the Syrian, whose hymns treated doctrine not as dry formulation but as luminous imagery—a tradition of symbolic, contemplative theology that scholars such as Sebastian Brock have described as a unique spiritual world vision. Syriac Christians also developed a long experience of living as a minority, first within the Persian and Byzantine empires and later under Islamic rule, a history examined in detail by historians such as Sidney Griffith. This accumulated experience of cultural negotiation, Antaby’s analysis suggests, forms a kind of institutional memory that equips Syriac-tradition churches to endure displacement better than a purely defensive posture would allow.

The contemporary migration that concerns the study has four main drivers: forced displacement, political instability, economic hardship, and religious persecution. The result is a durable Maronite and Syriac Christian presence across the Americas, Europe, Africa, and Australia. Antaby’s article treats these communities not as scattered remnants but as enduring, self-organizing ecclesial bodies. This aligns with a substantial body of sociological research on immigration and religion. Scholars such as Peggy Levitt, whose work is cited in the article, have shown that migrants frequently reconstitute religious life abroad with remarkable intensity, and that immigrant congregations often serve as the primary infrastructure for identity maintenance. Wendy Cadge and Elaine Ecklund’s review of the immigration and religion literature similarly documents that religious institutions are among the most important arenas in which migrants negotiate continuity and adaptation.

What makes the Maronite case analytically distinctive is the combination of factors it must simultaneously manage. A diaspora church in the Eastern Catholic tradition must preserve an ancient liturgical language and ritual form—West Syriac worship with its own calendar, chant, and sacramental theology—while functioning in host societies whose dominant religious cultures are either Latin-rite Catholicism, Protestantism, or secularism. It must maintain loyalty to a patriarchal center in Lebanon while building parishes in places as far apart as Sydney, São Paulo, Detroit, and Montreal. And it must transmit identity to second- and third-generation members who may speak little or no Arabic or Syriac and whose everyday cultural references are shaped entirely by their host countries. The article’s central claim is that these pressures, rather than merely eroding tradition, can become the occasion for a deliberate, creative re-articulation of what the tradition means.

Anthropological and sociological studies of the Maronite diaspora support this picture at the ground level. Nulia Hyndman-Rizk’s ethnography of emigration from the northern Lebanese village of Hadchit to Australia and America, cited in the study, shows how domestic and communal practices—food, hospitality, kinship networks, and devotional life—sustain a sense of belonging across oceans. Collections such as Ebaugh and Chafetz’s work on immigrant congregations and Warner and Wittner’s Gatherings in Diaspora document the wider pattern: religious communities among new immigrants do not simply replicate the old country, they adapt, hybridize, and sometimes thrive in ways the original communities could not. Antaby’s contribution is to read this sociological evidence through a theological and pastoral lens, asking not only what diaspora communities do, but what they mean within the church’s own self-understanding.

The key conceptual move in the article is its reframing of diaspora itself. In much of the literature, and in common perception, diaspora is treated as rupture: a loss of homeland, a thinning of tradition, a drift toward assimilation. Antaby argues instead that diaspora should be understood as a locus—a place—of creative fidelity and renewal. This is not mere optimism. The argument rests on the observation that displacement forces a church to articulate its identity explicitly, to a degree that a secure, geographically rooted community never needs to do. When the liturgy must be explained to newcomers, when hymns must be translated, when catechesis must answer why this rite differs from the Catholic parish down the street, the tradition is tested, clarified, and sometimes strengthened. Scattering, on this reading, becomes a form of mission rather than mere dispersal.

The study’s methodology reflects this interdisciplinary ambition. According to the author’s contribution statement, the research rests on a literature review across historical, theological, and qualitative sources, together with an illustrative case study drawn from publicly observable ecclesial practices and institutional experience. No new datasets were generated and no human subjects were studied, a point the journal’s ethics declarations confirm; the evidentiary base is published scholarship and documented institutional practice. This makes the article a work of synthesis and interpretation rather than empirical survey, but synthesis of exactly the kind that migration and religion scholarship often needs: a bridge between the sociological description of immigrant congregations and the theological vocabulary in which those congregations actually understand themselves.

The stakes of such work extend well beyond the Maronite community. Middle Eastern Christians as a whole are experiencing one of the fastest relative declines of any religious population in their historic homeland, a trend documented in surveys such as Andrea Pacini’s study of Christian communities in the Arab Middle East and in the Oxford Handbook of Refugee and Forced Migration Studies. Whether these traditions survive may depend less on what happens in the Middle East alone than on what happens in the diaspora. Scholars associated with the so-called Syriac renaissance—a renewed scholarly and cultural engagement with Syriac language, literature, and history, documented in a major multi-author volume cited in the article—have argued that diaspora communities, with their access to universities, printing, and digital media, can become engines of revival rather than agents of dilution. Antaby’s study gives that argument a concrete ecclesial expression.

The article’s vision of hope and resilience, then, is not a slogan but a structural claim about how religious identity survives under stress. Communities that anchor themselves in a deep liturgical tradition, that invest in pastoral structures capable of crossing cultural boundaries, and that read their displacement as participation in a long history of faithful endurance, are better positioned to persist than communities that experience exile only as victimhood. For pastoral psychologists, the practical implication is that support for diaspora churches—language preservation, liturgical formation, youth engagement, and connections to the homeland church—is not nostalgia but resilience infrastructure. For the general reader, the Maronite–Syriac case offers a striking counter-narrative to the assumption that migration inevitably dissolves ancient identities. In the parishes of the diaspora, one of Christianity’s oldest traditions is not quietly fading. It is being rewritten, sung, and handed on—often in new languages, in new continents, by communities that have decided that distance from the homeland does not mean distance from the faith.

Subject of Research: Preservation of faith and identity in the Maronite–Syriac Christian diaspora

Article Title: The Maronite Church in the Syriac Tradition: Preservation of Faith and Identity in the Diaspora as a Vision of Hope and Resilience

Article References: The Maronite Church in the Syriac Tradition: Preservation of Faith and Identity in the Diaspora as a Vision of Hope and Resilience. (n.d.). https://doi.org/10.1007/s11089-026-01372-1

Image Credits: AI Generated

DOI: 10.1007/s11089-026-01372-1

Keywords: Maronite Church, Syriac Christianity, diaspora, Middle Eastern Christianity, religious identity, resilience, migration, ecclesiology, liturgy, pastoral theology, Lebanon, immigrant congregations

The research team, led by investigators affiliated with Beirut Arab University, recruited 299 adults with confirmed heart failure from outpatient clinics and primary healthcare services across all major regions of Lebanon between January 2024 and October 2025. Participants were Arabic-speaking adults aged 30 to 80 years with either reduced ejection fraction of 40 percent or less, or symptomatic preserved ejection fraction confirmed by echocardiography, diagnosed for at least three months according to the Framingham criteria. Of 475 people initially screened, some were excluded because their understanding of the term heart failure was distorted, a striking detail in itself: many patients who had undergone open-heart surgery misinterpreted the diagnosis, underlining how much work remains in patient education. After removing cases with missing data, 299 participants formed the analytical sample.

The burden carried by this group was considerable. More than 90 percent had hypertension, roughly 60 percent had diabetes, and the average Charlson Comorbidity Index was 5.58, indicating substantial multimorbidity. Depression had been formally diagnosed in 35.5 percent of participants. The mean left ventricular ejection fraction was 37.52 percent, nearly half the sample was in New York Heart Association functional class III, and participants had lived with heart failure for an average of 5.3 years. Most were unemployed, nearly half reported a monthly household income between 200 and 500 US dollars, and almost all relied on a family caregiver, most often a spouse or an adult child. These socioeconomic realities matter, because in Lebanon out-of-pocket medication costs and repeated hospital admissions place enormous financial pressure on households already battered by currency collapse and inflation.

To measure the study’s central construct, the researchers used the Connor-Davidson Resilience Scale, a 25-item instrument covering domains such as personal competence, trust in one’s instincts, positive acceptance of change, control, and spiritual influences, scored from 0 to 100. In this Lebanese sample the scale showed exceptional internal consistency, with a Cronbach’s alpha of 0.965. Quality of life was assessed with the Arabic-validated Minnesota Living with Heart Failure Questionnaire, depressive symptoms with the Patient Health Questionnaire-9, and self-care with the Revised Self-Care Heart Failure Index version 7.2, which captures self-care maintenance, symptom monitoring, and self-care management as distinct subscales. All instruments had been previously translated and psychometrically evaluated for the Lebanese population, and reliability coefficients in the current study ranged from 0.86 to 0.965.

The headline result was a picture of a population split almost exactly in two. The mean resilience score was 58.41, just above the developer’s suggested cut-off of 55, and 51.2 percent of participants were classified as resilient while 48.8 percent were not. Depressive symptoms averaged 13.76 on the PHQ-9, corresponding to moderate depression, with more than half of the sample falling into the moderate to severe categories. Self-care maintenance and monitoring scores were low at 62.68 and 64.71, below the conventional adequacy threshold of 70, but self-care management scored 78.24, the only subscale to surpass the cut-off. Quality of life, at 56.07 on the Minnesota questionnaire, reflected moderate impairment. Statistically, resilience correlated negatively with depression and positively with all three self-care subscales, with the strongest correlation, r = 0.540, linking resilience to self-care maintenance.

The multivariable regression model identified four independent predictors of resilience, explaining 36.1 percent of the variance in resilience scores. Higher self-care maintenance and higher self-care management each independently predicted greater resilience, with unstandardized coefficients of 0.248 and 0.282 respectively. Male participants scored higher than female participants after adjustment, a gender difference of just over four points on the CD-RISC. Perhaps most intriguingly, participants taking loop diuretics showed resilience scores more than eight points higher than those not taking this class of medication, a finding that likely reflects the association between being on guideline-directed therapy and being engaged with care rather than a pharmacological effect on psychological coping. Bivariate analyses added further texture: resilient patients were more likely to have received influenza and COVID-19 vaccinations, to be current with medical follow-up, to have higher education, and to be cared for by a spouse rather than a child.

One of the most provocative findings is the negative, though statistically non-significant, correlation between resilience and quality of life, which runs counter to virtually all of the published literature, including studies from Egypt, Iraq, and general populations worldwide. The authors argue that no prior research has examined a population exposed to the compounded burden of simultaneous health, political, social, and economic crises as Lebanon has experienced since 2019, encompassing currency devaluation, hyperinflation, the Beirut Port explosion, and continuing regional instability. In such a context, the usual relationship between adaptation and wellbeing may be distorted: patients who have been forced into self-reliance by a failing system may report functional resilience even as their perceived quality of life erodes. The team also notes that quality-of-life scores among Lebanese heart failure patients nearly doubled between 2018 and 2022 before stabilising, a trajectory that mirrors the country’s crisis timeline.

The self-care management result tells a parallel story. In earlier Lebanese studies, self-care management was consistently the weakest subscale, with mean scores around 47. In the present sample it exceeded 78, suggesting a growing culture of self-reliance in disease management driven by necessity, as patients navigate medication shortages, costly follow-up visits, and disrupted continuity of care. This shift occurred despite previously documented deficiencies in discharge education. For nursing science, the implication is that resilience is not a fixed trait but a modifiable domain that can be assessed, monitored, and supported through education, counselling, family-inclusive care planning, and community-based follow-up, particularly in resource-constrained settings where nurses and advanced practice nurses are often the most accessible point of contact.

The authors are careful to acknowledge the limitations of a cross-sectional design, which cannot establish causal direction between resilience and self-care, along with the possibility of social desirability bias in self-reported questionnaires and the constraints of convenience sampling. Even so, the study stands as the first to document resilience and its predictors among heart failure patients living through sustained national collapse, and its patterns may generalise to Lebanese diaspora communities and to other populations enduring protracted instability. The practical message for clinicians is concrete: screening for low resilience, reinforcing self-care maintenance behaviours, supporting female patients who carry lower resilience scores, ensuring guideline-directed medication including diuretic therapy, leveraging spousal caregivers, and promoting vaccination and regular follow-up may together form the scaffolding that keeps chronically ill patients upright when the systems meant to support them cannot.

Subject of Research: Predictors of psychological resilience among patients living with heart failure during prolonged sociopolitical and economic crises in Lebanon

Article Title: Predictors of Resilience Among Patients Living With Heart Failure Amid Escalating Sociopolitical Challenges: A Cross‐Sectional Approach

Article References: Deek, H., Massouh, A. R., & Shatila, W. (2026). Predictors of Resilience Among Patients Living With Heart Failure Amid Escalating Sociopolitical Challenges: A Cross‐Sectional Approach. Nursing Open, 13(9), Article e70816. https://doi.org/10.1002/nop2.70816

Image Credits: AI Generated

DOI: 10.1002/nop2.70816

Keywords: heart failure, resilience, self-care, Lebanon, depression, quality of life, nursing, cross-sectional study, Connor-Davidson Resilience Scale, chronic illness, sociopolitical crisis, cardiology