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Mental morbidities have been widely investigated at Primary Health Care (PHC) worldwide, but no data available in Palestine have discussed these diseases' burden. This study aimed to assess the prevalence of psychological morbidity among primary health care attendees and related factors. A cross-sectional design was adopted in this research. We collected data from primary healthcare center attendees from Sept 2019 to Jan 2020, using an interviewer-administered questionnaire called the Four-Dimensional Symptom Questionnaire. It is a valid tool that can be used in a primary healthcare setting. The Chi-square test explored psychological morbidity risk factors, and the multivariable logistic regression model was used to adjust for confounders. The study included four hundred clients >18 years of age; 287 (71.8%) were females, and 209 (52.3%) were > 50 years of age. The prevalence for high psychological morbidity of any type was 63.9% (95% CI: 58.8%-68.7%), while 24.9% (99 clients) reported very high psychological morbidity. Very high psychological morbidity was significantly higher among unmarried [adjusted OR = 2.7 (95%CI = 1.4-5.4)], lower educational level (less than 12 years schooling) [adjusted OR = 4.0, 95%CI (1.8-4.8)], and clients with high distress [adjusted OR = 15.6, 95%CI (7.9-30.9)]. In conclusion, the high prevalence of psychological morbidity identified in this study highlights the importance of early detection and management, especially among unmarried, less educated, and distressed primary health care attendants. Early interventions are of high value to reduce patient suffering, decrease the financial strain on the health system, and improve the quality of care., Author(s): Marah Abu Zant [sup.1] , Zaher Nazzal [sup.2] , Layali Qaddoumi [sup.1] , Rana Abdallah [sup.1] , Beesan Maraqa [sup.1] , Khalid Najjar [sup.1] Author Affiliations: (1) grid.11942.3f, 0000 [...]

Background: End-stage renal disease (ESRD) patients often experience accelerated bone turnover, leading to osteoporosis and osteopenia. This study aimed to determine the prevalence of osteoporosis in Peritoneal Dialysis (PD) patients using bone mineral density (BMD) measurements obtained through dual-energy X-ray absorptiometry (DEXA) scan and to explore any possible associations with clinical and biochemical factors. Methods: In this cross-sectional study, we enrolled 76 peritoneal dialysis patients from the dialysis center at An-Najah National University Hospital in Nablus, Palestine. We used the DEXA scan to measure BMD at the lumbar spine and hip, with values expressed as T-scores. We conducted a multivariate analysis to explore the relationship between BMD and clinical and biochemical parameters. Results: Over half (52.6%) of the PD patients had osteoporosis, with a higher prevalence observed among patients with lower BMI (p<0.001). Higher alkaline phosphatase levels were found among osteoporotic patients compared to non-osteoporotic patients (p = 0.045). Vitamin D deficiency was also prevalent in this population, affecting 86.6% of patients. No significant correlation was found between 25 vitamin D levels and BMD. No significant correlation was found between Parathyroid hormone (PTH) levels and BMD. Conclusion: A notable proportion of PD patients experience reduced BMD. Our study found no correlation between vitamin D levels and BMD, but it highlighted the significant vitamin D deficiency in this population. Furthermore, our analysis indicated a positive correlation between BMI and BMD, especially in the femoral neck area. This underscores the significance of addressing bone health in PD patients to mitigate the risk of fractures and improve their overall well-being. [ABSTRACT FROM AUTHOR]

Background and objectives: Depression and anxiety are common mental health disorders among the elderly worldwide. In this study, we estimated the prevalence of depression and anxiety and related risk factor among elderly attending Primary Health care (PHC) centers in Palestine. Methods: A cross-sectional study was conducted from February to July 2021 with a sample size of 380 participants aged =60 attending PHC centers in West Bank, using an interviewer-administered questionnaire. We used the Geriatric ***Depression Scale-15 and the Geriatric anxiety Scale to screen for depression and anxiety, respectively. Logistic regression models were used to identify predictors of depression and anxiety. Results: The prevalence of depression and anxiety was 41.1 and 39.2%, respectively. Elderly people living in rural areas (aOR = 2.63; 95% CI: 1.72-4.20), uneducated (aOR = 2.92; 95% CI: 1.41-6.13), and without monthly income (aOR = 3.42; 95% CI: 1.52-7.61) were more likely to have depression. On the other hand, anxiety was independently associated with living in rural areas (aOR = 1.93, 95% CI: 1.23-3.04) and having non-communicable diseases (aOR = 2.01; 95% CI: 1.13-3.49). Conclusion: Depression and anxiety are common in Palestine, a developing country with a lack of elderly related services. This should be emphasized at the national and regional levels where geriatric health care services are scarce. Such information is required by policymakers and external funding agencies in order to develop future agendas. [ABSTRACT FROM AUTHOR]

Background: High-sensitive cardiac troponin T (h-cTnT), which serves as a marker for myocardial damage, has also been linked to adverse outcomes in asymptomatic hemodialysis patients. This study aims to explore the correlation between interleukin-6 (IL-6) and h-cTnT in asymptomatic hemodialysis patients to unravel the relationship between inflammation and cardiovascular risk. Methods: A cross-sectional study involving 81 patients was conducted from November 2022 to March 2023 at An-Najah National University Hospital in Palestine. We gathered clinical data, including comorbidities, and obtained blood samples for measuring IL-6 and h-cTnT levels. We performed statistical analyses, including correlation tests and linear regression, to assess the associations between these variables. Results: The study revealed a notable increase in both h-cTnT and IL-6 levels, and a significant correlation between the two (rho = 0.463, P<0.001) in asymptomatic hemodialysis patients. Likewise, h-cTnT levels displayed positive correlations with age (rho = 0.519, P<0.001) and negative correlations with albumin (rho = -0.297, p = 0.007) and transferrin saturation (rho = -0.227, P = 0.042). IL-6 levels exhibited correlations with age (rho = 0.422, P<0.001), albumin (rho = -0.389, P<0.001), iron (rho = -0.382, P<0.001), and transferrin saturation (rho = -0.362, P = 0.001). Notably, higher h-cTnT levels were associated with diabetes, hypertension, a history of coronary artery disease, cerebrovascular accidents, older age, and male gender. Conclusion: This study underscores the significant association between the inflammatory marker IL-6 and h-cTnT in asymptomatic hemodialysis patients, suggesting that inflammation may play an essential role in the elevation of h-cTnT levels. This association may have implications for predicting cardiovascular events and guiding interventions to reduce cardiovascular disease morbidity and mortality in hemodialysis patients. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to assess the results of stenting in unprotected left main coronary artery disease (uLMCAD) at a tertiary hospital center. Methods: We assessed all patients who received stenting for uLMCAD, including stable patients who underwent elective, urgent, or emergent procedures. Data were gathered by reviewing hospital records and coronary angiograms and calculating SYNTAX scores. Patient follow-up was conducted via clinic visits and phone calls. Results: Percutaneous coronary intervention (PCI) was performed on seventy patients with uLMCAD, all of whom had successful revascularization. During their hospital stay, only one patient (1.4%) died from a noncardiac cause and no patient experienced target lesion failure. After an average follow-up of 17.4 ± 12.36 months, four patients (5.7%) died, with three of the deaths being noncardiac. Eight patients (11.4%) also experienced major adverse cardiac events, and six (8.6%) required target vessel revascularization. The crush technique was associated with a lower rate of target lesion failure than the noncrush technique (0% vs. 14%, p=0.03). Furthermore, patients with one- to two-vessel disease had lower rates of target lesion failure than those with three-vessel disease (2.5% vs. 16.7%, p=0.048). Other variables, such as the Syntax score and the lesion site (distal and nondistal left main disease), did not appear to affect target lesion outcomes. Conclusions: In our center, the stenting procedure for uLMCAD resulted in favorable outcomes during hospitalization and at the long-term follow-up, comparable to the results of large clinical trials. [ABSTRACT FROM AUTHOR]

The COVID-19 vaccine coverage has been shown to differ by gender, with females being more hesitant to vaccinate, even among healthcare workers. This study aimed to assess female healthcare workers' COVID-19 vaccination coverage and anti-vaccination attitudes. We conducted a cross sectional study using an online questionnaire. We included healthcare workers from various professions and examined their sociodemographic characteristics and anti-vaccination attitudes using the Vaccination Attitudes Examination Scale and COVID-19 vaccination coverage. In addition, we assessed factors associated with coverage using multivariable analysis. Female healthcare workers had significantly lower vaccine coverage [59.6% (95%CI: 55.5%-63.7%)] than males [74.9% (95%CI: 70.7-78.8%)]. In addition, they have significantly higher anti-vaccination attitudes and lower perceived vaccine knowledge. Vaccine coverage is age-related in female healthcare workers, with 52.7% in the less than 30-year age group and 70.7% in the ≥50-year age group. The age group 40-49 and middle-income category are positively associated with vaccination coverage among female healthcare workers. In contrast, living with a child, having a history of COVID-19 infection, mistrust of vaccine benefits, and worries about unforeseen effects are all associated with lower coverage. In conclusion, female healthcare workers have significantly lower vaccine coverage, especially for the younger age groups, associated with mistrust of vaccine benefits and worries about unforeseen effects. These findings highlight the importance of addressing vaccine hesitancy among female HCWs as part of efforts to improve COVID-19 vaccination; evidence-based communications tailored to their concerns are needed. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is a significant risk factor for using potentially inappropriate medication (PIM), which is using drugs with more risks than benefits, especially for elders. This study aimed to estimate the prevalence of PIM using Beers Criteria, polypharmacy, and their related risk factors. Methods: A descriptive cross-sectional study was conducted in West Bank primary health care clinics (PHC)from December 2021 to March 2022. Data were collected from PHC clinic attendees aged 65 and above via an interviewer-administered questionnaire and a review of their medical records. We used the Beers Criteria 2019 update to identify PIM and performed a multivariable analysis to determine its associated factors. Results: The study included 421 older people (197 men and 224 women) with an average age of 73.6 years. The prevalence of polypharmacy was 75.1% (95%CI: 70.6%-79.1%), with an average of six medications dispensed per patient. On the other hand, PIM was identified among 36.8% of the study participants (CI:95%CI: 32.2%- 41.6%). Sulfonylureas were the most common (24.2%) reported PIM, followed by peripheral alpha-blockers (4.3%), non-steroidal anti-inflammatory drugs (3.1%), proton pump inhibitors (2.9%), and central nervous system medications (2.1%). Hyperpolypharmacy (> 10 drugs) [aOR = 4.1, 95%CI: 1.6–10.7], polypharmacy [aOR = 2.8, 95%CI: 1.4–5.4], and Diabetes [aOR = 3.5, 95%CI: 2.0–6.0] are the main associated factors of PIM. Conclusion: This study found that over one-third of the older people attending PHC clinics have PIM, with polypharmacy and Diabetes being the main predicting variables. Improving physicians' awareness of clear and specific PIM lists can reduce the number of PIM prescribed and decrease their impact. [ABSTRACT FROM AUTHOR]

Background: The exposure to chemicals in detergent factories, as some studies have shown, has a negative impact the health of workers' respiratory systems. The aim of the study was to assess the lung function parameters of detergent factory workers and compare it with those of a group of non-chemical workers using spirometry. Methods: A comparative cross-sectional study was performed involving male detergent factory workers and a comparison group of non-chemical workers. An interviewer-administered questionnaire was used to record workers' characteristics, and the data were entered to the spirometry device. The spirometry test was performed to assess workers' lung functions; we recorded the forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow (PEF), forced expiratory flow between 25 and 75% of FVC (FEF25–75%), and lung age. Results: A total of 94 participants (28 detergent factory workers and 66 non-chemical workers) were included in the study. Detergent factory workers showed significant decreasing in the values of FEV1, FEV1/FVC ratio, PEF, FEF25–75%, and increased lung age compared to non-workers group (p < 0.05 to p < 0.001). Conclusions: This study showed that detergent factory workers have significantly lower pulmonary functions compared to workers in other non-chemical occupations. Further studies are needed to find the cause of this difference. [ABSTRACT FROM AUTHOR]

Purpose: to determine COVID-19 vaccination coverage among pregnant women and investigate the factors affecting vaccine uptake. Design: Analytical cross-sectional study. Setting: Palestinian health care facilities. Between October and November 2021 – eight months after the country's first COVID-19 vaccination. Sample: We needed 820 people to estimate vaccination coverage among pregnant women with a precision rate of 3%. Therefore, we invited 950 pregnant Palestinian women who were eligible and had a response rate of 91.6%. Measures: An interviewer-administered questionnaire examined vaccination uptake, attitudes, and concerns about the COVID-19 vaccine. Analysis: Bivariable and multivariable analysis using SPSS. Results: vaccination uptake was reported by 219 pregnant women [25.5%, 95% CI: 22.6% −28.5%]. Knowledge (aOR=2.0; 95% CI: 1.2-3.1), perceived benefits (aOR=1.1; 95% CI: 1.06-1.16), employment (aOR=5; 95% CI: 3.1-8.1), and underlying medical condition (aOR=2.1; 95% CI: 1.1-4.1) predicted uptake. Reporting vaccine barriers reduces vaccine uptake (aOR=.92; 95% CI:.89-95). Conclusions: Pregnant women's COVID-19 vaccination rates are low. Concerns regarding the COVID-19 vaccine for infants affected their decision. COVID-19 vaccination regulations and legislative nudges drove maternal vaccination. Vaccine fears and misconceptions among pregnant women should be addressed. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is one of the most common surgical emergencies encountered in clinical practice. New inflammatory markers, named neutrophils/lymphocytes ratio (NLR), platelet/ lymphocyte ratio (PLR), and C-reactive protein /platelets ratio (CRP/PLT), have been implemented recently in clinical practice for the diagnosis and assessment prognosis of many conditions like malignancies, cardiovascular diseases, and end-stage renal disease. However, none of those markers have been well studied in acute appendicitis. In this article, the role of NLR, PLR, and CRP/PLT in diagnosing acute appendicitis and the correlation of their values to the severity of the disease has been studied. Methods: A retrospective study was conducted on 346 patients of all ages and genders who were admitted to Al-Makassed Islamic Charitable Hospital in Palestine for three years, from 2018 to 2021, with the diagnosis of acute appendicitis. Complete blood count and CRP were reviewed. NLR, PLR, and CRP/PLT ratios were calculated and compared between divided groups according to the age and severity of the disease. A T-test was used for the analysis of the results. Results: Neither NLR nor PLR showed a statistically significant association with the diagnosis of acute appendicitis or prediction of its severity. Regarding CRP/PLT ratio, it was 0.202±0.431in the pediatric group who were diagnosed with acute appendicitis and 0.039±0.061 in the pediatric group who had normal appendix (P value of 0.029), while it was 0.194±0.316 in adult appendicitis group and 0.107±0.132 in an adult group with normal appendix (P value of 0.567). The CRP/PLT ratio in the pediatric group who had uncomplicated acute appendicitis was 0.186±0.452 compared to 0.305±0.323 in complicated appendicitis (P value of 0.001), while the ratio in the adult simple appendicitis group was 0.154±0.293 compared to complicated cases that were 0.426±0.345 (P value of <0.001). Conclusion: Based on a complete analysis of the novel inflammatory markers in the two age groups, pediatrics, and adults, in both simple and complicated acute appendicitis, only the CRP/PLT ratio showed high accuracy for diagnosis of acute appendicitis in pediatrics and distinguishing complicated cases from simple ones in both pediatric and adult age groups. [ABSTRACT FROM AUTHOR]

Purpose: Establishing the normal range of lumbar spinal canal in the Palestinian population helps provide a quantitative method for assessing spinal canal abnormalities in the lumbar region. Materials and Methods: The data was gathered from Governmental Hospital in Nablus from January to July 2018. It is a cross-sectional descriptive study among 400 patients (201 males, 199 females), ranging from 20 to 60 years. CT scan radiographs were used to measure the canal and the vertebral body diameters to obtain the canal body ratio. Results: The results represent the normal ratio of dimensions at each level of the bony lumbar spinal canal. The measurements presented are taken at the level of each lumbar vertebra starting from the 1st down to the fifth lumbar vertebra. It was found that the mean ratio of the spinal canal increases from L1 down to L5. Conclusion: After analyzing each lumbar level's results, the mean ratio of the spinal canal increases from L1 to L5. In addition, there were no significant differences between males and females regarding the measurement tool. [ABSTRACT FROM AUTHOR]

Patients on maintenance dialysis therapy are especially vulnerable to COVID-19 and its complications. This study aimed to assess the incidence, epidemiological characteristics, and mortality rate of COVID-19 among maintenance dialysis patients. This retrospective observational chart review study included 548 patients from all dialysis units in the West Bank of Palestine who acquired COVID-19 between 5 March 2020, and 11 August 2021. We collected data on patients' demographics, clinical features, and outcomes. A multivariable logistic regression model was used to assess independent risk factors for COVID-19-related mortality. The incidence of COVID-19 among maintenance dialysis patients was 35.3%, as 548 out of 1554 patients have tested positive during the study period. Patients on haemodialysis were three times riskier to get infected than those on peritoneal dialysis (37% vs 11.3%). Half (50.2%) of infected patients required hospitalisation, and 24.5% were admitted to an intensive care unit, while the mortality rate stood at 26.8%. Old age, male sex, central venous catheter use, comorbid diabetes, smoking, and having an RH negative blood group type were determined to be significantly associated with increased risk of mortality. In conclusion, the incidence of COVID-19 among Palestinian maintenance dialysis patients was notably high, especially among haemodialysis patients. High rates of hospitalisation, ICU admission, intubation and death were observed, and predictive factors for COVID-19-related mortality were identified. Therefore, the implementation of strict infection control measures and promotion of home dialysis are warranted to reduce the infection rate. The incidence of COVID-19 among Palestinian maintenance dialysis patients was notably high; more than one-third of the total dialysis population acquired COVID-19, with haemodialysis patients being three times more likely to get infected compared to their peritoneal dialysis counterparts. The mortality rate among maintenance dialysis patients was 26.8%, more than 25 times higher than that of the general population. The risk of mortality was significantly increased with age, male sex, smoking, diabetes, and having central venous catheter as vascular access for haemodialysis. Strict infection control measures, as well as the promotion of home dialysis, are necessary to reduce the risk of infection. [ABSTRACT FROM AUTHOR]

Background/Aim: Hypomagnesaemia has been shown to have a significant impact on both glycaemic control and diabetes complications in type 2 diabetes mellitus (T2DM) patients. This study aims to assess the prevalence of hypomagnesaemia in T2DM patients and find the association between serum magnesium levels and outcomes relevant to glycaemic control and diabetic complications in primary care unit. Methods: A cross-sectional study was conducted and included 373 patients (222 males and 151 females) from primary care unit. Serum magnesium levels were measured by the colorimetric endpoint method using the Cobas C501 system. Hypomagnesaemia was determined to be a serum magnesium level <1.6 mg/dL. In addition, the following data was also obtained: patients' characteristics, anthropometric measurements, smoking status, HbA1c, comorbidities and therapeutic management. Results: Patients' mean age was 56.2 ± 10.8 years, 24.6% were smokers, and most were overweight or obese. About 60% have a history of hypertension, and the majority have had diabetes for more than 10 years. Their mean HbA1c level was 8.5 ± 2%. The prevalence of hypomagnesaemia was 11% (95% CI: 8%–14.6%). It was found to be significantly higher among females (adjusted OR: 2.7, 95%CI: 1.2%–5.8%), patients with HbA1c ≥8% (adjusted OR: 2.4, 95%CI: 1.1%–5.5%) and patients with a history of diabetic retinopathy (adjusted OR: 2.7, 95%CI: 1.1%–7.1%). Conclusion: The study showed that hypomagnesaemia is more prevalent in females and is associated with diabetic retinopathy and poor glycaemic control. Having a sufficient magnesium level may be associated with better glycaemic control and a reduced occurrence of complications. [ABSTRACT FROM AUTHOR]

This study aims to explore pregnant women's attitudes to COVID-19 vaccination and determinants of vaccine acceptance. We conducted a cross-sectional study among pregnant women attending PHC clinics and hospitals in the West-bank of Palestine. We used an interviewer-administered questionnaire based on Health Belief Model. The study's primary outcome was COVID-19 vaccination acceptance. We used the Chi-square test to compare those who accepted the vaccine versus those who refused it and conducted binary logistic regression to explore independent determinants of vaccination acceptance. Among the 728 pregnant women who took part in the study, 20.7 percent showed positive attitudes (acceptance) toward COVID-19 vaccination. Employment (aOR 4.0; 95 percentCI: 2.2–7.3), a history of COVID-19 (aOR 1.9; 95 percentCI: 1.2–3.1), and having a relative who died from COVID-19 (aOR 2.3; 95 percentCI: 1.2–4.7) increased the likelihood of vaccine acceptance, as did vaccine perceived effectiveness (aOR 1.9; 95 percentCI: 1.2–3.2) and perceived protection from severe disease (aOR 2.0; 95 percentCI: 1.2–3.5). On the other hand, perceived limited access (aOR 0.540; 95 percentCI: 0.31–0.87) and perceived harm to the baby (aOR 0.346; 95 percentCI 0.22–0.54) remained the main barriers toward vaccine acceptance. In conclusion, pregnant women's acceptance of the COVID-19 vaccine is unsatisfactory. Concerns about its effect on unborn babies were major barriers to vaccination. [ABSTRACT FROM AUTHOR]

Due to geopolitical and socioeconomic challenges, the Family Medicine (FM) speciality in Palestine is in early stages of development. Volunteer British General Practitioner (BGP) trainers worked with FM faculty to develop an online tutorial program (OTP) and a novel evaluation framework E-QUaL (Evaluation-Quality, Utilization and Learning) to enhance residents' patient-centered communication and clinical skills. Three OTP cycles were facilitated and evaluated at An Najah National University (ANNU) in Palestine between 2017–2020. Qualitative data were collected during focus groups and online chats and analysed. The development and joint facilitation of the OTP developed faculty skills and enhanced clinically oriented education. The collaborative (BGPs and ANNU faculty) approach and the use of the EQUaL framework helped to identify and address strengths and opportunities as well as the challenges and threats of the educational content and the virtual learning format with each iteration. The COVID pandemic provided a new and inexpensive platform which improved training quality. Issues such as the volunteer nature of BGPs, internet instability, and differing cultural approaches and expectations between physicians and patients were addressed in a continuous quality improvement approach and continues today. This may be a useful model in other low resourced settings. [ABSTRACT FROM AUTHOR]

Background: In our clinical practice, conventional radial access has been employed routinely for coronary procedures. The distal radial artery (DRA) access site has recently emerged as a novel technique in cardiac procedures.Objectives: This study compares distal radial access to standard forearm radial access (FRA) in terms of feasibility, outcomes, and complications.Method: This prospective, randomized trial was conducted at a single center. The patients were chosen from An-Najah National University Hospital's catheterization laboratory between December 2019 and November 2020. A total of 209 patients were randomized into two groups: DRA group (n = 104) and FRA group (n = 105).Results: Access was successful in 98% of patients in both the groups. The DRA group had a longer puncture duration and a higher number of attempts (duration: 56.6 ± 61.1 s DRA vs. 20.0 ± 18.4 s FRA, p < 0.001, attempts: 1.9 ± 1.3 DRA vs. 1.2 ± 0.60 FRA, p < 0.001). Puncture-associated pain was greater in the DRA group (4 ± 2.2 DRA vs. 3 ± 2.1 FRA, p=0.001). There were two radial artery occlusions in the FRA group and none in the DRA group (p=0.139). Percutaneous coronary intervention (PCI) was performed in 26% of the DRA group and 37.1% of the FRA group. The DRA group had significantly shorter procedure times (p=0.006), fluoroscopy times (p=0.002), and hemostasis times (p=0.002). Over time, the learning curve demonstrated improved puncture duration and a decrease in the number of puncture attempts.Conclusions: DRA is a safe and practical alternative to FRA for coronary angiography and intervention. The overtime learning curve is expected to improve puncture-related outcomes. [ABSTRACT FROM AUTHOR]

Background: Digital health interventions have been shown to improve data quality and health services in low- and middle-income countries (LMICs). Nonetheless, in LMICs, systematic assessments of time saved with the use of digital tools are rare. We ran a set of cluster-randomized controlled trials as part of the implementation of a digital maternal and child health registry (eRegistry) in the West Bank, Palestine. Objective: In the eRegTime study, we compared time spent on health information management in clinics that use the eRegistry versus the existing paper-based documentation system. Methods: Intervention (eRegistry) and control (paper documentation) arms were defined by a stratified random subsample of primary health care clinics from the concurrent eRegQual trial. We used time-motion methodology to collect data on antenatal care service provision. Four observers used handheld tablets to record time-use data during one working day per clinic. We estimated relative time spent on health information management for booking and follow-up visits and on client care using mixed-effects linear regression. Results: In total, 22 of the 24 included clinics (12 intervention, 10 control) contributed data; no antenatal care visits occurred in the other two clinics during the study period. A total of 123 and 118 consultations of new pregnancy registrations and follow-up antenatal care visits were observed in the intervention and control groups, respectively. Average time spent on health information management for follow-up antenatal care visits in eRegistry clinics was 5.72 minutes versus 8.10 minutes in control clinics (adjusted relative time 0.69, 95% CI 0.60-0.79; P<.001), and 15.26 minutes versus 18.91 minutes (adjusted relative time 0.96, 95% CI 0.61-1.50; P=.85) for booking visits. The average time spent on documentation, a subcategory of health information management, was 5.50 minutes in eRegistry clinics versus 8.48 minutes in control clinics (adjusted relative time 0.68, 95% CI 0.56-0.83; P<.001). While the average time spent on client care was 5.01 minutes in eRegistry clinics versus 4.91 minutes in control clinics, some uncertainty remains, and the CI was consistent with eRegistry clinics using less, the same, or more time on client care compared to those that use paper (adjusted relative time 0.85, 95% CI 0.64-1.13; P=.27). Conclusions: The eRegistry captures digital data at point of care during client consultations and generates automated routine reports based on the clinical data entered. Markedly less time (plausibly a saving of at least 18%) was spent on health information management in eRegistry clinics compared to those that use paper-based documentation. This is likely explained by the fact that the eRegistry requires lesser repetitive documentation work than paper-based systems. Adoption of eRegistry-like systems in comparable settings may save valuable and scarce health care resources. [ABSTRACT FROM AUTHOR]

Introduction. Acute kidney injury (AKI) remains a critical issue for cancer patients despite recent treatment improvements. This study aimed to assess the incidence of AKI in cancer patients and its related risk factors. Methods. A Retrospective cohort study was conducted at tertiary hospitals in the period 2016–2018. A data abstraction sheet was used to collect related variables from patients' records. During admission, the incidence of AKI was assessed using creatinine measurements. RIFLE criteria were used to classify it into five categories of severity: risk, injury, failure, loss, and end-stage renal disease. Results. Using RIFLE (Risk, Injury, Failure, Loss, and End-stage renal disease) criteria, 6.9% of admissions were complicated with AKI. The severity of these fell into the categories of risk, injury, and failure, 3.3%, 1.7%, and 1.9%, respectively. In the multivariate model, the odds for developing AKI was significantly higher for patients with congestive heart failure (AOR = 17.1, 95% CI 1.7–80.1), chronic kidney disease (adjusted OR = 6.8, 95% CI 1.4–32.2 (P value 0.017)), sepsis (AOR = 4.4, 95% CI 1.9–10.1), hypercalcemia (AOR = 8.4, 95% CI 1.3–46.1), and admission to the ICU (AOR = 5.8, 95% CI 2.1–16.2). In addition, the mortality rate was nearly seven times higher for patients complicated by AKI (relative risk = 7.6, 95% CI 3.2–18.2). Conclusion. AKI was significantly associated with congestive heart failure, chronic kidney disease, sepsis, ICU admission, and hypercalcemia in cancer patients, resulting in poorer outcomes and higher mortality rates. AKI assessment for hospitalized cancer patients should be performed regularly, especially for patients at increased risk. [ABSTRACT FROM AUTHOR]

Introduction: Despite discovery of effective vaccines, healthy behaviors and good practices remain the cornerstone of the prevention and control of COVID-19 and the mitigation of adverse impacts. This study aimed to assess the Palestinian population's COVID-19 prevention measures and correlate them with their knowledge, attitude, and background characteristics. Methodology: A cross-sectional study was performed between Dec 2020 and Jan 2021 on 1,451 respondents =18 years via an intervieweradministered questionnaire, comprising 35 questions assessing knowledge, attitude, and practice toward COVID-19. Data were analyzed using univariate and multivariable regression analyses. Results: Of the 1,451 respondents, 768 were females (52.9%), the mean age was 32.8 ± 13.7 years, and 161 (11.1%) reported having been infected with the coronavirus. Overall, 38.7% (95%CI: 36.2-41.2%), 23.4% (95%CI: 21.3-25.7%), and 50.2% (95%CI: 47.6-52.9%) reported good knowledge, attitude, and practice, respectively. Respondents over 50 [aOR 1.9, 95%CI: 1.3-2.8], females [aOR 1.7, 95%CI: 1.4-2.2], and people who had COVID-19 infection [aOR1.7, 95%CI: 1.2-2.5] were more likely to report good practice. Participants with good attitude were 5. times more likely to report good practice than those with poor attitude [p-value < 0.001, aOR 5.7, 95%CI: 3.9-8.4]. Conclusions: The knowledge, attitude, and practice of the participants are no ideal. A positive attitude is a crucial predictor of good practices for COVID-19 prevention and control. Public health interventions are essential for developing and sustaining positive attitudes and good practices and preventing misconceptions. [ABSTRACT FROM AUTHOR]

Ocular complications are common in patients with end-stage renal disease treated with hemodialysis. Disability due to visual impairment in these patients represents a global public health problem. The study aimed to estimate the hemodialysis effect on intraocular pressure (IOP) fluctuation and related factors. A cross-sectional study of 60 patients with hemodialysis (120 eyes) from the hemodialysis unit at a major tertiary teaching hospital in Palestine. Clinical tests were carried out using the Goldman application tonometry and the volk 90d non-contact slit lamp lens. Participant's mean age was 55.5±12.6 years. Thirtytwo of them were males (53.3%), and 22 (36.7%) were diabetic. IOP changed significantly after hemodialysis compared to pre hemodialysis level; (14.28±2.68mmHg before versus 12.39±2.24 after hemodialysis) (P<0.001). This change was more significant among females (P<0.001) and patients with diabetes (P=0.001) and correlated significantly with baseline systolic blood pressure (P=0.002), serum sodium (P<0.001), chloride (P=0.034), BUN (P=0.01), and osmolarity (P<0.001). In conclusion, hemodialysis treatment affects IOP and several other laboratory parameters significantly. It likely causes underestimation of IOP and corneal morphometry changes, and these changes may be necessary when planning corneal or lenticular surgeries in hemodialysis patients. [ABSTRACT FROM AUTHOR]

This study aimed to assess the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) total antibodies in the north, middle, and south regions of West Bank and the prevalence of SARS-CoV-2 specific antibodies (IgA, IgM, and IgG) in the Palestinian population. This was a cross-sectional study. The serological and epidemiological data of 1269 persons were assessed. Participants were selected randomly among primary health care center attendees in Palestine between November 1, 2020 and December 31, 2020. All serum samples were tested for total antibodies using an enzyme-linked immunosorbent assay (ELISA) test. IgM, IgG, and IgA-specific antibody titers were measured using ELISA. The overall prevalence (with 95% confidence intervals [CIs]) of SARS-CoV-2 total antibodies and specific antibodies were estimated. A multivariate regression model was used to assess the predictive factors for SARS-CoV-2-specific antibodies. The overall seroprevalence of SARS-CoV-2 antibodies was 24·0% (95% CI, 21·7%–26·5%). Seroprevalence was significantly higher among people living in south West Bank (adjusted Odds ratio [aOR], 2·22; 95% CI: 1·58–3·11), people who had COVID-19 symptoms (aOR, 3·92; 95% CI, 2·83–5·43), people with a COVID-19 contact history (aOR, 1·44; 95% CI, 1·03–2·03), patients with hypertension (aOR, 1·57; 95% CI, 1·06–2·33), and non-smokers (aOR, 0·47; 95% CI, 0·31–0·72). A total of 171 blood samples from SARS-CoV-2-positive patients were chosen at random for additional serological testing. Specific IgM, IgG, and IgA antibodies were positive in 14·0% (95% CI, 9·2%–20·2%), 88·3% (82·5%–92·7%), and 42·1% (34·6%–59·9%) of the samples, respectively. SARS-CoV-2 antibodies were common among PHC center attendees and were significantly associated to sex, smoking, and COVID-19 contact history. However, considering that almost three-quarters of this population remains susceptible, maintaining public health measures and encouraging access to immunization is critical in protecting this population. [ABSTRACT FROM AUTHOR]

Objective: To measure COVID‐19 vaccine acceptance and related factors to undercover nurses' concerns and fears. Design: A cross‐sectional study. Sample: The study included 639 nurses; 83% were women and 80% under 50 years. Measurement: A self‐administered questionnaire was used. It included demographic characteristics, COVID‐19‐related fears and concerns, COVID‐19 vaccine perceived benefits, and intention toward getting the vaccine. Results: Forty percent of the nurses planned to get the vaccine when available, 41% would take it later when adequate protection and safety were presented, and 18% would never take it. Significant factors associated with vaccination intention were as follows: age (adjusted OR 1.42, 95% CI: 1.02–1.99); lack of knowledge about the vaccine (adjusted OR 2.6, 95% CI 1.81–3.8); concern about long‐term side effects (adjusted OR 2.0, 95% CI 1.4–2.9); fear of injection (adjusted OR 1.5, 95% CI 1.04–2.13); natural immunity preference (adjusted OR 5.8, 95% CI 4.5–8.3); media misrepresentation (adjusted OR 1.7, 95% CI 1.2–2.4); and getting COVID‐19 from the vaccine (adjusted OR 1.5, 95% CI 1.1–2.1). Conclusion: COVID‐19 vaccine safety and side‐effects concerns impact nurses' intentions to accept the vaccine and may result in low acceptance rates. Urgent action is needed to address these fears and raise confidence, as nurses' vaccine‐related decisions can affect the public's vaccine acceptance. [ABSTRACT FROM AUTHOR]

Introduction: Due to their stressful lives, Palestinian refugees are prone to use cognitive enhancers (CE) and psychostimulant substances (PS). Recognising health problems associated with CE/PS use can indicate how preventive programs should be directed towards adolescents. Unfortunately, research has not thoroughly investigated the health problems related to tobacco and caffeine products, the most socially acceptable CE/PS among Palestinian refugee adolescents. Methodology: In 2021, schoolchildren from five Palestinian refugee camps (N=271) aged 12-< 16 years agreed to give blood samples and to be interviewed to address the association between metabolic syndrome (MetS) and tobacco smoking, coffee, energy drinks (ED), black tea, and chocolate consumption. MetS was diagnosed based on International Diabetic Federation Criteria. To address the association, we used binary logistic regression models adjusted to age, gender, BMI, and central obesity. Results: The prevalence of MetS was [17 (6.3%)]; (7.4%) in males, (5.1%) in females. The prevalence of substance use was as follows: ED [163 (48.9%)], coffee [255 (76.6%)], black tea [295 (89.1%)], cigarette [35 (10.5%)], waterpipe [59 (17.7%)], and chocolate [309 (93.6%)], with male predominance. Cigarette smokers have increased central obesity (p-value=0.024), and decreased HDL-cholesterol (p-value=0.015) than non-smokers. Similar results were observed for waterpipe smokers besides the increased levels of triglycerides (p-value=0.01). ED consumers have increased central obesity (p-value=0.03) and fast blood sugar (p-value=0.003) than non-consumers. Chocolate consumers have decreased central obesity (p-value=0.008) and increased HDL levels (p-value=0.04) than non-consumers. ED consumers were significantly at higher risk of MetS (OR=9.97, p-value=0.019) than non-consumers and chocolate consumers were at lower risk of MetS (OR=0.14, p-value=0.046) than non-consumers. Waterpipe smokers were at a higher risk of having increased plasma triglycerides than non-consumers (OR=3.4, p-value=0.03). Conclusion: The high prevalence of ED consumption and waterpipe smoking in Palestinian refugee adolescents is problematic. Their use was associated with higher odds of MetS, dyslipidemia, and central obesity, which justifies greater attention. [ABSTRACT FROM AUTHOR]

Background: University students, who are at risk of eating disorders (ED), are more liable to use cognitive enhancers and psychostimulants to improve their cognitive functions and lose weight. ED in Palestinian male students is a neglected health issue. We aimed to investigate the prevalence and the association between ED and cognitive enhancers, and psychostimulants use among An-Najah National University students (ANNU). Methods: In a cross-sectional study conducted in 2020 at ANNU, 1047 students completed anonymous surveys for cognitive enhancers practice, the Eating Attitude Test-26 (EAT-26), Sick, Control, One, Fat and FOOD (SCOFF) screening tests. Results: The prevalence of ED among ANNU students was 21.2% based on EAT-26 (17.1% in males, 23.8% in females) and 31.5% based on SCOFF (24.0% in males, 36.3% in females). The binary logistic regression revealed that students at risk to have ED were water-pipe smokers (OR: 1.471, p-value 0.047), especially males, while students who were less likely to have ED were males (OR: 0.341, p-value< 0.001), coffee users (OR: 0.581, p-value 0.014) and chocolate users (OR: 0.530, p-value 0.041) than nonusers. Moreover, the risk of ED increased with increasing body mass index (p-value< 0.01). Clinical medical students showed the lowest prevalence (11.1%) compared to preclinical (22.5%), health sciences (23.7%), and non-medical students (20.9%) (p-value 0.059). Conclusion: Our findings highlight water-pipe smoking as a significant health problem in males with ED, which may require unique treatment and prevention strategies. Moreover, coffee and chocolate consumption were associated with decreased risk of ED, only among males. The gender-gap in ED prevalence was very narrow compared to international results. These results prompt the need to focus on both genders in future studies instead of females. They also suggest the urgent need to address ED among Palestinian university students by educating students about mental health, identifying high-risk students, and offering easily accessible psychological help. [ABSTRACT FROM AUTHOR]