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The present study explored the links between maternal insomnia symptoms, maternal depressive symptoms, and young children's sleep quality among two major cultural groups in Israel: Arab and Jewish. We also assessed the prevalence of maternal insomnia and depressive symptoms, in both cultural groups.Mothers of 497 healthy, typically developing infants and toddlers, ranging in age from 3-36 months, participated in the study: 253 of the mothers were Arab and 244 were Jewish. Mothers completed the Insomnia Severity Index (ISI), the Edinburgh Postnatal Depression Scale (EPDS), and the Brief Infant Sleep Questionnaire.For both cultural groups, there were significant positive associations between maternal ISI and EPDS, as well as between maternal ISI and child sleep variables (nighttime wakefulness and perceived child's sleep problems), after controlling for child age. Significant correlations were also found between maternal EPDS and child sleep, after controlling for child age, but these correlations were not significant once controlling for ISI. Cross-cultural differences in prevalence of insomnia and depressive symptoms were found based on the clinical cutoffs of the ISI and EPDS: Arab mothers, compared to Jewish mothers, reported higher levels of insomnia and depressive symptoms, and were more likely to have scores higher than the clinical cutoff on both measures.Maternal insomnia, depressive symptoms, and child sleep quality are significantly intertwined in both Arab and Jewish families in Israel. The findings highlight the importance of taking these three domains into consideration in research and in clinical assessments of families with young children.

Commitment to organ donation may vary among willing younger and older adults. We aimed to understand attitudes toward organ donation among Arab adults.We conducted a cross-sectional survey of a representative sample of adults from 13 regions in Saudi Arabia between February 12, 2021, and March 14, 2021. We stratified the analyses by individuals' age (younger, 18 to 39 years old; older, ≥40 years old).Of 4217 individuals contacted, 3120 respondents (1846 younger and 1274 older) completed the survey, with a response rate of 74%. We found that 54% of younger and 47% of older respondents expressed support for organ transplantation, and 49% of younger and 35% of older respondents wanted to donate their organs. However, only 4% of younger and 3% of older respondents had registered in the national donor database. Knowledge sources that most likely to influence attitudes toward organ donation for younger and older respondents, respectively, were physician/health care worker (58% and 55%), family member (29% and 26%), scientist/researcher (29% and 22%), and religious scholar (16% and 23%).Though many younger and older adults express a willingness to donate, few are registered to be a donor. Our findings highlight the influential sources of knowledge that can be implemented in future interventions to increase commitment to organ donation.

In response to this extraordinary outbreak, many countries and companies rush to develop an effective vaccine, authorize, and deliver it to all people across the world. Despite these extensive efforts, curbing this pandemic relies highly upon vaccination coverage. This study aimed to determine SARS-COV-2 vaccine uptake among Palestinian healthcare workers, the factors that influence vaccination uptake, and the motivators and barriers to vaccination.A cross-sectional study was conducted using an online anonymous self-administered questionnaire during April and May 2021, after the Palestinian Ministry of Health launched the COVID-19 vaccination campaign. The questionnaire collected socio-demographic characteristics, vaccination attitude and vaccination uptake status, and motivators and barriers towards vaccination. In addition, multivariate logistic regression was performed to identify the influencing factors of vaccination uptake.The study included 1018 participants from different professions, including 560 (55.0%) females. Of the participants, 677 (66.5%; 95% CI: 63.5-69.4%) received the vaccine. Higher uptake was observed among males (aOR = 1.5; 95 %CI: 1.1-2.1), single HCWs (aOR = 1.3; 95 %CI: 1.1-1.8), HCWs working in the non-governmental sector (aOR = 1.6; 95 %CI: 1.2-2.4), higher monthly income (aOR = 1.9; 95 %CI: 1.4-2.8) and smoking (aOR = 1.5; 95 %CI: 1.1-3.5). The lower level of negative vaccination attitudes predicted higher intake; mistrust of vaccine belief (aOR = 1.6; 95 %CI: 1.4-1.7) and worries over unforeseen future effects (aOR = 1.2; 95 %CI: 1.1-1.3).In conclusion, the COVID-19 vaccination uptake was comparable to other studies worldwide but still needs to be improved, especially in the context of this ongoing global pandemic. It is imperative to invest resources to promote vaccination uptake and target all the vaccine misconceptions and fears.

Background Coronary Artery Disease (CAD) is one of the most common causes of death in Palestine. This study aimed to assess the nontraditional risk factors among CAD patients underwent invasive coronary angiography in Gaza-Palestine. Methods Unmatched one-to-one case-control study was conducted among 200 participants. Cases were recruited from newly discovered CAD patients after a confirmed diagnosis of CAD by interventional cardiologist post catheterization "coronary angiography" in Al-Shifa Cardiovascular Catheterization Center. Controls were enrolled from individuals with no history of CAD. An interview-based questionnaire was used to assess patient's characteristic data and medical history; anthropometric, and the Ankle Brachial Index(ABI) was measured and calculated. Furthermore, biochemical analysis of high sensitivity C-reactive protein (hs-CRP) level and Random blood glucose level (RBG) and Leukocyte count (WBCs)were investigated. All required ethical approvals were obtained. Data were managed and analyzed by STATA version 14. Correlation analysis by multivariate logistic regression was done. Results hs-CRP, RBG, and WBCs remained significant predictors for CAD adjusted for age, education level, employment status, and monthly income. As, the odds of CAD increased by 3% for each unit increased in hs-CRP (Odd Ratio (OR)=1.03; 95% confidence interval (CI):1.01, 1.06; P = 0.020); and the odds of CAD was augmented by 30% for each unit increased in WBCs (OR= 1.30; 95% CI: 1.07, 1.67; P = 0.010); While the odds of CAD was 5 times more for each unit increased in RBG (OR=5.04; 95% CI: 1.17, 14.88; P = 0.003). Still, age remained a significant risk factor as the odds of CAD was 19% more for each increased year in age (OR=1.19; 95%CI: 1.13, 1.26; P Conclusion Nontraditional factors (hs-CRP, RBG, and WBCs) are significant predictors of CAD, and should be considered in adult patients coming with attacks of angina pain.

"This study aimed to assess the level of Post-Traumatic Stress Disorder (PSTD) and to examine the relationship between exposure to war stress and posttraumatic symptoms among people who were injured during the Great March of Return (GMR) in the Gaza Strip, Palestine. A sample of 264 adults who were injured during participation in the events of GMR completed the Impact Event Scale-Revised (IES-R). IES-R has three sub-scales; intrusion, avoidance, and hyper-arousal. Only 27.3% of the participants had two or more injuries and 38.4% of participants reported having disability due to their injuries. The results showed that 95.4% of the participants had severe posttraumatic symptoms. Total score of IES-R ranged between 29 and 88 (mean = 61.28). The most frequent symptoms of trauma subscales was “Intrusion” (mean = 2.90), followed by “Avoidance” (mean = 2.73), and then “Hyper-arousal” (mean = 2.70). Level of PTSD was affected by working status, need for hospitalization, need for a referral for treatment outside the Gaza Strip, disability and severity of injury. Such high level of PSTD will have negative consequences on participants' physical and mental status. Therefore, a need for special counseling programs is required to help them to survive with least consequences of PTSD on their wellbeing. " "هدفت هذه الدراسة إلى تقييم مستوى اضطراب ما بعد الصدمة (PSTD) وفحص العلاقة بين التعرض لضغوط الحرب وأعراض ما بعد الصدمة بين الأشخاص الذين أصيبوا خلال مسيرات العودة الكبرى في قطاع غزة ، فلسطين. أكملت عينة من 264 بالغًا أصيبوا أثناء المشاركة في أحداث مسيرات العودة مقياس حدث التأثير المنقح (IES-R).و الذي يحتوي على ثلاثة مقاييس فرعية ؛ التطفل والتجنب والإثارة المفرطة. النتائج: 27.3٪ فقط من المشاركين تعرضوالنوعين من الاصابة أو أكثر و 38.4٪ من المشاركين أفادوا بأنهم يعانون من إعاقة بسبب إصاباتهم. وأظهرت النتائج أن 95.4٪ من المشاركين يعانون من أعراض شديدة لما بعد الصدمة . تراوحت الدرجة الإجمالية لـمقياس ما بعد الصدمة بين 29 و 88 (متوسط ​​= 61.28). تأثر مستوى اضطراب ما بعد الصدمة بالعوامل التالية: حالة العمل ، والحاجة إلى الاستشفاء ، والحاجة إلى الإحالة للعلاج خارج قطاع غزة ، والإعاقة ، وخطورة الإصابة. سيكون لهذا المستوى المرتفع من اضطراب ما بعد الصدمة عواقب سلبية على الحالة الجسدية والعقلية للمشاركين. لذلك ، هناك حاجة إلى برامج استشارية خاصة لمساعدتهم على البقاء على قيد الحياة مع أقل عواقب اضطراب ما بعد الصدمة على صحتهم."

Objective To evaluate trends in the incidence and survival of gynecologic carcinosarcoma over the last 35 years and to explore ethnic disparities. Study design Using the Israeli National Cancer Registry database, all cases of gynecologic carcinosarcoma were included (1980-2014). Age at diagnosis, patient's ethnicity and anatomical site were extracted. Age-standardized incidence rates (ASRs) were calculated for 3 time periods (1980-1994, 1995-2004 and 2005-2014). Relative survival was calculated using the Pohar-Perme method. Results Overall, 935 cases of gynecologic carcinosarcomas were diagnosed during 1980-2014. The most common gynecologic anatomical site was the uterus (83.4%). Most cases (66%) were diagnosed at ages 60-80, with median age of 69 years. There was a steady increase in ASRs from 5.6 to 8.2 per million women. Throughout 1980-1994 and 2005-2014, ASRs were significantly higher in the Jewish compared to the Arab population (5.8 vs. 3.1, p = 0.02 and 8.5 vs. 5.2, p = 0.002, respectively). Relative survival rates increased throughout the study period. No significant differences were noted in relative survival between the Jewish and Arab populations (p = 0.18). Conclusion The incidence of gynecologic carcinosarcoma increased significantly from 1980 through 2014. Nevertheless, survival rates increased during this time, with no difference in survival between the Jewish and Arab populations.

Objective To describe the prevalence, incidence, and risk factors of epilepsy in Arab countries. Methods In this systematic review, electronic databases including PubMed, ProQuest Public Health and Cochrane Library were searched to identify relevant English articles published until April 2020. The search was conducted to cover all 22 Arab countries. Studies were eligible for inclusion if they assessed any of these epidemiological parameters of epilepsy: prevalence, incidence, and/or risk factors and focused on at least one of the Arab countries. The quality of the studies was evaluated using standardized quality assessment tools. Results Twenty-nine articles met the inclusion criteria. Out of the 22 Arab countries, only 11 were found to have published studies reporting on the epidemiology of epilepsy. The median lifetime prevalence of epilepsy in Arab countries was found to be 6.9 per 1000. The median incidence is 89.5 per 100000. The most frequently identified risk factors were parental consanguinity, family history of epilepsy, and a history of perinatal infections/insults. Conclusion The prevalence and incidence of epilepsy varies in Arab countries. The most frequently reported risk factor is parental consanguinity. The lack of epidemiological studies on epilepsy in half of the Arab countries calls for more studies on this aspect to identify the burden and risk factors of epilepsy in this region.

A brief discussion with policy leaders and citizens was conducted to understand the unwillingness of people to get the COVID-19 vaccine and their suggestions to increase the vaccination level.Despite the crucial benefits of the COVID-19 vaccine, people are unwilling to get vaccinated. Vaccine hesitancy is a significant problem globally. In Palestine, at the time of this study only about 30% of the population were vaccinated.We used a descriptive qualitative design with semistructured interviews.The unwillingness of Palestinian people to get the COVID-19 vaccine was attributed to the spread of false rumours, misinformation, and conspiracy theories they received about the vaccine on the social media and mistrust towards vaccines the government purchased. There is a dire need to develop motivational strategies (i.e., incentives) and reconsider the media discourse and its unification to encourage people to get the vaccines. Social media and professionals should report the benefits/effectiveness of vaccination and avoid exaggerating its' side-effects.

Purpose Previous studies showed that among the pediatric ESRD patients who receive a kidney donation from a parent, in most cases the mother is the one that agrees to donate her kidney to the sick child, whereas fathers are less willing to donate. The present study sought to explore decision making regarding which parent would donate a kidney to their child among Muslim Arab parents of pediatric ESRD patients. Design and methods The study design is a cross sectional qualitative study. We conducted semi-structured interviews with thirty-one parents: twenty-five mothers and six fathers, who donated a kidney to their child. Results Parents tended to refrain from donating a kidney to a sick daughter; mothers were more willing to donate than fathers. Our findings imply that culturally constructed notions of gender and motherhood are mobilized to the realm of health and illness, and mothers' body work is an influential factor in determining survival chances of pediatric ESRD patients and their quality of life. Conclusions Our study shows that kidney donation made by mothers to their children represents a gendered body work and powerfully demonstrate gender relations in Arab society. Cultural artefacts shape parents' differential propensity to donate organs for a female or a male offspring. Practice implications It is recommended that the nursing staff enlist the help of Muslim clerics to increase the willingness of fathers to donate a kidney for their offspring, and also to encourage both parents to donate a kidney to a sick daughter. Education campaigns are needed to raise awareness and encourage changes in the attitudes of the Muslim families of pediatric ESRD patients toward parental kidney donation.

Objectives This study aims to examine the reported prevalence of sufficient physical activity among adults in Arab countries and to determine the use of validated instruments for assessing physical activity. Study design This is a systematic literature review. Methods This review follows recommendations outlined in the Meta-Analysis of Observational Studies in Epidemiology guidelines. The protocol for this study was preregistered with PROSPERO. Cross-sectional, cohort and intervention studies with a minimum of 300 adults aged ≥18 years assessing physical activity using a questionnaire or other self-report measure in the Arabic language were identified from seven electronic databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, PsycINFO, SPORTDiscu and PubMed). Databases were searched from 1st January 2008 to 17th September 2018. Descriptive analysis was performed using frequency and percentages. The prevalence of physical activity was calculated as the average prevalence for the reported percentages from the studies with similar tools. Results Fifty studies involving 298,242 participants were included in this review. The mean (range) sample size was 5964.8.1 (323–197,681). Data were collected from participants in 16 of the 22 Arab countries. Great variation exists across the studies in determining whether adults were sufficiently active or not. Twenty studies reported usable data from the Global Physical Activity Questionnaire and the International Physical Activity Questionnaire (moderate & high categories). In these studies, prevalence of physical activity ranged from 34.2 to 96.9%. It was not possible to compare the other studies owing to variation in instruments used to assess physical activity and in the case definition used for ‘physically active’. Conclusions This study highlights the need for wider reporting of physical activity and the adoption of valid and reliable instruments to support the development of evidence-informed policy and programmes at both country and regional level. International tools need to be correctly validated, or context-specific tools must be developed to accurately measure physical activity.

Objectives To examine differences in maternal sleep-related cognitions and to explore the associations between those cognitions and reported child sleep quality in a sample of mothers of young children, from two major cultural groups in Israel: Arab and Jewish. Method Mothers of 497 healthy, typically developing infants and toddler ranging in age from 3-36 months, participated in the study: 253 of the mothers were Arab and 244 were Jewish. Mothers completed the Maternal Cognitions about Infant Sleep Questionnaire, and the Brief Infant Sleep Questionnaire. Results Cross-cultural differences in maternal sleep-related cognitions were found between Arab and Jewish mothers. Arab mothers were more likely to hold sleep-related cognitions reflecting their difficulty in limiting their nighttime intervention in response to their child’s awakenings, compared to Jewish mothers who were more likely to report feelings of anger and higher levels of doubts in their parental competence in response to their child`s nocturnal awakenings. Moderation analyses demonstrated that, only for Arab mothers but not for Jewish mothers, cognitions reflecting difficulty in limiting nighttime intervention, and feelings of anger and doubts were positively associated with poorer perceived child sleep quality. Conclusion The results suggest that the links between maternal cognitions and child sleep are culturally-specific. Moreover, the discrepancies between Arab and Jewish mothers in sleep related cognitions may reflect differences between collectivistic and individualistic cultures. Maternal sleep-related cognitions seem to be an important parental aspect to consider in clinical sleep interventions of infants in the Arab society.

The twelve Arab countries of the Middle East are inhabited by 117 species of scorpions of varying medical importance within six families. Scorpion stings are a very common occurrence throughout the region. Twenty-two scorpion species are considered to be dangerously venomous, causing potentially life threatening stings. Accessible literature in English and Arabic on scorpions, scorpion stings and available antivenoms was reviewed to document the scorpion fauna and scorpion stings in each country. Saudi Arabia, Iraq and Jordan report the highest numbers of stings and envenomings. Clinically, the most important toxins in Old World scorpion venoms are α-toxins that target voltage-gated sodium (Nav) channels at neurotoxin binding site 3, causing sympathetic excitation and the endogenous release of catecholamines that is responsible for transient, but life-threatening myocardial damage. Most victims of scorpion stings suffer severe local pain, but a few, especially children, develop systemic envenoming which, in the case of most Middle Eastern buthid species, such as Androctonus and Leiurus species, is dominated by the cardiovascular and respiratory consequences of hypercatecholinaemic myocarditis. Other syndromes include paralysis (Parabuthus leiosoma), coagulopathy (Nebo hierichonticus and Hemiscorpius species), and local tissue damage, haemolysis and acute kidney injury (H. lepturus). Early antivenom treatment is recommended but its value remains controversial. However, intensive care, with the ancillary use of vasoactive drugs such as prazosin and dobutamine, has proved effective.

The Tigris-Euphrates River Basin (TERB) is one of the key transboundary basins among the developing countries in the Middle East which has been significantly damaged by mismanagement, exploitation for energy production and unsustainable water use. This study aimed to evaluate the water and soil resources in the lower parts of this basin. More specifically, how the area of the Shatt al-Arab River (SAR) formed at the confluence of the Tigris and Euphrates rivers is affected in terms of quality by upstream activities. Four mathematical models of hydrodynamics, advection-dispersion in the river, and convection-dispersion in soil were used in conjunction with assessment of soil salinization by irrigation water. The soil salinization based on direct saltwater infiltration from riverbanks and soil salinization by irrigation with river water were predicted after simulating the intrusion of saline seawater by considering the tidal conditions of the SAR. The results showed that by applying six optimistic and probable scenarios of freshwater inflows for the future, changes in the water and soil quality in downstream riparian countries (Iran and Iraq) reflect this basin's developments and water allocation upstream. Regarding the possible scenario of maximum inflow reduction in the future, the findings of this study can be used to create a comprehensive view of the current condition and development challenges. This emphasizes the need for participatory crisis mitigation strategies between the upstream and downstream countries.

Objective The popularity of social networks provide an incredible opportunity to enhance the impact of preventive medicine programs. We aimed to assess whether a targeted Facebook campaign among mothers may increase the uptake of human Papilloma virus (HPV) immunization among their 8th-grade daughters. Methods This field study was conducted among the members of a state-mandated health organization in Israel. Included were all 21,592 members who were mothers to 14 year-old daughters in the 2018-19 school-year. A total of 17,271 (80%) were randomly allocated to the campaign arm and the rest (n=4,321) were selected as a reference group. The Facebook ads addressed issues and concerns regarding HPV-related diseases and HPV vaccine. Main outcome measures were Facebook metrics on exposure to campaign and HPV immunization among eighth grade daughters of the study participants. Results Between 8/2018-10/2018, Facebook ads were shown 1.8-million times (a reach of 88%). The uptake of HPV vaccine among daughters of women allocated to the campaign arm (55.3%) was similar (p = 0.749) to 55.0% in the control group. The only significant differences between study groups were observed when stratifying by SES level. In the lowest SES quartile, Facebook campaign significantly (p = .02) reduced vaccine uptake (35% vs. 39.0%), with a relative risk of 0.90 (95%CI: 0.82-0.98), while in the second SES quartile, Facebook campaign increased vaccine uptake from 52.6% to 55.8%, with a RR of 1.06 (95%CI,1.00-1.12). Among mothers in higher SES levels, daughters of exposed and unexposed mothers had similar immunization rates. Conclusions Facebook campaign may increase the uptake of HPV vaccine among daughters to mothers of medium-to-low SES level, but it may reduce vaccination among lower SES groups.

Introduction This study quantifies the differences in infant outcomes by mother's self-identified race among Arab Americans and by self-identified race and ethnicity for Arabs and non-Arabs. Methods This study used data from the Standard Certificate of Live Birth on 8,204 infants born to Arab and 325,354 infants born to non-Arab mothers between 2012 and 2016 in Massachusetts; data were analyzed between 2019 and 2020. Mothers’ race was categorized as White, Black, or Other. Mothers’ ethnicity was categorized as Arab or non-Arab. Outcomes included birth weight, preterm birth, low-birth weight, small for gestational age, and large for gestational age. Linear and logistic regression models assessed the association between race and infant health outcomes. Results Black Arab mothers had higher odds of preterm birth (AOR=1.37, 95% CI=1.07, 1.76) and low-birth weight (AOR=1.35, 95% CI=0.99, 1.84) than White Arab mothers. Arab mothers who self-identified as Other had babies that were 51.4 grams lighter than babies born to White Arab mothers. White Arab mothers had higher odds of low birth weight (AOR=1.19, 95% CI=1.06, 1.34) and small-for-gestational-age babies (AOR=1.22, 95% CI=1.11, 1.36) but lower odds of large-for-gestational-age babies (AOR=0.77, 95% CI=0.70, 0.86) than White non-Arab mothers. Conclusions Both ethnicity and race are important determinants of the health of Arab American infants. Arab ethnicity may play a negative role in the infant health of Arab Americans who identify as White. A better understanding of the lived experiences of Arab American mothers, with regard to their racial and ethnic identity, may help better inform clinical practice.

Purpose This cross-sectional study examined the frequency of different forms of bullying victimization (verbal, physical, and social), predictors of victimization, and whether bullying is reported to an adult. Design and methods The study utilized a community sample of 150 Arab American adolescents, age 12 to 16 years. The Adolescent Peer Relations Instrument-Victimization Scale was used to determine the participant's experiences of victimization in the past year. The adolescents indicated where bullying occurred, why, and whether they reported the incidence to an adult. Results Approximately 30% of the study sample reported that victimization occurred occasionally (once a month or more frequent). Classrooms and hallways were the most common locations where bullying had occurred. Country-of-origin and obesity were the most frequent reasons for victimization. Predictors varied among the different forms of victimization; however, cyber-victimization [OR = 24.5; 95% CI 5–119.5)], perceived problematic attire [OR = 8.4; 95% CI 2.2–31.9)], female gender [OR = 5.2; 95% CI 1.2–22.7)], and being overweight [OR = 0.14; 95% CI 0.01–2.6)] all predicted overall victimization. Conclusions Our findings provide a foundation for future research focusing on Arab American adolescents, an underrepresented population, more research is needed to understand the scope of bullying victimization among Arab American adolescents. Practice implications This study will inform future intervention research and practice to consider victimization and related factors among Arab American adolescents. Culturally sensitive and multilevel interventions are imperative to decrease bullying victimization among Arab American adolescents and prevent negative effects on their health and families.

Introduction Breast cancer is the most prevalent cancer in the United Arab Emirates (UAE). This is the first study to provide data on predisposition of breast cancer susceptibility genes with associated clinical and pathological aspects in the UAE. Material & methods A retrospective chart review for breast cancer patients undergoing genetic testing from 2016 to 2018. According to National Comprehensive Cancer Network (NCCN) guidelines genetic testing was offered. The analyzed data included; age, ethnicity, family cancer history, pathogenic variant, histopathology, stage, molecular subtype and proliferation. Results 309 patients underwent genetic testing with a positive result in 130 patients (11.9%) over a period of 36 months. In 34.6% pathogenic and likely pathogenic variants were identified. BRCA2 was the most common gene identified. The mean age was 42.9 years (±9.01). Positive family history was identified in 66 patients (50.7%). Majority had stage 1 or 2 disease (66.2%), invasive ductal carcinoma (81.5%) and hormone receptor positive cancer (45.3%). Conclusions This is the first study in the UAE to describe the clinical and pathological characteristics of hereditary breast cancer in a mixed ethnic group with dominant Arabic population. Further genetic studies will be required in the UAE population, as the prevalence of breast cancer continues to rise., Highlights • First study about breast cancer genetics in the United Arab Emirates with a mixed ethnic population. • BRCA2 is the most common mutation detected. • Most hereditary breast cancers with a dominant Arabic ethnic group is diagnosed at a lower stage. • Most hereditary breast cancers diagnosed a decade earlier compared to western population.

Background Several studies in the Arab region have recognised the rate of nosocomial infections caused by Pseudomonas aeruginosa (P. aeruginosa), which produce β-lactamase, and identified their emergence and prevalence in the region. This article reviewed molecular studies on these β-lactamase-producing P. aeruginosa during 2010–2018 in several countries of the Arab region in order to analyse the trend of rising prevalence of disease causing drug-resistant P. aeruginosa in the Arab region. Methods Data from selected clinical studies during 2010–2018 on β-lactamase-producing P. aeruginosa in the Arab region were obtained from reliable scientific databases for analysis and evaluation. Results Significant changes were found in resistance of P. aeruginosa towards certain antibiotics of the β-lactam class. There was an increasing trend in the occurrence of resistance genes in β-lactamase-producing P. aeruginosa. Conclusion This review showed that there is an increasing prevalence of β-lactamase-producing P. aeruginosa in some countries in the Arab region. This is a major cause of concern as this implies that more and more instances of multidrug resistance are emerging in this area. This leads to an overall negative impact on health concerns and amounts to increasing difficulty in combating disease. It is recommended that awareness about antibiotic use and abuse be made a priority and measures to curb unchecked use of prescription antibiotics be put into place. Effective screening methods to detect cases of resistance at their onset may be developed.

Background A high incidence of joint laxity has been reported among Asians compared with Western populations, but clear differences between more specific ethnic populations have not been established. This study aimed to determine the average knee laxity in the Malaysian and Jordanian populations. Methods Jordanian and Malaysian medical students from our institution were invited to participate in the study. General demographic data and factors affecting joint laxity were obtained from each participant using a printed questionnaire. Both knees were examined using the anterior drawer test while in 90° of flexion. Knee laxity was measured by three separate independent investigators through a knee laxity tester. Results One hundred and eighty-six participants (95 females) were enrolled in the study. Among them, 108 Malaysians participated. The Jordanians had significantly higher knee laxity in both knees compared with the Malaysians. The mean average right knee laxity for Jordanians was 2.98 mm vs. 2.72 mm for Malaysians (P = 0.005). Similarly, the mean average left knee laxity for Jordanians was 2.95 mm, while for Malaysians, it was 2.62 mm (P = 0.0001). Furthermore, smokers had significantly more laxity in both knees. After performing a multivariate linear regression analysis for all factors, race was the only independent factor that affected knee laxity in both knees. Conclusions Race is directly associated with knee laxity. Jordanians tend to have more laxity in knee joints compared with Malaysians. Larger multi-center and genetic studies are recommended to establish the racial differences between different ethnic groups.

Background Although the transition to fatherhood is a point of attention for researchers, little is known about the first time father's postpartum experience. This study aims to explore the first time fathers postpartum experience in the country of Jordan. Methods An exploratory qualitative design was used. Semi-structured interviews were conducted with a purposive sample consisting of twelve first time fathers. The study was conducted in a public university in Jordan. The data was collected in 2017 and was thematically analysed using the colour and file index method. Results The analysis revealed two main themes. The first theme centred around a feeling of relief which can be further divided into two sub-themes of self-actualisation and continuation of the family line. The second theme centred around the feeling of puzzlement, and this can also be further divided into two sub-themes of feeling unable to deal with a newborn baby and struggling to care for a recovering wife. The study identified fathers as willing to engage in the private care of their new babies and recovering wives but at a limited level of engagement. The fathers verbalised the lack of knowledge and exhibited sociocultural stereotypes related to masculinity and the role of the man in the family. Conclusions The first time fathers’ experiences ranged from feelings of relief to puzzlement. The fathers experiences were shaped by religion, culture, and masculinity which suggests education during antepartum may enhance the experience.

Aims To assess perceptions surrounding diabetes self-management (DSM) behaviors in Arab American patients with diabetes. Methods A 39-item survey was constructed from focus group discussions designed to better understand the impact of Arab American culture on DSM behaviors. The survey assessed perceptions about diet, adherence to medications, exercise, healthy lifestyle, and family support. Results Two hundred Arab Americans with diabetes completed the survey via face-to-face interviews. Most patients were female (59%), over fifty years of age (79%), and immigrated from Lebanon (73%). Receiving instructions in Arabic, having family support, family understanding of food choices, and employment status were found to be important predictors of the perceived importance of DSM. Conclusions Our findings suggest that there are multiple factors that dictate Arab American’s perception of the importance of DSM. The survey that was constructed may serve as a valuable tool for providers to assess DSM perceptions in order to provide patient-centered care that will help to improve diabetes outcomes. This study supports the importance of integrating cultural influences into DSM education and support when providing care to a population with a strong cultural identity.

Palestinians in the Gaza Strip continue to cope with persistent violations of their social, economic, political, and civil rights. This study sought to measure resilience among adult Palestinians and its relation to contextual factors (sociodemographic variables) and emotional response using a social-ecological framework.Community-based, cross-sectional.Involving 1068 households in the Gaza Strip, individuals (aged ≥18 years) completed (a) a questionnaire on demographics and social construct, (b) 25-item Connor-Davidson Resilience Scale (Cronbach alpha = .91), and (c) Positive and Negative Affect Schedule (PANAS) (Cronbach alpha = .89). Bivariate analysis, Pearson correlations, and step-wise multiple regression were conducted.Gazans scored significantly lower resilience compared to the normative mean in the general population (mean score = 75.9 vs. 80.4). Bivariate analysis revealed that being employed and highly educated were associated with higher resilience scores. Likewise, participants showed statistically lower positive affects (PA) (mean = 33.49, standard deviation [SD] = 7.5: 95% confidence interval [CI] 2.39-1.23, P 0.00) and higher negative affects (NA) (mean = 22.3, SD = 7.0; 95% CI 3.68-4.73, P 0.001) compared to normative means. Resilience scores were positively correlated with PA (r = .40, P 0.001), with much weaker negative correlation with NA (r = -.10, P 0.001). Only PA and NA were significant predictors of resilience (rSumud, the Palestinian notion of resilience, is an interactive process that depends on individual assets and contextual resources. Given the political turmoil and high levels of poverty, the employment opportunities must be addressed for this highly educated population to preserve resilience. Providing accessible mental health and social support services is critical.

Nutritional deficiencies are a well-recognized long-term complication following bariatric surgery. The presence of preoperative deficiencies has been shown to be predictive of postoperative deficiencies.The aim of the study was to investigate the prevalence of micronutrient deficiency in a large sample of patients with severe obesity preoperatively, and to determine whether such deficiencies may be related to patient's sex, body mass index, or ethnic subgroup.A cross-sectional study of data collected at the time of the preoperative evaluation.Data were collected during the preoperative evaluation of 872 bariatric surgery candidates in a university hospital in Israel between 2011 and 2018. The patients were 72.9% women, with a mean age of 37.9±12.1 years and mean body mass index of 42.4±4.7 MAIN OUTCOME MEASURES: Nutritional deficiencies according to blood assays. Data on anthropometrics, comorbidities, and demographic characteristics was also collected.Baseline differences between patient subgroups were analyzed using independent-samples t test, analysis of variance, or χDeficiencies of vitamin D, iron, folate, vitamin B-12, elevated parathyroid hormone and low transferrin saturation were present in 75.2%, 42.6%, 28.5%, 8.5%, 35.5%, and 70% of patients, respectively. Nutritional deficiencies were significantly more common among women compared with men for iron (45.9% vs 33.5%; P=0.002), low transferrin saturation (77.7% vs 44.6%; P0.001), vitamin D (77.5% vs 69.2%; P=0.019) and elevated parathyroid hormone level (39.5% vs 22.9%; P=0.002). Iron, transferrin saturation, and vitamin D deficiencies were more prevalent in Arab patients compared with Jewish patients: 59.6% vs 36%; P0.001, 80.2% vs 62.8%; P=0.003, and 85.1% vs 71.6%; P0.001, respectively. Vitamin D and iron deficiency were more common among higher body mass index subgroups (P=0.004 and P=0.040, respectively).The results indicate a high prevalence of nutritional deficiencies, mainly of iron and vitamin D in bariatric surgery candidates. Patients at higher risk for nutritional deficiencies include those with higher body mass index, women, and Arabs.

Background Human beings have an inbuilt desire to care and nurture others. In some professions such as nursing, women are perceived as privileged in relation to these traits, and women are in the majority in the nursing profession. The Gender theory suggests that men should adapt to feminine traits and nature in order to fit in the nursing profession. However, there is a paucity of literature in relation to Arab male nurses' experience in nursing. Purpose The purpose of this study was to explore the Jordanian male nurses' experiences of their career within their Arabic community. Methods A hermeneutic phenomenological approach, underpinned by VanManen's perspective was used. Twenty-two Jordanian male nurses were approached from four hospitals in Jordan. Four focus groups comprising 5-6 interviewees in each were used. The focus groups were audio-recorded and transcribed verbatim. The data were analyzed using Van Manen's hermeneutic approach and themes extracted from the Arabic version were compared critically with the analysis of the English version to develop the meaning of the narratives. Discussion Three major themes emerged from the data: (i) personal gains; (ii) masculinity; (iii) and cultural influences. Whilst male nurses recognized nursing is a female dominant profession, they viewed themselves as more independent in decision making and more productive than their female counterparts. Significantly, the participants described nursing as a means of fulfilling their spiritual needs and thus a personal gain. The interviewees linked their masculinity to resilience and endurance. Participants described that men in nursing face some social constraints within the Arab community. Conclusion The study findings partly supported the fact that nursing in Jordan is a predominantly female profession which lends support to the gender theory in which Jordanian male nurses experienced a social bias and disadvantages by Arabic culture stereotypes of a male nurse. Although nursing is still a feminine career, the findings of this study raise awareness that gender role stereotype might not hold a strong stance in relation to nursing and that could be attributed to elements such as economic and payment status.

Background: Studies have shown improvement in the outcome of blood stream infections (BSI) due to the use of Rapid PCR-Based Blood Culture Identification Panel (BCID) in Antimicrobial stewardship programs (ASP). There is currently no data on the use of BCID with ASP in the United Arab Emirates (UAE). Method: Pre-post quasiexperimental study included hospitalized patients with BSI, their positive blood cultures on BCID were studied in 2 groups: conventional culture with ASP (AS), and BCID with ASP (BCID). The primary outcomes were time to first appropriate antimicrobial therapy, infection related length of stay (LOS), ICU admission, 14 days bacteremia recurrence and in-hospital mortality. Secondary outcomes were 30 days reinfection rate, hospital cost and ASP interventions. Results: Out of total 477 positive blood cultures, 206 (AS and BCID) with real BSI were included. The time needed for organism identification was shorter in the BCID group than in the AS group (1.3 h vs. 51 h; P = 0.0002). BCID had a shorter time to appropriate antimicrobial therapy than AS (17.8 h vs.45 h; P = 0.0004). No statistical difference was observed in mortality rate, 14 days bacteremia recurrence, ICU admission, hospital cost, LOS or ASP interventions. Conclusion: Implementing BCID to ASP significantly decreased the time needed to identify the organism and time to appropriate antimicrobial therapy. Similarly, LOS and hospital cost were reduced, however, the reduction was not statistically significant. Keywords: antimicrobial stewardship, rapid blood culture identification, blood stream infection, BCID

The literature indicates that trust plays an important role in people's decision-making with respect to vaccinations. This research seeks to examine the impact of trust on the high response rate to vaccinations among the minority Arab population living in Israel. The research employs the qualitative phenomenological research method, using personal interviews to identify and analyze perceived trust among mothers of young children and teenagers (n = 70) and among nurses (n = 20) in the Arab population in the context of vaccinations and the high response rate to vaccinations among this population. The research findings point to differing levels of trust in the medical system. The participants placed the highest trust in the nurses working in the Tipat Halav Family Health Centers run by the Ministry of Health. These nurses are the main communicators of information about childhood vaccinations in Israel. Moreover, the interviewees saw vaccinations as an example of the state offering equal and optimal services to the Arab minority population. In addition, the interviewees consider the explanatory materials to be limited, superficial and not culturally appropriate. These positive attitudes toward vaccinations alongside reports that no importance is attributed to the explanatory materials due to their low quality may cause the population to accept vaccination recommendations as they are and to delegate responsibility and authority to the state.

The issue around vaccination of children has brought divergent opinions among the populations across the globe and among the Arab population. There has been a low response rate to the calls for vaccination of children and this is reflective of the sentiments which parents may have towards their children being vaccinated. This study aims to explore the parents' health beliefs, intentions, and strategies towards the COVID-19 vaccine for their children among Arab population.A cross-sectional study using an online survey from October to December 2021, was carried out in five Arab countries in the Middle East. A reliable health belief model (HBM) including five domains: severity, susceptibility, benefits, barriers and cues to action, was adopted. Chi-square, Mann-Whitney test, and multivariable logistic regression were performed for data analysis.The survey response rate was 58 % (1154/2000). Only 56 % of Arab parents are intended to vaccinate their children against COVID-19. The mean scores of parental health belief are largely driven by their concern over the vaccine's side effect (p = 0.001) followed by its efficacy, safety (p 0.001), and scheduling difficulty (p = 0.029). However, strategies that were statistically encouraged parents to vaccinate their children included doctor's recommendation, adequate information being provided, and acceptance of the vaccine by public (p 0.001). Parents with one child were almost three times most likely to vaccinate their children (OR = 2.660, 95 %CI = 1.572-4.504, p 0.001). Parents' desire to vaccinate their children is also influenced by other factors such as job loss owing to COVID-19 and the presence of a health worker in the family.Intention of Arab parents to vaccinate their children via COVID-19 vaccine is still limited. Thus, it is essential for health care authorities to avail the information which will debunk the erroneous beliefs which some parents have developed towards the vaccination of children against COVID-19.

Although mental disorders are a leading cause of disability in the Arab region, which includes 5·54% of the global population, Arab countries produce only 1·0% of the global output of peer-reviewed publications in mental health research. Various stakeholders, including Arab mental health researchers, institutional and funding agency officials, and international research collaborators, convened to identify challenges faced by Arab mental health researchers and propose an evidence-informed call for action. Challenges identified include prevalent stigma and low awareness, conflict and war, scarce institutional and funding resources, inadequate publishing opportunities, insufficient training in mental health research, and shortage of reliable and valid assessment tools. The proposed action plan includes ways of addressing stigma and spreading awareness, increasing collaborative efforts, building research infrastructure, strengthening the mental health workforce, and translating research findings into a call to action on societal and governmental levels. The proposed action plan could provide a roadmap for Arab mental health researchers and research institutions, which might ultimately increase research productivity in the Arab region and close the gap between Arab countries and the rest of the world.

Objective To screen 97 obese Arab adolescents for metabolic risk factors. Results Insulin resistance, metabolic syndrome and intermediate hyperglycaemia was found in 56.7 %, 14.4 % and 27.8 % (HbA1c) while fasting plasma glucose was impaired in 0–16.5 %, using different cut-offs. Interventions to prevent obesity and diabetes are needed.

Although contact-based interventions are the cornerstone of prejudice reduction, in high-conflict environments, incendiary contact with outgroups can instead exacerbate negative attitudes. Supplementing contact interventions with social-cognitive/emotional approaches may, instead, help facilitate positive contact. This study evaluated the effectiveness of two prejudice reduction interventions among 148 Palestinian-Israeli and 154 Jewish-Israeli 5th grade students (Mage.years = 10.55, SD = 0.26) in a high conflict area. Schools in Jaffa, Israel were assigned to a social-cognitive/emotional skills-based intervention, a skills- and contact-based intervention (i.e., skills, skills+contact), or the control group—all delivered as part of the curriculum. Prejudice was assessed through participants' judgments of and justifications about hypothetical scenarios of intergroup exclusion in peer and home contexts at pre-test, post-test, and 6-month follow-up. Repeated measures ANOVAs showed various main effects including gender, ethnicity, and context in which the exclusion occurred (peer/home). Significant higher level interactions with group by time demonstrated the positive influence of both treatment groups on prejudice reduction. The skills and skills+contact groups became more rejecting while the control group became more accepting of exclusion across time. Additionally, the skills and skills+contact groups increased in moral and empathic reasoning over time, whereas the control group increased in social conventional and stereotyped prejudiced reasoning. These findings illustrate the effectiveness of in-school social-cognitive/emotional skills and combined skills+contact approaches in reducing the prejudiced attitudes of Palestinian- and Jewish-Israeli pre-adolescents, especially in areas with protracted conflict.

Background Previous research has extensively used a socio-ecological perspective to find the correlates of youth involvement in violence. However, little is known about the extent to which ecological factors correlated with youth violence are affected by gender, especially in non-Western cultures. Objective The role of gender in the association between individual, family, and contextual factors and Arab youth involvement in several types of violence (severe physical, moderate physical, and verbal and indirect violence) was explored using a socio-ecological perspective. Participants and Setting: The study was based on a large random sample of 3,178 Arab students, aged 11–18, from Israel. Methods Information was collected from the adolescents through a structured, anonymous self-report questionnaire which they completed in the classroom under the guidance of a research assistant. Confidentiality and anonymity were ensured for all participants. Results Gender was found to moderate the association between impulsivity and parental support and all types of violence except verbal violence. No interaction effect was found in the association between affiliation with delinquent peers and exposure to community violence and Arab youth involvement in violence. Conclusions The results emphasize the importance of exploring gender differences with respect to risk and protective factors for violence. This knowledge is an important step in the design and implementation of gender-specific intervention strategies to deal with youth violence.

To assess lead poisoning among a pediatric population in Gaza Strip, the Palestinian Authority.A total of 1705 questionnaires and blood samples were collected from children aged 2-6 years, by the finger stick capillary procedure, for the assessment of blood lead level (BLL), using the LeadCare kits. The samples were collected from children living close to lead processing units (hotspots) and far 100-500 m away (general population). Management of elevated BLL was achieved by gavage of chelating agent d-penicillamine at a dose of 30 mg kgDistribution of children in Gaza Strip by sampling process illustrated those 326 children (19.1%) living in lead processing units (hot spots) and 1379 children (80.9%) from location far away 100-500 m from host spot (general population). The mean BLL was 10.4 μg/dl. A total of 440 children (25.8%) were found to be having BLL ≥ 10 μg/dl while 1265 children (74.2%) have BLL 10 μg/dl. BLL 10 μg/dl was taken as a cut point due to CDC standards. The prevalence of BLL in hotspot areas in children who were exposed to lead and have BLL ≥ 10 μg/dl was 95.7% while in general population it was 9.3%. The difference between the study population was statistically significant (p 0.01). Statistical significant differences between the study populations were found among several independent variables of risk factors such as household location and exposure sources, and occupational exposure. Gavage of d-penicillamine significantly reduced BLL to the acceptable level (BLL 10 μg/dl).Childhood lead poisoning accounts for a substantial burden in Gaza Strip. Hotspots of lead-related industries are the high risk areas that contributing to high BLLs in children. d-Penicillamine was effective in the treatment of lead poisoning among children. Health education and treatment campaigns should be designed to minimize or prevent childhood lead poisoning in Gaza Strip.

Aim To ascertain the pattern of diabetes management during Ramadan fasting in childhood and adolescence among physicians in Arab countries. Methods An online electronic survey questionnaire was distributed to physicians registered in the Arab society for Paediatric Endocrinology and Diabetes (ASPED). Results Of the 167 responders, 114 (86.0%) were paediatricians and the remaining 14.4% were adult physicians. 117 (79.6%) would allow patients to fast and 60.7% of them emphasized providing education before fasting. 69.1% of physicians thought that their patients complete >50% of fasting days. 46.9% recognized those with hypoglycemia unawareness among the very high-risk group for fasting. 62% reported that fasting should be broken if symptomatic hypoglycemia regardless of glucose level and 48.2% indicated that blood glucose above 300 mg/dl is another indication. 63.4% of respondents would decrease basal insulin by 25%, and 52.8% reported that using insulin pump during fasting reduced the frequency of hypoglycemia. 81.1% recommend several dietary adjustments and 56.4% used rapid-acting insulin analog according to carbohydrate counting. Conclusions There is a wide variation in the management of children and adolescents with diabetes during Ramadan in ASPED countries. A targeted educational program for physicians and establishing a guideline for this challenging area is needed.

Encounter with outgroup has been shown to elicit physiological stress response and when outgroup is perceived as threatening to one's own family and community, stress is higher. In such contexts, becoming familiar and learning to empathize with the other side may reduce stress. Building on the long-lasting Israeli-Palestinian conflict, we developed an eight-week group intervention focused on dialogue and empathy and tested it within a randomized controlled trial. Eighty-eight Israeli-Jewish and Arab-Palestinian adolescents (16-18 years) were randomly assigned to intervention or control groups. Before(T1) and after(T2) intervention, one-on-one interaction with outgroup member was videotaped, cortisol levels assessed five times during a 2.5-hour session involving exposure to outgroup stimuli, and adolescents were interviewed regarding national conflict. Intervention reduced cortisol response to social contact and reminders of outgroup (F = 4.92, p = .032, Eta2 = 0.109). This HPA-activity suppression was defined by two pathways. First, intervention had a direct impact on cortisol decrease; and second, intervention increased youth's behavioral empathy during one-on-one interaction with outgroup member and this empathic response mediated the effect of intervention on cortisol reduction. Adolescents' belief in the potential for reconciliation at T1 predicted greater empathy at T2. Our study provides the first evidence-based intervention for youth growing up amidst intractable conflict and demonstrates its impact on adolescents' physiological stress response to outgroup. Results contribute to research on the neurobiology of ingroup/outgroup relations, highlight the key role of dialogical empathy and social interactions for interventions targeting youth, and emphasize the importance of enhancing motivation for social inclusion for initiating positive behavioral and physiological processes. Clinical Trials Registry ( NCT02122887 ; https://clinicaltrials.gov ).

Objective The aim of the current study was to compare the prevalence of, and risk factors for postpartum depression (PPD) among Jewish and Arab women in Israel. Design Data were obtained from a study on 'Family Relations and Violence' conducted in Israel in 2014–2015 using a multilayered nationwide representative sample of mothers who were interviewed face to face using a structured questionnaire in each woman's native language (Arabic / Hebrew) 6 weeks to 6 months postpartum. Setting 63 Maternal and Child Health (MCH) clinics from five geographical districts. Participants Jewish (N = 853) and Arab (N = 275) women aged 16–48 who were 6 weeks to 6 months postpartum. Measurements PPD was measured by the Edinburgh Postnatal Depression Scale with a cutoff of ≥10. We examined a range of risk factors using multivariate logistic regression analysis and Generalized Estimating Equations (GEE) for the total sample, then separately for each ethnic group. Results For the total sample (n = 1128). Prevalence of PPD was 10.3%. Prevalence among Arab women was significantly higher compared to Jewish women (20.8% vs 7%, respectively). In the multivariable analysis, chronic stress, low social support, and unwanted pregnancy were major risk factors for PPD for Arab women. Among Jewish women the risk factors for PPD included chronic stress, low level of education, and intimate partner violence. Conclusions Our findings indicate ethnic inequalities in the prevalence of, and risk factors for PPD in Israel that should be considered in health planning and policymaking. Implications for practice Maternal health care nurses and other professionals should be aware of these inequalities and provide culturally sensitive health care services and programs to protect women in these population groups from PPD.

Primary ciliary dyskinesia (PCD), also known as immotile-cilia syndrome, is a rare genetic disease that is inherited in an autosomal recessive manner. Several studies have explored certain aspects of PCD in the Arab world, yet much is still lacking in terms of identifying the different characteristics of this disease. In this paper, we aim to briefly cover those studies published about PCD in Arab countries, as well as to provide recommendations and guidelines for future studies.

Background Dyslipidemia is among the most significant risk factors of cardiovascular disease. Many patients with dyslipidemia fail to meet certain therapeutic targets as a result of clinical inertia. Aims To explore the views and opinions of physicians who often see and provide healthcare to patients with dyslipidemia on clinical inertia and to achieve consensus on the factors they believed promote clinical inertia in the Palestinian clinical practice. Methods This study was conducted in an observational design using the Delphi technique as a formal consensus method. A panel of fifty physicians participated this study. A two Delphi rounds were followed to achieve consensus on a list of factors they believed promoted clinical inertia. Results The majority (86%) of the panelists believed that clinical inertia was prevalent in caring for patients with dyslipidemia. Of the 40 factors initially included in the questionnaire, consensus was achieved on 21 (52.5%) factors related to the physician, 10 (25.0%) factors related to the patient, and 5 (12.5%) factors related to the office and healthcare system as promoters of clinical inertia in the first and second Delphi rounds. Discussion This study highlights factors promoting clinical inertia in managing dyslipidemia from the views of physicians who often provide healthcare to patients with dyslipidemia. Conclusion Consensus was achieved on factors related to the physician, patient, and healthcare system that promote clinical inertia in caring for patients with dyslipidemia in the Palestinian clinical practice by a panel of physicians who often provide healthcare to those patients. Further studies are still needed to design strategies to eliminate or reduce the phenomenon of clinical inertia in caring for patients with dyslipidemia and improve patient outcomes.

Aim The purpose of this study is to assess the effectiveness of the Diabetes Comprehensive Care Model (DCCM) intervention on diabetes care outcomes. We hypothesized that participants receiving diabetes care from the mobile diabetes clinic (intervention group) would demonstrate significant improvement in glycemic control compared to those receiving treatment as usual (control group). Materials and methods We conducted a longitudinal, quasi-experimental study in which two similar clinics were identified. From both, we recruited 100 patients diagnosed with Type II diabetes. At baseline, patients were similar in terms of both socio-demographic and diabetes health variables. The team visited patients at the Bethlehem clinic at the beginning and end of the study (control group). Mobile diabetes care teams implemented the DCCM in Hebron four times over one year (treatment group). Results Most participants were female (63.5%) with average diabetes duration of 7.9 years. Initial HbA1c was 9.49% on average (SD = 1.93) and 9.20% (SD = 1.92) for the control and intervention groups, respectively. Statistically significant change in HbA1c, cholesterol, creatinine and systolic BP were observed in the intervention group (differences in change between recruitment and follow-up). That is, significant improvement over time was observed for the treatment group whereas little or no change was observed for the control group. Conclusion The DCCM-based intervention leads to improved glycemic control parameters indicative of diabetes control. Clinically significant change was observed in treatment group only. Integrative diabetes care appears especially well suited for fragmented healthcare systems with limited resources.

PURPOSE: To investigate associations between food insecurity experience and subjective wellbeing in Arab youth, across different political stability settings. METHODS: Data from the Gallup World Poll (2014-2015) were extracted for youth aged 15-24 years living in 19 Arab countries (n = 8,162). Food insecurity was assessed using the Food Insecurity Experience Scale. Life Evaluation Score and Affect Balance were used as indicators of youth wellbeing. The 2014 Political Stability and Absence of Violence and Terrorism score was used to stratify Arab countries into three categories; high, medium, and low political stability. Multivariable regressions were performed to explore the relationship between food insecurity and wellbeing indices adjusting for socio-demographic and socio-economic factors, across different political stability settings. RESULTS: The prevalence of food insecurity among Arab youth ranged between 3.1% in Lebanon to 91.3% in South Sudan. Food insecurity (moderate and severe) was negatively correlated with life evaluation (β: -0.74 for moderate food insecurity; -1.28 for severe food insecurity, p-value

Purpose Phonological processes are systematic changes in sound classes, sound sequences or syllable structure. The aim of this study was to develop an assessment tool for identification of developmental phonological processes in Arabic-speaking Egyptian children in order to provide normative data of phonological processes in typically developing children and distinguish between normal children and children with phonological impairment. Method The study design was a cross-sectional descriptive one. Mansoura Arabic Test for Phonological Processes (MATPP) was developed to elicit children’s single–word productions through picture naming task. After being pilot-tested, the MATPP was presented to a group of 120 typically developing children in the age range 2–5 years and another group of 30 children with developmental language disorder (DLD) in the age range 2½ - 5years for test validation. Results Assimilation processes were the commonest phonological processes followed by syllable structure processes and substitution processes. In contrast to English language, prevocalic devoicing, backing of fricatives and glottal replacement were considered normal for Egyptian children. The face validity was demonstrated by judging all words of the MATPP for being completely relevant to the purpose for which it was meant and Criterion -related validity was demonstrated by higher scores of the DLD children in all phonological processes. MATPP presented test-retest reliability when re-administered by the same examiner or a different examiner to the same child within a two week interval. Conclusion MATPP is a valid and reliable assessment tool for identification of phonological processes in Arabic-speaking Egyptian children and can differentiate typically developing children from those with a phonological impairment.

Resilience is increasingly recognised as a key process mitigating the impact of shocks and stressors on functioning. The literature on individual and community resilience is being extended to address characteristics of resilient service delivery systems in contexts of adversity. The validity and utility of a capacity-oriented resilience framework (including absorption, adaptation and transformation) is examined with respect to the functioning of United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) health systems in Lebanon and Jordan in the context of the Syrian crisis. We completed 62 semi-structured interviews (30 in Lebanon in November–December 2016, and 32 in Jordan in January 2017) with professionals at primary care, area, and country management levels. Participants reflected on changes in population health status and health service delivery during the Syrian crisis, notably with respect to the influx of refugees from Syria. Interviews were analysed through inductive thematic analysis and used to critically interrogate health systems resilience against a pro-capacities framework. We find that UNRWA systems in Lebanon and Jordan were broadly resilient, deploying diverse strategies to address health challenges and friction between host and refugee populations. Absorptive capacity was evidenced by successful accommodation of increased patient numbers across most service areas. Adaptive capacities were reflected in broadening of collaboration and reconfiguration of staff roles to enhance service delivery. Transformative capacities were demonstrated in the revision of the service packages provided. While manifest as technical capacities, these clearly drew upon solidarity and commitment linked to the political context of the Palestinian experience. The study adds to the limited literature on health system and organizational resilience and indicates that capacity-oriented framings of resilience are valuable in extracting generalizable lessons for health systems facing adversity. The proposed resilience framework promises to guide strategies for sustained care delivery in these contexts.

As surges of the COVID-19 pandemic continue globally, including in Palestine, several new SARS-CoV-2 variants have been introduced. This expansion has impacted transmission, disease severity, virulence, diagnosis, therapy, and natural and vaccine-induced immunity. Here, 183 whole genome sequences (WGS) were analyzed, of which 129 were from Palestinian cases, 62 of which were collected in 11 Palestinian districts between October 2020 and April 2021 and sequenced completely. A dramatic shift from the wild type to the Alpha variant (B 1.1.7) was observed within a short period of time. Cluster mapping revealed statistically significant clades in two main Palestinian cities, Al-Khalil (Monte Carlo hypothesis test-Poisson model, P = 0.00000000012) and Nablus (Monte Carlo hypothesis test-Poisson model, P = 0.014 and 0.015). The phylogenetic tree showed three main clusters of SARS-CoV-2 with high bootstrap values (90). However, population genetics analysis showed a genetically homogenous population supported by low Wright's F-statistic values (Fst0.25), high gene flow (Nm 3), and statistically insignificant Tajima's D values (Tajima's test, neutrality model prediction, P = 0.02). The Alpha variant, rapidly replaced the wild type, causing a major surge that peaked in April 2021, with an increased COVID-19 mortality rate, especially, in the Al-Khalil and Nablus districts. The source of introduction remains uncertain, despite the minimal genetic variation. The study substantiates the use of WGS for SARS-CoV-2 surveillance as an early warning system to track down new variants requiring effective control.

Differences have been reported in incidence rates of fractures in the pediatric population, between countries and over time. The aim of this study was to evaluate the incidence and characteristics of fractures over 20 years among Israeli children.Incidence rates of fractures were derived from the electronic database of Meuhedet Health Services, a health maintenance organization providing healthcare services to 1.2 million people in Israel. Demographic and clinical data were extracted of all the fractures in individuals aged18 years during 2000-2019. Fracture sites were determined according to ICD9 definitions. Fracture data were analyzed by age, sex, season and sector (general Jewish population, ultra-orthodox Jews and Arabs).During the study period 188,283 fractures occurred in 142,049 individuals. The most common were fractures of the upper limb (65%), followed by fractures of the lower limb [20%]. The overall fracture rate was 251 per 10,000 person- years (PY), and was higher for boys than girls (319 vs. 180 per 10,000 PY, p 0.001). During 20 years, standardized fracture rates decreased significantly in the general Jewish population, among both boys (from 457 to 325 per 10,000 PY, p 0.001) and girls (from 244 to 196 per 10,000 PY, p 0.001); increased among ultra-orthodox Jewish boys (from 249 to 285 per 10,000 PY, p = 0.002) and girls (from 147 to 194 per 10,000 PY, p 0.001); and did not change significantly among Arab boys and girls. The fracture rate peaked among girls aged 10-11 years and among boys aged 12-13 years. Seasonal variation showed a bimodal distribution with peaks during spring and autumn.The incidence of pediatric fractures is affected by age, gender, sector and season. Recognition of fracture characteristics may help identify specific populations and conditions for targeted prevention strategies.

This qualitative study was conducted to explore the current status of caring for women with epilepsy (WWE) in the Palestinian healthcare system.This study used an explorative qualitative design. A purposive sampling technique was used to recruit the participants. Semi-structured in-depth interviews were conducted with neurologists (n = 6), gynecologists (n = 5), psychiatrists (n = 3), an internist (n = 1), and clinical pharmacists (n = 5). The interpretive description methodology was used to thematically analyze the qualitative data.A total of 745 min (12.4 h) of interview time were analyzed. The qualitative data collected in this study were categorized under 3 major themes and multiple subthemes. The 3 major themes were: (1) diagnosis and care for patients with epilepsy, (2) general issues in caring for patients with epilepsy, and (3) consideration of women's issues in the pharmacotherapy of epilepsy. Formally adopted protocols/criteria for the diagnosis and care for WWE were lacking.Findings of this qualitative study showed a need to formally adopt uniform guidelines that can guide the diagnosis and care of WWE in the Palestinian healthcare system. The findings of this study might be informative to healthcare providers, decision-makers in healthcare authorities, WWE, and patient advocacy groups who could be interested in improving and benchmarking healthcare services provided to WWE. Future studies are still needed to quantitatively measure adherence to the international guidelines in caring for WWE.

Type 2 diabetes mellitus (T2DM) is a growing pandemic that will lead, if not managed and controlled, to frequent complications, poor quality of life, and high rates of disability and death. Little is known about T2DM complications in Palestine. The aim of this study is to estimate the prevalence of T2DM complications in Ramallah and al-Bireh governorate of Palestine.The study was conducted in eleven primary healthcare clinics offering services for persons with T2DM. Macrovascular complications were assessed using the Diabetes complication index. Microvascular complications were measured by physical examinations and laboratory tests. Questionnaires, laboratory tests, and physical examinations were used to assess socio-demographic characteristics, co-morbidities and other risk factors.517 adult men and nonpregnant women participated in the study (166 men, 351 women). The response rate was 84%. Mean age and mean duration of diabetes were 58.1 and 9.4 years respectively. Prevalence of diagnosed microvascular and macrovascular complications was 67.2% and 28.6% respectively. 78.2% of the participants had poor glycemic control (HbA1c≥7.0%).Significant proportions of persons with T2DM had macro- and microvascular complications and poor metabolic control. These findings are important for policy development and the planning of health services.

BACKGROUND Immunization has a significant impact in protecting from severe diseases. Various factors that could influence child immunization coverage and parents' decisions about vaccinating their children should be further explored in specific population groups. OBJECTIVES The current study has two main objectives: to assess the main information sources that affect parental decisions to vaccinate their children and to measure the extent to which these factors differ demographically by exploring the opinions and attitudes within four main population groups in Israel: ultra-Orthodox Jews, all other Jews, non-Bedouin Arabs, and Bedouins. METHODS 1504 parents, with similar representation among four main population groups, participated in this study. A structured, anonymous, self-administered questionnaire was used. RESULTS The most influential source on parents' decisions to vaccinate their children was the nurse at Mother and Child Health Clinics (MCHCs). Positive attitudes were shown regarding the key role of immunization in preventing severe diseases, while the most important concern expressed was the potential pain to the child while being vaccinated (rather than the safety of the vaccine). Higher compliance rates were reported among participants with a non-academic education level (χ2 = 12.21, p

Summary The UN Sustainable Development Goals affirm equality and dignity as essential to the enjoyment of basic human rights, including the right to the highest attainable standard of physical and mental health, which promotes global solidarity among all people, including refugees. The UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has provided support to Palestine refugees in Jordan, Lebanon, Syria, the Gaza Strip, and the West Bank since the 1950s. Today, however, conflict and violence, occupation, high levels of poverty, and other social determinants of health jeopardize the wellbeing of Palestine refugees. Health concerns include non-communicable diseases, mental health conditions, and access to hospital care. Additionally, UNRWA is continuing to face a severe funding crisis. Using a historical and health policy perspective, this Health Policy examines UNRWA strategies that facilitate continuous provision of health-care services for Palestine refugees. Given the increasingly volatile environment faced by this population, a multifaceted international response is needed to enable UNRWA to deliver sustainable services to Palestine refugees and avert further loss of life, dignity, and hope, pending a just and lasting solution to their plight in accordance with applicable international law and UN General Assembly resolutions.