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This study determined the prevalence and the associated factors with meeting the recommended amount of physical activity among type 2 diabetes mellitus (T2DM) patients receiving care in resource-limited settings of the West Bank of Palestine. Physical activity was assessed using the World Health Organization's Global Physical Activity Questionnaire. Associations were examined using multivariate logistic regression. Of the 302 patients included, 117 (38.7%) met the recommended amount of physical activity. Being younger than 58 years [aOR = 2.1 (95% CI 1.0–4.3], were employed [aOR = 2.3 (95% CI 1.1–4.9)], had high income [aOR = 3.9 (95% CI 1.3–11.9)], had thought that physical activity was crucial for T2DM patients [aOR = 32.7 (95% CI 3.9–275.5)], did not have comorbidities [aOR = 2.2 (95% CI 1.1–4.4)], had normal weight [aOR = 2.8 (95% CI 1.3–6.0)], and those who were overweight [aOR = 2.6 (95% CI 1.1–6.0)] were more likely to meet the recommended amount of physical activity compared to the patients who were 58 years or older, had low income, did not think that physical activity was crucial for T2DM patients, had comorbidities, and were obese, respectively. There is a need to increase physical activity among T2DM patients in resource limited settings. [ABSTRACT FROM AUTHOR]

Pharmacists are trusted and easily accessible healthcare providers. We assessed awareness and knowledge of symptoms, etiology, and treatment of autism spectrum disorders (ASDs) among pharmacists practicing in Palestine. The pharmacists reported low familiarity with ASDs. The median score on the 12-item knowledge section was 50.0% with an interquartile range of 16.7%. Having course(s) or lecture(s) on ASDs during pharmacy degree program was significantly associated with familiarity ("p" value <0.001), knowledge ("p" value <0.001), and confidence ("p" value <0.05) scores. Nearly 62% of the pharmacists reported as not feeling confident enough in their ability to counsel parents about medications used for their children with ASDs and their side effects. This study revealed gaps in awareness and knowledge of ASDs among pharmacists.

Background and aims: Genetic knowledge and familiarity among the population represent the lane toward effective participation in social decisions regarding genetic issues. This cross sectional research aimed to assess genetic knowledge and familiarity among university students in Palestine. Methods: The familiarity with genetics was evaluated using the Genetic Literacy and Comprehension instrument (GLAC), and genetic knowledge was measured using a 16-item scale of prevalent genetic concepts. Results: Among the 624 participants, 59.5% were females. 38.8% reported family history of genetic diseases. The genetic familiarity mean score was 4.83 and the genetic knowledge mean total score was 11.5. Students' genetic familiarity was high for the terms chromosome and genetic while it was low for the terms sporadic and vulnerability. Genetic knowledge was highest for gene definition while it was the lowest regarding the number of human genes. The age group, year of study, and learning genetic courses were the significant predictors of familiarity among medical students. The year of study, family history of genetic diseases, parental consanguinity, and learning genetic courses were the significant variables associated with genetic knowledge among medical students. Regarding the non-medical group of participants, all study variables were significant for both familiarity and knowledge scores except for age group with familiarity. Conclusion: Genetic familiarity and knowledge among Palestinian university students are inadequate. Consanguinity and hereditary disorders are prevalent in Palestine. These findings encourage university stakeholders to take action to improve genetic knowledge and familiarity among students through both appropriate pedagogical and non-pedagogical interventions. [ABSTRACT FROM AUTHOR]

Little studies were conducted to assess the health –related quality of life (HR-QoL) of patients with multiple myeloma (MM) in developing and resource-limited countries. This study assessed the HR-QoL of patients with MM who received treatment in the Palestinian healthcare system as an example of healthcare systems in developing and resource-limited countries. Predictors of deteriorated HR-QoL of the affected patients were also identified. In this cross-sectional study, the tool was a questionnaire that collected the demographic and disease variables of the patients. The questionnaire also contained the EORTC QLQ-MY24 items. The questionnaire was piloted to ensure readability, clarity, and comprehensibility. Additionally, the test–retest reliability and internal consistency were also assessed. In this study, 45.5% of patients with MM who were treated in the Palestinian healthcare system returned usable questionnaires. The mean age of the patients was 60.7 ± 7.5 years and the mean time elapsed since diagnosis was 2.6 ± 1.7 years. Of the patients, 54.3%, 47.8%, 46.7%, 66.3%, 46.7%, and 46.7% reported frequent bone pain, pain that increased with activity, back pain, feeling ill, lost hair, and feeling restless or agitated, respectively. Higher disease symptom scores were predicted by low self-rated satisfaction with the ability to do daily life activities and low self-rated satisfaction with overall health. The side effects of treatment scores were predicted by longer time elapsed since diagnosis and low self-rated satisfaction with overall health. Future perspective scores were predicted by low self-rated satisfaction with overall health. On the other hand, social support scores were predicted by having a university education and not receiving radiotherapy. Patients with MM who were treated in the Palestinian healthcare system reported a heavy burden of disease symptoms, treatment adverse effects, and dissatisfaction with the information they received about their disease. The findings reported in this study are informative to hemato-oncologists and other healthcare providers who care for patients with MM in Palestine and other developing and resource-limited countries. Policymakers might use the findings reported in this study to design interventions to improve the HR-QoL of the patients. [ABSTRACT FROM AUTHOR]

Background: The discussion about breast cancer (BC) causation continues to be surrounded by a number of myths and misbeliefs. If efforts are misdirected towards reducing risk from false mythical causes, individuals might be less likely to consider and adopt risk-reducing behaviors for evidence-based BC causes. This national study aimed to assess the awareness of BC causation myths and misbeliefs among Palestinian women, and examine the factors associated with having good awareness. Methods: This national cross-sectional study recruited adult women from government hospitals, primary healthcare centers, and public spaces in 11 governorates in Palestine. A modified version of the Cancer Awareness Measure-Mythical Causes Scale was used to collect data. The level of awareness of BC causation myths was determined based on the number of myths recognized to be incorrect: poor (0–5), fair (6–10), or good (11–15). Results: A total of 5,257 questionnaires were included. Only 269 participants (5.1%) demonstrated good awareness (i.e., recognizing more than 10 out of 15 BC mythical causes). There were no notable differences in displaying good awareness between the main areas of Palestine, the Gaza Strip and the West Bank and Jerusalem (5.1% vs. 5.1%). Having chronic disease as well as visiting hospitals and primary healthcare centers were associated with a decrease in the likelihood of displaying good awareness. Myths related to food were less frequently recognized as incorrect than food-unrelated myths. 'Eating burnt food' was the most recognized food-related myth (n = 1414, 26.9%), while 'eating food containing additives' was the least recognized (n = 599, 11.4%). 'Having a physical trauma' was the most recognized food-unrelated myth (n = 2795, 53.2%), whereas the least recognized was 'wearing tight bra' (n = 1018, 19.4%). Conclusions: A very small proportion of Palestinian women could recognize 10 or more myths around BC causation. There is a substantial need to include clear information about BC causation in future educational interventions besides focusing on BC screening, signs and symptoms, and risk factors. [ABSTRACT FROM AUTHOR]

Background: Fear of anesthesia for cesarean section delivery is an important health issue that should be addressed by anesthesiologists, obstetricians, and other providers of antenatal and perioperative healthcare. This multicenter study was conducted to assess the fear of anesthesia for cesarean section among Palestinian pregnant women and to identify the predictors of high fear. Methods: The study was conducted in a cross-sectional design among Palestinian pregnant women in different antenatal healthcare clinics. The study participants were recruited using a convenience sampling procedure. The pregnant women were asked to respond to items in a questionnaire. Results: In this study, a total of 394 pregnant women completed the questionnaires. Of the pregnant women, 280 (71.1%) have had cesarean delivery under anesthesia, and 104 (26.4%) elected cesarean delivery. Multiple linear regression showed that higher fear scores were predicted by having a university degree (p-value < 0.001), living in rural areas (p-value = 0.007), dissatisfaction with social life (p-value = 0.004), satisfaction with religious commitment (p-value = 0.001), having had cesarean delivery under anesthesia (p-value = 0.005), and preference of cesarean delivery (p-value < 0.001). Conclusion: Fear of anesthesia was prevalent among pregnant women in Palestine. Higher fear could be predicted by education level, place of residence, satisfaction with social life, satisfaction with religious commitment, having had cesarean delivery under anesthesia, and preference for normal delivery. Anesthesiologists, gynecologists and obstetricians, nurses, midwives, and other providers of antenatal and perioperative healthcare services should consider these factors while counseling pregnant women and addressing their fear of anesthesia. [ABSTRACT FROM AUTHOR]

Background: Anesthesia training is an important component of medical education. This multicenter study was conducted to determine the teaching approaches used during anesthesia training or rotations and to assess the satisfaction of the medical students. Methods: This multicenter study was conducted in a cross-sectional design. The study was conducted among 5th and 6th year medical students who completed their anesthesia rotations in different training centers in Palestine. The data were collected using a questionnaire in adherence to the strengthening the reporting of observational studies in epidemiology statement. Results: Questionnaires were returned by 385 medical students. The mean anesthesia rotation length was 12.4 ± 2.1 days. On average, the students witnessed 7.8 ± 4.9 procedures performed under general, regional, and local anesthesia in a week. Of the students, 135 (35.1%) and 126 (32.8%) stated that the educators always or often explained how and why they did procedures or techniques during the anesthesia rotation and assessed their baseline level of knowledge before giving new knowledge or explaining things. On the other hand, stepping back and allowing the trainees to work through, presenting articles or literature relevant to the case, and being open to trying new or different procedures or techniques were less often reported by the medical students. Less than half of the students were satisfied with their competencies gained through the anesthesia rotation. Conclusion: Educators used active and effective teaching or training approaches less frequently during the anesthesia rotations. The findings of this study also showed that the medical students were not satisfied with their competencies after their anesthesia rotations. More studies are still needed to determine the best ways to improve anesthesia rotations and medical education or training in Palestine. [ABSTRACT FROM AUTHOR]

Background: Preoperative anxiety is a health concern among patients scheduled for surgical interventions. Little is known about the prevalence of preoperative anxiety among patients in different healthcare systems of developing countries. This study was conducted to determine the prevalence of preoperative anxiety among patients undergoing surgery in Palestine. Another objective was to identify the factors associated with preoperative anxiety. Methods: This study was conducted in a cross-sectional descriptive design. Patients scheduled for surgical interventions were interviewed using an interviewer-administered questionnaire. The questionnaire collected the demographic, clinical, and surgical variables of the patients. The questionnaire also contained the Amsterdam preoperative anxiety and information scale (APAIS), and a short version of the Spielberger state-trait anxiety inventory (STAIS-5/STAIT-5). Result: A total of 280 patients were included. The mean APAIS total score was 13.6 ± 5.9, the mean APAIS anxiety domain score was 8.3 ± 4.3, and the mean APAIS need for information domain was 1.6 ± 0.50. Of the patients, 76 (27.1%) had high anxiety and 160 (57.1%) expressed a high need for information. The higher APAIS anxiety scores were predicted by being female, having chronic diseases, being scheduled to be operated on within 24 h, and having experienced surgical complications. The mean STAIS-5 score was 10.0 ± 4.2 and the mean STAIT-5 was 10.3 ± 3.8. Of the patients, 140 (50.0%) had high state anxiety and 56 (20.0%) had high trait anxiety. Higher STAIS-5 scores were predicted by being female, younger than 42 years, and scheduled to be operated on within 24 h. Higher STAIT-5 scores were predicted by being female. A positive correlation was identified between APAIS total, APAIS anxiety, APAIS need for information, STAIS-5, and STAIT-5 scores. Conclusion: Preoperative anxiety was prevalent among patients scheduled for surgical operations in Palestinian hospitals. Anesthesiologists and other providers of perioperative care should screen preoperative patients who are female, have chronic diseases, are scheduled to be operated on within 24 h, and having had experienced surgical complications for preoperative anxiety. More studies are still needed to investigate the effects of the implemented measures on the prevalence of preoperative anxiety. [ABSTRACT FROM AUTHOR]

Background: Burnout is a psychological syndrome that involves physical, mental, and emotional exhaustion. This study was conducted to determine the prevalence of burnout among unmatched trainees and residents in surgical and nonsurgical specialties in Palestine. Additionally, this study also sought to identify the associated variables and predictors of higher burnout scores. Methods: This study was conducted in a cross-sectional design using a questionnaire in the period between October 2020 and March 2021. The questionnaire collected sociodemographic characteristics of the residents and trainees in 18 different training centers/hospitals. The Copenhagen Burnout Inventory was used to determine burnout among the residents and trainees. Pearson's correlations, analysis of variance, Student's t-test, and multiple linear regressions were used to analyze the data. Results: The study tool was completed by 250 residents and trainees in surgical and nonsurgical specialties (response rate = 83.3%). Of all participants, 203 (81.2%) reported a moderate-severe degree of burnout in the personal domain, 188 (75.2%) reported a moderate-severe degree of burnout in the work-related domain, and 97 (38.8%) reported moderate-severe degree of burnout in the client-related domain. There was a moderate and positive correlation between personal and work-related burnout scores (Pearson's r = 0.69, p-value < 0.001), and client-related burnout scores (Pearson's r = 0.52, p-value < 0.001). Similarly, there was a moderate and positive correlation between work-related and client-related burnout scores (Pearson's r = 0.57, p-value < 0.001). The multiple linear regression model showed that higher burnout scores were predicted by being married, not having another paid employment, inability to financially support oneself, frequent consumption of tea/coffee, dissatisfied with the training/job, thinking to change the profession, and long working hours. Conclusion: The findings of this study indicated that burnout was highly prevalent among residents and trainees in surgical and nonsurgical specialties in Palestine. Decision-makers in healthcare authorities, hospital managers, professional groups, directors of residency programs, and educators/trainers should consider addressing burnout and improving the well-being of residents and trainees in surgical and nonsurgical specialties in Palestine. Future studies are still needed to determine which interventions could be effective in reducing burnout among residents and trainees in surgical and nonsurgical specialties in Palestine. [ABSTRACT FROM AUTHOR]

Background: Overactive bladder (OAB) is a popular distressing health condition that has negative impact on health-related quality of life (HRQoL) of the inflicted individuals. This multicenter study was conducted to determine the prevalence of OAB symptoms and their impact on the HRQoL of medical and dentistry students.Methods: This study was conducted in a cross-sectional design in the 3 main universities in Palestine. In addition to the sociodemographic, health, and academic characteristics of the medical and dentistry students, the questionnaire also contained the OAB symptom bother (6-items) and HRQoL (13-items) Short-Form (OAB-q SF) scales. Kruskal-Wallis test, Mann-Whitney U test, Pearson Chi-Square/Fisher's Exact Test, Spearman's rank correlations, and a multiple linear regression model were used to analyze the data.Results: Responses were collected from medical and dentistry students (n = 402). The median OAB symptom bother score was 54.1 [44.8, 81.9] and the median HRQoL score was 94.4 [88.4, 94.4]. There was a strong negative correlation between the OAB and HRQoL scores (Spearman's rho = 64.4%, p value < 0.001). OAB scores were significantly higher among dentistry students, females, who had chronic disease, and those who reported stressful life. HRQoL scores were significantly higher among medicine students, those who reported less stressful life, and those who reported satisfaction with their social life. Dentistry students, female, and those who self-reported high stress were 1.94-fold (95% CI 1.05, 3.56), 1.91-fold (95% CI 1.16, 3.14), and 1.88-fold (95% CI 1.21, 2.91) more likely to report less than optimal HRQoL compared to medicine students, male, and those who self-reported low stress, respectively.Conclusions: Our findings suggested that OAB symptoms were prevalent among medical and dentistry students across Palestinian universities. Decision makers in academia, healthcare authorities, and advocacy groups might need to design appropriate interventions to address health and wellbeing issues of medical and dentistry students. Using appropriate diagnostic procedures, reducing stress, and improving the social life might help in reducing the burden on OAB and improve the HRQoL of medical and dentistry students. More investigations should be conducted to investigate if such interventions are effective in reducing OAB symptoms and improving HRQoL. [ABSTRACT FROM AUTHOR]

Background: Medical students are the future workforce of physicians in primary, secondary, tertiary, and highly specialized care centers. The present study was undertaken to assess familiarity, knowledge, confidence, of medical students with regard to autism spectrum disorders (ASDs). Methods: This multicenter study was conducted in a cross-sectional design among medical students in the 3 main universities in Palestine. In addition to the sociodemographic and academic details, the questionnaire measured familiarity (8-items), knowledge (12-items), confidence and willingness to learn (5-items) with regard to ASDs. Results: The questionnaire was completed by309 medical students (response rate = 77.3 %). The median familiarity, knowledge, and confidence scores were 50 % (42.5 %, 57.5 %), 50 % (41.7 %, 66.7 %), and 60.0 % (54.0 %, 68.0 %), respectively. There was a positive moderate correlation between familiarity and knowledge scores (Spearman's rho = 0.29, p-value < 0.001) and familiarity and confidence scores (Spearman's rho = 0.34, p-value < 0.001). Medical students who have received a course on autism were 3.08-fold (95 % C.I. of 1.78–5.31) more likely to score ≥ 50 % on the familiarity items compared to those who did not receive a course. The medical students who were in their clinical academic stage, who received a course on ASDs, and those who interacted with individuals with ASDs were 2.36-fold (95 % C.I. of 1.34–4.18), 2.66-fold (95 % C.I. of 1.52–4.65), and 2.59-fold (95 % C.I. of 1.44–4.63) more likely to score ≥ 50 % on the knowledge items. Medical students who reported high satisfaction with their social life were 2.84-fold (95 % C.I. of 1.15-7.00) more likely to score ≥ 50 % on the confidence items. Conclusions: The present study identified considerable awareness and knowledge gaps among medical students with regard to ASDs. Medical students in this study reported low confidence in their ability to provide healthcare services to individuals with ASDs. Appropriately designed educational interventions might improve familiarity, knowledge, and confidence of medical students. More studies are still needed to investigate if such interventions can improve healthcare services for individuals with ASDs. [ABSTRACT FROM AUTHOR]

Objective: Pediatric acute lymphoblastic leukemia (ALL) is the most prevalent type of cancer among children. This study was conducted to describe and correlate the clinical characteristics and outcomes of treatment of patients with pediatric ALL in the main referral hospital in Palestine. Results: Complete data of 69 patients were included in this analysis. The majority (79.7%) of the patients had B-ALL phenotype. After induction chemotherapy, remission was experienced by the vast majority of the patients and 5 (7.2%) experienced relapses. Cytogenetics for patients with B-ALL phenotype indicated that 10 (18.2%) patients had t(12, 21) translocation, 5 (9.1%) had hyperdiploidy, 4 (7.3%) had t(1, 19) translocation, and 2 (3.6%) had t(9, 22) translocation. The initial white blood cells (p value < 0.001), absolute neutrophils (p value = 0.011), and hemoglobin (p value < 0.001) were significantly lower in patients with B-cell ALL. Platelet counts were significantly lower (p value = 0.012) in patients with splenomegaly and those with bleeding symptoms (p value = 0.008). Presence of palmar pollar was positively associated (p value = 0.035) with T-cell ALL. Presence of hepatomegaly was positively associated (p value < 0.001) with splenomegaly. [ABSTRACT FROM AUTHOR]

INTRODUCTION This study aimed to determine associations between health warning label content and motivation to quit waterpipe smoking by gender and smoking location. METHODS Convenience samples of university students in three Eastern Mediterranean countries - Egypt (n=442), Jordan (n=535) and Palestine (n=487) - completed an online survey assessing health warning labels. Multinomial logit regression models were conducted to determine the association between different variables, particularly gender and smoking location, with motivation to quit. RESULTS In Palestine, female smokers were more motivated to quit waterpipe smoking when seeing textual warning labels related to children (T2) and pregnancy (T6) [T2: 1.8 (95% CI: 1.1-2.8), T6: 2.7 (95% CI: 1.6-4.3)] compared to males. Similar results were found in Jordan [T2: 1.6 (95% CI: 1.0-2.6), T6: 1.8 (95% CI: 1.1-3.0)]. As for the smoking location, home-only smokers in Palestine were more likely to quit in response to the following warnings: waterpipe smoking is addictive T1: 2.3 (95% CI: 1.4-3.7), harmful for children T2: 2.3 (95% CI: 1.4-4.1), harmful for the baby during pregnancy T6: 2.4 (95% CI: 1.3-4.3), and to believe that quitting reduces the health risks T9: 1.8 (95% CI: 1.0-3.1). These results were not found in Jordan nor Egypt. Smokers reported that the most noticeable location of a HWL on a waterpipe device is the mouthpiece. CONCLUSIONS A better understanding of motivation to quit and its association with various warnings and smoking location could guide countries on which warnings to require in legislation and where best to require them particularly in relation to location. [ABSTRACT FROM AUTHOR]

Background: Among all cancers, breast cancer is the most prevalent cancer and the leading cause of mortality among women in developing countries including Palestine. Community pharmacists are trusted and easily accessible healthcare providers who could be engaged in breast cancer health promotion. This study was conducted with the aim of exploring knowledge, attitudes, beliefs, and barriers toward breast cancer health promotion among community pharmacists in the Palestinian territories.Methods: This study was conducted in a cross-sectional design using a questionnaire among community pharmacists. Knowledge of community pharmacists of breast cancer was tested using a 26-item knowledge test. Attitudes and beliefs of the community pharmacists with regard to breast cancer promotion were explored using 14 items. Barrier to breast cancer health promotion were explored using 9 items.Results: Data were collected from 200 community pharmacists. The median knowledge score was 69.2 % with and IQR of 15.2 %. Of the community pharmacists, 67.5 % scored 50 % and above in the knowledge test. Multivariate logistic regression showed that community pharmacists who were female in gender were more likely to score 50 % and above in the knowledge test compared to the community pharmacists who were male in gender (OR = 4.73, 95 % CI of 2.26-9.89). The community pharmacists had positive attitudes toward breast cancer health promotion. There was a significant moderate positive correlation between knowledge and attitudes scores (Spearman's rho = 0.37, p-value < 0.001). Lack of reimbursement, lack of enough personnel, lack of time, and fear of offending the patients were the main barriers to breast cancer health promotion (percentage of agreement > 60.0 %).Conclusions: This study shed light on the role of community pharmacists in breast cancer health promotion. Pharmacists had good knowledge of breast cancer and positive attitudes toward promoting the health of patients with breast cancer. Further studies are still needed to determine how to integrate community pharmacists in the team of healthcare providers caring for patients with breast cancer. [ABSTRACT FROM AUTHOR]

Background: Co-existence of depression and anxiety can be associated with severe detrimental consequences to the physical, mental and social wellbeing of the affected populations. This study was conducted to determine prevalence of depressive and anxiety symptoms among Palestinian medical students and to investigate associations between sociodemographic factors of the students with depressive and anxiety symptoms. Methods: This study was conducted in a cross-sectional observational design using a questionnaire in the period between September 2018 and April 2019 in a major university in the West Bank of Palestine. Depressive symptoms were assessed using the Beck Depression Inventory-II (BDI-II) and anxiety symptoms were assessed using the Beck Anxiety Inventory (BAI). The questionnaire also collected the sociodemographic characteristics of the students. Reliability of the questionnaire was tested using the test re-test method. A total of 425 medical students were invited to participate in the study. Results: Of those invited, 286 students completed the questionnaire, giving a response rate of 67.3%. More than half (56.6%) of the students had minimal depression, 20.3% had mild depression, 14.0% had moderate depression, 9.1% had severe depression, 23.4% had no anxiety, 29.7% had mild to moderate anxiety, 25.5% had moderate to severe anxiety, and 21.3% had severe anxiety. Multiple linear regression analysis showed that academic stage (p-value < 0.01), Grade Point Average (p-value < 0.01), mental health status (p-value < 0.001), ever attempted suicide (p-value < 0.05), and religious commitment (p-value < 0.01) were predictors of BDI-II scores. Multiple linear regression analysis showed that academic stage (p-value < 0.05) and mental health status (p-value < 0.001) were predictors of BAI scores. Conclusions: Depressive and anxiety symptoms were prevalent among Palestinian medical students in a major university in the West Bank of Palestine. Interventions might be designed to improve self-rated mental health of medical students in their academic years, ameliorate study conditions, and provision of counseling services to improve spirituality might be effective in reducing symptoms of depression and anxiety among medical students in Palestine. Future studies are still needed to investigate if these interventions could be useful in reducing depressive and anxiety symptoms among Palestinian medical students. [ABSTRACT FROM AUTHOR]

This article attempts to investigate the impact of the mixed electoral system on the creation of the state of cohabitation that occurred in the Palestinian political system after the second legislative elections in 2006, viewed through a theoretical framework based on the idea of divided societies. This study employed quantitative and qualitative research methods together. This study found several important results regarding this relationship. Firstly, cohabitation is more likely to occur when there is a low rate of party fractionalization (more polarization) produced in the mixed electoral system. Second, the strategic voting in this election was sensitive to the divided attitudes about the Israeli occupation. Third, the mixed electoral system did not greatly reduce the small parties punishment caused by the pluralistic system, which increased opportunities for creating a state of cohabitation. [ABSTRACT FROM AUTHOR]

Background Medication dispensing errors (MDEs) are frequent in community pharmacy practice. A definition of MDEs and scenarios representing MDE situations in Palestinian community pharmacy practice were not previously approached using formal consensus techniques. Objective This study was conducted to achieve consensus on a definition of MDEs and a wide range of scenarios that should or should not be considered as MDEs in Palestinian community pharmacy practice by a panel of community pharmacists. Setting Community pharmacy practice in Palestine. Method This was a descriptive study using the Delphi technique. A panel of fifty community pharmacists was recruited from different geographical locations of the West Bank of Palestine. A three round Delphi technique was followed to achieve consensus on a proposed definition of MDEs and 83 different scenarios representing potential MDEs using a nine-point scale. Main outcome measure Agreement or disagreement of a panel of community pharmacists on a proposed definition of MDEs and a series of scenarios representing potential MDEs. Results In the first Delphi round, views of key contact community pharmacists on MDEs were explored and situations representing potential MDEs were collected. In the second Delphi round, consensus was achieved to accept the proposed definition and to include 49 (59 %) of the 83 proposed scenarios as MDEs. In the third Delphi round, consensus was achieved to include further 13 (15.7 %) scenarios as MDEs, exclude 9 (10.8 %) scenarios and the rest of 12 (14.5 %) scenarios were considered equivocal based on the opinions of the panelists. Conclusion Consensus on a definition of MDEs and scenarios representing MDE situations in Palestinian community pharmacy practice was achieved using a formal consensus technique. The use of consensual definitions and scenarios representing MDE situations in community pharmacy practice might minimize methodological variations and their significant effects on the number and rate of MDEs reported in different studies. [ABSTRACT FROM AUTHOR]

• Caring for women with epilepsy can be challenged by many gender-related issues. • Healthcare system-, healthcare provider-, patient-, and society-related challenges and future directions were identified. • Addressing these challenges and applying the future directions can improve caring for women with epilepsy. This qualitative explorative study was conducted to explore the key challenges and future directions of caring for women with epilepsy (WWE) from the perspectives of healthcare professionals who provide care for WWE in Palestine. A qualitative explorative design was used in this study in adherence to the consolidated criteria for reporting qualitative research. The study participants were interviewed in semi-structured in-depth interviews using a pre-validated and pilot-tested interview schedule. The interpretative description approach was used to qualitatively analyze the contents of the interviews. Interviews were conducted with 6 neurologists, 5 gynecologists, 3 psychiatrists, 5 clinical pharmacists, and 1 internal medicine specialist. The current challenges and future directions in caring for WWE were grouped under healthcare system-, healthcare provider-, patient-, and society-related. Lack of adequate availability, accessibility, and affordability of neurology services and safe antiepileptic drugs (AEDs) were the main challenges. Increasing access of WWE to specialized neurology services and improving acceptance in the society were the main future directions. Findings of this study highlighted the key challenges and future directions of caring for WWE in a resource-poor healthcare system. Decision makers in health authorities, professional bodies, and patient advocacy groups should consider improving availability, accessibility, and affordability of neurology services and safe AEDs for WWE. Future studies are still needed to investigate if addressing these challenges can improve the care of WWE in Palestine. [ABSTRACT FROM AUTHOR]

• Students with epilepsy reported less engagement in physical exercise compared to their healthy peers. • Knowledge gaps and negative attitudes toward students with epilepsy were identified among physical educators. • Interventions are needed to improve knowledge and correct attitudes of physical educators about students with epilepsy. The study aimed to test knowledge and attitudes of physical educators in Palestine toward epilepsy and students with epilepsy. The study also aimed to identify the variables that were associated with adequate knowledge and positive attitudes toward epilepsy and students with epilepsy. This study was done in a cross-sectional design among physical educators in Palestinian schools. The questionnaire tested knowledge and attitudes of physical educators using 18-item and 12-statement tests, respectively. Complete questionnaires were returned by 226 physical educators (response rate = 75.3%). The median knowledge score of the physical educators on the 18-item knowledge test was 50% [33.0%, 61.0] and the median attitudes score of the physical educators on the 12-statemtns was 50.0% [42.0, 58.0]. Higher knowledge scores were associated with age, teaching experience, educational level, having known/interacted with people with epilepsy, and receiving education about epilepsy. Higher attitude scores were associated with gender, age, educational level, place of residence, type of school, having known/interacted with people with epilepsy, and receiving education about epilepsy. Knowledge gaps and negative attitudes toward epilepsy and students with epilepsy were identified among physical educators in Palestine. Appropriately designed interventions are still needed to improve knowledge and correct attitudes of physical educators about epilepsy and students with epilepsy. [ABSTRACT FROM AUTHOR]

The aim of this work was to report on imidacloprid [IUPAC name 1-(6-chloro-3-pyridylmethyl)-N-nitroimidazolidin-2-ylideneamine] residues in some vegetables, fruits, and water samples collected from the West Bank, Palestine, in 1998 and 1999. Imidacloprid and its derivatives in the study samples were extracted by methanol/water and oxidized into 6-chloronicotinic acid and subsequently derivatized into 6-chloronicotinic acid trimethylsilyl ester before being determined by GC/MS. Imidacloprid residues were detected in more than half of the analyzed samples. The highest and lowest imidacloprid concentrations were found in eggplant (0. 46 mg/kg) and green beans (0. 08 mg/kg), respectively. An increase of 11–120% in imidacloprid concentration in the 1999 samples was observed when compared with those of 1998. This may suggest imidacloprid accumulation in the soil and/or increased use by local farmers. The imidacloprid residue concentrations in several crops were found to exceed the CODEX maximum residue limit. [ABSTRACT FROM AUTHOR]

This article summarizes basic principles derived from Social Identity Theory for the case of minorities. It then uses them as a theoretical framework to discuss research findings on the self-categorization of the Palestinian minority in Israel. Based on recent findings, a "double marginality" model is proposed, according to which members of this minority internalize a marginal civic identity, alongside a marginal ethnic identity. It is argued that minority members resolve the inherent contradiction between their civic (Israeli) and ethnic (Palestinian) identities by separating the two, rather than by reconciling them. In addition to achieving a critical stability of the self, it is argued that such separation provides minority members with a reasonable degree of self-esteem. [ABSTRACT FROM AUTHOR]

• Patients with epilepsy may need anesthesia for epilepsy and nonepilepsy purposes. • Anesthesia poses challenges to anesthesiologists and patients with epilepsy. • Assessment, anesthetic, and recovery considerations were exposed. • Epilepsy-specific assessment and anesthesia protocols were lacking. • Findings may help benchmark quality of anesthesia for patients with epilepsy. This qualitative exploratory study was conducted to explore how anesthesiologists in Palestine provide perioperative care for patients with epilepsy and how they account for the unique challenges relevant to epilepsy while planning perioperative care for patients with epilepsy. This study was conducted in an explorative qualitative design. Purposive and snowball sampling approaches were used to recruit the study participants. Qualitative semi-structured in-depth interviews were conducted with anesthesiologists (n = 10) and a neurologist (n = 1). The qualitative data collected in this study were thematically analyzed using the interpretive description methodology to generate themes, subthemes, and patterns. Three major themes emerged from the collected qualitative data with a total of 18 subthemes. The 3 themes were: 1) considerations/challenges while assessing patients, 2) anesthetic considerations, and 3) recovery considerations. Lack of epilepsy-specific assessment and anesthesia protocols, underuse of neurology referral services, and lack of neuromonitoring were identified. Findings of this study highlighted the need to develop specific anesthesia protocols for patients with epilepsy. Anesthesiologists and planners of perioperative care should improve collection of patient information and assessment methods, ensure control over seizures, reduce triggers of seizures, and improve patient monitoring approaches. Findings of this study might be used to inform anesthesiologists and decision makers in professional groups, patient advocacy groups, and healthcare authorities to benchmark and improve anesthesia care and services offered to patients with epilepsy. More studies are still needed to quantitatively assess the quality of anesthesia care and services provided to patients with epilepsy. [ABSTRACT FROM AUTHOR]

Therapeutic drug monitoring (TDM) can play a major role in optimizing pharmacotherapy of epilepsy. This study was conducted to explore views and opinions of clinicians who care for patients with epilepsy (PWE) in Palestine and to develop consensus-based recommendations with regard to importance, justification, technical, and analytical issues of TDM of antiepileptic drugs (AEDs). The study was conducted in three phases: (1) the published literature was thoroughly searched for an initial list of items relevant to TDM of AEDs, (2) the list was supplemented by items provided by key experts (n = 8) through semi-structured in-depth interviews, (3) views and opinions of clinicians (n = 20) on TDM of AEDs were explored, and (4) a two-round Delphi technique was followed among a panel of experts (n = 27) to develop consensus-based recommendations to guide TDM of AEDs in Palestine. Consensus was achieved on items related to importance (8 items) of TDM of AEDs, clinical justifications of TDM of AEDs (19 items), guidelines for optimal TDM of AEDs (11 items), TDM of some AEDs (21 items), TDM practice (24 items), and some technical and analytical issues in TDM of AEDs (13 items). Consensus-based recommendations that might be used in guiding TDM of AEDs in Palestine were developed. Future studies are still needed to investigate if these consensus-based recommendations can improve healthcare of PWE in Palestine. • Antiepileptic drugs are one of the most common drugs subjected to therapeutic monitoring. • Guidelines for therapeutic monitoring of antiepileptic drugs in Palestine were not developed before. • Consensus-based recommendations that might guide therapeutic monitoring of antiepileptic drugs in Palestine were developed. • Successful implementation of these recommendations might improve care of patients with epilepsy in Palestine. [ABSTRACT FROM AUTHOR]

Physicians and complementary alternative medicine (CAM) specialists are not formally educated/trained on the benefits of exercises for people living with epilepsy (PWE). This study was performed to develop a consensus-based knowledge items on the benefits of exercises for PWE that physicians and CAM specialists need to know. Knowledge items were collected after an extensive review of the scientific literature and from in-depth interviews with key contacts in the domain (6 primary healthcare providers, 4 neurologists, 4 exercise and medicine specialists, 4 CAM practitioners, 4 researchers who did studies on the benefits of exercise for PWE, and 4 PWE). Items collected were reviewed by 12 researchers who did studies on exercise for PWE. A Delphi technique was followed among a panel of 50 members to develop the consensus-based core list. The final consensus-based core list contained 64 items that were grouped into the following categories: 1) general items recommending exercise for PWE, 2) benefits of exercise on prevention of seizures, 3) benefits of exercise on antiepileptic therapy, 4) benefits of exercise in preventing comorbidities associated with epilepsy, 5) benefits of exercise in improving quality of life of PWE, and 6) psychosocial benefits of exercise for PWE. This consensus-based core list might guide educators, trainers, or authorities while designing educational or training courses to increase knowledge of physicians in primary healthcare and CAM specialists with regard to the benefits of exercise for PWE. Further investigations are needed to determine if such consensus-based core list might improve care and wellbeing of PWE. • Exercise has many recognized health benefits in people with epilepsy that include improving control over seizures. • Primary healthcare providers are not adequately trained on the benefits of exercise for people with epilepsy. • A consensus-based core list of knowledge items on the benefits of exercise for people with epilepsy was developed. • Consensus-based knowledge lists might improve healthcare services and support of people with epilepsy. [ABSTRACT FROM AUTHOR]

Background: Medication transcription errors (MTEs) are frequent in hospitalized patient settings. Definitions and scenarios that represent potential MTEs in the Palestinian nursing practice were not previously approached using formal consensus techniques. This investigation was conducted to develop a consensual definition of MTEs and scenarios that represent different MTE situations by a panel of nurses and other healthcare professionals.Methods: In this observational study, consensus was sought using the Delphi technique. Panelists (n = 64) were invited and recruited from different hospitals in Palestine and a two-iterative rounds Delphi technique was used to achieve consensus on a proposed definition of MTEs and 76 different scenarios representing potential MTEs.Results: Consensus was achieve to accept the definition and to consider 69 of the 76 proposed scenarios (77.6%) as MTEs, exclude 3 scenarios (3.9%), and 4 scenarios (5.3%) remained equivocal. Equivocal scenarios might be considered as MTEs or not depending on the clinical situation.Conclusions: Consensus was achieved on a definition of MTEs and scenarios representing MTEs by a panel of nurses and other healthcare professionals. This study showed that it was possible to develop and achieve consensus on a definition and scenarios representing MTE situations using formal consensus techniques. Such consensual definitions could be useful in future epidemiological studies investigating MTEs. Using consensual definitions might reduce methodological variations, promote congruence in error counting and reporting, and permit comparing error rates in different hospital settings. [ABSTRACT FROM AUTHOR]

Summary: Studies have argued that empathy to the pain of out-group members is largely diminished by “in-group empathy bias”. Investigating the mechanism underlying the emotional reactions of Jewish Israeli participants toward the pain experienced by Palestinians in the context of the Israeli–Palestinian conflict affords a natural experiment that allows us to examine the role of neurohormones in emotion sensitivity across conflicting social groups. In a double-blind placebo-controlled within-subject crossover design, Israeli Jewish participants were asked to report their empathy to the pain of in-group (Jewish), neutral out-group (European), and adversary out-group (Palestinian) members. Oxytocin remarkably increased empathy to the pain of Palestinians, attenuating the effect of in-group empathy bias observed under the placebo condition. This effect, we argue, is driven by the general role of oxytocin in increasing the salience of social agents which, in turn, may interfere with processes pertaining to derogation of out-group members during intractable conflicts. [ABSTRACT FROM AUTHOR]

• The phytochemical composition of Nepeta curviflora Boiss essential oil growing in Palestine was investigated. • The essential oil displayed remarkable antioxidant activity compared with Trolox. • The essential oil exhibited significant anti-proliferative and anti-migratory effect against cervical cancer cell. • The α -amylase and α -glucosidase inhibitory activity of the essential oil was assessed. • Nepeta curviflora essential oil showed potent anti-obesity activity compared with Orlistat. The essential oils extracted from plants play an important role in medicine in addition to their huge value in the cosmetics and nutraceutical industries. In this investigation, besides the identification and quantification of the phytochemical composition of Nepeta curviflora Boiss essential oil, in-vitro antioxidant, porcine pancreatic lipase, α -glucosidase, and α -amylase inhibitory activities of the essential oil obtained by microwave ultrasonic-assisted extraction were investigated. More importantly, it was designed to assess the essential oil impact on cell migration and cell proliferation of cervical cancer cell lines. The phytochemical composition of Nepeta curviflora essential oil was qualitatively and quantitatively determined utilizing gas chromatography-mass spectrometry technique. Twenty compounds were identified from Nepeta curviflora essential oil representing 100% of total essential oil, of which 1,6-dimethyl spiro[4.5]decane (27.51%), caryophyllene oxide (20.08%), and β -caryophyllene (18.28%) were the most abundant compounds. The antioxidant activity of the essential oil was measured as 6.3 ± 0.43 μg/mL in comparison with trolox (positive control) employing the 1,1-diphenyl-2-picrylhydrazyl radical scavenging assay. The high concentrations of the caryophyllene oxide and caryophyllene thought to contribute significantly to the antioxidant of the essential oil. The obtained essential oil displayed α -glucosidase, α -amylase, and porcine pancreatic lipase inhibitory activities with half-maximal inhibitory concentration (IC 50) values of 26.3 ± 0.57, 45.7 ± 0.26, and 54.9 ± 0.34 μg/mL, respectively, in comparison with the positive controls orlistat and acarbose which showed IC 50 values of 12.3 ± 0.33, 28.84 ± 1.22 and 37.15 ± 0.32 μg/mL, respectively. Moreover, anticancer activity was established exploiting wound healing and cell proliferation assays against cervical cancer cell lines. Remarkably, non-cytotoxic concentrations of Nepeta curviflora essential oil have significantly inhibited the migration potential of cervical cancer cells after 24 h of treatment and revealed that the oil concentration and treatment time increase the inhibitory action on cervical cancer cell viability. [ABSTRACT FROM AUTHOR]