Publications by authors named "Zaher Nazzal"

28 Publications

  • Page 1 of 1

The outcomes of severe COVID-19 pneumonia managed with supportive care in Palestine: an experience from a developing country.

J Infect Dev Ctries 2021 08 31;15(8):1094-1103. Epub 2021 Aug 31.

Martyrs Medical Military Hospital, Palestinian Ministry of Health.

Introduction: About 14% of COVID-19 patients experience severe symptoms and require hospitalization. Managing these patients could be challenging for limited-resource countries, such as Palestine. This study aimed to evaluate hospitalized severe COVID-19 patients' treatment outcomes managed with supportive care and steroids.

Methodology: This was a single-center observational retrospective cohort study that enrolled COVID-19 patients admitted to the "Martyrs medical military complex- COVID Hospital" in Palestine. The managing physicians manually collected data through chart reviews, including patients' characteristics, complications, outcomes, and different management modalities. Continuous and categorical variables between those who were discharged alive and who died were compared using t-test and Chi-squares test, respectively.

Results: Overall, 334 patients were included in this study. Median (IQR) age was 62(11) years, 49.1% were males, and 29.6% were ICU status patients. The median (IQR) PaO2/FiO2 ratio was 76 (67), and 67.6% of these patients had moderate to severe acute respiratory distress syndrome, and 4.8% of the patients received invasive mechanical ventilation. Most of the patients (78.7%) had at least one comorbidity, and 18.3% developed at least one complication. The overall mortality was 12.3% (95% CI 8.9-16.2%), and the median (IQR) length of hospital stay was 11 (8) days. Age (aOR 1.05, p = 0.08), smoking (aOR 4.12, p = 0.019), IMV (aOR 27.4, p < 0.001) and PaO2/FiO2 ratio (aOR 1.03, p < 0.001) were found to predict higher mortality.

Conclusions: Supportive care for patients with severe COVID-19 pneumonia in a Palestinian hospital with limited resources was associated with in-hospital mortality of 12.3%.
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http://dx.doi.org/10.3855/jidc.14709DOI Listing
August 2021

Mid-term cumulative patency of fistula and PTFE grafts among hemodialysis patients: A retrospective, single-center study from Palestine.

J Vasc Access 2021 Aug 25:11297298211040988. Epub 2021 Aug 25.

Family and Community Medicine Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

Background: Due to the long waiting time for kidney transplantation, most End-Stage renal disease patients are commenced on either hemodialysis or peritoneal dialysis. Reusable fistulas have the lowest risk for death, cardiovascular events, and infections among all vascular accesses. This study aims to report the outcomes of the arteriovenous fistulas and PTFE grafts and the related predictive clinical and demographic variables.

Methods: This retrospective study reviewed the charts of all hemodialysis patients between January 2017 and January 2021 at the Dialysis Center of An-Najah National University Hospital, Nablus, Palestine. Our outcomes were a primary failure, primary and secondary patency, and the related factors. Survival analysis using the Kaplan-Meier method was conducted, and the log-rank test was used to compare patency rates. The Cox proportional hazards regression model tested factors relevant to primary and secondary patency rates in univariate and multivariate analyses.

Results: A total of 312 procedures were performed during the study period. Primary failure was 7.1% for AVF, 13.9% for arterio-venous graft (AVG) procedures. Peripheral arterial disease and left-sided AVF were associated with more primary failure rates. AVF, primary patency rates at 1, 2, and 3 years were 82%, 69%, and 59%, respectively, while secondary patency rates at 1, 2, and 3 years were 85%, 72%, and 63%, respectively. Factors associated with increased AVF patency in a proportional hazard model were younger age and dual antiplatelet administration.

Conclusion: Our study adds further evidence that autogenous AVF has better results than prosthetic AVG in both primary and secondary patency rates as well as less primary failure rates. Therefore, we encourage further longitudinal studies that assess the benefits of using antiplatelet on AVF outcome versus risks of bleeding, especially with dual agents.
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http://dx.doi.org/10.1177/11297298211040988DOI Listing
August 2021

Swept-source optical coherence tomography changes and visual acuity among Palestinian retinitis Pigmentosa patients: a cross-sectional study.

BMC Ophthalmol 2021 Jul 29;21(1):289. Epub 2021 Jul 29.

St. John of Jerusalem Eye Hospital Group, East Jerusalem, 91198, Palestine.

Background: Retinitis pigmentosa (RP) is a heterogeneous group of inherited ocular diseases that result in progressive retinal degeneration. This study aims to describe different Swept-source Optical Coherence Tomographic (SS-OCT) changes in Palestinian RP patients and to explore possible correlations with Visual Acuity (VA).

Methods: A cross-sectional observational study was conducted on Retinitis Pigmentosa patients diagnosed with RP in a tertiary eye hospital. Full history and ocular examination were made. SS-OCT imaging was done for all eyes assessing the presence of cystoid macular edema, epiretinal membrane, macular holes, and external limiting membrane, ellipsoid zone status. Also, central macular thickness and choroidal vascular thickness were measured.

Results: The study was run on 161 eyes of 81 patients; 53 males and 28 females. The average age at examination was 26.1 (6-78) years. Twenty-six eyes (16.1%) were of syndromic RP patients, mostly Usher syndrome; 20 eyes (12.4%). The mean Logaritmic minimal angle of resolution (LogMAR) of Best Corrected Visual Acuity (BCVA)of the study sample was 0.66 ± 0.7. The most prevalent change was cystoid macular edema [28 eyes, (17.4%)], followed by epiretinal membrane [17eye, (10.6%)]. A macular hole was noted only in one eye (0.6%). Ellipsoid zone and external limiting membrane were absent in 55 eyes (35.0%) and 60 eyes 37.5%. Vitreous hyperreflective foci were found in 35 eyes (43.8%). LogMAR of BCVA was associated significantly with cystoid macular edema (p = 0.001), ellipsoid zone(p = 0.001), and external limiting membrane (p = 0.001).

Conclusions: Detailed SS-OCT assessment in Palestinian patients diagnosed with RP identified different morphologies from other populations. Cystoid macular edema and vitreous hyperreflective foci may reflect signs of early or intermediate stages of the disease. Disease progression can be monitored by measuring the length/width (area) of ellipsoid zone +/- external limiting membrane and choroidal vascular thickness, which should be evaluated serially using high-resolution OCT.
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http://dx.doi.org/10.1186/s12886-021-02047-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8320214PMC
July 2021

The prevalence and risk factors of urinary incontinence among women with type 2 diabetes in the north West Bank: a cross-sectional study.

Lancet 2021 Jul;398 Suppl 1:S42

Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, occupied Palestinian territory.

Background: Diabetes is one of the most common chronic illnesses worldwide, and it is increasing in prevalence. Urinary incontinence is another worldwide health problem, with a reported prevalence that ranges from 9% to 67%. It decreases quality of life for men and women and has been associated with many poor outcomes, such as longer hospital stays, recurrent or persistent urinary tract infection, and a higher mortality rate. Previous studies have suggested that diabetes is an independent risk factor for urinary incontinence. In addition, the patients' background and clinical characteristics such as age, obesity, and child-bearing history have been found to increase the risk. The aim of this study was to determine the prevalence of urinary incontinence in women with type 2 diabetes in the north West Bank and to assess the role of potential risk factors, including age, marital status, weight, and diabetes control.

Methods: Women with diabetes attending the six governmental primary health care centres in the north West Bank (Jenin, Tubas, Tulkarem, Nablus, Qalqilya, and Salfit) were interviewed using the CDC National Health and Nutrition Examination Survey (NHANES) standardised incontinence questionnaire. SPSS version 22 was used for data entry and analysis. The prevalence of urinary incontinence was estimated and differences between groups (variables of interest) were evaluated using the chi squared test. The study was approved by the Institutional Review Board of An-Najah National University, and permission to conduct the study was obtained from the Ministry of Health.

Findings: 400 Palestinian women with diabetes were invited to participate in the study by convenience sampling, of whom 381 were recruited (a sample size that was chosen with a sample size formula, based on the population of the north West Bank). The participants were aged 30-83 years, and 44% (165 of 381; 95% CI 39-49) reported incontinence, regardless of the type. The prevalence of stress and urge incontinence were 34% (128) and 35% (133), respectively. 30% of women with urinary incontinence (49 of 165) reported that it did not affect their quality of life, and 34% (56 of 165) stated that it did not affect their daily activity. The presence or absence of urinary incontinence was studied in relation to the background and clinical variables by use of the chi squared test. The analysis showed a significant relationship between urinary incontinence status and age (p=0·0011), previous abdominal and genitourinary surgeries (p=0·0037), and caffeine consumption (p=0·041). There was no relationship between urinary incontinence and the duration, type of treatment, or complications of diabetes.

Interpretation: The prevalence of urinary incontinence (regardless of the type) is high among Palestinian women with diabetes. This is similar to reported prevalence in women with diabetes in neighbouring countries, such as Jordan (44%) and Qatar (21%). The majority of participants in this study (70%) reported that urinary incontinence did not affect their quality of life. This may suggest that patients consider the problem to be ordinary, that it does not require medical advice, or that the symptoms are mild. The findings highlight the importance of educating women with diabetes about urinary incontinence. The primary health care medical teams, general practitioners, and nurses who care for patients with diabetes should focus on this neglected problem, and physicians should be alert to urinary incontinence as it may often go unreported and therefore undertreated. To understand whether non-reporting of urinary incontinence reflects mild symptoms, investigating a potential association between non-reporting and the severity or frequency of urinary incontinence may be of interest for future study.

Funding: None.
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http://dx.doi.org/10.1016/S0140-6736(21)01528-2DOI Listing
July 2021

Somatic symptom disorders and utilization of health services among Palestinian primary health care attendees: a cross-sectional study.

BMC Health Serv Res 2021 Jun 29;21(1):615. Epub 2021 Jun 29.

Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

Background: Many primary health care (PHC) clients come in with medically unexplained complaints, leading to frequent consultations and high usage of services and healthcare costs. This study aimed to determine the prevalence of somatic symptom disorder (SSD) among PHC attendees and explore its relation to other mental conditions and risk factors.

Methods: A cross-sectional design was used to interview 400 attendees. Men and women aged over 18 years old without a psychiatric diagnosis were invited to participate. The Somatization scale of the Four-Dimensional Symptom Questionnaire was used to assess somatic symptom disorders. It is a valid tool to be used in a PHC setting. We used the Chi-square test and multivariable logistic regression to explore determinant variables.

Results: Prevalence of SSD was 32.5% (95%CI = 27.9-37.1%). The most common symptoms were painful muscles (61.5%) followed by back pain (52.3%). Female gender [adjusted OR = 2.1 (95% CI = 1.2-3.7)], chronic diseases [adjusted OR = 2.4 (95%CI = 1.3-4.5)], depression [adjusted OR = 3.3 (95%CI = 2.0-5.5)], and anxiety [adjusted OR = 2.1 (95%CI = 1.2-3.6)] were all associated with SSD. In addition, frequent primary health care attendance was found to be associated with SSD [adjusted OR = 2.4 (95%CI = 1.4-4.1)].

Conclusions: SSD significantly higher among females, patients with chronic diseases, clients with anxiety and depressive disorders, and patients with frequent doctors' visits. Painful muscles and back pain are the most common symptom presented by patients, and this could be used initially by PHC physicians as a signal to consider for screening.
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http://dx.doi.org/10.1186/s12913-021-06671-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240383PMC
June 2021

Eating Disorders and the Use of Cognitive Enhancers and Psychostimulants Among University Students: A Cross-Sectional Study.

Neuropsychiatr Dis Treat 2021 25;17:1633-1645. Epub 2021 May 25.

Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, 00970, Palestine.

Background: University students, who are at risk of eating disorders (ED), are more liable to use cognitive enhancers and psychostimulants to improve their cognitive functions and lose weight. ED in Palestinian male students is a neglected health issue. We aimed to investigate the prevalence and the association between ED and cognitive enhancers, and psychostimulants use among An-Najah National University students (ANNU).

Methods: In a cross-sectional study conducted in 2020 at ANNU, 1047 students completed anonymous surveys for cognitive enhancers practice, the Eating Attitude Test-26 (EAT-26), Sick, Control, One, Fat and FOOD (SCOFF) screening tests.

Results: The prevalence of ED among ANNU students was 21.2% based on EAT-26 (17.1% in males, 23.8% in females) and 31.5% based on SCOFF (24.0% in males, 36.3% in females). The binary logistic regression revealed that students at risk to have ED were water-pipe smokers (OR: 1.471, p-value 0.047), especially males, while students who were less likely to have ED were males (OR: 0.341, p-value<0.001), coffee users (OR: 0.581, p-value 0.014) and chocolate users (OR: 0.530, p-value 0.041) than nonusers. Moreover, the risk of ED increased with increasing body mass index (p-value<0.01). Clinical medical students showed the lowest prevalence (11.1%) compared to preclinical (22.5%), health sciences (23.7%), and non-medical students (20.9%) (p-value 0.059).

Conclusion: Our findings highlight water-pipe smoking as a significant health problem in males with ED, which may require unique treatment and prevention strategies. Moreover, coffee and chocolate consumption were associated with decreased risk of ED, only among males. The gender-gap in ED prevalence was very narrow compared to international results. These results prompt the need to focus on both genders in future studies instead of females. They also suggest the urgent need to address ED among Palestinian university students by educating students about mental health, identifying high-risk students, and offering easily accessible psychological help.
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http://dx.doi.org/10.2147/NDT.S308598DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164711PMC
May 2021

Determinants of smoking cessation counseling favorable practice for primary care physicians: A cross-sectional study from Palestine.

J Family Med Prim Care 2021 Mar 8;10(3):1275-1281. Epub 2021 Apr 8.

Primary Health Directorate, Palestinian Ministry of Health, An-Najah National University, Nablus, Palestine.

Background: Smoking cessation counseling is not well established in Middle East countries including Palestine. This study assesses the practice of smoking cessation counseling among primary healthcare (PHC) physicians in Palestine and its determinants.

Methods: Over the period from April to September 2019, general practitioners, family medicine physicians, obstetricians and gynecologists, and dentists working at the PHC Centers in Palestine were approached through a cross-sectional design using a self-reported questionnaire. Proportionate stratified random sampling approach has been used. Sociodemographic, medical background, smoking cessation counseling training, smoking history, practice, knowledge, attitude, and confidence were evaluated. The proportion of favorable practice has been determined and its relationship with all variables has been evaluated. Ethical approval was received from the National University of An-Najah.

Results: 295 physicians were enrolled in the study with an 86% response rate. 75.5% ( = 222) were males with a mean age of 39.9 ± 9 years. The majority were General Practitioners (76.5%, n = 252). Most of them (84.3%, n = 215) had not received any training. The favorable practice was seen in 36.6% (95% CI 31-41%). Attitude is the main predictor of favorable practice ( value = 0.002, adjusted OR = 1.1).

Conclusion: Palestinian PHC physicians have a low level of counseling for smoking cessation. Given the efficacy of counseling for smoking cessation and the high level of the tobacco epidemic in the area, health policy to ensure all healthcare personnel-especially physicians-receive training in cessation counseling and call for a public health campaign for control of tobacco should be taken into account.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_1456_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140223PMC
March 2021

COVID-19 vaccine hesitancy among health care workers in Palestine: A call for action.

Prev Med 2021 08 13;149:106618. Epub 2021 May 13.

Ministry of Health, Palestine.

With the planned COVID-19 vaccine, vaccine hesitation is a great challenge, particularly for healthcare professionals. In this study, we examined the acceptance of the COVID-19 vaccine by health care workers, their concerns about it, and the reasons that might prevent them from getting vaccinated. We conducted a cross-sectional study using an anonymous online survey from December 25, 2020, to January 6, 2021. The questionnaire consisted of demographic characteristics (age, gender, profession, sector, medical history, and general health), COVID-19 related knowledge, and personal history of influenza vaccination. The intention to get the vaccine once it is available was directly asked, and attitudes towards the diseases and the vaccine were studied using a four-point Likert scale statement based on the health belief model's constructs. The study included 1159 HCWs; 62.9% were females, and 52.5% were between the ages of 30-49 years. The intention to get vaccinated was only 37.8% [95%CI: 35.0%-40.6%], while 31.5% were undecided, and 30.7% planned to refuse it. Higher levels of intention were reported among males (OR; 2.7, 95%CI: 2.0-3.7), younger ages (OR 1.7, 95%CI: 1.1-2.8), physicians (OR; 2.9, 95%CI: 2.0-4.0), HCWs at non-governmental settings (OR; 1.4, 95%CI: 1.1-1.9), those who previously received the influenza vaccine (OR 4.0, 95%CI: 2.3-7.1), and those who had higher COVID-19 related knowledge (OR; 1.7, 95%CI: 2.3-7.1). In conclusion, vaccine acceptance among HCWs was much lower than expected, which would greatly diminish the role of vaccination in reducing the burden of the COVID-19 pandemic throughout the community.
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http://dx.doi.org/10.1016/j.ypmed.2021.106618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8117476PMC
August 2021

Factors affecting nurses' intention to accept the COVID-19 vaccine: A cross-sectional study.

Public Health Nurs 2021 09 12;38(5):781-788. Epub 2021 Apr 12.

Department of Family Medicine & School of Public Health, Brown University, Providence, RI, USA.

Objective: To measure COVID-19 vaccine acceptance and related factors to undercover nurses' concerns and fears.

Design: A cross-sectional study.

Sample: The study included 639 nurses; 83% were women and 80% under 50 years.

Measurement: A self-administered questionnaire was used. It included demographic characteristics, COVID-19-related fears and concerns, COVID-19 vaccine perceived benefits, and intention toward getting the vaccine.

Results: Forty percent of the nurses planned to get the vaccine when available, 41% would take it later when adequate protection and safety were presented, and 18% would never take it. Significant factors associated with vaccination intention were as follows: age (adjusted OR 1.42, 95% CI: 1.02-1.99); lack of knowledge about the vaccine (adjusted OR 2.6, 95% CI 1.81-3.8); concern about long-term side effects (adjusted OR 2.0, 95% CI 1.4-2.9); fear of injection (adjusted OR 1.5, 95% CI 1.04-2.13); natural immunity preference (adjusted OR 5.8, 95% CI 4.5-8.3); media misrepresentation (adjusted OR 1.7, 95% CI 1.2-2.4); and getting COVID-19 from the vaccine (adjusted OR 1.5, 95% CI 1.1-2.1).

Conclusion: COVID-19 vaccine safety and side-effects concerns impact nurses' intentions to accept the vaccine and may result in low acceptance rates. Urgent action is needed to address these fears and raise confidence, as nurses' vaccine-related decisions can affect the public's vaccine acceptance.
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http://dx.doi.org/10.1111/phn.12907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251396PMC
September 2021

Prevalence of Vitamin D Deficiency among Hemodialysis Patients in Palestine: A Cross-Sectional Study.

Int J Nephrol 2021 12;2021:6684276. Epub 2021 Mar 12.

Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus 44839, State of Palestine.

Introduction: The level of vitamin D status and its relationship to kidney function and liver function among patients with and without type 2 diabetes were not studied among Palestinian hemodialysis patients before. The aim of this study was to assess the status of vitamin D in hemodialysis patients with and without type 2 diabetes and its determinants.

Methods: Data were collected on 163 patients on hemodialysis therapy in the Nephrology Department at Najah National University Hospital. Information on age, sex, plasma 25 (OH)D, serum calcium, serum phosphate, parathyroid hormone, dialysis period, hypertension, diabetes, ALT, AST, albumin, alkaline phosphates, and BMI was obtained from the medical records. Data were analyzed using SPSS. . The mean level of 25 (OH)D was 17.3 ± 10.5 ng/ml. Only 12.9% of subjects had 25 (OH)D levels >30 ng/ml, whereas 65% had levels between 10 and 30 ng/ml; the remaining 22.1% were severely vitamin D deficient (<10 ng/ml). Vitamin D deficiency was more prevalent among females. It was not related to PTH, calcium, kidney, or liver function tests.

Conclusion: Vitamin D deficiency is highly prevalent among patients on hemodialysis with or without DM2.
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http://dx.doi.org/10.1155/2021/6684276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984929PMC
March 2021

Diabetic retinopathy screening barriers among Palestinian primary health care patients: a qualitative study.

J Diabetes Metab Disord 2020 Dec 29;19(2):875-881. Epub 2020 Jun 29.

Department of Family Medicine & School of Public Health, Brown University, Providence, RI USA.

Purpose: Diabetic Retinopathy (DR) screening among Palestinian diabetic patients is limited. To improve the care of our patients, we explored the barriers to DR screening with a qualitative study.

Methods: Three focus groups were conducted in the northern West Bank. Patients noncompliant with DR screening were recruited from Primary Health Care clinics. Questions were adapted from similar published studies. Informed consent was obtained and group discussions were audio recorded, transcribed, and analyzed for themes by three researchers.

Results: Most patients reported financial barriers including the costs of the exam and additional treatments, and transportation to the referral clinic. System related issues were the difficulty of getting appointments and long wait times due to inadequate numbers of ophthalmologists or screening facilities, and physicians failing to recommend screening. Personal concerns related to patients having other priorities, fears about the results, and the negative experiences of family members. Finally, cultural aspects included the stigma of wearing glasses and not doing a test for a condition without symptoms.

Conclusions: Barriers to completing retinopathy screening are multidimensional with financial, personal, educational, health system, and cultural factors. These should be taken into consideration by policy makers in order to increase the uptake and quality of service.
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http://dx.doi.org/10.1007/s40200-020-00575-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7843686PMC
December 2020

Mixed Method Study to Explore Ethical Dilemmas and Health Care Workers' Willingness to Work Amid COVID-19 Pandemic in Palestine.

Front Med (Lausanne) 2020 5;7:576820. Epub 2021 Jan 5.

Department of Family Medicine & School of Public Health, Brown University, Providence, RI, United States.

The high potential risks involved in working in a healthcare setting during a pandemic and the associated fear that may affect health care workers' (HCWs') willingness to work are important to understand to eliminate potential barriers to working. This study aimed to assess Palestinian HCWs' willingness to work and the related factors as well as to explore their ethical dilemmas during the coronavirus disease 2019 (COVID-19) pandemic. Quantitative (survey questionnaire) and qualitative (semi-structured interviews) data were collected. Frontline HCWs ( = 550) received an online survey link via closed institutional networks. Frequencies summarized the data, and chi-square compared variables and outcomes. Odds ratios (ORs) and multivariable analysis examined predictors for willingness to work. Fifteen HCWs (physicians, nurses, and lab and radiology technicians) were purposefully sampled and agreed to interviews to explore their thoughts, motivations, and worries. Thematic analysis focused on ethical dilemmas to enhance the breadth and the depth of the study. Almost 25% of surveyed HCWs were not willing to work during the pandemic. Logistic model results showed that physicians and nurses had higher willingness to work than others ( = 0.004, Adj. OR = 3.5). Lower stress levels and longer professional experience were predictors of more willing to work ( = 0.03, Adj. OR = 2.5; = 0.03, Adj. OR = 2.6, respectively). Interviews showed that willingness to work did not preclude HCWs from fulfilling their duties despite grueling workloads and grave fears about safety and security. HCWs felt poorly prepared, unappreciated, and frustrated by unfair work distribution. The occupation presented additional safety issues. Physicians and nurses were more likely to comply with a commitment to their professional ethics and the duty or obligation to work. Stress levels could be mitigated in the future with better leadership, adding supports to address mental health and psychosocial challenges to enhance HCWs' well-being and improve quality of care. The realities of the occupation added additional threats and uncertainty.
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http://dx.doi.org/10.3389/fmed.2020.576820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7813812PMC
January 2021

eRegCom-Quality Improvement Dashboard for healthcare providers and Targeted Client Communication to pregnant women using data from an electronic health registry to improve attendance and quality of antenatal care: study protocol for a multi-arm cluster randomized trial.

Trials 2021 Jan 11;22(1):47. Epub 2021 Jan 11.

Division for Health Services, Global Health Cluster, Norwegian Institute of Public Health, PB 222 Skøyen, 0213, Oslo, Norway.

Background: This trial evaluates interventions that utilize data entered at point-of-care in the Palestinian maternal and child eRegistry to generate Quality Improvement Dashboards (QID) for healthcare providers and Targeted Client Communication (TCC) via short message service (SMS) to clients. The aim is to assess the effectiveness of the automated communication strategies from the eRegistry on improving attendance and quality of care for pregnant women.

Methods: This four-arm cluster randomized controlled trial will be conducted in the West Bank and the Gaza Strip, Palestine, and includes 138 clusters (primary healthcare clinics) enrolling from 45 to 3000 pregnancies per year. The intervention tools are the QID and the TCC via SMS, automated from the eRegistry built on the District Health Information Software 2 (DHIS2) Tracker. The primary outcomes are appropriate screening and management of anemia, hypertension, and diabetes during pregnancy and timely attendance to antenatal care. Primary analysis, at the individual level taking the design effect of the clustering into account, will be done as intention-to-treat.

Discussion: This trial, embedded in the implementation of the eRegistry in Palestine, will inform the use of digital health interventions as a health systems strengthening approach.

Trial Registration: ISRCTN Registry, ISRCTN10520687 . Registered on 18 October 2018.
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http://dx.doi.org/10.1186/s13063-020-04980-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7802344PMC
January 2021

Prevalence and risk factors of chronic kidney disease among Palestinian type 2 diabetic patients: a cross-sectional study.

BMC Nephrol 2020 11 16;21(1):484. Epub 2020 Nov 16.

Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

Background: Chronic kidney disease (CKD) is a global public health concern and diabetes is one of the main risk factors for its occurrence and progression. The aim of this research is to determine the prevalence of chronic kidney disease in a cross-sectional population of patients with type 2 diabetes in primary health centers in North West Bank.

Methods: Patient data including patient characteristics, creatinine level, blood pressure, HbA1c, and hypertension and period of diabetes were obtained from primary health care centers. The eGFR has been determined using the CKD-EPI equation. CKD was staged according to the 2012 Kidney Disease Improving Global Outcomes Framework (KDIGO) guideline. Both univariable and multivariable statistical analysis was conducted using SPSS.

Results: The prevalence of chronic kidney disease among diabetic adults in North West Bank was found to be 23.6% (95% CI: 19.4-28.1%) divided as follows: 19.7% had stage 3 CKD, 2.6% had stage 4 CKD and 1.3% had stage 5 CKD. In multivariable logistic regression, CKD was significantly associated with Age ≥ 60 years [adjusted OR: 3.2, 95% CI: 1.8-5.9], hypertension [adjusted OR: 5.7, 95% CI: 2.2-15.2], and smoking [adjusted OR: 2.3, 95% CI: 1.3-4.2].

Conclusions: CKD is very prevalent among diabetic adults in Palestine. Co-morbid hypertension, smoking and older age has been shown to increase the risk of developing CKD. Extensive screening for diabetic patients to diagnose CKD at an early stage and to follow more aggressive treatment methods for diabetes as well as other important risk factors, especially hypertension and smoking, is recommended.
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http://dx.doi.org/10.1186/s12882-020-02138-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7667814PMC
November 2020

Bone mineral density in Palestinian patients with end-stage renal disease and the related clinical and biochemical factors: Cross-sectional study.

PLoS One 2020 12;15(11):e0241201. Epub 2020 Nov 12.

Nephrology Consultant, Nephrology Department, An-Najah National University Hospital, An-Najah National University, Nablus, Palestine.

Introduction: End-Stage Renal Disease (ESRD) is the ultimate result of chronic kidney disease (CKD). In Palestine, the prevalence of ESRD was 240.3 PMP which is comparable with the nearby countries. Accelerated bone loss among ESRD patients is attributed to abnormal bone turn over that leads to osteoporosis and osteopenia. The risk of fractures is increased four-fold in men and women on hemodialysis, which explains the importance of assessing the bone mineral density among these population. The goals of this study were to find the prevalence of osteoporosis in ESRD patients as determined by bone mineral density (BMD) at different sites and to determine whether BMD correlates with many other clinical parameters.

Methods: A cross-sectional study of 194 ESRD patients were recruited from the dialysis unit in An-Najah National University Hospital, Nablus, Palestine. The patients were on regular hemodialysis or peritoneal dialysis. BMD was measured at the lumbar spine and the hip using the dual-energy X-Ray absorptiometry (DEXA) and the value is expressed as T-score. The data were analyzed using SPSS, version 26. The relationship between BMD and the clinical and biochemical parameters among the ESRD patients was assessed.

Results: We found that 42.8% of ESRD patient had osteoporosis and 40.2% had osteopenia. There were significantly higher proportions of osteoporosis and osteopenia among patients >60 years of age (p<0.005). Patients with osteoporosis and osteopenia had significantly higher serum levels of PTH (792.9 and 469.7) (p<0.05). BMD decreases as the duration of dialysis (39.0 months Vs. 56.8 months), (p<0.05). We found no significant difference between patients on hemodialysis or peritoneal dialysis.

Conclusion: This study showed that Palestinian patients with ESRD have low BMD at the hip and spine. The observed high serum level of PTH was associated with low BMD. Those patients should be closely monitored especially those with more than one risk factor. Moreover, more attention should be paid for these category of patients to decrease the incidence of falling down and the resulting fractures that might lead to mortality and morbidity.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241201PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7661051PMC
December 2020

Epidemiology of Sepsis Syndrome among Intensive Care Unit Patients at a Tertiary University Hospital in Palestine in 2019.

Indian J Crit Care Med 2020 Jul;24(7):551-556

Department of Critical Care, An-Najah National University Hospital, Nablus, Palestine, Occupied Palestinian Territory.

Background: Sepsis syndrome is an emerging healthcare problem, especially in critically ill patients, regardless whether it's community- or hospital-acquired sepsis. This study evaluates the characteristics of these patients, in addition to the type, source, and outcome of sepsis and septic shock, in a university tertiary hospital in Palestine. It also studies the most common organisms encountered in these patients.

Materials And Methods: This is retrospective observational chart review study of all adult admissions to the intensive care unit over a period of 2 years. The presence of sepsis and septic shock was assessed and documented based on the Third International Consensus Definitions (Sepsis-3). Data regarding demographics, severity, comorbidities, source of infection, microbiology, length of stay, and outcomes (dead/alive at discharge from ICU) were recorded.

Results: A total number of 174 patients were included. The mean age was 57.4 years, with cardiovascular diseases and diabetes being the leading comorbidities encountered in them. Respiratory infections were the most common site of sepsis, found in around 71% of patients, followed by urinary tract infections. More than 70% of cases were due to hospital-acquired infections (HAIs). species were the most common gram-negative organisms encountered, while was the most common gram-positive organisms. Around 54% of patients had multidrug-resistant organisms. The average length of stay in the ICU was 8 days. The average mortality rate was 39.7%, which is higher among septic shock patients.

Conclusion: Both sepsis and septic shock carry high morbidity and mortality rates, and they are very frequent among critically ill patients. Special care and developing management bundles are crucial in controlling and preventing this threat.

How To Cite This Article: Rabee HA, Tanbour R, Nazzal Z, Hamshari Y, Habash Y, Anaya A, Epidemiology of Sepsis Syndrome among Intensive Care Unit Patients at a Tertiary University Hospital in Palestine in 2019. Indian J Crit Care Med 2020;24(7):551-556.
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http://dx.doi.org/10.5005/jp-journals-10071-23474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482333PMC
July 2020

Palestinian Health Care Workers' Stress and Stressors During COVID-19 Pandemic: A Cross-Sectional Study.

J Prim Care Community Health 2020 Jan-Dec;11:2150132720955026

Brown University, Providence, RI, USA.

Background: COVID-19 is thought to be the most significant public health threat the modern world has encountered. Health care workers (HCWs) face enormous pressure due to work overload, negative emotions, exhaustion, lack of contact with their families, and risk of catching the infection and death.

Aim: This study aims to assess the level of stress perceived by HCWs and possible associated factors during the COVID-19 outbreak in Palestine.

Methods: A cross-sectional sample of 430 frontlines HCWs was conducted using an online self-reported questionnaire. HCWs' stress from the COVID-19 outbreak, factors that increase stress, and the activities that reduced stress were assessed. Chi-square test was used to compare between a categorical variable and the study outcome; associations are presented as odds ratios (OR) and confidence intervals (95% CI) with 0.05 significance level. Al-Najah National University institutional review board granted ethics approval.

Results: Most respondents (74.0%) reported high-stress levels during the outbreak. Fear of transmitting the virus to family was the most stressful factor (91.6%). HCWs who did not have training on the outbreak response were more likely to have high-stress levels (OR = 2.7 [95% CI = 1.7-4.4],  < .001). Those with high stress reported being disappointed (OR = 2.4 [95% CI = 1.5-3.6],  < .001), and strongly considered taking sick leave (OR = 3.9 [95% CI = 1.9-7.9],  < .001).

Conclusion: HCWs are under tremendous stress, given the ongoing COVID-19 pandemic. Understanding the psychological impact of the outbreak on HCWs and the activities that mitigate the stress is crucial to guide policies and interventions that can maintain psychological well-being.
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http://dx.doi.org/10.1177/2150132720955026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457680PMC
August 2020

Effects of Waterpipe Tobacco Smoking on the Spirometric Profile of University Students in Palestine: A Cross-Sectional Study.

Can Respir J 2020 27;2020:5949834. Epub 2020 Jun 27.

Al Hakim Medical Complex, Nablus, State of Palestine.

Background: Waterpipe smoking in young individuals is increasing with limited studies addressing its respiratory health effects. The aim of the study was to determine the effect of waterpipe smoking on young adults' lung functions. Spirometric parameters were compared between waterpipe smokers and nonsmokers.

Methods: A comparative cross-sectional study of university students, including males and females, was conducted. An interviewer-administered questionnaire was used to record students' characteristics. The spirometry test was performed to assess students' lung functions; we recorded the forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow (PEF), and forced expiratory flow between 25 and 75% of FVC (FEF%).

Results: A total of 300 apparently healthy students (150 waterpipe smokers and 150 nonsmokers) were included in the study. Waterpipe smokers showed significantly lower values in FEV, FEV/FVC ratio, PEF, and FEF% compared to the nonsmoker group ( < 0.05 to < 0.001). The subgroup analysis on female students (50 WP smokers and 50 nonsmokers) showed a significant decrease in FEV/FVC ratio, PEF, and FEF% parameters ( < 0.001).

Conclusion: Waterpipe smoking is associated with reduced spirometric parameters in healthy young adults with relatively limited smoking years.
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http://dx.doi.org/10.1155/2020/5949834DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336226PMC
June 2021

Prevalence of Hypothyroidism among Dialysis Patients in Palestine: A Cross-Sectional Study.

Int J Nephrol 2020 13;2020:2683123. Epub 2020 May 13.

Department of Endocrinology, Istishari Arab Hospital, Ramallah, State of Palestine.

Introduction: The kidney affects the thyroid gland causing various derangements in its function whenever the kidney is impaired, even with a minor imperfection in its job, and this makes dialysis patients more prone to thyroid disorders with subsequent increase in mortality and morbidity. This study aims to assess the prevalence of thyroid disease (hypo- and hyperthyroidism) among dialysis patients and their associated factors.

Methods: This cross-sectional study was conducted in the dialysis unit of An-Najah National University Hospital. 209 dialysis patients (60% were male, 57.6 ± 14.5 years, mean age) meeting our inclusion criteria were tested for thyrotropin (TSH) and free thyroxine (FT4) in addition to routine laboratory tests. . The prevalence of hypothyroidism was assessed as 16.3% (95% CI = 11.29% to 21.3%), overt hypothyroidism was 9.1%, and subclinical hypothyroidism was 7.2%. Subclinical hyperthyroidism prevalence was 1%, and no overt hyperthyroidism cases were reported. We observed no significant association between thyroid state and age, gender, duration of dialysis, or weight. . Hypothyroidism (both subclinical and overt type) is commonly seen in dialysis patients, and its symptoms are ordinary complains even in euthyroid dialysis patients, and this warrants screening programs and more studies on the efficacy of thyroid hormone supplements.
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http://dx.doi.org/10.1155/2020/2683123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243013PMC
May 2020

The prevalence and risk factors of urinary incontinence amongst Palestinian women with type 2 diabetes mellitus: A cross-sectional study.

Arab J Urol 2020 9;18(1):34-40. Epub 2019 Dec 9.

Department of Urology, An-Najah National University Hospital, Nablus, Palestine.

: To determine the prevalence of urinary incontinence (UI) in women with type 2 diabetes mellitus (T2DM) in the North West Bank, Palestine, and to assess the role of potential risk factors including age and DM control. : Adult women with DM attending governmental primary healthcare centres in the North West Bank were interviewed using the Centers for Disease Control and Prevention National Health and Nutrition Examination Survey (NHANES) standardised UI questionnaire. The prevalence of UI was estimated and differences between groups were evaluated using the chi-square test. A multivariate logistic model was used to estimate the adjusted relationships and to control for confounders. The statistical significance level was set at < 0.05. The study was approved by the Institutional Review Board at An-Najah National University. : The study included 381 women with T2DM, aged 30-83 years, of whom 43.2% (95% confidence interval [CI] = 37.9-47.8%) reported UI regardless of the type. About 40% reported that they were extremely bothered by the condition and 35.2% stated that their daily routine life was greatly affected. Amongst the women with UI, 133 (80.6%) and 128 (77.6%) were found to have urge and stress UI, respectively. UI was found to be significantly associated with a history of recurrent urinary tract infection (adjusted odds ratio [OR] 3.0, 95% CI 1.9-4.9; < 0.001) and parity (adjusted OR 1.7, 95% CI 1.1-2.7; = 0.04) : The prevalence of UI amongst Palestinian women with T2DM regardless of the type is high. The findings highlight the importance of educating women with T2DM about UI. The medical team should focus on this problem as it is often neglected; physicians should be alert for UI as it is often underreported and therefore undertreated. BMI: body mass index; (T2)DM: (type 2) diabetes mellitus; HbA: haemoglobin A; MoH: Ministry of Health; NHANES: National Health and Nutrition Examination Survey; OR: odds ratio; QoL: quality of life; (S)(U)UI: (stress) (urge) urinary incontinence.
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http://dx.doi.org/10.1080/2090598X.2019.1699340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7006689PMC
December 2019

Motivators and barriers to mammography screening uptake by female health-care workers in primary health-care centres: a cross-sectional study.

Lancet 2018 02 21;391 Suppl 2:S51. Epub 2018 Feb 21.

Nablus Primary Health Directorate, Ministry of Health, Nablus, West Bank, occupied Palestinian territory.

Background: Mammography screening is an effective tool for early detection and management of breast cancer. Female health-care workers' awareness of breast cancer screening is important because their beliefs and behaviours could influence other women. The aim of this study was to assess mammography screening uptake by female health-care workers at primary health-care centres and to identify the primary motivators and barriers that affect uptake.

Methods: This cross-sectional study included all governmental primary health-care centres in the West Bank. Governorates were grouped into three regions as follows: north West Bank (Nablus, Jenin, Tulkarm, Tubas, Qalqiliya, and Salfit), middle West Bank (Jerusalem, Jericho, and Ramallah), and south West Bank (Hebron, and Bethlehem). The study population included all female health-care workers older than 40 years. Those who performed mammography for a suspected mass or other breast abnormalities were excluded. A self-administered questionnaire was used to collect data on demographic characteristics, knowledge about mammography screening, the extent and regularity of mammography screening, and motivators and barriers influencing their mammography screening uptake. The rate of mammography screening uptake was calculated. χ test and t tests were used to assess screening motivators and barriers. The study was approved by the Institutional Review Board of the An-Najah National University. Participation was voluntary, and written consent was obtained from each participant.

Findings: 299 female health-care workers completed a self-administered questionnaire. The mean age of the participants was 46 years (SD 4·7). 284 (95%) women had adequate knowledge about breast cancer and mammography screening, and 149 (50%) women reported having had at least one mammogram. 62 (21%) women had had regular scheduled mammograms. The most frequent reported motivators were the perceived benefit that early detection of breast cancer is important for its management (269 [90%] women) and the belief that mammography can detect breast cancer before its symptoms appear (251 [84%] women). The most frequent barrier to mammography screening was being busy (140 [47%] women) and the lack of perceived susceptibility (125 [42%] women).

Interpretation: Mammography screening was suboptimal in a population of female health-care workers. Educational interventions are needed to remove barriers that limit compliance to recommendations and to emphasise the importance of early detection in breast cancer management. Ensuring the availability and accessibility of screening services, particularly for health-care workers within their work settings, would improve the acceptance and compliance for mammography screening programmes.

Funding: None.
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http://dx.doi.org/10.1016/S0140-6736(18)30417-3DOI Listing
February 2018

Physicians' knowledge and practice on death certification in the North West Bank, Palestine: across sectional study.

BMC Health Serv Res 2018 01 8;18(1). Epub 2018 Jan 8.

Department of general surgery, Palestine medical complex, Ramallah, Palestine.

Background: Mortality data are essential for many aspects of everyday public health practices at both national and international levels. Despite the current developments in various aspects of the medical field, the apparent inability of physicians to complete death notification forms (DNF) accurately is still worldwide concern. The aim of this study is to assess the physicians' knowledge and practice on completing the DNF.

Methods: A self-administered questionnaire was distributed to 200 physicians in governmental and non-governmental hospitals in the North West-Bank in Palestine. Furthermore, a case scenario was included in the questionnaire and physicians were asked to fill the cause of death section. The percentage of errors committed while completing the cause of death section were computed. A Chi square test was used to assess the association between physicians' characteristics and their responses.

Results: Only 40.6% of the participants completed the cause of death section correctly. The immediate and underlying causes of death were correctly identified by 48.7% and 71.3% of physicians, respectively. Almost one-fifth (17.3%) of physicians wrote the mechanism of death without reporting the underlying cause of death and 14.7% of them reported the sequence of events leading to death incorrectly.

Conclusions: Physicians' knowledge and practice on completing the DNF is poor and insufficient, which may seriously affect the accuracy of mortality data. Complicated cases, problems in the current design of the DNFs and lack of training were the most common factors contributing to inaccuracy in death certification. We recommend offering periodical training workshops on completing the DNF to all physicians, and developing a manual on completing the DNFs with clear instructions and guidelines.
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http://dx.doi.org/10.1186/s12913-017-2814-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759221PMC
January 2018

Quality of death notification forms in North West Bank/Palestine: a descriptive study.

BMC Res Notes 2017 Apr 11;10(1):154. Epub 2017 Apr 11.

Department of general surgery, Palestine Medical Complex, Ramallah, Palestine.

Background: The death notification forms (DNFs) are important documents. Thus, inability to fill it properly by physicians will affect the national mortality report and, consequently, the evidence-based decision making. The errors in filling DNFs are common all over the world and are different in types and causes. We aimed to evaluate the quality of DNFs in terms of completeness and types of errors in the cause of death section.

Methods: A descriptive study was conducted to review 2707 DNFs in North West Bank/Palestine during the year 2012 using data abstraction sheets. SPSS 17.0 was used to show the frequency of major and minor errors committed in filling the DNFs.

Results: Surprisingly, only 1% of the examined DNFs had their cause of death section filled completely correct. The immediate cause of death was correctly identified in 5.9% of all DNFs and the underlying cause of death was correctly reported in 55.4% of them. The sequence was incorrect in 41.5% of the DNFs. The most frequently documented minor error was "Not writing Time intervals" error (97.0%).

Conclusion: Almost all DNFs contained at least one minor or major error. This high percentage of errors may affect the mortality and morbidity statistics, public health research and the process of providing evidence for health policy. Training workshops on DNF completion for newly recruited employees and at the beginning of the residency program are recommended on a regular basis. As well, we recommend reviewing the national DNFs to simplify it and make it consistent with updated evidence-based guidelines and recommendation.
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http://dx.doi.org/10.1186/s13104-017-2469-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5387246PMC
April 2017

Growth modulation and remodeling by means of posterior tethering technique for correction of early-onset scoliosis with thoracolumbar kyphosis.

Eur Spine J 2017 06 9;26(6):1748-1755. Epub 2016 Dec 9.

Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.

Purpose: The aim of this study is to evaluate the role of the non-fusion instrumented procedure with compression adjunct to lengthening by distraction in facilitating spinal modulation of the wedged peak vertebra, in patients with congenital thoracolumbar kyphosis/kyphoscoliosis according to the Hueter-Volkmann law. The authors seek to address the progressive modulation of the most wedged vertebra by analyzing the subjects' pre-operative and latest follow-up sagittal radiograph.

Methods: Ongoing data collection of 14 peak wedged vertebra modulation during surgical management of 13 patients with Type I congenital thoracolumbar kyphosis (5 patients) or kyphoscoliosis (8 patients). Age at initial surgery averaged 58.6 months, with mean follow-up of 55.6 months (24-78). All were done with hybrid rib construct with clawing fashion through a single posterior approach with at least 4 lengthenings.

Results: Two vertebral bodies were selected, the peaked deformed vertebrae within the instrumentation compression level (WICL) and the vertebrae nearest but outside the instrumentation compression process (OICL). Anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) were measured in both vertebral bodies. Regarding measured vertebrae (WICL), average preoperative AVBH/PVBH ratio significantly increased from 0.54 to 0.77 in the final follow-up. Regarding measured vertebrae (OICL), the average preoperative AVBH/PVBH ratio increased from 0.76 to 0.79 in the final follow-up. Modulation can be confirmed in the most deformed vertebrae (WICL) as the difference between the change in AVBH/PVBH ratio between vertebrae (OICL) and (WICL) was statistically significant (P < 0.001).

Conclusions: Through the compression model adjunct to lengthening through distraction implemented in the surgical management of early-onset scoliosis, wedging improves through vertebral modulation (WICL) in comparison with the (OICL). This calls for further studies on the impact of surgical correction of EOS on modulation of the vertebrae.
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http://dx.doi.org/10.1007/s00586-016-4910-9DOI Listing
June 2017

Mammography Screening Uptake among Female Health Care Workers in Primary Health Care Centers in Palestine - Motivators and Barriers.

Asian Pac J Cancer Prev 2016 ;17(5):2549-54

Faculty of Medicine and Health Sciences, An-Najah National University, Palestine E-mail :

Background: Early detection remains the cornerstone of breast cancer control in terms of outcome and survival. Thus far the only breast cancer screening method proven effective is mammography. The awareness of female health care workers (HCW) about breast cancer prevention is of vital importance, as their beliefs and behavior may have a major impact on other women. This study was designed to assess mammography screening uptake among female healthcare workers at primary healthcare centers, and to identify the primary motivators and barriers that affect uptake results.

Materials And Methods: A cross sectional study design was used to assess mammography screening by 299 female healthcare workers who completed a self-administered questionnaire that assessed demographics, screening uptake, motivators and barriers.

Results: The mean age was 46 years (within age of risk). The majority (95.1%) demonstrated adequate knowledge about breast cancer and mammography screening and 50% of the participants reported having at least one mammogram; however only 21% of them had regularly scheduled mammograms. The most frequent reported motivator was the perceived benefit that early detection of breast cancer is important for its management (89.6%), followed by the belief that mammography can detect breast cancer before its symptoms appear (84.4%). On the other hand, the most frequent barrier reported was being busy (46.7%), followed by the lack of perceived susceptibility (41.5%).

Conclusions: Mammography screening was found to be sub-optimal in a population of HCW's with 50 % stating that they received a mammogram at least once, and a minority reported regular screening. There is a pressing need for educational programs aimed at removing the barriers that limit compliance with recommendations for mammography screening, and to emphasize the importance of early detection in breast cancer treatment. Ensuring the availability and accessibility of screening services, particularly for healthcare workers within their work settings are other important factors that would improve the acceptance and compliance for mammography screening programs.
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January 2017

Risk factors of hepatitis B transmission in northern Palestine: a case - control study.

BMC Res Notes 2014 Mar 28;7:190. Epub 2014 Mar 28.

Assistant Professor in Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Box 7,707, Nablus, Palestine.

Background: The Hepatitis B (HB) infection is a significant health problem in Palestine, which is categorized as an HB virus moderate endemic area, with the HB carrier rate ranging from 2-6%. The aim of this study is to determine the risk factors of Hepatitis transmission in the northern areas of Palestine in order to help prevent and control this prevalent health problem.

Methods: A case-control study was implemented to achieve the study objectives. One hundred HB virus seropositive cases and another 100 seronegative controls were included in the study. Univariate analysis and a logistic regression model were performed to examine probable risk factors of acquisition of HB infections.

Results: Univariate analysis showed that HB case-patients were more likely to report having a history of blood transfusion, dental visits, hospitalization, Hejamat, sharing shaving equipments, intravenous drug use, or living abroad than controls were. The logistic regression model revealed a history of dental visits to be the most significant risk factor, (P value <0.001, OR 5.6; 95% CI 2.8-11.1).

Conclusion: The presence of these risk factors emphasizes the need for both increasing the uptake of HB vaccine and implementing risk-targeted public health education. Development and enforcement of appropriate infection control guidelines for dental care services are important to prevent HB virus transmission as well.
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http://dx.doi.org/10.1186/1756-0500-7-190DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986636PMC
March 2014

Prevalence of patients with end-stage renal disease on dialysis in the West Bank, Palestine.

Saudi J Kidney Dis Transpl 2013 Jul;24(4):832-7

An-Najah National University, Nablus, Palestine.

This study was conducted to determine the point prevalence of patients with end-stage renal disease (ESRD) on dialysis in the West Bank, Palestine. As part of this study, the following parameters were studied: District, gender, age and presumed cause. This cross-sectional study was undertaken during the period 26-30 December 2010 at all dialysis units in the West Bank, and included all cases of ESRD on dialysis. The total prevalence of patients with ESRD on dialysis during the study period was 240.3 per million population (PMP). The highest prevalence was seen in Jericho city. There were 57.7% males and 42.4% females in the study. The majority of patients (62.3%) were living in villages, while 28.8% were living in cities and 8.9% were living in refugee camps. Most of the patients (45%) were aged between 45 and 64 years. The vast majority of patients were either diabetic (22.5%) or hypertensive (11.1%) or both at the same time (10.6%). There were a considerable number of patients in whom the cause was undetermined (27.6%). The majority of recorded cases of congenital causes were from the Hebron, Jenin and Tubas districts. The prevalence of ESRD noted in our study is comparable with other regional countries but far below the rate recorded in industrialized countries. In the Palestinian territories, there is a general lack of national statistics and surveys, particularly in the public health section. Increased efforts and awareness should be focused on the prevention and treatment of diabetes mellitus and hypertension as they are the main causes of ESRD. There should also be an additional enhancement and implementation of strategies for the registration of data in order to conduct periodic comparisons and analytical studies to improve the management and quality of life of ESRD patients.
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http://dx.doi.org/10.4103/1319-2442.113913DOI Listing
July 2013

Pandemic influenza A/H1N1 vaccination uptake among health care workers in Qatar: motivators and barriers.

Vaccine 2011 Mar;29(11):2206-11

Health Promotion and Community Medicine, Primary Health Care, Qatar.

Influenza A/H1N1 new vaccine helps control disease spread. Cross-sectional survey was conducted at PHC & Emergency Departments in Qatar to determine influenza A/H1N1 vaccination rate among HCWs and associated factors, 523 HCWs were enrolled. The study showed that 13.4% HCWs received vaccination. Feeling protected strongly influenced vaccination decision (OR = 14.5). Uncertainty about vaccine efficacy and fear of side effects strongly influenced decision to reject the vaccine (OR = 0.3 and 0.2 respectively). Vaccination coverage was very low. The most common barriers were uncertainty about vaccine efficacy and fear of side effects. Health authorities should build message highlighting how the benefit of vaccination outweighs risk.
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http://dx.doi.org/10.1016/j.vaccine.2010.08.093DOI Listing
March 2011
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