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A Quantitative Prospective Study for Whole Body- Diffusion MRI and PET-CT in Detection of Primary and Metastatic Malignant Lesions
(جامعة القدس, 2022-05-22) Ahmed Mohammed Ahmed Abu Ali; أحمد محمد أحمد أبوعلي
The idea of having an integrated nuclear medicine unit consisting of a scanner with a compatible source of isotopes like cyclotron to work efficiently in Palestine is almost impossible due to many issues beginning from political issues and ending with financial issues. Moreover, the nature of materials that have been used in nuclear medicine is radioactive which could increase the ability of causing other malignancies, PET scan can sometimes show areas of high activity, which may be mistaken for cancers like inflammatory conditions, in order to avoid all these pitfalls that might interfere with the diagnostic process, it is necessary to start looking for an alternative to support oncologists and their patients to use another safe, valid, available in abundance and lower cost technology called Whole Body Diffusion MRI which can project areas of restricted water diffusion for pathologies and for tumors through the whole body in places where cellular activity is increased with decreasing of relevant water diffusion in the same area. A prospective data collection for 33-oncology patient, who advised previously to do PET scan had been agreed to participate in our study for WB-DWI MRI scanning in a period not exceeding ten days between PET and MRI, 60% are male participants (n=20) and 40% female (n=13), ages of participants are ranging between 18-74 years old with an age average of 48 years old, body weight average is 83kg with a maximum and minimum weight are125kg and 56kg respectively. Their primary diseases varied between non Hodgkin lymphoma (NHL), Hodgkin lymphoma, endometrial, prostate, pancreatic, and gastric, thyroid cancer, pathological fracture and skin lesions. Our result in PET shows 181 hypermetabolic lesion distributed in the four zones (head neck, chest, abdomen-pelvis and musculoskeletal), WB-DWI MRI shows most of the same lesions restricted in diffusion with extra small sub centimetre lesions totally 251 lesions in count with a comparison between standard uptake volume (SUV) and apparent diffusion coefficient ADC) which shows most high SUV (SUV>2.5) have ADC < 1.1 x10-3 mm2/s. Statistical quantitative analysis shows a significant positive correlation between number of detected lesions in both modalities, in the same zone for each patient, at p value < 0.05 (p=0.00004) and R-value = 0.178, 0.434, 0.606 and 0.840 for head-neck, chest, abdomen pelvis and musculoskeletal respectively, a comparative correlation between ADC and SUV shows a significant negative correlation between SUV and ADC at p value < 0.05 and R-value= -0.3073. WB-DWI MRI can be used in some lymphoma cases for follow up as an alternative for PET scan in case no access is available for PET imaging, DWI can be used also for localized tumors follow up to monitor the response for treatment after chemotherapy or radiotherapy either post-surgical resection. Oncology and radiology departments recommended activating diffusion sequence in each MRI study for oncology patients in order to assure the idea of diffusion restriction for follow up studies فكرة وجود وحدة طب نووي متكاملة تتكون من جهاز ماسح مع مصدر للنظائر المشعة مثل المسارع النووي الدائري للعمل بكفاءة في فلسطين يكاد يكون مستحي ا لً بسبب العديد من القضايا التي تبدأ من القضايا السياسية وتنتهي بالقضايا المالية بسبب الإحتلال الإسرائيلي. الهدف من هذه الدراسة هو إيجاد طريقة آمنة وصالحة ومتاحة على نطاق واسع كبديل للتصوير البوزيتروني الطبقي لمساعدة أطباء الأورام وكذلك المرضى ، اقترحنا بروتوكول نموذجي معدل للرنين المغناطيسي لتصوير الجسم بالكامل ) WB-DWI MRI ( لاستسغلال خاصية الإنتشار من جزيئات الماء داخل انسجة الجسم. شارك 33 مريضًا من مرضى الأورام بهذه الدراسة ، 60 ٪ ذكور ) 20 ( و 40 ٪ إناث ) 13 ( ، تتراوح أعمارهم بين 18 - 74 عامًا بمتوسط عمري 48 عامًا ومتوسط وزن جسم 83 كجم . تم تشخيص إصابة المشاركين بالفعل بأورام أولية بما في ذلك سرطان الغدد الليمفاوية اللاهودجكين،و سرطان الغدد الليمفاوية هودجكين ، سرطان الرحم ، والبروستات ، والبنكرياس ، والمعدة ، والغدة الدرقية ، والكسور المرضية ، والكُتل الجلدية. أظهرت نتائجنا أن التصوير المقطعي بالإصدار البوزيتروني أظهر 181 كتلة ذات نشاط حيوي عالي في المناطق الأربع )الرأس والعنق، الصدر، البطن والحوض، والجهاز العضلي الهيكلي( لجميع المرضى ، تم اكتشاف نفس الكتل بواسطة WB-DWI MRI الذي يُظهر معظم الكتل نفسها مقيدة في الانتشار بالإضافة لكتل لمفاوية ذات حجم أقل من 1 سم بعدد إجمالي 251 كتلة مع مقارنة بين حجم الامتصاص القياسي ) SUV ( ومعامل الانتشار الظاهر ADC حيث تبين أن الكتل ذات حجم الإمتصاص القياسي ) SUV> 2.5 ( كان معامل الإنتشار الظاهر لها ADC أقل من 3-10× 1.1 مم 2 / ث. يُظهر التحليل الكمي الإحصائي ارتباطًا إيجابيًا معنويًا بين عدد الكتل المكتشفة باستخدم الرنين المغناطيسي والتصوير البوزيتروني في نفس المنطقة لكل مريض بدلالات إحصائية موزعة كالتالي: 0.178 و 0.434 و 0.606 و 0.840 للرأس والعنق والصدر والبطن والحوض والجهاز العضلي الهيكلي على التوالي ، ويظهر الارتباط المقارن بين ADC و SUV وجود ارتباط سلبي بقيمة p <0.05 وقيمة R = -0.3073 . يمكن أن يحل التصوير بالرنين المغناطيسي WB-DWI محل التصوير المقطعي بالإصدار البوزيتروني في حالات سرطان الغدد الليمفاوية ومتابعة الأورام لمراقبة الاستجابة للعلاج بعد العلاج الكيميائي أو العلاج الإشعاعي وكذلك الأمر بعد عمليات الإستئصال الجراحي.
Age of Complementary feeding introduction in infancy and growth among adolescence residing in a refugee camp: A follow up study.
(Al-Quds University, 2021-12-20) Rand Shafeeq Ramlawi; رند شفيق رملاوي
Background: Obesity is becoming a global health issue and a public health challenge; due to the significant increase of obesity rates worldwide especially during adolescence and its relation with non- communicable diseases.Overfeeding during infancy leads to obesity, and studies suggest that nutrition in infancy and childhood may play an important role in adulthood obesity. However, no study in Palestine investigated the association between adolescent obesity and the time of complementary feeding introduction during infancy in Palestine. Aim & objectives: This study aimed to determine the relationship between age of introduction of complementary foods and overweight/obesity among school children in the early adolescence age in the Al-Amari refugee camp. Its objectives were to determine the associations between socio-demographic and economic characteristics, various lifestyle aspects, birth weight, and breastfeeding with the risk of developing obesity during adolescence. Study methodology:The study is a follow-up cohort study of 97 adolescents who participated in a previously conducted study 10 years earlier. A structured interview- questionnaire that covers all study objectives wasused for data collection. Also, anthropometric measurements (height and weight) and hemoglobin levels were measured for the participants. Statistical analysis:SPSS version 25 was used for data entry and analysis. Descriptive analyses were done for the collected data at adolescence and infancy. Frequencies means and standard deviations were calculated. For the univariate analysis, chi-square test and t-test were used to study the associations between adolescences’ growth indicators and their determinants. Also, diet and infant growth indicators were examined for any association with adolescent growth at a significant p-value of 0.1. Ethical considerations: The study was approved by Al-Quds University Research ethical committee. Permission to conduct the study was obtained from theUNRWA. Furthermore, participants’ parents signed a consent form that confirmed their acceptance to include their children in this study. Results: Analysis of the study participant’s data showed that the range of participant’s age was 13-14 years,57% of them were males, 45% of them have a family income of more than 3000 NIS and 56% of them were overweight/ obese. Only 5.2% who were of normal weight before 2 years of age stayed normal at adolescence and 40% stayed overweight or obese. However, 50% had a change in their BMI by the time either to become normal weight (38%) or overweight/obesity (16.5%). The univariate analysis of the study data showed positive associations for overweight/obesity with gender –male-(p-value <0.1), being the first or second child in the family(p-value <0.1), mother education level (p-value <0.1), monthly income (p-value >0.1), eating or drinking after dinner(p-value >0.1) ; being family members the source of nutrition information; buying sandwich or cake from school canteen (p-value >0.1). However, a negative association between overweight/obesity and birth weight of the participants (p-value >0.1),eating or drinking while watching TV (p-value <0.1); satisfying with appearance (p-value <0.1), effect of school curriculum on food consumptionand with Hemoglobin level(p-value >0.1).Lower frequency of physical activity is associated with a higher percentage of overweight/obesity (p-value>0.1). Finally, higher frequency of breastfeeding (p-value >0.1) was found to be protective factor against overweight/obesity. Conclusion:Obesity in adolescence is a predictor for obesity during adulthood. Therefore, adolescents should be directed to maintain normal weight by increasing their awareness of the determinants of obesity. Several factors have been investigated in this study either related to infancy or adolescence. Unfortunately, the small sample size prevented us from obtaining significant results as expected. But, the results showed a trend toward protective effect against overweight/obesity for higher frequency of BF. العلاقة بين عمر ادخال الأغذية التكميلية في مرحلة الطفولة والنمو لدى المراهقين في مخيم الأمعري للاجئين-رام الله: دراسة متابعة إعداد: رند شفيق عبد الرحمن رملاوي إشراف: الدكتورة نهى الشريف ملخصالدراسة أصبحتالسمنةمشكلةصحيةعالميةوتحديللصحةالعامة؛بسببالزيادةالكبيرةفيمعدلاتالسمنةفيجميعأنحاءالعالمخاصةخلالفترةالمراهقةبالاضافة الى علاقتهابالأمراضغيرالمعدية.انالتغذية المفرطةأثناءالطفولة قد تؤديإلىالسمنة،وتشيرالدراساتإلىأنالتغذيةفيمرحلةالرضاعة والطفولةقدتلعبدورًامهمًافيالاصابة بالسمنةعندالبلوغ. ومعذلك،لمتبحثأيدراسةفيفلسطينالعلاقةبينالسمنةلدى المراهقينوعمرادخالالأغذيةالتكميليةخلالمرحلة الطفولة. هدف الدراسة الرئيسي:تهدف هذه الدراسة الى تحديد العلاقة بين عمر ادخال الاغذية التكميلية للأطفال و زيادة الوزن\ السمنة لدى طلبة المدارس في سن المراهقة المبكرة في مخيم الأمعري للاجئين الفلسطينيين. و تتمثل أهدافها الفرعية في تحديد العلاقة بين العوامل الاجتماعية والديموغرافية والاقتصادية, العوامل المتعلقة بنمط حياة المراهقين, الوزن عند الولادة والرضاعة الطبيعية مع خطر الاصابة بالسمنة خلال فترة المراهقة. منهجية الدراسة:هذه الدراسة عبارة عن دراسة تتبع مبنية على دراسة سابقة (حول الرضاعة الطبيعية والاغذية التكميلية). 97 مراهق تم ايجادهم من أصل 199 طفل حيث قام المشاركون في الدراسة بالاجابة على أسئلة الاستبيان المعد خصيصا لأهداف هذه الدراسة عن طريق مقابلتهم جميعا,بالإضافةإلىقياسات الوزن والطولوفحصمستوىالهيموجلوبين. التحليل الاحصائي: تم ادخال جميع البيانات وتحليلها باستخدام الاصدار 25 من برنامج SPSS-IBM ففي المرحلة الأولى تم حساب التكرارات, المتوسط والانحراف المعياري لجميع المتغيرات الخاصة بمرحلتي الطفولة والمراهقة, وقد عرضت البيانات في جداول و أشكال بيانية, أما في المرحلة الثانية فتم فحص العلاقة بين مؤشر كتلة الجسم لدى المراهقين والعوامل المراد دراستها بواسطة فحص العامل المستقل (t-test) وفحص كاي تربيع (Chi-square) بالاضافة الى فحص علاقة مؤشرات النمو للرضع وتغذيتهم مع نموهم في مرحلة المراهقةعند مستوى الدلالة الاحصائية (P<0.1). الاعتبارات الأخلاقية: قدمت هذه الدراسة للجنة البحث العلمي والدراسات العليا في جامعة القدس. تم الحصول على اذن لاجراء الدراسة منوكالةالأممالمتحدةلإغاثةوتشغيلاللاجئينالفلسطينيينفيالشرقالأدنى (الأونروا) بالاضافة الى الحصول على توقيع من أهالي المشاركين على نموذج موافقة أكدوا من خلاله على موافقتهم بانضمام أبنائهم للدراسة بعد ابلاغهم بأهدافها. النتائج: أظهرتحليلبياناتالمشاركينفيالدراسةأنعمرالمشاركينكان 13-14 سنة، 57٪ منهممنالذكور، 56٪ منهميعانونزيادة الوزن\ السمنةو 45٪ لديهمدخلعائليأكثرمن 3000 شيكل. 5.2% منهم لديهم اوزان طبيعية قبل عمر السنتين و حافظو على أوزانهم الطبيعية في سن المراهقة, بينما 40% منهم كانوا يعانون من زيادة الوزن\السمنة قبل عمر السنتين واستمروا كذلك في سن المراهقة. بالمقابل, حدث تغير في الوزن لدى 50% منهم فأصبحت أوزانهم طبيعية 38% أو العكس 16.5%. وقد أظهر التحليل علاقة ايجابية لزيادة الوزن\ السمنة مع الجنس (ذكر)(p <0.1), الترتيب في الأسرة (الطفل الأول أو الثاني)(p <0.1), مستوى تعليم الأم(p <0.1), دخل الأسرة الشهري(p >0.1), تناول الطعام والمشروبات بعد العشاء(P>0.1), تلقي المعلومات المتعلقة بالتغذية من قبل أفراد الأسرة, بالاضافة الى شراء الأغذية من مقصف المدرسة(P>0.1). بالمقابل, أظهر التحليل علاقة عكسية للأوزان غير الطبيعية مع وزن الطفل عند الولادة(p >0.1), تناول الطعام والشراب أثناء مشاهدة التلفاز(p <0.1), مستوى الرضى عن المظهر الخارجي(p <0.1),تأثير المناهج الدراسية على استهلاك الغذاء بالاضافة الى مستوى الهيموجلوبين(p >0.1). بالاضافة الى ذلك, أظهرت نتائج التحليل أن زيادة تكرار الرضاعة الطبيعية (p >0.1) يعتبر عامل وقائي ضد زيادة الوزن/ السمنة. وأخيرا, أظهرت النتائج أن قلة ممارسة النشاط البدني مرتبط بارتفاع نسبة زيادة الوزن والسمنة لدى المراهقين(p >0.1). الخلاصة:ان زيادة الوزن في مرحلة المراهقة تعتبر مؤشر لزيادة الوزن في الكبر. وبالتالي, يجب أن يتم توجيه المراهقين للحفاظ على أوزانهم ضمن النطاق الطبيعي لحماية أنفسهم من مضاعفات السمنة وذلك يتم من خلال زيادة الوعي لديهم بمخاطر السمنة و مسبباتها. لقد تم في هذه الدراسة البحث في كثير من العوامل المتوقع ارتباطها بالسمنة لدى المراهقين سواء في مرحلة الطفولة أو في مرحلة المراهقة. لسوء الحظ, صغر حجم عينة الدراسة منعتنا من الوصول للنتائج المتوقعه منها ولكن النتائج أظهرت اتجاها نحو تأثير وقائي للرضاعة الطبيعية ضد زيادة الوزن والسمنة في عمر المراهقة.
Anti-Phospholipid Syndrome among Aborted Women in Their Second-Trimester in Gaza: Case-Control Study
(Al-Quds University, 2012-06-24) Mahmoud S. El-Haj Ahmed; محمد الحاج أحمد
Background: Antiphospholipid syndrome (APS) is an acquired thrombophilia cause recurrent venous or arterial thrombosis and/or fetal loss, which occurs in approximately (1%) of women worldwide. Aim: to assess the relationship between APS and second-trimester abortion in Southern Gaza Governorates. Methods: The design of the study is a case-control study. Convenient sample obtained from Southern Gaza Governorates, one hundred participants of equal number of cases and control. Data collected by two methods: The first, a questionnaire interview which included socioeconomic data and group of risk factors to exclude them from the study. The second, which included withdrawal blood samples to investigate group of tests related to APS and abortion. For this study we used techniques such as ELISA, Ag-Ab reaction and spectrophotometer to measure the level of various variables such as lupus anticoagulant (LA) test, dilute Russell viper venom time (dRVVT), anticardiolipin (ACL) (IgM and IgG), toxoplasma (IgM), rubella (IgM), fasting blood sugar (FBS) and thyroid stimulating hormone (TSH). Results: The results of our study showed that there is a statistically significant relationship between APS and second-trimester abortion (P < 0.05). Also we found significant relationship between dRVVT and second-trimester abortion. As well LA test showed a significant relationship with the second-trimester abortion (P < 0.05). Moreover, the dRVVT was the most specific test for APS diagnosis. According to our results morbidity and mortality associated with APS second-trimester abortion could be decreased by early diagnosis of APS using dRVVT as a diagnostic test beside clinical findings. There is no relationship between toxoplasma (IgM) and second-trimester abortion. Moreover, there is no relationship between rubella (IgM) and second-trimester abortion. Conclusion: Our findings added an impute in the early diagnosis of APS and dRVVT is the most specific test for APS diagnosis more than other tests. Also the tests that were positive for APLs should be repeated after 6 weeks because actual cases usually have persistent APLs in their blood. In future research there is a need to study inherited thrombophilia and its relationship to abortion.
Assessing Drug Dispensing Safety Practices at Community Pharmacies in The Gaza Strip
(Al-Quds University, 2020-01-11) Reem Bashir Khamis Ghannam; ريم بشير خميس غنام
Medication safety has long been recognized as a key issue within the broader patient safety agenda. Medication errors can cause unwanted adverse drug events and, in some cases, can lead to life-threatening injuries. In Palestine, community pharmacies are engaged mainly in dispensing medications, including antibiotics, without prescription. However, the quality of the service provided by community pharmacies in developing countries has often been questioned and is often suboptimal. This study aimed to evaluate the current medication safety practices in the community pharmacies at Gaza Strip. The study employed a descriptive, analytical cross-sectional approach with an explanatory sequential mixed method (quantitative and qualitative). Interview based questionnaires (five point Likert scale) and key informant interviews were used for data collection. Two-stages systematically randomized sample was used to select the eligible community pharmacies and the eligible participants. The calculated sample size was 270, out of them, 258 completed the questionnaires, with a response rate of 95.5%. An adapted Medication Safety Self-Assessment instrument (10 dimensions) was used to collect the quantitative data. The reliability coefficient for the study instrument was excellent 0.95. Semi structured, face to face, in-depth interviews were conducted with seven key informants from community pharmacies and five patients as a second data collection technique. The data was analyzed by SPSS version 23, findings revealed that the overall mean score of the medication safety practices was satisfactory 3.20, SD = 0.56, T-value =5.81, and P-value =0.000. The analysis showed that the Drug Standardization, Storage, and Distribution scored the highest level of implementing the medication safety practices 3.57, T-value=11.91 and P-value=0.000 , followed by the Staff Competency and Education 3.55, T-value=12.47 and P-value=0.000, Use of Devices and medical supplies 3.51, T-value=7.89 and P-value=0.000, Environmental Factors, Workflow, Staffing Patterns 3.42, T-value=11.45 and P-value=0.000, and Drug Information 3.33, T-value=7.09 and P-value=0.000. The least score was for the Drug Labeling, Packaging, and Nomenclature 2.69, T-value=4.92 and P-value=0.000, and Patient Information 2.81, T-value=4.26 and P-value=0.000. The findings showed insignificant variation in medication safety practices in reference to gender, age, salary, qualification, and work experiences, except for governorate, and specialization where P-value was ˂0.05. The researcher strongly recommends using a multifaceted implementation strategies targeting the use an electronic prescription with patient personal information, clinical history, and complete medication history, properly manage the look-alike drug names and packaging, and using validated tools to identify potential risk factors to avoid medication errors in addition to using continuous quality improvement programs in the community pharmacies. إن سلامة الدواء قضية رئيسية ضمن أجندة سلامة المرضى، وإن الأخطاء الدوائية لها العديد من الآثار الجانبية وفي كثير من الأحيان قد تؤثر سلبيا على حياة المرضى. في فلسطين، تعتبر عملية صرف الأدوية هي المهمة الأساسية للصيدلياتالمجتمعية، بما في ذلك جميع الأدوية التي تصرف بدون وصفة طبية. ومع ذلك، فإن جودة الخدمة التي تقدمها الصيدليات المجتمعية في البلدان النامية كثيراً ما كانت موضع تساؤل وغالبًا ما تكون دون المستوى الأمثلولذلك تهدف هذه الدراسة إلى تقييم ممارسات السلامة الدوائية الحالية في الصيدليات المجتمعية داخل قطاع غزة. صممت الدراسة على أنها دراسة مقطعية وصفية تحليله متسلسلة توضيحية (كمي ونوعي) باستخدام الاستبيانات القائمة على المقابلة ومقابلات أصحاب الخبرة كوسيلة لجمع البيانات. تم استخدام عينة عشوائية من مرحلتين بشكل منتظم لتحديد صيدليات المجتمع المؤهلة والمشاركين المؤهلين. كان حجم العينة المحسوب 270 صيدلية، شارك منهم 258 في تعبئة الاستبيانات، وكان معدل الاستجابة 95.5 ٪. تم عمل ملائمة لأداة السلامة الدوائية العالمية MSSA (10 أبعاد) بما يناسب الصيدليات المجتمعية في غزة لجمع البيانات الكمية كان معدل الثبات لأداة الدراسة ممتازًا 0.95.ثم أجريت مقابلات شبه منظمة، وجها لوجه،مسموعة، متعمقة مع سبعة من الصيادلة الذين يعملوا في صيدليات مجتمعية رئيسية ف قطاع غزة،وخمسة من المرضى الذين يعانوا من أمراض مزمنة. تم تحليل المعطيات بواسطة الإصدار 23 من SPSS، وكشفت النتائج أن النتيجة الكلية المتوسطة لممارسات سلامة الدواء كانت مرضية بمعدل 3.20 (64.05٪). وأظهر التحليل أنالبعد الخاص بمعايرة وتخزينوتوزيعالادوية سجل أعلى مستوى من تطبيق ممارسات السلامة الدوائية بمعدل 3.57 (71.44٪)، يليها كفاءة الموظفين وتعليمهم بمعدل 3.55 (71.10٪)، ثم استخدام الأجهزة والمستلزمات الطبية بمعدل 3.51 (70.20٪)، العواملالبيئية، سير العمل،وأنماط التوظيف بمعدل 3.42 (68.44٪)، ثم معلومات الدواء بمعدل 3.33 (66.69٪). بينما كانت أقل درجة كانت في وصف الدواء وتعبئته وتسميته بمعدل 2.69 (53.7٪) ومعلومات المرضى 2.81 (56.2٪). وأظهرت النتائج تباينًا ضئيلًا في ممارسات سلامة الدواء فيما يتعلق بنوع الجنس والعمر والراتب والمؤهلات وخبرات العمل، باستثناء المحافظات والتخصص حيث يؤثر كل منها على الممارسات المتعلقة بسلامة الأدوية كانت قيمة P ˂0.05.ركزت المقابلات بشكل أساسي على شرح نتائج الجزء الكمي واستكشاف الواقع من وجهات نظر أخرى. يمكن التوصية باستخدام أداة التقييم الذاتي لسلامة الدواء (MSSA) لتقييم ممارسات سلامة الدواء داخل الصيدليات المجتمعية.وتوصي الباحثة بشدة باستخدام استراتيجيات تنفيذ متعددة الأوجه تستهدف استخدام طرق الكترونية في تسجيل الوصفة الطبية مع المعلومات الشخصية للمريض، والتاريخ المرضي، وإدارة أسماء الأدوية المتشابهة وتعبئتها بشكل صحيح، واستخدام أدوات تم التحقق منها لتحديد عوامل الخطر المحتملة لتجنب الأخطاء الدوائية بالإضافة إلى استخدام برامج التحسين المستمر للجودة (CQI) في صيدليات المجتمع.
Assessment of Awareness, Biochemical and Hematological Parameters among Pesticides' Seller in Gaza Governorate
(Al-Quds University, 2011-07-28) Ibrahim Hassan Lubbad; ابراهيم حسن ابراهيم لبد
Pesticides sellers are exposed to multiple pesticides such as insecticides, herbicides and fungicides. An exploratory awareness and health study was conducted to assess awareness, biochemical and hematological parameters among pesticides' sellers in Gaza Governorate.A cross section of 26 pesticides sellers were asked to fill in a questionnaire on knowledge, attitudes, practice towards pesticide handling, and work and health aspects. Biochemical and hematological parameters of 14 pesticides sellers and 14 controls with no history of pesticides exposure were also examined. T-test and one-way ANOVA test were applied. The mean age of pesticides’ sellers was 34.3±9.7 years. Fifteen (57.7%) of them were owners and 11 (42.3%) were employees. The shops were well ventilated, and 18 (69.2%) of the sellers admitted that they have no special place for eating and drinking in the shop. All sellers have knowledge about the types and ways of pesticides use, and adverse health effects. Half of them had knowledge on alternatives of pest control. Twenty five (96.1%), 24 (92.3%) and 23 (88.5%) knew that pesticides exposure through oral, inhalation and skin, respectively. Attitude toward pesticides use and effectiveness of protective gear particularly gloves and mask was positive. Half of the sellers throw the empty pesticide containers in the garbage site or in the street. Protective measures in use was generally poor except for gloves 19 (73.1%) and masks 18 (69.2%). Pesticide sellers who wore gloves and masks had more knowledge on route of pesticides exposure through inhalation, skin and oral than those who did (P<0.05). Serum alanine aminotransferase and aspartate aminotransferase were significantly increased in cases compared to controls. Urea and creatinine were also higher. Such increase was statistically significant for urea (P=0.007). White blood cell count was higher in cases (p=0.047). In contrast, blood platelets and red blood cells were significantly lower in cases (p=0.002 and p=0.027, respectively). In parallel, hemoglobin and hematocrit showed no significant decrease in cases. Mean corpuscular volume, mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration exhibited no significant changes (P>0.05). ALT, AST, urea and creatinine showed successive increase with increase work duration, whereas blood platelets exhibited successive decrease. Conducting of educational awareness programs on pesticides alternatives and training courses related to extension and health impact of pesticides are recommended.
Assessment of exposure to quarries and pulmonary function among quarry workers in Beit Fajjar village
(Al-Quds University, 2021-05-25) Aya Ali Hasan Taqatqa; آية علي حسن طقاطقة
Assessment of exposure to quarries and pulmonary function among quarry workers in Beit Fajjar village. Background: Occupational health has been defined as ―Promotion and maintenance of the highest degree of physical, mental and social well - being of workers in all occupations; (WHO, 2012). Workers in the quarry industry face numerous risks emerging from airborne particulate inhalation, and thisexposure mightpose a major health and safety concern. Aim: This study aims to identify theassessment of exposuretothe quarry industry and pulmonary function among quarry workers in BeitFajjar-Palestine. Methodology: A descriptive cross-sectional study was conducted in 2020, with a sample of 200 quarry workersthat were conveniently recruited for this study. Data was collected bya data collection sheet, which included personal information of the workers;years of work for workers, and other personal variables, in addition to the ―questionnaire”that is used for chronic respiratory illness assessmentin Epidemiological Research‖.Spirometer device was used in this study to measure the lung functions with main concentration on three parameters: Forced Vital Capacity (FVC), Forced expiratory volume in 1st second (FEV1), and FEV1% (FEV1/FVCV). Results: All of the participants weremale at the worker site. Workers ‗agewasbetween 20 to 50years. Most of participants (77%) did not use personal protective equipment (PPE). 92 percent of the study participants work in quarries for more than 35 hours a week, meaning that the majority of them are at risk of inhaling quarry dust. 77% of the study sample is a smoker, which is a high prevalence. The most common reported respiratory symptoms by the participant were having cough and shortness of breath. Normal lung function test was among only 30% of respondents. Decreased pulmonary function was found among a significant percentage of the industry workers, 48% was found to have a moderate to a severe decrease in FCV, and 31% had a moderate to a severe decrease in FEV1, and 45% had moderate to severe decrease FEV1%. VIII By using independent sample t-test, there was no significant difference in mean FEV1 and FEV1% upon using protective equipment kit, smoking, family history of respiratory disease, worker‘s history of respiratory disease diagnosis, presence of shortness of breath, cough, nasal congestion, and educational level ( p > 0.05), While there was a statistically significant difference of mean FEV1% for the favor of workers without wheezing (88.5 % ) as compared to those who reported wheezing (81.1% )(P = 0.002) . In correlation demographic and work-related variables with FEV1 and FEV1% there was no statistically significant correlation between FEV1, FEV1% and Age, practical, and total working hours per week (p > 0.05). And there is a statistically significant difference of mean FEV1% upon the work place, with favor for the stone crushing industry workers (with FEV1% 89.4%) as compared to the stone pits (with FEV1% of 83.7%). By using multivariate stepwise regression the model revealed that practical experience is the only predictor of FEV1, with very weak R2, justifying nearly 2% of the variation in the dependent variable (FEV1) which is considered a very weak explanation of the variation in the dependent variable and working place represented in the stone pit or crushing is the only significant predictor of FEV1%, in favor for stone crushing facility workers (89.41%, SD 10.47%) as compared to stone pits (83.76%, SD 16.73%), with a very weak explanation of the variation of the dependent variable R2 (0,041). Conclusion: This study showed chronic exposure to quarry dust was associated with deterioration of lung function indicated by reduced lung function indices among quarry workers. This finding reflects the need for periodic evaluation of lung function to help in preventing any deterioration in the respiratory health of these workers. Also, it emphasizes the need for advocacy that will drive the responsible body for this occupation to put clear legislations and enforce these workers to wear the proper PPEs. IX ملخص
Assessment of Knowledge, Attitude, and Practice among Nurses Toward Nutrition Care in Hospitals at Hebron / West Bank
(Al-Quds University, 2024-05-30) Hala ibrahem ali shalaldah; حلا ابراهيم علي شلالدة
Accountability in identifying nutritional issues, evaluating patients' nutritional status in clinical settings, creating diet plans, and advising patients about specific dietary modifications are all part of maintaining appropriate nutrition for patients and clients. However, there are not enough dietitians and nutritionists to meet the growing needs of an aging population because they interact with patients the most. Nurses are essential multidisciplinary players in nutritional care. They routinely perform preliminary nutritional assessments, refer patients, and work with patients, their families, or important caregivers to support recommendations for changing meal planning and implementing special diets. Aim: This study aimed to assess nurses' knowledge, attitude, and practice toward nutrition care in Hebron/Palestine. Method: This is a descriptive cross-sectional study, including all nurses who work in selected hospitals in Hebron, Yata Hospital, Mezan Hospital, Mohtseb Hospital, Alia Hospital, Hebron Red Crescent Hospital and have direct contact with patients. 200 nurses participated in the study out of 220nurses. Data were collected by valid and reliable (Cronbach Alpha 0.81) self-administered questionnaire that asked about Nutrition knowledge, attitudes, and practices of nurses with their sociodemographic factors. The data were analyzed using the Statistical Package for Social Sciences (SPSS), version 25. Result: Most nurses (77%) were under 30 years old. Participants showed insufficient knowledge of Nutrition. The study shows positive attitudes towards nutrition among the participants. However, results found good practices toward nutrition, 89.5% of them agree that the protocols for nutrition screening and assessment are available in their hospital. Conclusion: The study shows insufficient nutritional knowledge and neutral attitudes among nurses, while their practices are good. The study also shows that most of the participants receive nutrition training in their universities. In addition to effective and efficient training and teaching programs in all hospitals to target all nurses who have direct patient contact, it is advised that nutrition curricula be added to medical and nursing schools.
Assessment of Occupational Health and Safety Measures among Municipal Solid Waste Workers in UNRWA Sanitation in Gaza Governorates
(Al-Quds University, 2010-06-01) Jehad Ibrahim Abu Lebda; جهاد ابراهيم ابو لبدة
Background: Solid waste handling is of great importance due to its potentials hazards to workers, public health and the environment. Health impacts of solid waste on workers were studied worldwide. However, no previous published research was reported about occupational health and safety measures among municipal solid waste workers in Gaza Governorates. This study was aimed to assess health problems and safety measures among municipal solid waste workers working at UNRWA Sanitation Department serving refugee camps. Methodology: Through a cross sectional study, a sample of 158 solid waste workers in the Gaza Governorates were asked to complete a questionnaire about knowledge and practices towards safety measures, and associated self-reported health symptoms and work injuries. Results: The mean age of workers was 45.1±8.1 years. The mean work duration was 14.0 ± 7.8 years. High level of workers knowledge was generally found on hazards of solid waste on environment 144 (91.1%), workers themselves 140 (88.6%), residents nearby containers 113 (71.5%) and on general population 98 (62.0%). In addition, 149 (94.3%) and 104 (65.8%) workers reported that medical waste is more dangerous than domestic waste and safety tools can protect from risks of solid waste, respectively. Only 16 (10.1%) workers reported that safety tools are available throughout the year. Practices of workers towards safety measures showed that the use of gloves, hat, goggles and masks during work were distributed as 29 (18.4%), 27 (17.1%), 8 (5.1%) and 7 (3.8%), respectively. Workers who were practicing smoking, drinking and eating during work had been distributed as 67 (42.4%), 120 (75.9%) and 89 (56.3%), respectively. The most frequently self reported symptom was back pain 81 (51.3%). Forty four (27.8%) workers reported headache and the same percentage reported complaining from conjunctivitis. Other symptoms included dermatitis 38 (24.0%), dyspepsia 37 (23.4 %) and dyspnea 33 (20.9%). The most common injuries were wounds 65 (69.9%), needle sticking 47 (50.5%) and slipping 32 (34.4%). About two thirds of workers 105 (66.5%) did not attend training courses about risks of solid waste. Workers who attended training courses reported less symptoms and less injuries (p=0.043 and 0.044, respectively) than their counterparts. Self-reported symptoms increased with the increase of working years. Workers who used gloves, goggles and masks during work reported less symptoms than who did not (p=0.002, p=0.009 and p=0.041, respectively). However, more symptoms were reported among workers who drunk during work (p=0.040). Conclusion: The present study revealed that the use of safety measures including safety tools and personal habits was poor. Lack of training and awareness courses, and vaccination were recorded among workers. Provision of training and awareness courses on health hazards of solid waste, ensuring the availability safety measures, and monitoring the health status of the workers are highly recommended. .
Assessment of Personnel Fitness of the Intensive Care Unitsí Teams - Gaza Governorates
(Al-Quds University, 2011-07-15) Mymona Sobhi. Esleem; ميمونة صبحي اسليم
care unit (ICU) is different from other units. Its team works under stressful situations within a complex environment, and each member should have special criteria. This study is aimed to assess to what extent the Palestinian staff match with international criteria for ICU through four dimensions, physical fitness, competency, professional requirement and structure of ICU. The design of the study is a descriptive cross sectional one. Data were collected through a self-administered questionnaire for (172) full time doctors and nurses who work regularly in ICU in the hospitals in Gaza strip and an observation checklist for 9 health care units. The reliability of the instrument was assured; data were analyzed using SPSS (version 18). The response rate was 77.9%. About 70.9% of the participants were married and 79% have bachelor degree. The main physical fitness was 85.5%, the main competency 55.6%. There was significant relationship between competency and each of physical fitness and work place (sig. 0.0). The check list which assessed the structure of ICU revealed that all units are nearly standardized except in some areas like the space between patient beds (2.5 - 3) meters, there is no fire safety measures, and lack of some equipment like double vacuum out lit. This study recommended that a special committee should be formed from the MOH to build " national ICU standards" based on international standards. Intensive in-service education for ICU staff should be considered.
Assessment of the Effectiveness and Performance of Blood Bank Services in Gaza Governorates during the War on Gaza
(Al-Quds University, 2010-05-30) Khitam A. Abu- Zinada- Natil; ختام علي أبو زنادة " نتيل
Globally, effectiveness of blood bank services plays a vital role in rescuing people's life. In particular, during the last war on Gaza, the performance of the blood banks was critical for meeting the emerged demands. This study aims at assessing the performance of blood bank services in Gaza Governorates during the war on Gaza in order to appraise strengths and challenges encountered. The design of this study is across sectional. All blood banks and hospitals involved in treating war casualties were included. Data collected through a questionnaire and an observatory checklist. The population of study included 116 respondents who completed the questionnaire plus 13 observational checklists. Data collected by the researcher and all participants were positively responded. This study shows that blood banks had faced shortage in the required blood units, fresh frozen plasma, required instruments, screening kits, alcohol 70% and the needed disposables. The shortage of blood units was more prominent in the north of Gaza with the south being the least affected with statistically significant differences between the two locations. Around 90% of respondents perceived the total number of staff wasn't sufficient for working during crisis. Similarly, the great majority 87% of respondents perceived the number of blood donation chairs as not sufficient to accommodate the extra ordinary number of donors during the war. blood donations was intensified during the war and the media was actively manipulated to recruit blood donors. The main reported strength points in the blood banks performance were extending working hours 81%, obtaining large number of blood units 75% and rapid responsiveness 43.8%. In contrary, the main reported weakness points were lack of instruments and equipment 81.3%, poor communication among the involved parties 56.3%, insufficiency of laboratory kits 43.8% and lack of administrative support 37.5%. As resulting of impaired accessibility during the war 25% of staff and 18.7% of mangers were unable to reach their work. The study recommends that the working condition should be improved by providing needed instruments, supplies and equipping the laboratories with the needed human resources. To ensure the availability of the need blood units, the service by the current central blood bank located in Gaza City should be expended to cover all Gaza Governorates .
Assessment of the Palestinian Red Crescent society emergency medical workers’ health risks, satisfaction, and psychologically situation in Palestine.
(Al-Quds University, 2021-06-05) Ismael Osama Abu Zayyad; اسماعيل زياد ابو زياد
Introduction: Emergency medical services (EMS) systems of care and health provision, respond to major events of crises and individual health emergencies, but they face many challenges not recognized by many organizations. EMS risk factors are difficult to define and characterize. Objective: To assess the health status of workers in the Palestinian Red Crescent Society- Emergency Medical Services in Palestine. Methods: A cross-sectional study was conducted in the Palestinian Red Crescent Society in three areas (Jerusalem, West Bank, Gaza Strip) in the year 2019. The study includes all EMS workers predominantly males, with only 11.9% being female. The questionnaire includes demographic characteristics, personal information, functional information, job difficulties, job satisfaction and leave decision, injuries and illness, and organization systems. Pilot questionnaires were excluded and not considered in the final research results (they form 7.96 % of the population). Descriptive analyses used Chi-square, mean, and frequency, Fisher test, and logistic regressions were conducted to analyze the factors that affect the decision of leaving EMS. Result: The main source of a work injury that occupies 66.8% is the structures and surfaces on the scene. While the person's source of illness is significant. A traumatic injuries to muscles cover a high number of occupational injuries among EMS workers. Surface wounds and bruises are the significant nature of the injury, followed by chemical burns and corrosion injuries. Where the percentage of work injury was 61.8% of employees and 42.5% of employees have an illness at work. The highest percentage of participants have a respiratory system ailment (38%). For the event of injury Jerusalem showed a high level from moving and transferring patients at 85.0%, and the military (Israeli army) situation with 65.0% of events that injuries occur in. For illness, the highest percentage is from the same event of moving and transferring patients, and the military (Israeli army) situation. Incredibly about 57.1% of the employees with an injury never get leave due to injury, also 36.9% who get illnesses never get sick leave. There are 13.1% suffering from a chronic disease, however, 94.3% of employees have an average physical time off weekly of less than 150 minutes. 41.8% of employees have over 15 years of EMS experience, unfortunately, there is just 1% of workers who have the paramedic certification. Conclusion: The study identified the health status and main health problem of the EMS workers in PRCS, their event, and source of exposure that affects the worker by the organization or the scene are also identified. The difference between the areas of work and between the workers and their effect on their health was taken into consideration especially in Palestine that is under occupation. Further research is needed to understand, address and improve the health of EMS workers.
Assessment of the Status of the Non-Governmental Medical Supply Warehouses in Gaza Governorates
(Al-Quds University, 2011-01-29) Mohammed Ismail Tabash; محمد اسماعيل طبش
Background: Storage of medicine is one of the most important stages in the pharmaceutical and medical preparations management, which influences the quality and the effectiveness of these products. Aim: To assess the storage system of the drugs, medical disposables and their management in the international, local NGOs and private warehouses in Gaza governorates in order to improve efficiency and effectiveness of the pharmaceuticals storage, management and subsequently its utilization. Methods: The design of the study was descriptive, analytical, cross sectional one; the sample included all medical warehouses which belong to local and international NGOs and the private sector and all the employees working in these warehouses who had direct responsibilities in storage process. Data was collected through self-administered questionnaire completed by one hundred and five employees and checklist for fifty one warehouses. The response rate was 95% for employees and 98% for warehouses. Result: Almost all warehouses had special areas for receiving and checking medical supplies and more than half of them had considered these areas as sufficient and 64% had no emergency doors; and 53% had no emergency alarm system. The study showed that 19% of employees had received training courses in store related work. More than 90% of employees had not written procedures for dealing with pharmaceuticals during emergency situation, 36% have antitheft security system, 41% of them kept controlled drugs in a separate storage space designated for this purpose. The majority of respondents (68%) reported that the medical supplies were always quarantined till the quality is checked. All employees in medical supply warehouses used first expire first out dispensing policy for medical supplies. Regarding environmental conditions, 58% of the warehouses had instruments to measure the temperature and 4% of the warehouses had an instrument to measure humidity. Computers were available in 82% of the surveyed warehouses and 29% of warehouses had a written regulation for receiving and distribution procedures. Of the surveyed warehouses, 77% had a vehicle to distribute drugs and disposables. Calculating the scores reflecting the favourable conditions and procedures indicate that international NGOs had elicited higher scores in all aspects pertaining to storage management cycle than local NGO and private warehouses and the differences between these warehouses were statistically significant , (p-value = 0.000). Also, the management cycle was better in warehouses that implemented training than those who haven’t with statically significant differences (p-value = 0.015. Conclusion: Warehouses need to pay attention to the commodity management cycle and to ensure the avalibility of safety measurements. Provision of training to employees dealing with the storage process is essential accompanied by monitoring and supervision.
Assessment of Tyres Waste Disposal Processes In Gaza Governorates
(Al-Quds University, 2008-12-17) Khalil Ibraheem Hassanein; خليل ابراهيم احمد حسنين
Tyre waste and its disposal is a worldwide problem. Tyres are not biodegradable; hence the time required for their decomposition is undetermined. Due to their chemical composition, when tyres are burnt, they release organic and inorganic pollutants to the air and soil, including hydrocarbons, dioxins, and other toxic substances. Tyre disposal requires special and expensive technology. The purpose of this research is to assess the current situation of waste tyres disposal process in the Gaza Governorates, in order to provide data base for future interventions. The study was carried out through tow questionnaires that targeted the owners of the tyres repair-shops and the professionals working at relevant local institutions, over a period of three months. The total sample was 101 owners of tyres' repair-workshops and sixteen professionals from different ministries and municipalities. The study illustrates that in Gaza governorates there are weaknesses in all stages of the waste tyres management process which includes collection, storage, transportation and treatment. The study revealed that there is no activities done in the fields of recycling and energy recovery. The absence of a national strategy for waste tyres management is represented in the lack of cooperation among the institutions who issue the work license and the repair-shops owners. No specific regulation had been developed, absence of database system and no enforcement activities from the government to regulate this field. The absence of monitoring system for the waste tyres disposal activities is an additional weak point that makes the possible alternative methods for end use of waste tyres difficult to implement. There is a potential for future waste tyres industry in Gaza since there is about 250,000 tyres or more that can be collected every year. This study is the first to be conducted in Gaza Governorates and provides first-hand data in the field of waste tyres disposal process. It's recommended that an integrated process for waste tyres management including establishment of new collection system, storage facilities, cooperation among the stakeholders, treatment options and the bylaws for waste tyres disposal. Among the recommended treatment options are reuse and recycling of waste tyres in several fields such as engineering constructions and recreational areas.
Assocication between ABO Blood Group System and the Severity of COVID-19 in the West- Bank : A Case-control study
(Al-Quds University, 2021-08-12) Alaa Hamdan Mohammed Obeyat; آلاء حمدان محمد عبيات
Background: A new coronavirus disease-2019 (COVID-19) outbreak was recorded in Wuhan, Hubei province and spread rapidly to all districts and communities in China nationwide, also spreading all over the map of world. In Palestine the number of cases is still continuous. Study problem and justifications: Several studies have examined risk factors for COVID-19. And there was a conflict between the results and reports of researchers about whether the type of blood type had a role in influencing the risk of COVID-19. Therefore, the current study planned to find the effect of blood type on the severity of risk to infect with COVID-19 so that it can be taken as a reference towards adhering to prevention measures among people and the treatment mechanism towards COVID-19 by the decision makers. Aim and Objectives: This study aimed to determine the association between ABO blood group system and the severity of COVID-19 in the West-Bank in Palestine. Its objectives are to determine the susceptibly to infect with COVID-19 in consonance with blood group, the severity of symptoms, the various risk factors of COVID-19 as sociodemographic variables, health status, smoking status, seasonal flu experience and COVID-19 infection experience as potential confounder variables. And demonstrate the COVID-19 composite outcomes according to their blood groups. Methodology: A case control study design, consisted of 338 participants (169 cases and 169 controls) who had tested COVID-19 PCR during March/2021 in the West Bank, stratified according to their COVID-19 test result. Cases were who have COVID-19 positive test with symptoms and Control were who have COVID-19 negative test. A self-administrated questionnaire was used for data collection and filled by contacting the participants via their phone numbers. Statistical Analysis: Data entered and analyzed using the Statistical Package for Social Science version 23(SPSS-23). Both descriptive and analytical analysis were carried out. Descriptive statistics used for representing the frequencies and percentages categorical variables whereas the continuous variables were represented by the means, and standard deviation. Chi-square test was used to compare two categorical variables association between blood group and COVID19, also between cases and controls. Binary logistic regression (Enter model) was used in the multivariate analysis to demonstrate the odds ratio. Ethical Considerations: This study submitted to the school of public health research committee. Ethical approval of consent form was taken verbally from the participants, the permission to conduct the study obtained from the MOH. Collected the consent form of all the participants verbally. Results: The analysis of the study data revealed that the mean age of the participants was 38±16 (mean ± SD) years, the majority of the participant’s blood group was “O” (37.9%), followed by “A” (36.7%), and (13.6%) of them were “B” and (11.8%) with “AB”. Regarding the rhesus factor (RH), the majority of participants were positive RH with (80.2%) and (19.8%) of them were RH negative. The multivariate analysis compared blood group “A” versus others which showed that blood group B is more protective against COVID-19 than “A” (AOR= 0.40, CI= 0.223-0.27). “AB” is more protective towards COVID-19 by 31.6% more times (P < 0.05, AOR= 0.316, CI= 0.143-0.698). On the other hand, there is no difference between blood group A and blood group O (P> 0.05, AOR= 0.843, CI= 0.382-1.863) and no significant difference between blood groups according to the severity of symptoms or the composite outcomes of COVID-19. Also, being not vaccinated for seasonal flu increases the risk for COVID-19 infection by 1.97 times compared to people who gets vaccinated P < 0.05, AOR= 1.974, CI= 1.119-3.483). Conclusion: This is the first study in Palestine that concerned with blood group and COVID19. The study confirmed the association between blood group and COVID-19 susceptibility to infect, but it showed that no association with the severity of symptoms or the composite outcomes of COVID-19. As blood group “A” showed high risk for COVID-19 than others blood group. Taken seasonal flu vaccination shown as a protective factor towards COVID-19, no association between study participants characteristics (gender, RH, health status, BMI, occupation exposure and COVID-19) except the “Age” which had been a confounder variable in the study. Furthermore, people with blood group A should strengthen prevention methods against COVID-19, taking into consideration the commitment of all other blood groups to safety and prevention measures, other studies should be conducted on a large sample size and assessing more confounder variables. خلفية الدراسة: تم تسجيل تفشي مرض فيروس كورونا الجديد في ووهان بمقاطعة هوبي وانتشر بسرعة إلى جميع المقاطعات والبلديات في الصين على الصعيد الوطني ، وانتشر أيضًا في جميع أنحاء العالم. وفي فلسطين عدد الاصابات والوفيات في تزايد واستمرار. مشكلة الدراسة والمبررات: فحصت العديد من الدراسات عوامل الخطر لفايروس كوفيد المستجد. وكان هناك اختلاف بين نتائج وتقارير الباحثين حول ما إذا كان لنوع فصيلة الدم دور في التأثير على خطر الإصابة بالفايروس لذلك ، خططت هذه الدراسة لتقييم تأثير فصيلة الدم على حدةّ الإصابة بفايروس كوفيد المستجد في جميع محافظات الضفة الغربية بحيث يمكن اعتبارها كمرجع نحو الالتزام بإجراءات الوقاية بين الآخرين وتحديث آلية العلاج تجاه فايروس كوفيد 19 من قبل صناع القرار. الأهداف الرئيسية: هدفت هذه الدراسة إلى تحديد العلاقة بين نظام فصائل الدم وحدة الإصابة بفايروس كوفيد 19 في الضفة الغربية في فلسطين. وتتمثل أهدافها في تحديد مدى قابلية الإصابة بالفايروس وفقًا لفصيلة الدم ، وشدة الأعراض ، وعوامل الخطر المختلفة كمتغيرات اجتماعية ديموغرافية ، والحالة الصحية ، وحالة التدخين ، وتجربة الأنفلونزا الموسمية وتجربة الإصابة بفايروس كوفيد 19 كمتغيرات محيرة محتملة. وإثبات النتائج المترتبة على حدةّ الإصابة بفايروس كوفيد 19 وفقًا لفصائل الدم. منهجية الدراسة: الدراسة عبارة عن دراسة للحالات والضوابط ، تتألف من 338 مشاركًا 169 حالة و 169 ضابطة، الذين قاموا بعمل فحص كوفيد خلال شهر 3 من العام 2021 في جميع محافظات الضفة الغربية حيث تم تصنيفهم بناءً على نتيجة الاختبار. كانت الحالات عبارة عن ذوي النتيجة الإيجابية مع أعراض كوفيد 19 . والضوابط عبارة عن الأشخاص ذوي النتيجة السلبي لفحص كوفيد 19 .تم جمع البيانات عن طريق استبيان الدراسة وتم تعبئته عن طريق الاتصال بالمشاركين عبر أرقام هواتفهم. التحليل الإحصائي: تم إدخال البيانات وتحليلها باستخدام برنامج 23) - (SPSS تم إجراء كل من التحليل الوصفي والتحليلي. تم تمثيل الإحصاء الوصفي لإظهار التكرارات والنسب المئوية للمتغيرات الفئوية والمتوسطات والانحراف المعياري للمتغيرات المستمرة. تم استخدام اختبارمربع كاي لمقارنة ارتباط متغيرين معنويين بين فصيلة الدم واحتمالية الاصابة بفايروس كوفيد 19 ، وكذلك في المقارنة بين الحالات والضوابط. تم استخدام الانحدار اللوجستي الثنائي في التحليل متعدد المتغيرات لإثبات نسبة الأرجحية ودرجة الثقة % 95 واعتماد العوامل المؤثرة عند الدلالة الاحصائية P<0.05 . الاعتبارات الأخلاقية: قدمت هذه الدراسة إلى لجنة البحث العلمي والدراسات العليا في جامعة القدس , تم أخذ الإذن بإجراء الدراسة التي تم الحصول عليها من وزارة الصحة الفلسطينية .حيث تم جمع استمارة الموافقة من جميع المشاركين شفهيًا عن طريق التواصل معهم عبر الهاتف. النتائج: أظهر تحليل بيانات حالات الدراسة أن متوسط عمر المشاركين كان 38 عاما ، كانت الغالبية العظمى من المشاركين ذوي فصيلة الدم ”O” بنسبة 37.9 % تليها فصيلة الدم “A” بنسبة 36.7 % ومن ثم فصيلة الدم “B” وفصيلة الدم “AB” حيث شكّلت نسبتهما 13.6 % 11.8 % على الترتيب. وأظهر التحليل متعدد التغيرات عند مقارنة فصيلة الدم “A” مع فصائل الدم الأخرى أنها الأكثر احتمالية للإصابة بفايروس كوفيد , كما أن فصيلة الدم “B” أقل عرضة للإصابة بفايروس كوفيد من فصيلة الدم “A” بمقدار 0.40 مرة وفصيلة الدم “AB” أقل عرضة للإصابة من فصيلة الدم “A” بمقدار 31.6% مرات . ولم يظهر أي اختلاف في احتمالية الإصابة والخطر بين فصيلة الدم “A” وفصيلة الدم “O” بالإضافة إلى كونه لم يوجد أي دلالات فروقية بين حدة الأعراض بناءً على نوع فصيلة الدم أو على المضاعفات والنتائج المترتبة على الإصابة بفايروس كوفيد .كما تبين أن أخذ تطعيم الانفلونزا الموسمية في الأعوام الماضية يقلل من خطر الإصابة بفايروس كوفيد بمقدار 1.97 مرة من الذين لم يقوموا بأخذ التطعيم . الخلاصة: هذه هي الدراسة الأولى في فلسطين التي تهتم بالارتباط بين فصيلة الدم وخطورة كوفيد 19 حيث أكدت الدراسة الارتباط بين فصيلة الدم وقابلية الإصابة بفايروس كوفيد 19 ، لكنها أظهرت أيضًا أنه لا يرتبط بشدة الأعراض أو النتائج المرتبطة بفايروس كوفيد 19 .تبين أن الأشخاص ذوو فصيلة الدم “A” يمتلكون احتمالية الإصابة بفايروس كوفيد 19 أكثر من غيرهم من فصائل الدم الأخرى. كما تبين أن أخذ تطعيم الانفلونزا الموسمية في الأعوام الماضية هو عامل وقائي تجاه كوفيد 19 . لم يظهرعلاقة ارتباط بين خصائص المشاركين في الدراسة )الجنس، عامل ريزوس، والحالة الصحية ، ومؤشر كتلة الجسم ، والتعرض للمهنة وتجربة فايروس كوفيد (19 باستثناء "العمر" الذي كان متغيرًا مرتبطا بكلا السبب والنتيجة في الدراسة وتبين أنه عامل محير في الدراسة. علاوة على ذلك ، يجب على الأشخاص ذوي فصيلة الدم A تعزيز طرق الوقاية ضد كوفيد 19 ، مع الأخذ بعين الاعتبارضرورة التزام جميع مجموعات الدم الأخرى بتدابير السلامة والوقاية وينبغي إجراء دراسات أخرى ذات حجم عينة أكبر وتقييم المتغيرات الأكثر إرباكًا لتحديد مدى تأثير فصائل الدم على حدة فايروس كوفيد 19 المستجد.
Clients Centeredness of the Governmental Primary Health Care Services: Gaza Governorates
(Al-Quds University, 2011-08-16) Huda Haidar Anan; هدى حيدر عنان
Universally, Primary Health Care (PHC) services are considered the vertebral column of health care systems. Ideally, it is assumed that PHC services should be responsive to people's needs and expectations. Client-centered PHC services could meet the goal of being responsive through designing and providing health care services that suit clients and guarantee appropriate accessibility, involvement in the caring processes and the delivery of quality health care services. A quantitative analytic cross-sectional study was conducted in order to assess the extent to which the governmental PHC services are client-centered. The instruments used in this study were exit interviews for 300 randomly selected clients who received health care services from the 10 randomly selected PHC clinics in the Gaza Governorates (GG), with a response rate of 91%. Another questionnaire was used to capture general information about the investigated PHC clinics. The researcher collected the data by herself with the help of two welltrained data collectors. Validity and reliability measures such as standardisation of data collection and data quality check and re-entry were assured. Reliability consistency test was very high (Cronbach’s Alpha 0.9). Clients' perceptions were good regarding physical, financial, technical and information accessibility. Accessibility to essential medications was good but there were gaps in the dispensing, labelling procedures and the constant availability of drugs. Most of the clients were satisfied with the delivery of health care services such as; waiting time, time spent with health care providers, communication, respect and quality of basic amenities. Clients have low chances to select the health care provider or to provide consent before undergoing medical procedures. Clients were not adequately involved where most of the clients did not participate in activities aiming to improve health care services. Three out of the ten (30%) investigated PHC clinics reported having community committees with regular meetings. Clients’ participation in deciding their treatment plans were perceived as weak. Also, most of the clients did not participate in activities related to evaluating the health care services they receive from the PHC clinics. The most important factor that reflects good quality of health care services from clients perspectives was the availability of drugs (67.3%), being respected by the health care providers (46.5%) followed by being cured (34.6 %). Respondents from level two and level three clinics, southern governorates clinics and clinics that had community committees, elicited higher scores than their counterparts from other clinics with statistically significant differences (P <0.05) between these groups. Similarly, respondents with higher education level reported higher scores than their counterparts with statistically significant differences between these groups (P<0.05). The study recommends adopting new policies that enhance the client centeredness of the heath care services through increasing the awareness about basic clients’ health rights, increasing clients’ involvement in the planning, implementation and evaluation of health services. Also, improving communication and interaction between the clinics teams and the local communities is essential including establishing community committees.
Compliance of Dental Health Care Providers with Infection Prevention and Control Protocol in the Dental Units at UNRWA Health Centers in Gaza Governorates
(Al-Quds University, 2010-04-01) Tamam Mohamed Abu Zaid; تمام محمد عبد الرحمن ابو زيد
Nowadays, the issue of cross infection becomes a vital part of dental practice and a major concern to dentists and policy makers. This is due to the increased risk of blood borne diseases. Health care-associated infections lead to increase mortality and morbidity, disability and excessive medical costs. In 2004, a National Palestinian Infection Prevention and Control Protocol has been developed, but its implementation in dental units has not yet been adequately investigated. This study aims to evaluate the compliance of dental healthcare providers with the infection prevention and control practices in all UNRWA health centers. The study included 80 participants, divided as follows; 48 dentists, 28 practical nurses and 4 oral hygienists. Three instruments were used; interviewed questionnaire for health care providers, a checklist of infection prevention and control practices of health providers and a checklist of dental units structure and suitability. All subjects positively responded. The study showed that males represented 78% and females represented 21%. Half of the respondents have had received a training on the infection prevention and control. The infection prevention and control protocol was reported to be available by 43.8% of the respondents. The study revealed that there were no severe shortages in the basic equipment and infrastructure that are needed for the protocol implementation in the dental units. In contrary, there were shortages in some items such as utility gloves, alcohol with glycerin, towel papers for beds, face mask and aprons. Regarding the participants knowledge about the infection prevention and control standards precautions; 56% said that they are familiar with this concept and of those 40% could define the term of standard precautions. Regarding measures needed to increase the compliance with infection prevention and control, participants reported decreasing work overload (46%) and rewards and punishment 21%. By observing the participants during their work, the study showed that only 35% of the respondents had washed their hands between patients, 76.7% changed gloves between patients, 80% used mouth mask when dealing with patients, 26.3% of them disinfected the dental surfaces with disinfectant solution, 1.7% used face mask, 73.8% used mouth masks, 98.7% of participants always used coats, 49.6% of the total participants disposed waste in a proper way. The study has revealed that there were no statistically significance differences between the IPC practices and the socio demographic variables. The study revealed that there were statistical significant differences between infection prevention and control practices and education and the availability of a copy of infection prevention and control protocol. The researcher recommends disseminating the infection prevention and control protocol, providing training, providing resources and adequate follow up.
Compliance with the Infection Prevention and Control Protocol at the Governmental Pediatric Hospitals - Gaza Governorates
(Al-Quds University, 2011-02-01) Shareif M. El-Dalow; شريف محمد الدلو
Nosocomial infection is a significant burden for both the patient and health system as well. The Palestinian Ministry of Health has adopted the National Infection Prevention and Control (IPC) protocol in 2004, aiming to combat infections among health care providers, clients, community and the environment. However, the compliance with the infection prevention and control protocols were poorly assessed. The aim of this study is to assess the compliance of health care providers with the infection prevention and control protocols in the governmental pediatric hospitals in Gaza in order to contribute to decreasing the childhood morbidity and mortality resulted from infection. The design of the study is a descriptive cross sectional one that included a self-administered questionnaire for all doctors, nurses, and physiotherapists (334); an observation checklist for the health care providers’ practices that was repeated three times for each of them (1002), and an observation checklist for the health facility three times for each department (69). All of these data were analyzed using SPSS (version 18). The reliability of the instrument was assured and the response rate was 92%. In addition, ten in-depth interviews with purposively selected key informants were conducted.The study revealed that 69.4% of respondents were males; the majority of study populations were married (80.5%), 30.9% were physicians and 66.5% were nurses. About 80% of the study population had less than fifteen years experience. Only 2.3% of respondents have a copy of the IPC protocol, while 65.8% did not know about its existence. There was no real hospital surveillance program; only 16.9% of respondents had participated in training session about IPC. 63.2% had received three doses of the hepatitis B vaccine, and 66.1% have been exposed to an injury from used needles. Despite the high concern of health care providers about the importance of the IPC practices, their compliance with IPC recommended practices as the questionnaire results were: compliance with wearing uniform (90.9%); hand washing (79.7%); wearing gloves (89.1%); using antiseptic and disinfectant (79.8%); and safe work practices (45.3%) but their observed practices revealed lower level of compliance; such as wearing uniform practices (86.6%); hand washing (45.9%); wearing gloves (40.7%); using antiseptic and disinfectant (49.16%); and safe work practices (45.3%). Health facility checklist indicates the absence of some essential equipment and materials needed such as the absence of protocol copies, covered waste containers, and heavy duty gloves. The most important reasons for non-compliance with the IPC protocol were: Absence of education or training program (61.5%), lack of knowledge (52.4%) and scarcity of the required supplies (46.9%). These results were confirmed through the in-depth interviews with key informants. enThe study recommended that the IPC protocol should be available in all the departments; intensifying education, training, and supervision by a highly qualified team of infection control committee and providing the needed equipment and facilities.
Coping Strategies of Cancer Patients at Shifa Hospital in Gaza Strip
(Al-Quds University, 2009-02-03) Mohammed Tameem/ M. Al Jadili; محمود عبد اللطيف تيم محمد الجديلي
طرق التكيف لمرضى السرطان في مستشفى الشفاء بقطاع غزة تهدف الدراسة إلى فحص طرق التكيف لمرضى السرطان وعلاقتها بالصحة النفسية في مستشفى الشفاء بقطاع غزة , و التي استخدمت لمواجهة المواقف الضاغطة. و تهدف الدراسة إيجاد العلاقة بين المشاكل النفسية و المتغيرات الديموغرافية. تتكون عينة الدراسة من 358 مريض و تشمل جميع أنواع الأورام السرطانية في مستشفى الشفاء بقطاع غزة كعينة ممثلة (114) ذكور و (244) إناث و أعمارهم تتراوح بين أقل من 40 و أكثر من 70 عاما. واستخدمت الدراسة الطريقة الوصفية التحليلية التي أعدت للمستوفين الشروط. وقد تم إعداد الاستبانة و التي ركزت على معرفة طرق التكيف لمرضى السرطان في مستشفى الشفاء بقطاع غزة , وطلب منهم تعبئة الاستبانة حيث كان معدل الاستجابة 89.5)%) ودرجة ثبات الاستبانة حسب عامل اختبار كرنبخ لحالة القلق (0.828) وسمة القلق (0.773) وكذلك درجة ثبات الاستبانة حسب عامل اختبار كرنبخ لكرب ما بعد الصدمة 0.908 ودرجة ثبات الاستبانة حسب عامل اختبار كرنبخ لطرق التكيف كانت تتراوح بين ( 0.419 - 0.869) و جميعها تعطى المصداقية المقررة للدراسة باستخدام عامل ارتباط 0.4 و ما فوق باعتبارها نقطة الحسم. استخلصت الدراسة بعض النتائج لحالة القلق وكانت تتراوح بين 66.7)% إلى 69.7%) بشكل عام ,ونسبة سمة القلق كانت تتراوح بين 63.2)% إلى 69.5%) ونسبة كرب ما بعد الصدمة تتراوح بين 57.0)% إلى 60.7%) وكانت جميعها نتائج مرضية تدل على حالة هؤلاء المرضى. كما وأظهرت النتائج ظهور بعض المشاكل النفسية حسب العمر حيث أن مجموعة الأعمار 40 سنة أو اقل كانت أعلى في إعادة التجربة من اللذين أعمارهم 70 أو أكثر. كذلك النتائج حسب الحالة الاجتماعية و كرب ما بعد الصدمة و أبعادة الثلاثة وهى إعادة التجربة , التجنب , و الاستثارة بين الفئة المتزوجة و الأرامل لصالح الفئة المتزوجة. وهناك اختلافات هامة في حالة القلق و سمة القلق حسب العمل , المتقاعدين مقابل الفئات الأخرى وهم " العاطلين , العاملين , وأخرى " لصالح الفئات الثلاثة الأخرى. هناك اختلافات هامة في نتائج كرب ما بعد الصدمة و أبعادها الثلاثة بين المتقاعدين و الفئات الثلاثة الأخرى لصالح الفئات الثلاثة. كما انه هناك اختلافات هامة في الانزعاج والهروب حسب الجنس لصالح الذكور. كذلك يوجد اختلافات هامة في تحمل المسؤولية بين مجموعة الأعزب و الأرامل لصلح مجموعة الأعزب في عينة الدراسة. يوجد اختلافات هامة في أغلب طرق التكيف , تفكير التمني ,التجنب , حل المشكلات إعادة التفسير , تحمل المسؤولية و الانزعاج و الهروب طبقا لعينة الدراسة. هناك ارتباط هام ايجابي بين تفكير التمني و التجنب , و حالة القلق و سمة القلق, و إعادة التجربة في كرب ما بعد الصدمة بين أفراد العينة. هناك ارتباط هام ايجابي بين تحمل المسؤولية , حالة القلق , سمة القلق , كرب ما بعد الصدمة و أبعادها الثلاثة بين أفراد العينة، أيضا يوجد ارتباط هام ايجابي بين الانزعاج والهروب , حالة القلق, سمة القلق , و كرب ما بعد الصدمة بأبعادها الثلاثة. كان الاختلاف في طرق التكيف , حل المشكلات , إعادة التفسير , الارتباط طبقا لكرب ما بعد الصدمة لصالح اللذين لم يتعرضوا للصدمة , بينما الاختلاف في الانزعاج والهروب حسب كرب ما بعد الصدمة لصالح المرضى اللذين لم يتعرضوا للصدمة في عينة الدراسة.
Determinants and Risk Factors of Neonatal Mortality in Gaza Governorates in the Year 2008.
(Al-Quds University, 2010-01-09) Imad Ismael Mahmood El Awoor; عماد اسماعيل محمد العوور
Universally, neonatal mortality accounts for almost 40 % of under-five child mortality. The overall aim of the study was to determine the major risk factors contributing to neonatal mortality in the Gaza Strip, in order to provide scientific evidence for future preventive strategies to promote child and maternal health. The study was carried out in all Gaza Governorates at the house hold level. A case control design was adopted and interviewed questionnaire was completed by 715 eligible mothers. Of the respondents, 220 were cases who unfortunately experienced neonatal deaths and 495 controls with corresponding a live baby matched by sex, locality and nearest one week of birth date. Response rate was 95%. Cross tabulation, odds ratio, and multilevel bivariate logistic regression was done to explore the risk factors associated with neonatal mortality. The odds of neonatal mortality was higher among low birth weight babies than of the normal weight group (P=0.001, OR= 9.08) and premature babies than the full term ones (P=0.01, OR=2.83). In addition, the odds of neonatal mortality was also higher among neonates whose mother had a history of prolonged labor (P=0.01, OR=0.52), or caesarean section delivery (P=0.03) and/or previous history of neonatal death (OR=5.64, P=0.002). In addition, the study clarified that, consanguineous marriage was a predictor for neonatal mortality (P= 0.04, OR= 1.20). Also, the influence of domestic violence against mother during pregnancy on neonatal mortality was prominent more among cases than controls (P= 0.02, OR= 1.58). Unconsciousness status of the newborn after delivery, and previous history of neonatal death were found to be strong risk factors for the neonatal mortality, while adherence to colostrums feeding, type of vaccine given to the new born early initiation of breast feeding and breast feeding exclusivity were found to be protective factors for the neonatal mortality. The study concluded that, public health interventions at all levels, community awareness, with the help of all stakeholders including MOH, UNRWA, UNICEF and other NGO s and improvement of secondary and tertiary care could help in reducing neonatal mortality.
Determinants of anemia among pregnant women attending the UNRWA healthcare clinics in Jerusalem: A Follow-Up Study
(Al-Quds University, 2024-06-02) Munera Kamal Eddin Ismail Al Abed; منيرة كمال الدين اسماعيل العبد
In Palestine, the prevalence of anemia among normal and high-risk pregnant women was 27.6 % and 30.3 % respectively. Many risk factors are responsible for increasing the risk of anemia. This study aims (1) to identify the factors associated with maternal anemia in the pre-conception and during pregnancy periods and (2) to determine the compliance and affectivity of the micronutrient intervention program implemented at the UNRWA primary health care clinics of Jerusalem in the year 2022. Study methodology: A follow-up study design of 400 women was done using interview questionnaires. Also, data regarding their hemoglobin level was extracted from their medical file. Descriptive statistics and bivariate analysis were done and a p-value <0.10 was considered statistically significant. The chi-square test and T-test were used as needed to calculate the difference between the anemic and non-anemic groups regarding all variables in the study. The multivariate logistic regression model was done and the adjusted risk Ratio and its 95% Confidence Interval (CI) were reported for controlling for study confounders and study risk factors. The study was approved by the UNRWA and by the Al Quds University research ethical committee and women had a sign consent forms before participation. Results: Our study results indicate significant associations between anemia at 24 weeks, women’s age, the location of the clinic, and place of residence (p <0.10). The history of past pregnancies anemia, history of anemia in the last pregnancy, history of anemia at registration, and history of iron intake for six months determined the incidence of anemia at 24 weeks of pregnancy (p-value <0.10). Also, the occurrence of anemia at 24 weeks was significantly associated with meal frequency /day, history of a healthy diet, history of changes in eating habits, tea /coffee consumption during/after meals, iron intake compliance, minimum dietary diversity for women (MDD-W), grains, white root, nut, milk, yogurt, meat, and fish intake, lower intake of vitamin A-rich fruit and vegetables and sweet food, (p <0.10). Concerning health education and counseling, our study showed that receiving information about iron and multivitamin supplements, doctor’s confirmation of daily iron and multivitamin intake, and health staff counseling about iron side effects are significant factors for anemia occurrence. Also, encouragement of iron-rich foods such as red meat and green leafy vegetables, taking iron with juice, taking iron supplements at bedtime, avoidance of taking iron supplements with antiacid tablets or with milk, dairy products, or calcium supplements, and avoidance of drinks that affects iron absorption such as tea and coffee, and women perceive that iron intake for a long time is boring were factors that determined the incidence of anemia at 24 weeks of pregnancy (p<0.1). Moreover, the prevalence of anemia among pregnant women in the 1st trimester (Hb < 11.0 g/dl) was 20%. While in the 2nd trimester of pregnancy, this percentage had increased to 32% (Hb < 10.5 g/dl). Conclusions: This study results showed that women’s age, history of anemia in past pregnancies, being anemic in the first trimester, and low iron compliance were significant determinants of anemia in pregnancy. While, obtaining iron information counseling, eating a healthy diet, and increasing meat and fish intake were significantly associated with a lower risk of anemia at 24 weeks of pregnancy. This is the first study in UNRWA healthcare clinics in the Jerusalem Area, to demonstrate the primary healthcare system factors—nutritional habits, and mother's health before and throughout pregnancy. Also, health education and counseling were significantly associated with anemia in pregnancy. The study recommends advocating for an awareness campaign about anemia in pregnancy and adopting a healthy lifestyle for women before and during pregnancy. Proper implementation of preconception care, antenatal care, postnatal care, and family planning should be emphasized in the UNRWA’s policies and guidelines, especially among women who are highly susceptible to anemia.

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