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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.
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 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 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.
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.
Effects of Exposure to Radiation on the Immunity Status of Medical Radiographers at Governmental Hospitals-Gaza Governorates
(Al-Quds University, 2016-01-01) Mousa Hafez Alnahhal; موسى حافظ النحال
Long-term exposure to low doses of ionizing radiation may affect cells, tissues, and body systems and result in various adverse health effects. Immunity system is known to be highly radiosensitive; therefore it’s susceptible to radiation. Medical radiographers are occupationally exposed to chronic levels of ionizing radiation that may affect their immune response. So, the aim of this study was to investigate effects of exposure to radiation on the immunity status of medical radiographers at governmental hospitals-Gaza governorates. The study design was a case control study conducted in six main hospitals. A total of 92 medical radiographers exposed to chronic ionizing radiation compared with control group of 97medical laboratories who never exposed to chronic radiation. The cases and controls had the same age, gender, years of experience, and smoking status. A questionnaire and blood tests were the tools of the study. The study reported a response rate of 83.6 % for exposed group and 74.6 % from control group for the questionnaire. While the response rate of the venous blood samples was 58.8 % and 60.2 % for exposed and non-exposed groups respectively controls in case of venous blood sampling. The results revealed that several health complains such as headache were higher among medical radiographers (46.7%) compared to medical laboratories (10.3%) with highly statistically significant level (p.0.000). Regarding immunity systems, the study found that clinical symptoms such as gastritis, sore throat, repeated infections, and sinusitis were prevailing among exposed group compared with non-exposed group with statistically significant differences (p<0.05). Other clinical symptoms such as skin diseases, fever, and pallor did not reached the statistically significant levels (p>0.05). About venous blood samples, our study results found that mean difference of Immunoglobulin G and A were higher among medical radiographers (1279±359), (215±108) compared with the control group (1225±209) and ((1202±89) with no statistically significant level (p=0.324 and 0.498) respectively. In addition, white blood cells and lymphocytes counts showed some variations between exposed and control group with no statistically significant differences. In conclusion, significant health complaints and clinical symptoms were recorded among medical radiographers compared with the matched control group. Thus, personnel monitoring for ionizing radiation, periodic medical examination, and increasing level of protection for MRs is of utmost importance.
Emotional Intelligence and its Relationship with Job Stress and Organizational Commitment among Nurses in Governmental Hospitals in the Gaza Strip.
(Al-Quds University, 2021-05-31) Mohammed Kamel AL Asmar; محمد كامل الأسمر
Nursing is a stressful profession and nurses face multiple stressors in their work environment daily and continuously. Emotional Intelligence had a very important effect on job stress and organizational commitment. This study aims to identify the role of emotional intelligence and its relationship with job stress and organizational commitment among nurses in governmental hospitals in the Gaza Strip. This study is quantitative, descriptive cross sectional design; 318 nurses completed self-administered questionnaire from 340 with 93.5% response rate. Sample was selected using a stratified proportionate random sample from five governmental hospitals. The researcher used international scales for emotional intelligence, organizational commitment and nursing stress scale. Data were analyzed by SPSS using a variety of descriptive and inferential statistics including independent sample t-test, one-way ANOVA, Pearson correlation test, and Multiple Linear Regression were performed at a significance level of P-value < 0.05. Findings showed thatthere is a significant positive relationship between participants’ emotional intelligence and their job stress (R Square = 0.116, p-value=0.039), The results revealed that there is no significant relationship between participants’ emotional intelligence and their organizational commitment (R Square = 0.109, p-value=0.052), and that there is a significant inverse relationship between participants’ job stress and their organizational commitment (R Square = -0.179, p-value=0.001). The results revealed that the high scores in emotional intelligence, organizational commitment and nursing stressors frequency & severity, 59.7%, 68.2% and 47.0% &87.5% respectively. For emotional intelligence dimensions; motivation domain scored the highest (69.25%). Regarding organizational commitment dimensions; normative commitment scored the highest (69.80%). With regard to nursing stressor frequency; workload domain scored the highest (51.5%). In addition, the highest nursing stressor severity was noted is “Uncertainty concerning treatment” (94.5%). Additionally, there is a relationship between socio-demographic characteristics and emotional intelligence toward years of experience (F = 6.072, P = 0.000), salary (F = 2.897, P = 0.035) and educational level (F = 4.521, P = 0.001). Also there is a relationship between socio-demographic characteristics and organizational commitment: age (F = 3.620, P = 0.007), marital status (F = 4.376, P = 0.005), salary (F = 3.211, P = 0.023) and years of experience (F = 11.466, P = 0.000). Finally, the study concludes that contribute of nurses’ job stress and emotional intelligence to their organizational commitment, which showed that an increase in job stress among nurses, leads to a decrease in the organizational commitment by (76.0%). Moreover, with an increase in the nurses’ empathy, their organizational commitment increases by (14.9%) and with an increase in the nurses’ self-awareness, also their organizational commitment increases by (11.7%).
Evaluation of Current Screening Test for Asymptomatic Bacteriuria during Pregnancy at First Antenatal Visit in Rimal Health Center UNRWA ,Gaza 2007
(Al-Quds University, 2008-01-26) Rasmiya Khamis Ghsoub; رسمية خميس غصوب
Urinary tract infection is a common problem during pregnancy and if it is not diagnosed and treated properly, bad sequels could occur affecting the mothers and their outcome of pregnancy. The main objective of this study is to determine the prevalence of urinary tract infection (UTI) and asymptomatic bacteriuria (ASB) during pregnancy, as well as to evaluate the validity of current screening test (nitrite dipstick) at first antenatal visit. This is a cross sectional study conducted among pregnant women in Rimal Health Center which is a Primary Health Care Center; UNRWA in Gaza City. The total study population was 160 pregnant women attending antenatal care at first antenatal visit from 12th April 2007 to 25th July 2007. Midstream urine was collected and tested with culture, dipstick and microscopic examinations. Validity of tests was measured by sensitivity, specificity, positive predictive value and negative predictive value. Antibiotic sensitivity was also done. Thirty one out of 160women were identified positive urine culture with prevalence of 19.4%, 18/160 was asymptomatic (11.25%) while 13/160 was symptomatic (8.15%). Among the 31 culture positive, the commonest organism was staphylococcus aureus (29%), followed by E-coli (25.80%) and klebsiella (22.58%). Ciprofloxcine was shown as the 1st sensitive drug in all cultures (93.54%) followed by cefuroxim (83.87%) and co-amoxiclave and norfloxacine were equal (70.96%) while amoxicillin, co-trimoxazol and erythromycine had the lowest sensitivity. Maximum resistance was seen to co-trimoxazol (67.74%) followed by doxycycline (29.03%). Symptoms of UTI, weeks of gestation and the previous history of premature deliveries were statistically significant risk factors for the occurrence of ASB. Age, gravidity, parity, educational level, previous CS, history of urinary catheterization and previous history of UTI were not significant risk factors for this disease. Nitrite dipstick had low sensitivity (29%), high specificity (97.7%), with positive predictive value of 75% (PPV) and negative predictive value of 85% (NPV). Asymptomatic bacteriuria in pregnancy is a major public health problem and nitrite dipstick reagent is not sufficiently sensitive to be of use in screening of asymptomatic bacteriuria in pregnancy and many of patients would be missed for management. So, the researcher recommends the use of urine culture for screening of all pregnant women at first antenatal visit.
Evaluation of Quality Improvement Project implemented at the Ministry of Health at Gaza Strip
(Al-Quds University, 2010-10-10) Khalid Abdel Sattar Abu Ghali; خالد غالي
Universally, in the last decades quality in health continues to be a matter of interest for policy makers, health providers and managers. In Palestine, since the establishment of the Palestinian Authority, the Ministry of Health pays great attention to improve the quality of health services as manifested in many measures including the establishment of the quality improvement(QI) project. The study has been conducted to assess to which level the Quality Improvement Project met its objectives and the QI concepts and activities have been institutionalized into the Ministry of Health units. The researcher developed a self administered questionnaire to gather data from all those involved in quality improvement activities and focused on evaluating the impact of the QI project on their work settings particularly in terms of sustainability and institutionalization. From those who have been trained in quality and participated in its activities, 81 participants completed a self administered questionnaire (response rate 71%). Using the SPSS the study indicated that males constituted the largest proportion of participants (86.4). Age category 41-50 represented the highest age category and similarly 53% of participants were living in Gaza area. Physicians constituted 43% followed by nurses 33% and administrators 16%. Participants from Hospitals constituted the main bulk of participants indicating un-fair distribution of participants. Additionally, head of departments constituted almost half of participants. Factor analysis revealed eight factors (dimensions) labeled as; policy, leadership, core value, resources, structure, capacity building and information and communication. The findings showed that the mean of factors was ranged from 3.26- 2.19. The highest mean was seen with leadership factor (mean 3.36) whereas the lowest level of perception was seen with information and communication factor (mean 2.19). Although participants have been trained on quality improvement approaches, few of them engaged in quality improvement activities, or have good knowledge about quality, therefore, quality should be seen as a continuous process that requires follow up and monitoring. From institutionalization perspective, more focus should be directed on increasing communications and information about quality. Unless quality initiatives are adequately communicated, it could not be institutionalized. For increasing institutionalization, focus should be directed at developing and empowering an effective rewarding system that acknowledges proper performance. To institutionalize quality as a part of the organizational culture it is important to develop an effective organizational structure supportive to quality.
Evaluation of Reproductive Health Services at Jabalia and Al-Bureij Women's Health Centers
(Al-Quds University, 2015-01-01) Maha Sabry mustfa El Akkad; مها صبري مصطفى العقاد
Worldwide, Reproductive Health problems are among the top leading causes of morbidity and mortality among women of reproductive age. In the Gaza Strip, programs that offer Reproductive Health services exist in most health service organizations; however, not all of these programs provide comprehensive services. Among the programs that provide comprehensive Reproductive Health services are the two Women Health Centers in Jabalia and Al-Bureij refugee Camps. The two Centers also provide legal, psychosocial, and physiotherapy services. The study aimed to evaluate the Reproductive Health services in the two women health Centers in order to improve the quality and effectiveness of the provided services. This study is a mixed methods; it involves both quantitative and qualitative data. The quantitative were collected from beneficiaries of Reproductive Health clinics within the two Centers. In total, 375 randomly selected women participated in the quantitative study, with 89.3% response rate. The qualitative data were collected through nine in-depth interviews with senior managers and providers, and six focus group discussions with beneficiaries of two Centers' service, with participation of 38 women. The researcher insured reliability, validity and trustworthiness of the study tools. Different descriptive and inferential statistical tests were used to analysis the quantitative data while Open Coding Thematic analysis was used to analyze the qualitative data. The quantitative study revealed that the participants were women aged between 16 and 65 years with average of 11.86 years of schooling. The majority of participants (96.8%) were married. Only 16% of the participants were employed and about 52% of them have monthly income of less than 1,000 ILS per month. Both quantitative and qualitative studies revealed that women's health status and their wellbeing have been improved as a result of utilizing the two center services. The vast majority of the participants (98.7%) have received the services they were supposed to, and these services met their health needs as indicated by 95.2% of participants. From beneficiaries' perspectives, the overall mean percentage of accessibility, affordability, and availability of selected services was 81.18%. And for providers’ respect of privacy, confidentiality and dignity, the mean percentage was 87.68. It was 83.4% for the infrastructure and equipment, while it was 85.30% for skilled and competency of the health providers. General satisfaction of women related to the provided Reproductive Health services was 87.8%, congruently; the qualitative findings have shown high level of satisfaction with the provided legal, psychosocial, and physical therapy services. The study has showed that there is a limited financial sustainability of services as the two Centers are funded by external donors. To conclude, offering integrated reproductive services was very efficient and effective way of providing services; more efforts are needed to increase the utilization of postnatal care service and utilization of services by youth and single women.
Knowledge, attitudes and practices of mental healthcare providers regarding the evidence-based practice in the Gaza Strip
(Al-Quds University, 2021-06-05) Sally Suhail Ibrahim Saleh; سالي سهيل إبراهيم صالح
Evidence-based practice is spreading in many healthcare disciplines. One of its main features is the reliance on the partnership among the three fundamental components, the best research evidence, the clinician expertise, and the client preference. This study is a mixed method one that includes both quantitative and qualitative components. A total of 135 participants (66 men, 69 women) participated in the quantitative part with a response rate of 83.3%, and 10 participants joined the qualitative part. The quantitative component followed the census approach in which the researcher recruited all the mental healthcare providers in the Gaza Strip. The method of sampling for the qualitative part was purposive sampling. The quantitative data was collected via online questionnaire. The qualitative data was collected through face-to-face interviews. The reliability of the total scale is very good as the alpha Cronbach= 0.756. The quantitative data was analyzed using the SPSS software by conducting descriptive, frequency, and inferential statistics. The qualitative data was analyzed via the content thematic analysis using the NVivo software to find out the most common themes and codes. Findings show that those who had up to bachelor degree represented 37.7% of the respondents, and those who had postgraduate studies represented 62.3%. Most of the participants (78.5%) were graduated from local universities, and 77.8% of the participants were working in technical positions. The results show that 81.5% of the participants used the evidence- based practice during the daily practice, but the frequency and the sources of evidence were not sufficient. The overall knowledge score among the participants was 66.05% and the overall attitude score toward the evidence- based practice was 60.76%. The overall practice score was 71.27%, but the actual implementation was not good enough. The qualitative results showed that the knowledge, attitudes and practices are not systematic nor sufficient to fulfil the mental health needs. In addition, they were humble and depended on personal motives mainly. The institutional factors were obvious in inhibiting the evidence- based practice due to the lack of sufficient infrastructure, poor system for the evidence- based practice, lack of policies, unsupportive management, and poor culture. The institutional barriers to implement the evidence- based practice included lack of policies, and absence of good appraisal system. The individual barriers to implement the evidence- based practice included poor research and statistical analysis skills and lack of knowledge about the evidence- based practice and its significance. The inferential statistics show that there were no significant differences in relation to the age, residency, profession, type of university or the profession type indicating that issues around evidence-based is a cross-the-board. The study concluded that the knowledge, attitudes, and practices about the evidence- based practice needs further improvement and development through initiating supporting policies and strategies that promote the use of evidence base in daily practices.
Knowledge, Attitudes, Perception, Practices, Psychological Factors and Coping Strategies among Healthcare workers with Positive COVID-19 in the Gaza Strip
(Al-Quds University, 2021-12-20) Dina Ahmed Ismail Abu hamed; دينا أحمد إسماعيل أبو حامد
Background: COVID-19 epidemic causes dramatic losses in the lives of many health care workers. It has overwhelmed health system and health manpower. In addition, it causes heavy psychological burden on the medical staff. Study aim: This study aims at identifying knowledge, attitudes, practices, psychological impact and coping strategies among healthcare workers who tested COVID-19 positive in the Gaza Strip. It is very important to gain better understanding of the difficulties they faced and identifying their top needs in order to promote their physical and psychological wellbeing with its positive effect on the society as a whole. Methods: A quantitative method wasused to collect the needed data from participants. It was performedthrough an online questionnaire;the study included a total of 389 of medical staff who agreed to fill in the questionnaire. Results: Males represented 54.8% of the participants, 44% of them were 30-years-old and younger, 73.5% were married, 71.5% had Bachelor degree, nurses represented 50.1%, and 81.2% of the participants work in hospitals. The majority of participants (95.4%) had COVID-19 symptoms; the most common five symptoms were headache, fatigue, cough, muscle and back pain, and fever (86.5%, 85.2%, 76.6%,73.3%, and 72.5%, respectively). Loss of smell represented (68.5%), loss of taste (59.3%), sore throat (61.2%), runny nose (43.1%), shortness of breath (39.9%), chest pain (38.5%), diarrhea (46.1%), abdominal pain (32.1%), vomiting (14.3%), and rash (3.2%). Majority of study participants (81.0%) got supportive treatment at home, and 6.2% needed hospital admission. Sixty six percent received training on donning and doffing PPE properly, and 82.9% received formal training on infection control procedures. 52.6% said that these trainings were inadequate. Regarding risk factors, 10% were smokers, 12% were pregnant, 12.9% were obese, 8.5% were hypertensive, 4.9% were diabetic, 2.6% had respiratory disease, 2.6% had liver disease, and 1.5% had thyroid disease. The participants have an acceptable knowledge level with a mean score of 67.55 while the mean score of attitudes was 69.02. Practices of participants were very good with mean score 82.34. With regardto PPE adherence at work place, the mean adherence was 63.04. Nurses reported the highest score in practicing preventive measures. Male and Lab technicians were the highest in PPE adherence. ICU department was the most PPE adherent department. Female, nurses, health care workers in hospitals were the most anxious and depressed people. Results revealed the absence of relationship between blood typeand severe COVID-19 infection. On Depression, Anxiety, Stress Scale (DASS-21), the prevalence of depression among participants was 32.4% (17.5% mild, 14.1% moderate, 0.8% severe), anxiety was 54% (19% mild, 22.4% moderate, 12.6% severe) while stress prevalence was 33.7% (28.5% mild, 5.2% moderate). The study results show that transmission of COVID-19 infection to families was the most common source of anxiety and stress among infected staff (weighted mean= 80.2). Family support was the most common factor that contributed to reduce stress (weighted mean= 87). Most of participants adopted positive coping strategies during the infection period; spiritual and religious activities were the most common coping strategy (94.6%). Conclusion: In light of these finding, it is recommended to implement advancedtraining programs oninfection control procedures and PPE adherence. In addition, honoring medical staff properly for their efforts both morally and financially,and improving vaccination awareness campaigns. As well as, conduction of ongoing long- term programs for periodic education and psychological support sessions. Training psychologists on phone counselingisvery important especially in crises. The study also recommends improving the coordination between the Ministry of Health and other ministries and improving the follow up system and evaluation system of psychological services. خلفية الدراسة: سبب وباء كورونا خسائر فادحة في حياة العديد من العاملين في مجال الرعاية الصحية، حيث إنه أرهق النظام الصحي والقوى العاملة الصحية، بالإضافة إلى أنه سبب عبئًا نفسيًا ثقيلًا على الطاقم الطبي. هدف الدراسة: تهدف الدراسة الى التعرف على معرفة وتوجهات وسلوكيات الطواقم الطبية الذين أصيبوا بفيروس كورونا في قطاع غزة كما تهدف الى التعرف على الأثر النفسي للإصابة ووسائل التأقلم التي اتبعوها خلال فترة الإصابة، لاكتساب فهم أفضل للصعوبات التي واجهوها وتحديد احتياجاتهم الأساسية من أجل تعزيز صحتهم الجسدية والنفسية مع تأثيرها الإيجابي على المجتمع ككل. طرق اجراء الدراسة: تم استخدام الطريقة الكمية لجمع البيانات من المشاركين من خلال استبيان عبر الإنترنت. اشتملت الدراسة على 389 من الكادر الطبي الذين وافقوا على ملء الاستبيان. نتائج الدراسة: يمثل الذكور 54.8٪ من المشاركين، 44٪ منهم 30 سنة فأقل، 73.5٪ متزوجون، 71.5٪ حاصلون على درجة البكالوريوس، الممرضون شكلوا 50.1٪، 81.2٪ من المشاركين يعملون في المستشفيات، غالبية المشاركين (95.4 ٪) لديهم أعراض فيروس كورونا؛ كانت الأعراض الخمسة الأكثر شيوعًا هي الصداع، والتعب، والسعال، وآلام العضلات والظهر، بالإضافة إلى ارتفاع درجة الحرارة (86.5٪، 85.2٪، 76.6٪، 73.3٪،.572٪ على التوالي)، مثلت نسبة فقدان حاسة الشم حوالي (68.5٪)، فقدان حاسة التذوق (59.3٪)، التهاب الحلق (61.2٪)، سيلان الأنف (43.1٪)، ضيق التنفس (39.9٪)، آلام في الصدر (38.5٪)، إسهال (46.1٪)، آلام في البطن (32.1٪)، قيء (14.3٪)، بالإضافة الى الطفح الجلدي (3.2٪). حصل غالبية المشاركين في الدراسة (81.0٪) على علاج داعم في المنزل، و6.2٪ احتاجوا إلى دخول المستشفى. 66.4٪من المشاركين تلقوا تدريباً على ارتداء وخلع معدات الوقاية الشخصية بشكل صحيح، و82.9٪ تلقوا تدريباً رسمياً على إجراءات مكافحة العدوى.52.6٪ قالوا إن هذه التدريبات لم تكن كافية، وفيما يتعلق بعوامل الخطر كان 10٪ مدخنين، و12٪ حوامل، و12.9٪ يعانون من السمنة، و8.5٪ يعانون من ارتفاع ضغط الدم، و4.9٪ مصابين بالسكري، و2.6٪ يعانون من أمراض الجهاز التنفسي، و2.6٪ يعانون من أمراض الكبد، و1.5٪ يعانون من أمراض الغدة الدرقية، يتمتع المشاركون بمستوى معرفة مقبول بمتوسط درجة 67.55 بينما كان متوسط درجة التوجه 69.02. كانت ممارسات المشاركين جيدة جدًا بمتوسط درجة 82.34، وفقًا للالتزام بمعدات الحماية الشخصية في مكان العمل، كان متوسط الالتزام 63.04. سجل التمريض أعلى الدرجات في ممارسة الإجراءات الوقائية، كان الذكور وتقنيو المختبر هم أكثر الفئات التي التزمت بمعدات الحماية الشخصية، كان قسم العناية المركزة القسم الأكثر التزامًا بمعدات الوقاية الشخصية، كانت النساء والممرضات والعاملون في مجال الرعاية الصحية في المستشفيات أكثر الناس قلقًا واكتئابًا، كشفت النتائج عن عدم وجود علاقة بين فصيلة الدم والإصابة الشديدة بفيروس كورونا. على مقياس الاكتئاب والقلق والتوتر (DASS-21)، كان معدل انتشار الاكتئاب بين المشاركين 32.4٪ (17.5٪ خفيف، 14.1٪ متوسط، 0.8٪ شديد)، كان القلق 54٪ (19٪ خفيف، 22.4٪ متوسط ، 12.6) ٪ شديد) بينما كان انتشار الضغط العصبي 33.7٪ (28.5٪ خفيف، 5.2٪ متوسط)،وأظهرت نتائج الدراسة أن القلق من انتقال عدوى كورونا إلى العائلات كان المصدر الأكثر شيوعًا للقلق والتوتر بين الطواقم الطبية (المتوسط=.280)، كان دعم الأسرة هو العامل الأكثر شيوعًا الذي ساهم في تقليل التوتر (المتوسط=87)، اعتمد معظم المشاركين استراتيجيات التأقلم الإيجابية خلال فترة الإصابة، كانت الأنشطة الروحية والدينية هي أكثر استراتيجيات المواجهة شيوعًا (94.6٪). توصيات الدراسة: في ضوء هذه النتائج، يوصى بتعزيز برامج التدريب حول إجراءات مكافحة العدوى والالتزام بمعدات الحماية الشخصية، بالإضافة إلى تكريم الطواقم الطبية ماديا ومعنويا تقديرا لجهودهم وتحسين حملات التوعية بالتطعيم، بالإضافة إلى تنفيذ برامج مستمرة طويلة المدى لجلسات توعوية وجلسات دعم نفسي، يعد تدريب الأخصائيين النفسيين على الاستشارة عبر الهاتف أمرًا مهمًا للغاية خاصة في الأزمات، كما أوصت الدراسة بتحسين التنسيق بين وزارة الصحة والوزارات الأخرى لتقديم الخدمات أفضل، كما أوصت الدراسة بتحسين نظام المتابعة ونظام التقييم للخدمات النفسية.
Mothers’ Knowledge, Attitudes and Practices about Childhood Obesity in the Gaza Strip
(Al-Quds University, 2021-12-20) Hazem Mahmoud Yousef Parghout; حازم محمود يوسف برغوث
The prevalence of childhood obesity has been increasing alongsidewith the rapid global economic and technological situation, including Palestine. This study aims to examine the association between nutritional knowledge, attitude and practice (KAP) of Palestinian mothers and childhood obesity of their children in 1st to 4th grade of governmental joint schools. This study is an analytical cross-sectional where 400 questionnaires were completed by using the personal interview method with the mother. The study sample was selected by using multi-stage cluster sampling from seven educational directorates. The socio--economic characteristics, family history, life style, dietary intake, physical activity and parental modeling were assessed for the targeted population. The childhood obesity was determined by anthropometric measurements using the 95 percentile of Body Mass index for age as a cut-off point. KAP data were obtained from the mothers by using valid and reliable questionnaire that contains 12 questions related to nutritional knowledge and 18 questions and 12 questions in the Likert scale form were used to assess the attitude and the practice of the mothers, respectively. The average age of the children was 7.96 years and almost one third of the children (29.8%) were males, while the remaining were females. The prevalence of obesity among the children was 23%. The result indicated that mothers who hold higher degree were 36.3% and the double-headed households were 97%. Moreover, the average number of household member was 6.86. The educational levels of mothers and fathers were statistically significant between obese Versus Non-obese groups and the P < 0.001. Regarding the variables of socioeconomic status, there were no relationship with childhood obesityat the multivariate analysis (Logistic regression). The mean differences in the knowledge, attitude and practice of the mothers of non-obese children Versus obese children were; 15.19, 14.03 and 5.28 respectively and all the three differences were statistically significant. The results showed that each one-point increase in the mother’s knowledge, attitudes, and practices will reduce the child obesity rate by 6.2%, 4.2%, and 8.5%, respectively. Moreover, child who own a computer, laptop or smart phone will be more likely to be obese by approximately 7 times, and a child was on exclusively breastfed will be 0.11 times less likely to be obese. As for the child’s birth weight, the relationship is negative, whenever the child’s birth weight decreases by 1 kg, the rate of obesity will increase by approximately 65%. The result also indicated that child who eats nuts daily, 59 times more likely to be obese. The study concluded that there is a need to establish educational sessions and workshops in cooperation between the Ministry of Health and the Ministry of Education along with other Community-Based Organizations (CBOs) for mothers regarding healthy lifestyle. In addition, monitoring of school canteens and integration of the vegetables and fruits into the food sold inside the canteen. يتزايد انتشار سمنة الأطفال بالتوازي مع الوضع الاقتصادي والتكنولوجي العالمي السريع ، بما في ذلك فلسطين. تهدف هذه الدراسة إلى فحص العلاقة بين المعرفة التغذوية والموقف والممارسة للأمهات الفلسطينيات والسمنة لدى أطفالهن في الصف الأول إلى الرابع من المدارس الحكومية المشتركة, هذه الدراسة مقطعية تحليلية حيث تم استكمال 400 استبانة باستخدام أسلوب المقابلة الشخصية مع الأم. تم اختيار عينة الدراسة باستخدام العينة العنقودية متعددة المراحل من سبع مديريات تعليمية, تم تقييم الخصائص الاجتماعية - الاقتصادية ، تاريخ الأسرة ، نمط الحياة ، المدخول الغذائي ، النشاط البدني والنموذج الأبوي للسكان المستهدفين. تم تحديد السمنة في مرحلة الطفولة من خلال قياسات الأنثروبومترية باستخدام 95 بالمائة من مؤشر كتلة الجسم للعمر كنقطة فاصلة. تم الحصول على بيانات المعرفة, المواقف والممارسات من الأمهات باستخدام استبيان صالح وموثوق به يحتوي على 12 سؤالًا متعلقًا بالمعرفة التغذوية و 18 سؤالًا و 12 سؤالًا في نموذج مقياس ليكرت تم استخدامها لتقييم إدراك وممارسة الأمهات على التوالي. بلغ متوسط عمر الأطفال 7.96 سنة وكان ما يقرب من ثلث الأطفال (29.8٪) من الذكور والباقي من الإناث. بلغت نسبة انتشار السمنة بين الأطفال 23٪. كانت الفروق المتوسطة في المعرفة والمواقف والممارسات لأمهات الأطفال غير البدينين مقابل الأطفال البدينين ؛ 15.19 و 14.03 و 5.28 على التوالي وجميع الفروق الثلاثة كانت ذات دلالة إحصائية. وأظهرت النتائج أن كل زيادة بمقدار نقطة واحدة في معرفة الأم و مواقفها وممارساتها ستقلل من معدل السمنة عند الأطفال بنسبة 6.2٪ و 4.2٪ و 8.5٪ على التوالي. علاوة على ذلك ، فإن امتلاك جهاز كمبيوتر أو كمبيوتر محمول أو هاتف ذكي من قبل الأطفال سيعرضهم للإصابة بالسمنة اكثر بحوالي 7 مرات ، والطفل الذي يرضع حصريًا من الثدي سيكون 0.11 مرة أقل عرضة للإصابة بالسمنة. أما بالنسبة لوزن الطفل عند الولادة ، فالعلاقة سلبية ، فكلما انخفض وزن الطفل عند الولادة بمقدار 1 كيلوغرام ، فإن معدل السمنة سيزداد بنحو 65٪ ، والطفل الذي يأكل المكسرات يومياً ، 59 مرة أكثر عرضة للإصابة بالسمنة. وقد خرجت هذه الدراسة ببعض من التوصيات الهامة من بينها: إقامة دورات وورش عمل تثقيفية بالتعاون بين وزارة الصحة والتعليم للأمهات حول التغذية الصحية بشكل عام والأطفال بشكل خاص. ضرورة وجود برامج لتشجيع الرضاعة الطبيعية في مستشفيات الولادة وللمرأة في المجتمع بشكل عام. إرشاد صناع القرار في وزارة الصحة إلى مخاطر سمنة الأطفال في مراحل التعليم الابتدائي ، وأن السمنة في هذه المرحلة الحرجة يمكن أن تسبب عبئاً اقتصادياً على الدولة في المستقبل. زيادة التعاون بين وزارة التربية ووزارة الصحة في مراقبة المقاصف المدرسية لإدخال الخضار والفواكه في المواد الغذائية المباعة داخل المقصف. إدخال مادة تثقيفية جديدة تتناول التغذية الصحية في المدارس ليتم تدريسها للطلاب بشكل يزيد من الوعي الغذائي والصحي بشكل عام لأهميتها التي ستعود على صحة الطلاب والوقاية من سوء التغذية وجميع مخرجاتها. تشجيع الأنشطة الرياضية التي تتم للمنافسة بين الطلاب، لأن ذلك يزيد من النشاط البدني لدى الطلاب ويمنع قلة الحركة ويقلل من السمنة لدى الأطفال. ترسيخ العمل بين وزارة الصحة ووزارة التربية والتعليم من جهة، والجهات المعنية، وخاصة وزارة الإعلام، في تعزيز عادات الأكل الصحي والتوعية بالسمنة لدى الأطفال.
Nurses' Knowledge and Practices about BloodTransfusion in Gaza Governmental Hospitals
(Al-Quds University, 2021-12-20) Heba Ahmad Abdelrahman Abu Nada; هبه احمد عبدالرحمن ابوندى
Blood transfusion is a life- saving common procedure. However, its associated-mistakes can lead to morbidity and mortality. Therefore, it must be performed by well-trained, highly qualified health care personnel due to potential life-threatening complications. The aim of this study was to assess level of knowledge and practice among nurses working at Gaza Governmental Hospitals to blood transfusion. To fulfill the aim of the study, the researcher used cross-sectional descriptive mixed approaches for data collection. A convenience sample of 400 nurses, with a response rate of 100%, consisted of 221 females and179 males with a mean of age 31.0±6.8 from the medical, surgical and obstetric departments completed a self-administered, modified (Routine Blood Transfusion Knowledge Questionnaire) to measure nurses’ level of knowledge and practice. Of these only 100 were observed during the process of blood transfusion using a checklist that was especially design for this purpose. A sample of 12 nurses’ managers, head nurses and blood bank directors were purposively interviewed for the qualitative part. Based on the scale: poor: less than 50%, moderate: 50-74.9% and 75% and more indicates good level, the results of this study revealed that almost all nurses have a moderate to a good level of knowledge where 43.5 % of nurses have good level of knowledge and only 4.85% have poor knowledge with a mean 0f 71±1.1. Nurses’ knowledge was honestly poor in the areas related to the initial blood flow during the 1st 15 minutes, transferring blood from the blood bank, priming blood with normal saline, compatible fluids, the optimum time for starting blood after its arrival to the department and the blood transfusion related policy issue. However, only 9% of nurses reflected satisfactory level of practice and 31 % of them performed in a poor manner with a mean of 57.4± 10.2. The findings showed a noticeable deficiency in the nursing performance related to donning gloves, using normal saline as the main Intravenous fluid line, transmitting blood in a special box, measuring vital signs and remaining with the patient for the 1st 15 minutes. The findings of this study revealed absence of any statistically significant differences in the overall level of knowledge nor practice in relation to nurses’ characteristics. However, receiving training programs significantly affected the level of nurses’ knowledge, while the hospital has a statistically significant effect on the level of practice among nurses. Moreover, nurses working in Al-Shifa Hospital performed better than others. A positive correlation was detected between the knowledge and practice levels. However, a gap between nurses’ knowledge and actual practice was detected. This study emphasizes the importance of in-service training courses for nurses besides establishing of a written policy related to blood transfusion in order to improve nurses’ knowledge and practice and to avoid blood transfusion complications. To explore this topic more deeply, longitudinal and observational studies are recommended in different settings. Key words: Knowledge, Practice, Blood Transfusion نقل الدم هو إجراء شائع لإنقاذ الحياة. ولكن الأخطاء المرتبطة به يمكن أن تؤدي إلى المرض والوفاة لذلك، يجب أن يتم إجراؤها من قبل 'طاقم صحي مدرب تدريباً جيداً ومؤهلتأهيلا عاليا بسبب المضاعفات المحتملة التي تهدد الحياة. تهدف هذه الدراسة الى تقييم مستويات المعرفة والممارسة بين الممرضين العاملين في المستشفيات الحكومية في قطاع غزة فيما يتعلق بنقل الدم. فقد استخدم الباحث الأسلوب المختلط لجمع البيانات لتحقيق هدف الدراسة. تم استخدام العينة الملائمة التي استهدفت 400 من الممرضين العاملين في اقسام الباطنة والجراحة والتوليد في المستشفيات الحكومية المستهدفة مكونة من 221 من الاناث و179 من الذكور بمتوسط عمري 31.0 ± 6. حيث أتم الممرضين المستهدفين تعبئة الاستبيان المعدل الذاتي." المعرفة الروتينية لنقل الدم." بمعدل استجابة 100% وتم ملاحظة 100 من الممرضين فقط أثناء عملية نقل الدم باستخدام قائمة مرجعية مصممة خصيصًا لهذا الغرض. وتم اجراء مقابلات مع مصادر المعلومات الرئيسة شملت كلا مدراء المستشفيات، مدراء التمريض، رؤساء الأقسام التمريضية ومديري بنك الدم. أظهرت نتائج الدراسة الحالية أن المستوى المعرفي لدى معظم الممرضين حول نقل الدم تقريبا يتراوح من متوسط إلى جيد واشارت ان 43.5% يمتلكون مستوى معرفيا جيدا بينما يمتلك 4.85٪ مستوى معرفيا ضعيفا بمتوسط 1.1± 71بناءً على المقياس التالي: ضعيف: من 50٪ فاقل، متوسط: 50-74.9٪ و75٪ فأكثر تشير إلى مستوى جيد، وافادت الدراسة بشكل واضح ان الممرضين يمتلكون معرفة ضعيفة في المجالات المرتبطة: بنقل الدم من بنك الدم، الوقت الأمثل لبدء نقل الدم بعد وصوله إلى القسم و بتدفق نقل الدم خلال 15 دقيقة الأولى، تجهيز الدم بمحلول ملحي والسوائل المتوافقة معه. ومع ذلك، أظهرت الدراسة ان 9٪ فقط من الممرضين لديهم اداء مرضٍ من الممارسة و31٪ كان أداؤهم سيئ بمتوسط 57.4 ± 10.2. وأظهرت النتائج وجود نقص ملحوظ في أداء التمريض بما يتعلق بارتداء القفازات، واستخدام محلول ملحي عادي كخط رئيسي للسوائل الوريدية، ونقل الدم في صندوق خاص، وقياس العلامات الحيوية والبقاء مع المريض لمدة 15 دقيقة الأولى اثناء نقل الدم. وقد كشفت نتائج الدراسة عن عدم وجود أي فروقات ذات دلالة إحصائية في المستوى العام للمعرفة أو الممارسة فيما يتعلق بخصائص الممرضين. ومع ذلك، فقد أثر تلقي البرامج التدريبية بشكل كبير على مستوى معرفة الممرضين، بينما للمستشفى تأثير ذو دلالة إحصائية على مستوى الممارسة بين الممرضات. علاوة على ذلك، كان أداء الممرضين العاملين في مستشفى الشفاء أفضل من غيرهم. تم الكشف عن علاقة إيجابية بين مستويات المعرفة والممارسة. ومع ذلك، تم الكشف عن فجوة بين معرفة الممرضين والممارسة الفعلية. تؤكد هذه الدراسة على أهمية الدورات التدريبية أثناء الخدمة للمرضين إلى جانب وضع سياسة مكتوبة تتعلق بنقل الدم من أجل تحسين معرفة الممرضين وممارستها وتجنب مضاعفات نقل الدم. لاستكشاف هذا الموضوع بشكل أعمق، يوصى بالدراسات الطولية والرصدية في أماكن مختلفة. الكلمات الدالة: المعرفة، الممارسة، نقل الدم.
Oral Health Problems among Heart Diseases Patients Attending Governmental Health Centers in Gaza Governorates
(Al-Quds University جامعة القدس, 2022-07-30) Wissam Abdullah Ali Alborsh; وسام عبدالله علي البرش
oral health status among type 2 diabetes mellitus patients attending governmental primary health care centers at gaza governorates
(Al-Quds University, 2022-07-30) Aesha Mohammed Joma' Fetaiha; عائشه محمد جمعه فتيحه
Background / Objective: Diabetes mellitus disease is a main public health problem which badly affects oral health and overall quality of life. This thesis aimed to examine oral health problems and needs of patients with type 2 diabetes mellitus attending governmental primary health centers in Gaza Governorates. Methods: A mixed method convergent parallel design was employed in May 2021. A cross-sectional study was applied to 376 patients with type 2 diabetes mellitus selected through systematic random sampling from 5 randomly selected governmental primary health centers. Moreover, 13 patients were purposefully recruited for interviews in the qualitative part. The World Health Organization Decayed ,Missing and Filling Tooth Index, semi-structured questionnaire and interview guide were used to collect data accordingly. Descriptive, analytical and thematic analysis were applied for the quantitative and qualitative research, respectively. Results: Most patients (64%) see themselves susceptible to oral complications, and 67.8% perceived high severity of these complications. Nearly three quarter (73.2%) believe that there are benefits from oral health practices, and 56.2% perceived many barriers to oral health practices. Nearly half of participants (57.6%) are aware about oral complications resulted from type 2 diabetes mellitus, and 42% committed to oral hygiene practices. The mean of Decayed ,Missing and Filling Tooth Index is 13.18±6.39 and the mean teeth with loss of attachment is 1.88±0.76. Majority of participants have no periodontitis (160/376; 42.6%). In return, 8.5%, 21.5% and 27.4 % presents with severe (32/376), moderate (81/376) and mild periodontitis (103/376), respectively. Gingival bleeding and loss of attachment are higher among males ,ex-smoker and who live in the southern part of Gaza strip. The mean of Decayed ,Missing and Filling Tooth Index, gingival bleeding, and loss of attachment is higher among patients having type 2 diabetes mellitus for more than 10 years and with history of chronic diseases, whereas, the mean of pocket is higher among patients having uncontrolled diabetes mellitus and type 2 diabetes mellitus less than 10 years Decayed ,Missing and Filling Tooth Index and loss of attachment is higher among patients with history of chronic diseases. Conclusion: Patients with type 2 diabetes mellitus suffer from many oral health problems especially dental caries, periodontitis and loss of attachment. Furthermore, there is a need for establishing health education campaigns at governmental, non-governmental settings and within community to sensitize diabetic patients about importance of controlling glycemic level on promoting healthy oral cavity and vice versa. خلفية البحث: مرض السكري هو مشكلة رئيسية تؤرق الصحة العامةوله تداعيات سيئة على صحة الفم ونوعية الحياة بشكل عام. هدفت هذه الأطروحة إلى فحص مشاكل صحة الفم واحتياجات مرضى السكري من النوع الثاني الذين يترددون على مراكز الصحة الأولية الحكومية في محافظات غزة. منهجيه البحث: تم استخدام أسلوب النسق المختلط المتوازي في مايو1202، وطبقت الدراسة الكمية المقطعية على 376 مريض بالسكري النوع الثانيحيث تم اختيارهم عشوائيا بالطريقة المنتظمة من 5 مراكز صحية أولية حكومية تم اختيارها عشوائيا. علاوة على ذلك، تم تجنيد 13 مريضا عن قصد لإجراء مقابلات معمقة في الجزء الكيفي من الدراسة. ثلاث أدوات رئيسية استخدمت لجمع البيانات: مؤشر صحة الأسنان التابع لمنظمة الصحة العالمية، استبيان شبه منظم وأسئلةمقابله. استخدم التحليل الوصفي والتحليلي والموضوعي على البيانات الكمية والكيفية على التوالي. النتائج: اغلب المرضى (64%) يرون أنفسهم قابلين للإصابة بمضاعفات السكري على الفم و67.8% منهم يقر بخطورة هذه المضاعفات. ثلاث أرباع المرضى تقريبا (73.2%) يعتقدون بأهمية ممارسات نظافة الفم، في حين 56.2% ذكروا الكثير من المعيقات التي تمنعهم من اتباع نظافة الفم. أيضا 57.6% على علم بالمضاعفات التي يحدثها مرض السكري النوع الثاني ولكن 42% فقط ملتزمون بممارسات نظافة الفم. مؤشر تسوس الأسنان كان 13.18±6.39، وكان متوسط الاسنان التي تعاني من انحصار اللثه هو 1.88±0.76 42.6% ليس لديهم التهاب دواعم الأسنان. على العكس، التهاب اللثة الشديد والمتوسط وجد عند 8.5% و 21.5% من المرضى على التوالي. نزيف اللثة وانحصار اللثهأعلى بين الذكور والمدخنين السابقين والذين يعيشون في جنوب القطاع. مؤشر صحة الأسنان، النزيف اللثوي و انحصاراللثه مرتفع كثيرا عند المرضى الذين لديهم السكري اكثر من 10 سنوات، بينما متوسط الجيب اللثوي مرتفع عند المرضى الذين لديهم عدم انتظام السكري ومدة السكري اقل من 10 سنوات. الخلاصة: يعاني مرضى السكري النوع الثاني من مشاكل فمية كثيرة. وأخيرا، إقامة الحملات التوعوية المجتمعية على مستوى الرعاية الأولية الحكومية وغير الحكومية لتعزيز وعي مريض السكري بأهمية ضبط السكري في الحفاظ على صحة الفم سليمة والعكس صحيح.
Organizational climate at UNRWA as perceived by clinical staff working in the West Bank field
(Al-Quds University, 2004-02-16) Maysoon Mousa Said Obeidi; ميسون موسى سعيد عبيدي
Patient's perspective of outpatient clinic services delivery during Covid-19 outbreak in East-Jerusalem
(Al-Quds University, 2022-05-24) Firas zeyad Abdulqader Daghlas; فراس زياد عبد القادر دغلس
Background: Corona viruses are called zoonotic viruses that are transmitted from animals to humans, at the end of 2019, the appearance of a new Coronavirus disease COVID-19 in Wuhan China. The state of emergency was declared by Palestinian Minister of Health in 5 march 2020, and in 11 March 2020, the 'World Health Organization' (WHO) declared COVID-19 as a "pandemic". The COVID-19 pandemic has the same implications on health system due to reduced accessibility and availability of health resources. During COVID-19 pandemic the quality of care suffered and the virus stretched some health systems to breaking point and intensive care units being overwhelmed. Patient's attitude toward healthcare has shifted during COVID-19 pandemic, and out-patients have reduced their regular visits to the clinics. Understanding of patient's preference leads the care to be cheaper, more effective and closer to the individuals' desires. The COVID-19 morbidity and mortality indicators were higher in Palestine in comparison with the global level. Furthermore, social gathering and lack of readiness of the fragmented health system were risk factors in the spread of COVID-19. Aim: To assess the patient's perspective of outpatient clinics services delivery during COVID-19 outbreak in East-Jerusalem. Methodology: A cross sectional study was conducted by using convenience sampling technique and self-administered questionnaires which consisted of the socio-demographic data sheet and patient's perspective of health care system delivery on accessibility, availability of resources quality of care, and patient's attitude and preferences during COVID-19 outbreak scale which developed based on Jadoo (2014) study. The sample included 300 participants from outpatient clinics in East- Jerusalem hospitals which were Al-Makassed hospital, Augusta Victoria Hospital and Saint-Joseph hospital. Statistical analysis was done using T-test, one-way ANOVA, the statistical significance was defined as a P-value of (0.05). Results: The results showed that the most of the participants (98.6%) had negative opinion when the current situation is compared with before the COVID-19 period in terms of accessibility, availability of resources, quality of care, attitudes and patient's preference. Only 5.55% of participants had a positive opinion regarding the preference of the health care system during the COVID-19 outbreak. The relationship between the dependent and IV the independent variables showed that there was a statistically significant relationship between patient's perspectives of health care system delivery items and occupation, pvalue is equal to 0.036(α ≤ 0.05). Moreover, there was no significant relationship between medical history variables and patients‘ perspectives, since (α ≤ 0.05). Multivariate analysis indicated that there was no significant relationship between occupation and participant's opinion (p= 0.089) prevalence odds ratio [POR] = 1.98, 95%CI 1.225-3.215). Conclusion: This study revealed that the most of the participants had a negative opinion when the current situation is compared with before the COVID-19 period in terms of accessibility, availability of resources, quality of care, attitudes and the patient's preference. Only 5.55% of participants had a positive opinion regarding the preference of the health care system during the COVID-19 outbreak. Most of the participants reported that there is a decrease in the accessibility to health services that were provided during the COVID-19 outbreak in East Jerusalem. Policy makers should pay attention to the accessibility to health care, availability of health resources, quality of healthcare, patient's attitudes and patient's preference during COVID-19 pandemic and other pandemics. Also, policymakers should investigate the reasons behind increased waiting time and more money consuming to get health care services. Moreover, should pay attention to the importance of patient's perspective and their opinion in health care system which leads to better understanding of patients needs and preferences. There is a need to conduct a qualitative study to understand the issues in more detail ,the reasons why patients do not prefer the health services (now) during the COVID-19 outbreak period.
Perceptions and Experiences of Sub-fertile Couples Served at the In Vitro Fertilization Centres in the Gaza Strip
(Al-Quds University, 2020-12-20) Shahd Bassam Abu Hamad; شهد بسام أبو حمد
Background: Infertility is a difficult experience with many overwhelming challenges originated from medical, social, financial and psychological factors. This study explores experiences and challenges that infertile/sub-fertile couples face when they utilize in vitro fertilization services in Gaza and flags priority areas for supporting them. Method: The study followed a quantitative, analytical cross-sectional approach. Data were collected from a convenient sample of 320 participants attending In Vitro Fertilization centers in the Gaza Strip. After consenting, a qualified data collection team administered face to face interviews with participants at the centers serving them. The study tool has been constructed by the researcher to incorporate medical, social, psychological and financial dimensions. Tool validation has been done through experts’ review and statistical testing. The SPSS software has been used for data entry, cleaning and analysis. Results: The mean age of respondents was 29.8 years, and the mean age of their husbands was 34.9 years. Despite that 76.6% of husbands are working, almost two thirds of them earn less than New Israeli Shekels 1000; 33.4% reported receiving social assistance, half of them indicated that their monthly income is not sufficient to meet their basic needs. Still, 82.2% didn’t receive any financial support when they seek In Vitro Fertilization services. One average, interviewed participants reported living with their infertility for around 5.5 years, three quarters of them were told about the reason of infertility, among them, 63.3% reported that disturbed spermatogenesis is the reason for couples’ infertility. Two thirds of cases have secondary infertility, 63.4% reported being pregnant before. Of the total surveyed women, 14.7% reported developing health problems attributed to infertility management. Sub-fertile couples reported starting seeking infertility management early, with 40% doing that within less than 1 year of marriage. On average, couples approached around 5 doctors for infertility management and tried two centers, nevertheless, only 13.2% were provided with medical documents that can be used when they approach other centers. More than half (56.9%) of the respondents confirmed visiting a traditional healer. The vast majority of couples reported exposure to social pressure (89.4%), especially by in-laws to conceive which increased their stress. The level of satisfaction reported by respondents about the services received was particularly high (93.34%). More importantly, General Health Questionanire-12 scores indicate significant level of psychosocial stress with one quarter showing signs of psychological distress (using 6 as cut off point) and three quarters reporting psychological distress when using 3 as a cut-off point. The overall quality of life score (wellbeing) was 71%, lower than the general population scores with the social domain eliciting the highest score (79.13%) and the environmental domain eliciting the lowest scores 65.93%. The main challenges facing sub-fertile couples were financial difficulties (91.6%), discrimination (76.6%) especially by in-laws, psychosocial stress (53.1%) and side effects of hormonal therapy (20.6%). Family was the main source of support for sub-fertile couples, as 82% reported being supported by their husbands, 55% by their in-laws and 54.4% by their parents. Psychosocial services are rarely provided at In Vitro Fertilization centers; instead focus was more on hormonal therapy and medical treatments. Conclusion: Sub-fertile couples face numerous challenges and should be better supported financially and psychosocially. Beneficiaries’ rights to get adequate information, counseling and informed choices should be maintained. Regulatory measures to promote and standardize services at IVF centers is a priority. Also, social discriminatorynorms and stigma around infertility should be addressed.

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