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- ItemPsychosocial Challenges, Coping Strategies and Access to Support for Women with Breast Cancer in the Gaza Strip(Al-Quds University, 2024-04-20) Ayda Ahmad Mohammad AL-Hadad; عايدة أحمد محمد الحدادBreast cancer represents 11.7% of all cancer cases worldwide and 18% in in the Gaza Strip. In addition to being a common bodily health problem, cancer is also associated with psychosocial problems such as depression, anxiety. Universally, there is growing evidence around the challenges and support for women with breast cancer. The study is conducted to explore key psychosocial and mental health challenges facing women with BC, appraise their coping strategies, and to ascertain formal and informal support accessible to them. Methods A cross sectional design was used, in which data have been triangulated, quantitatively and qualitatively. The quantitative part is conducted through an interviewed questionnaire with 330 women diagnosed with breast cancer and focused on exploring the challenges they are facing and the support provided to them. The qualitative part looked in-depth to the lived experiences of women with breast cancer, their perspectives were explored through four focus group discussions with 25 participants. Quantitative data was analyzed using the SPSS and open coding thematic analysis technique was used for analyzing qualitative materials. Findings Findings revealed that 35.6% of the participants were 51-60 years old, nearly half of them from Gaza City, 76% were married, 93.3% were housewives and 53.8% reported that their monthly household income is less than 1000 ILS. With regard to the staging of BC, nearly a quarter (24%) were stage I and 36.8% were stage II. As reported by women, 60% took more than 4 weeks to initiate treatment after confirming their diagnosis. Chemotherapy was received by 83% of women, surgery was done for 84%, hormonal therapy was received by 71%, while 68.4% of participants received radiotherapy. Participants scores on mental health scales show that anxiety was more prominent (76% with moderate and severe) than depression (29% moderate and severe) or stress (9% moderate or severe). When asked how BC affected them, 31% reported that cancer reduced their activity level and negatively affected their psychosocial status (26.7%).Findings show that among the five social support dimensions, positive social interaction was the most common dimension, while tangible support (provision of practical resources and material aid) was the least common. Women used different strategies to cope with their disease, the most frequent coping strategies were praying or meditating (75.5%), followed by trying to find comfort in religion or spiritual beliefs (55.2 %).Inferential analysis showed that younger women (less than 40 years), recently diagnosed (one year and less) and women diagnosed at stage of III and IV were facing more challenges than their counterparts from other groups in reporting higher scores of depression, anxiety and stress, and had higher scores of avoidant coping strategies when compared to other women. Women who had mastectomy, reported higher scores in the challenges they face, depression, anxiety and stress, and received more social and formal support compared to women who had breast conservative surgery, but these variances are not statistically significant.Conclusions and recommendations The study concluded numerous challenges that are facing women throughout their course of disease, which found to be adversely affecting their mental health outcomes and points out to the necessity of addressing these challenges. Breast cancer management is not only medical rather, it requires multi-modal interventions including intensive psychosocial support and social protection which needs to be integrated as a crucial component of care.
- ItemAssociation of GLP-1R Gene Polymorphisms with the risk of Dyslipidemia in Palestinian Patients with Type 2 Diabetes Mellitus(Al-Quds University, 2024-07-11) Maha Rashad Joma AlSharabati; مها رشاد جمعة الشرباتيThe high risk of cardiovascular events in diabetic patients is associated with dyslipidemia, a common concomitant disease of diabetes. Dyslipidemia comprises of a wide range of lipid disorders including over production of lipids or its deficiency. It is characterized by the presence of either elevated low density lipoprotein cholesterol (LDL-C) or elevated high total cholesterol (Hypercholesterolemia) or elevated triglycerides (Hypertriglyceridemia) or decreased high density lipoprotein cholesterol (HDL-C). Several studies have found that dyslipidemia can be associated by single nucleotide variations in specific genes. Therefore, the present study aimed to investigate GLP-1R gene polymorphisms rs10305420 and rs3765467 and its association with the risk of dyslipidemia in Palestinian patients with type 2 diabetes mellitus (T2DM). A cross sectional study was conducted between October 2023 and February 2024 at Jericho health center MOH. Herein, we used next generation sequencing (NGS) to study two single nucleotide polymorphisms (SNPs), rs10305420 and rs3765467 within the GLP-1R gene in one multiplex PCR tube. Bioinformatics analysis was done using free online galaxy program (https://usegalaxy.org.au/). A total of 216 T2DM patients were enrolled in this study and divided into two groups: The control group (patients without dyslipidemia) and case group (patients with dyslipidemia). The control group included patients aged 40 years or older with confirmed T2DM (diagnosed according to WHO criteria) and had no history of dyslipidemia (TC < 200 mg/dl, TG < 150 mg/dl, and no use of lipid‐lowering agents), while the case group included patients who aged 40 years or older with confirmed T2DM and dyslipidemia. Dyslipidemia was defined by TC ≥ 240 mg/dl and/or TG ≥ 150 mg/dl, LDL-C ≥ 140 mg/dl, HDL-C < 40 mg/dl, and/or use of lipid‐lowering drugs. Participants under 40 years old, individuals with confirmed diagnosis of Type 1 Diabetes Mellitus, patients with incomplete medical records, patients with severe comorbidities (e.g., severe liver disease or cancer), and pregnant women were excluded from the study. The results showed higher rates of diabetic neuropathy, retinopathy, and hypertension among patients with dyslipidemia compared to those without dyslipidemia (p < 0.05). However, no statistically significant differences were observed in the prevalence of nephropathy, diabetic foot, or tobacco smoking status between the two groups, whereas female patients were more prevalent in the dyslipidemia group (p = 0.04). The genotype distributions of rs10305420 in the studied groups showed that the most frequent genotype in the dyslipidemia group was CC (27.8%), followed by CT (15.3%) and TT (7.9%). For those without dyslipidemia, the CC, CT, and TT genotypes were 26.4%, 17.6%, and 5.1%, respectively. The study showed no significant difference in the distribution of the rs10305420 genotype between the T2DM patients with and without dyslipidemia. For the second SNP, the GLP-1R rs3765467 polymorphism, almost all samples exhibited the GG genotype. The mean (TC, TG, and LDL) of T2DM patients with dyslipidemia were respectively higher than those without dyslipidemia (178.7± 39.2 vs. 155.5 ± 33.6, p < 0.001), (189.1 ± 140.1 vs. 106.7 ± 40.6, p < 0.001), and (103.1 ± 32.3 vs. 92.9 ± 27.6, p < 0.015). Mean age, BMI, systolic blood presure of T2DM patients with dyslipidemia were higher than those without dyslipidemia. In conclusion, the rs10305420 and rs3765467 polymorphisms in the GLP-1R gene were not significantly associate with dyslipidemia in this population. Further studies with larger sample sizes are needed to confirm these findings.
- ItemEvaluation of Type 2 Diabetes Mellitus Services Provided by the Ministry of Health in Gaza Strip: A Mixed-Methods Study(Al-Quds University, 2024-03-06) ولاء كلاي دلول; Walaa Klay DaloulDiabetes Mellitus control and complications are affected by the structure of health services provided. Aims: This study aims to evaluate T2DM services provided in the Ministry of Health (MoH) primary health care clinics (PHC) in the Gaza Strip (GS) from providers’ and patients’ perspectives. Methods: A cross-sectional study was done using a two-stage stratified random sample of PHC clinics from the four Gaza Strip regions, A convenient sample of 400 patients was selected from the 8 PHC clinic patients and were interviewed using a structured questionnaire. A purposing sample of 16 nurses and physicians treating T2DM patients was interviewed from each PHC clinic Quantitative data analysis was done using descriptive and bivariate. Chi-square, correlations, t-tests, and one-way ANOVA testing were employed using SPSS as needed. Qualitative data was collected using individual interviews that were recorded, transcribed, and submitted open-ended. The study was ethically approved and each participant had to sign a consent form before participation. Results: Participants had a mean age of 61 years (± 9.23), 59.8% were females and 66% had a family history of DM. The average diagnosis duration for T2DM was 9.5 years (SD ± 6.67) and 63.7% had co-morbidities. 61% had low diabetic awareness, 33.8% had low attitude, and over two-thirds had low practice. Input services indicators: 41.8% thought DM services met expectations. The most common service need was drugs (85.5%), followed by blood sugar control (37%). There was good compliance with MoH non-communicable illness standards and protocols (PEN). In addition, 58.8% of participants didn’t visit the health center for T2DM follow-up due to its appearance and facilities. For process indicators, 79% exclusively used MoH PHC services and 84.8% said it was easy to access the health center. In interviews, doctors said early morning crowds disrupted work. خلفية الدراسة: تتأثر متابعة ومضاعفات مرض السكري ببنية الخدمات الصحية المقدمة مثل عوامل الإمداد والعوامل المتصلة بتقديم الخدمات. اهداف الدراسة: وتهدف هذه الدراسة إلى تقييم الخدمات التي تقدمها وزارة الصحة في عيادات الرعاية الصحية الأولية في قطاع غزة من منظور مقدمي الخدمات والمرضى. طرق البحث: استُخدمت لأغراض التحليل الكمي دراسة استقصائية شاملة لعدة قطاعات شملت 400 من المرضى المراجعين من 8 عيادات للرعاية الأولية. حيث تم اختيار العينة من أربع مناطق في قطاع غزة. كما أجريت مقابلات شخصية مع عينة مقصودة لأغراض التحقيق النوعي حيث تم اختيار 16 ممرضة وطبيباً يعالجون مرضى السكري موزعين على العيادات المشاركة في الدراسة. وقد تم عرض بيانات الدراسة بصورة وصفية وتحليلية باستخدم اختبارات chi-square، ومعامل الارتباطات و t-test حسب انواع لبعوامل المدروسة بنسبة p-value <0.05 لاعتبار العلاقة بين العوامل احصائيا صحيحة. وقد وُقعت استمارة الدراسة من قبل المشاركين بعد اعتماد الدراسة أخلاقياً. النتائج: كان متوسط عمر المشاركين 61 سنة (بانحراف معياري SD± 9.23 سنة)، حيث بلغت نسبة الإناث 59.8 %، و %66 كان لديهن تاريخ أسري من مرض السكري. اما متوسط مدة التشخيص بمرض السكري 9.5 سنة (6.67 SD±( وعانى 63.7 % من امراض مزمنة اخرى. كما اظهرت النتائج ان معرفة المشاركين (61%) وممارساتهم (66%) وتوجهاتهم (33.8%) نحو مرض السكري لم تكن بالمستوى الجيد. مؤشرات بناء الخدمات: اظهرت النتائج ان نسبة 41.8 % من المرضى قد حصلوا على الخدمات المتوقعة من هذه المراكز ولكن أعرب 85.5% بان اهم مشكلة في هذه المراكز هو عدم توفر الادوية و37% أعربوا عن عدم توفر فحص مراقبة السكري. اما نسبة الالتزام بمعايير وبروتوكولات وزارة الصحة المتعلقة بالأمراض غير المعدية باستخدام الى PEN approach فقد كانت جيدة، وبالإضافة إلى ذلك، تجنب 58.8 % من المشاركين الذهاب للمراجعة لتلك المراكز بسبب المرافق المتوفرة والمظهر العام لها. وبالنسبة لمؤشرات العمليات، فإن 79 % من المرض استخدموا الخدمات و84.8 % أعربوا انه من السهل الوصول إلى المركز الصحي. اما في خلال مقابلات مع الطواقم الصحية، فقد أعرب الاطباء ان حشود الصباح الباكر تعطل العمل على تقديم الخدمات الشاملة للمرضى. اما عن التوثيق والملفات فقد اغرب المشاركين عن عدم كفايتها وعدم اكتمالها، كما ان 66% اكدوا بوجود متابعة لمرضهم وان 60.5% قد تم اجراء فحص السكري لهم. وقد اكد %78 من المشاركين عن تلقيهم تدريب لإدارة مرضهم ذاتيا و49% اكدوا ان التدريب كان يتم من قبل الممرضين المرفق الصحي. . اما الطواقم الطبية، فقد أعرب المشاركون بالدراسة عن الحاجة للتدريب دوريا على الالية المتطورة في ادارة مرض السكري. وفيما يتعلق بقياس نواتج الخدمات الصحية، فقد أعرب أكثر من نصف المشاركين في الدراسة الاستقصائية عن رضاهم عن الخدمات. وكانت نسبة 85 % راضية عن النظافة ولكن 58.8% أعربوا عن عدك توافر للأدوية المطلوبة. وشعرت نسبة 72.5 % من المشاركين بتحسن صحتهم حين تلقوا الرعاية الصحية في مراكز وزارة الصحة، في حين قال 43.3 % بان الكلفة العالية للخدمات الصحية هي احد المشاكل الاكثر انتشاراً فيما يتعلق بخدمات الرعاية الصحية الأولية. ولسوء الحظ، أظهرت السجلات الطبية أن 35.5 % فقط من مرضى السكري النوع الثاني (T2DM) لديهم السيطرة على السكري، وخضع 60.5 % منهم لفحص شبكية العين سنويا، و41.5 % تم اجراء اختبار فحص القدمين، و95 % اجروا التحليل المخبري السنوي. اما عن المعامل القياسي لمضاعفات السكريات ( DCI) فأظهرت النتائج ان فقط 19.3 % من المشاركين في الدراسة لم يكن لديهم اي مشاكل مع مرض السكري وبينما عانى 71.3 % من مضاعفات المرض، وكان الاعتلال العصبي هو الأكثر شيوعا. وكشفت التحليل المتفاوت أن الأشخاص الذين لا يعانون من مضاعفات السكري (مثلاً، النوبة القلبية، والإصابة بسرطان الدم، والإصابة بفيروس نقص المناعة البشرية، والاعتلال العصبي، والقدم المريضة، وصعوبات العين) لديهم قدرة أفضل على التحكم في مرض السكري (p < 0.05)، وقد شهدت النساء تعقيدات أكبر في مرض السكري بين الأفراد الذين لديهم تاريخ طويل من مرض السكري (10 سنوات أو أكثر)، والذين لديهم تاريخا عائليا من مرض السكري، أو اي امراض مزمنة اخرى. وترتبط قلة المعرفة والممارسة والمواقف ورضا المريض ارتباطاً كبيراً بالمشاكل الناشئة لدى المرضى المصابين بمضاعفات السكريات (p < 0.05). واشارت النتيجة ان المستوى الغذائي والنشاط البدني المنخفض يرتبط ارتباط مباشرا لدى المشاركين بحدوث مشاكل صحية نتيجة الاصابة بمرض السكري p < 0.05). وخلصت هذه الدراسة إلى أن برنامج الفحص لمضاعفات السكري من النوع 2 جيد نسبياً في عيادات وزارة الصحة. ومع ذلك، فإن معرفة المرضى ومواقفهم وممارساتهم فيما يتعلق بضبط النوع 2 من السكري (HbA1c) يعتبر ضعيفا نسبياً. ويمكن تفسير ذلك بالتركيز المحدود على الرعاية الذاتية لمرضى السكر، وعدم كفاية التثقيف الصحي، ومحدودية الاتصال بين مقدمي الرعاية الصحية والمرضى، وقصر وقت الاتصال. وثمة حاجة إلى مزيد من الدراسات لتقييم محددات مركز السيطرة. وتحتاج وزارة الصحة إلى زيادة وقت الاتصال وتحسين إدارة الرعاية الذاتية والمعارف المتعلقة بالمضاعفات.
- ItemDeterminants of Glycemic Control among Patients with type 2 Diabetes Attending UNRWA Health Centers: A Comparative Study(Al-Quds University, 2024-03-23) Randa Mansour Ahmed Masoud; رندة منصور أحمد مسعودDue to its heavy burden on mortality, morbidity, and health costs, there is a growing attention to noncommunicable diseases including diabetes. This study aims to investigate the determinants of glycemic control among patients with type 2 Diabetes mellitus attending United Nations Relief and Works Agency for the Refugees of Palestine health centers in the Gaza Strip. Methodology The research employs a comparative mixed methods approach, combining a quantitative survey with semistructured interviews. The quantitative component assessed the effects of sociodemographic, lifestyle, nutritional, physical activity, healthcare-related, medication-related, and mental health factors on glycemic control. A stratified random sampling technique was applied to select 420 participants, divided equally between those with controlled and uncontrolled glycemic control. Laboratory tests and body measurements were also extracted from medical records. The qualitative component explored the perspectives of patients and healthcare providers regarding factors influencing glycemic control through 4 focus group discussions with patients and 20 in-depth interviews with healthcare providers. Thematic analysis was used to explore enablers and barriers to glycemic control. Key findings Slightly more than half (55%) of participants were women, the average age was 60.5 years,78% were married, 72% had secondary education or above and 75% were unemployed. The average family size was 5.48 members, median monthly family income was 450 ILS while the median monthly family expenditure was 750 ILS. The food consumption analysis revealed that food diversity was poor as scored by 4% of participants, 17% borderline and 79% were acceptable. Findings show that food diversity is a significant factor in controlling diabetes; as food diversity score increases the HbA1c level decreases, and this correlation was statistically significant. The study shows that most participants (73%) reported scores suggesting having depression according to the PHQ-9 screening tool, and 51% perceived their mental health as bad or half/half. Participants with scores suggesting having depression were less likely to show optimal glycemic control and vice versa and this relationships between the score of PHQ-9 and control status were statistically significant. Regarding physical activity, the study shows that 58% of participants had a low level of physical activity according to the IPAC score. Scoring high in physical activity was statistically significant associated with higher level of control. Findings show that only 3% of respondents reported regular self-monitoring of blood glucose at home by glucometers, 43.5% of patients had low to medium adherence to medications. Respondents who reported high adherence to medications had better control status and the differences between patients with high adherence and their counterparts with low adherence in control status were statistically significant. Findings also show that the presence of obesity plays a negative role in control with obese patients with diabetes are less likely to show glycemic control than their counterparts who were not obese. Good self-management practices like monitoring blood glucose level at home were associated with better control status with statistically significant differences. Also, developing complications were more prominent among patients with high glycemic levels than among people with optimal control. Conclusions and recommendations Achieving optimal glycemic control requires a multi-faceted approach to address the root reasons behind hyperglycemia, including proactive targeting of categories of diabetic people at risks, improving access to the needed resources, focusing on patient education, and addressing mental health problems. The study recommends interventions to improve control status through promoting healthy lifestyles, investing in mental health support, addressing dietary challenges, promoting physical activity through community-based approaches, better family engagement and promoting adherence to medications.
- ItemDeterminants 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 العبدIn 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.