Epidemiology علم الأوبئة
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- ItemDeterminants of Colorectal Cancer among Palestinians(Al-Quds University, 2021-05-08) Nidal Eid Mohammad Al-Jebrini; نضال عيد محمد الجبرينيWorldwide, incidence and mortality rates of colorectal cancer (CRC) have been increasing during the past ten years. This increase is primarily attributed to drastic changes in the lifestyle and food consumption patterns with more Western-style and ready-made food in addition to adopting a sedentary lifestyle in daily life and other related activities. In this study, we aimed to describe the clinical and pathological characteristics of CRC and understand the role of lifestyle factors and dietary intake in CRC etiology. Methodology A case-control study of 131 pathologically confirmed CRC cases and 104 cancer-free controls was conducted. Cases were ascertained through two hospitals; Beit-Jala Hospital in the South and Augusta Victoria Hospital in Jerusalem. Data were collected using an extensive interview-based questionnaire focused on several risk factors of the disease. Results Among CRC cases, 52.7% were females and the median age at diagnosis was 56 years (interquartile range 48-64 years). The majority of cases were diagnosed at advanced stages of the disease. Body mass index (BMI) was not associated with CRC, but a history of diabetes, hypertension, or cardiovascular disease was significantly more common among cases. Furthermore, unexpectedly, physical activity was associated with an increased risk of CRC. Regarding dietary intake, highest intake of fish, fruits, nuts, and sweets were positively associated with an increased risk of CRC. Conclusions The rising incidence and mortality could be explained by lifestyle and dietary factors; however, the findings of this study require further investigation.
- ItemMaternal and infant factors associated with the one-year child’s growth and development at the UNRWA clinics in the Jerusalem Area / West Bank(Al-Quds University, 2024-10-27) Manal Shihadeh Mustafa Natour; منال شحادة مصطفى ناطورMaternal health and well-being, including nutrition, mental health, and access to healthcare services, are foundational to an infant's initial growth and development trajectory. Infant factors, such as birth weight, breastfeeding practices, and immunization status, also play a critical role in shaping the child’s growth and development. By studying these elements, healthcare providers and policymakers can better identify at-risk populations, tailor interventions, and create policies that promote equitable health outcomes. Aim: To assess the growth and development of infants. Further to assess the maternal and infant factors associated with the growth and development of the infants in the UNRWA clinics in the Jerusalem Area. Methodology: The study employed a cross-sectional design. The target population comprised infants and mothers registered at the UNRWA healthcare centers in the Jerusalem area. A convenience sampling method was employed. The sample size was 169 infants and their mothers. The study’s instruments were the Ages and Stages Questionnaire to evaluate the infant's development milestones. In addition, infants’ anthropometric measurements were taken by the researcher to assess infants' growth. (weight, height, head circumference), in addition to the body mass index measurement that was calculated according to the equation suggested by the World Health Organization for infants. The sociodemographic characteristics of the mothers as well as infant and maternal factors were assessed by using a structured questionnaire based upon the literature review. Study tools validation was ensured through adherence to standardized procedures and the use of a reliable tool adapted for the Palestinian context. Data collection was done by the researcher and trained staff in face-to-face attendance with the mothers who were also asked to fill out the questionnaire. Results: The physical growth scores for infants in this study were well within the normal age range. The mean of infant’s weight was 10.9 kg (SD7.03), the mean Height was 73.2 cm (SD 10.1), mean Head circumference was 46.2 cm (SD 5,6), and the BMI was 18.2 (SD 2.4). The total item scores of the developmental milestones of infants showed a normal range and above the cutoff point when compared with the specific chart of the ages and stages questionnaires. The mean of the total item scores was 51.5 for communication, 45.6 for Gross motor, 47.5 for problem-solving, and was 49.1 for personal-social development. However, the mean of total items of fine motor development was 43.5 which is very close IV to the cutoff point suggesting monitoring and more involvement in learning activities. Significant correlations were found between BMI and both head circumference (r = .475, p < .01) and weight (r = .253, p < .01). Additionally, personal-social skills are significantly related to problem-solving (r = .553, p < .01) and fine motor skills (r = .434, p < .01). Maternal factors such as comorbidities showed a strong negative correlation with infants' weight (r = -0.400**, p < 0.01), while infant factors such as complimentary food and the Child's intake of Vit A showed significant correlation with the child development milestones (r =0.424**, p < 0.01). Conclusion: The study revealed that infants' growth and development were at an acceptable level with some slight variations. Enhancing maternal health services and addressing key developmental indicators are crucial for optimizing child development outcomes in the UNRWA clinics of the Jerusalem Area. The child's growth and development should be frequently monitored. to be able to detect developmental delay at an early stage. It is recommended to study other environmental and hereditary factors that might impact the child's growth and development.
- ItemGestational diabetes and adverse pregnancy outcomes : role of HbA1c, Anemia and other risk factors(Al-Quds University, 2021-06-01) Inas Adnan Hasan Saleh; إيناس عدنان حسن صالحBackground- Some women experience health problems during pregnancy such as gestational diabetes mellitus (GDM) and iron deficiency anemia. These complications can affect the health of the mother and fetus. Getting early detection can decrease the risk of adverse pregnancy outcomes. It has been reported that on average, 2-6% of pregnant women develop temporary GDM. Glycated hemoglobin (HbA1c) which is used to diagnose diabetes mellitus is not used for diagnosing GDM and the gold standard for diagnosis is still the oral glucose tolerance test (OGTT). Aims- To evaluate the role of HbA1c in screening and diagnosing GDM and its correlation with adverse pregnancy outcomes and assess its levels during and after pregnancy in the high-risk pregnant women to develop GDM. Among the risk factors, iron deficiency anemia and its correlation with adverse pregnancy outcomes will also be evaluated. Settings and design- Prospective study in prenatal care units of the United Nations Relief and Works Agency for Palestine Refugees in the West Bank (UNRWA). Methods- Data was collected by a structured questionnaire including age, gravidity, parity, BMI (Body Mass Index), family history for Diabetes Mellitus, and personal history of previous GDM. Blood pressure was taken on every visit. HbA1c, FPG (Fasting Plasma Glucose), and CBC (Complete Blood Cell count) were measured for all subjects, while 2 hour oral glucose tolerance test (OGTT) was done when required. GDM was diagnosed at pregnancy weeks 4-22 and 24-37 by the WHO (World Health Organization) criteria from 1999 as FPG ≥ 126 mg/dl or plasma glucose ≥ 140 mg/dl 2 hours after ingestion 75g glucose orally (OGTT), and the International Association of Diabetes and Pregnancy Study Groups (IADPSG) (FPG ≥ 92 mg/dl or plasma glucose ≥ 153 mg/dl 2 hours after the glucose load). A total of 955 pregnant women participated in this study. Statistical Analysis- Data was collected and analyzed using SPSS software version 23. Comparisons of the means, correlations and calculation of sensitivities and specificities for viii diagnosing GDM by HbA1c and the prediction of adverse pregnancy outcomes were performed. Results: Accumulated GDM percentage was 7.4% by WHO1999 criteria, and 45.8% by modified IADPSG criteria. The mean HbA1c1 value (HbA1c measured at first visit) in women with GDM1-WHO was significantly higher than women without GDM1-WHO (5.9 ± 0.6% compare to 5.4 ±0.4%, P = 0.000). In the same direction, a statistically significant difference was detected in the mean value of HbA1c1 between women who developed T2DM after delivery and those who didn’t (5.9 ± 0.5% compare to 5.4 ± 0.4%, P = 0.000). A positive correlation was observed between a baby’s birth weight and the baby’s head circumference and HbA1c1 at first visit. The optimal HbA1c1 threshold value at first visit for detecting GDM1-WHO was 5.75% with sensitivity 57.5% and specificity 85.1%. The HbA1c1 cutoff value ≥ 5.65% had a sensitivity of 31.1 % and specificity of 88.5% in detecting adverse pregnancy outcomes. A significant relationship was observed between pre-abortion and GDM1-WHO (P = 0.001), 64.5% of participant who previously complained from abortion were at risk to develop GDM. Four hundred and nine (43.6%) of the study population suffered from different adverse pregnancy outcomes, including abortion, perinatal death, having macrosomic babies, and cesarean delivery. The mean value of HbA1c1 (HbA1c measured at first visit) in women with adverse pregnancy outcomes was significantly higher than women without adverse effect (5.5 ± 0.44% compared to 5.3 ± 0.4%, respectively), as well as FPG1 (88.7 ± 10.8 compared to 86.1 ± 9.4) and OGTT1 (measured at first visit ) (107 ± 27.5 compared to 101 ± 22.8), respectively. A statistically significant difference was observed in the mean value of baby birth weight between GDM-IADPSG diagnosed and non-diagnosed at first and second visit, while baby birth weight was higher in GDM-WHO women diagnosed at the first and second visit but not statistically significant. Serum ferritin concentration in GDM1-WHO women was (36.8 ± 24 μg/dL), in GDM1-IADPSG, it was (28 ± 21.6 μg /L) and in DM women diagnosed at first visit by IADPSG was (31.7 ± 24.3 μg /L) that were higher than those who didn’t develop GDM1 or DM but not statistically significant. The percentage of anemia in the study population at first visit was 13.8% according to WHO definition (hemoglobin < 11g/dL), 25.3% had IDA (Iron Deficiency Anemia) ix according to WHO definition (serum ferritin < 12 μg /L), and the percentage of anemia at the second visit was 22.8% according to WHO definition (hemoglobin < 10.5g/dL at the second visit). 21.8% suffered from adverse outcomes related to anemia (baby birth weight < 2500g and preterm delivery < 37 gestational weeks) which were statistically significant with mean hemoglobin concentration at first visit (P = 0.033). Conclusions- HbA1c level in early pregnancy is increased in GDM, however, it does not replace OGTT for diagnosing GDM. However, including HbA1c as part of the diagnostic criteria for diabetes during pregnancy in 2010 by IADPSG was important which is still not adopted in Palestine. HbA1c level was associated with various adverse pregnancy outcomes in high risk women. Anemia in early pregnancy was associated with preterm delivery and low birth weight baby. Serum ferritin level in early pregnancy was higher in GDM women in comparison to non-GDM women, but it was not statistically significant. Keywords- HbA1c, GDM, OGTT, Ferritin, and adverse pregnancy outcomes.
- ItemEvaluation of Colorectal Cancer Management in the Gaza Strip(AL-Quds University, 2019-05-11) داليا طلعت عبدالنبي الوحيدي; Dalia Talaat Abd AlNabi Wehedi; يحيى عابد; د. خالد ثابت; د. بسام أبو حمد; د. أحمد الشرفا
- ItemChild Marriage in the Gaza Strip:Triggers and Consequences(AL-Quds University, 2019-05-04) سماح تيسير عوض الله العمصي; Samah T. A. Elamassie; بسام أبو حمد; أ. د. يحيى عابد; د. عريفة الكسيح