Adolescents' electronic devices use during the COVID-19 pandemic and its relationship to anxiety and depression levels: a cross-sectional study.

BACKGROUND: The aim of this study is to assess the prevalence of anxiety and depression symptoms among adolescent students in the West Bank region of Palestine, with a particular focus on the impact of electronic device usage on their mental well-being. METHODS: This cross-sectional study included a representative sample of 1,140 adolescents enrolled in governmental secondary schools. We targeted schools located in Nablus, Ramallah, and Hebron districts, which, respectively, represent the northern, central, and southern regions of the West Bank. We collected data on their sociodemographic characteristics, patterns of electronic device usage, scores from the Beck Depression Inventory-II, and the 7-item Generalized Anxiety Disorder scale, all gathered through a self-administered online questionnaire. To explore the independent relationship between anxiety, depression, and various factors, we calculated odds ratios and their corresponding 95% CI using a binary logistic regression model. RESULTS: The study revealed a prevalence of moderate to severe anxiety at 35.4% [95% CI: 32.7-38.3%] and moderate to severe depression at 23.9% [95% CI: 21.4-26.4%]. Notably, anxiety scores were significantly higher among females [OR = 3.8, 95% CI: 2.5-5.9], individuals with lower academic performance [OR = 3.4, 95% CI: 2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.1-3.0]. Similarly, significantly elevated depressive scores were observed among females [OR = 2.0, 95% CI: 1.3-3.1], those with lower academic performance [OR = 3.4, 95% CI: 2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.3-2.8]. Conversely, students who used electronic devices for shorter durations were less likely to experience depression [OR = 0.49, 95% CI: 0.32-0.76] or anxiety [OR = 0.47, 95% CI: 0.32-0.69]. CONCLUSION: Considering the alarming rates of anxiety and depression in adolescents, along with their connection to the time spent using electronic devices, we strongly recommend the creation of initiatives and support networks to alleviate this issue's impact. Encouraging healthier lifestyles, such as reducing screen time and increasing physical activity, could potentially enhance the mental well-being of adolescents.

Dapagliflozin in peritoneal dialysis patients: a pilot study evaluating peritoneal membrane function.

BACKGROUND: Patients taking SGLT-2 inhibitors may experience delayed peritoneal fibrosis, better ultrafiltration of water and toxins, and higher survival rates. We aimed to evaluate the possible effects of Dapagliflozin in changing the peritoneal solute transfer rate, reducing peritoneal glucose absorption, and, hence, increasing ultrafiltration. METHODOLOGY: A pilot pre-post interventional study was used to evaluate 20 patients on continuous ambulatory peritoneal dialysis (CAPD) enrolled in a one-month self-controlled study [Trial#: NCT04923295]. Inclusion criteria included being over 18, and having a Peritoneal Dialysis (PD) vintage of at least six months. All participants were classified as having high or average high transport status based on their Peritoneal Equilibrium Test with a D0/D4 > 0.39. and using at least two exchanges with 2.35% dextrose over the previous three months before enrollment. RESULTS: Following the treatment, 13 patients had an increase in median D4/D0 from 0.26 [0.17-0.38] to 0.31 [0.23-0.40], while seven patients had a decline from 0.28 [0.17-0.38] to 0.23 [0.14-0.33]. Additionally, nine patients had a decrease in median D/P from 0.88 [0.67-0.92] to 0.81 [0.54-0.85], while 11 patients had an increase from 0.70 [0.6-0.83] to 0.76 [0.63-0.91]. CONCLUSION: According to the findings of this study, Dapagliflozin usage in peritoneal dialysis patients did not result in a reduction in glucose absorption across the peritoneal membrane. Additionally, Dapagliflozin was also associated with a small increase in sodium dip, a decrease in peritoneal VEGF, and a decrease in systemic IL-6 levels all of which were not statistically significant. Further large-scale studies are required to corroborate these conclusions.

Healthcare workers' attitudes toward and factors influencing their acceptance of an annual COVID-19 booster vaccine: a cross-sectional study in Palestine.

BACKGROUND: The emergence of several SARS-CoV-2 variants may necessitate an annual COVID-19 booster vaccine. This study aimed to evaluate healthcare workers' (HCWs) acceptance of a COVID-19 yearly booster vaccine if recommended and its association with their attitudes and burnout levels. METHODS: We used an online self-administered questionnaire to conduct a cross-sectional study of all HCWs in the West Bank and Gaza Strip of Palestine between August and September 2022. We used the Vaccination Attitudes Examination scale to assess HCWs' vaccination attitudes and the Maslach Burnout Inventory to assess work-related Burnout. In addition, we conducted logistic regression to identify factors independently associated with the acceptance of the booster vaccine. RESULTS: The study included 919 HCWs; 52.4% were male, 46.5% were physicians, 30.0% were nurses, and 63.1% worked in hospitals. One-third of HCWs (95% CI: 30.5%-36.7%) said they would accept an annual COVID-19 booster vaccine if recommended. HCWs who are suspicious of vaccine benefits [aOR = .70; 95%CI: .65-.75] and those concerned about unforeseeable future effects [aOR = .90; 95%CI: .84-.95] are less likely to accept the booster vaccine if recommended, whereas those who receive annual influenza vaccine are more likely to get it [aOR = 2.9; 95%CI: 1.7-5.0]. CONCLUSION: Only about a third of HCWs would agree to receive an annual COVID-19 booster vaccine if recommended. Mistrust of the vaccine's efficacy and concerns about side effects continue to drive COVID-19 vaccine reluctance. Health officials need to address HCWs' concerns to increase their acceptance of the annual vaccine if it is to be recommended.

Factors contributing to the rising prevalence of waterpipe smoking dependence among university students: a cross-sectional study.

INTRODUCTION: Waterpipe smoking (WPS) has been associated with a variety of adverse health effects, consequences, and symptoms of nicotine dependence. This study aims to determine the prevalence of WPS dependence among Palestinian university waterpipe smoking students, their normative beliefs about WPS, and their relationship to dependence. METHODS: A cross-sectional study of current WPS university students at five major Palestinian universities was conducted from September to December 2022. Participants were recruited using convenient sampling, and data collection was carried out via an interviewer-administered questionnaire. We assessed students' WPS dependence using the Lebanese Waterpipe Dependence Scale. We used the Poisson regression model with robust variance to analyze factors independently associated with high WPS dependence. RESULTS: The study included 746 current WPS university students. Results revealed a high prevalence of WPS dependence, with 69.4% (95%CI: 66.0-72.7%) exhibiting high dependence. Factors contributing to high WPS dependence included dual cigarette smoking (aPR: 1.18; 95%CI: 1.12-1.25), studying medical sciences (aPR: 1.13; 95%CI: 1.10-1.18), friends' approval of WPS (aPR: 1.25; 95%CI: 1.17-1.34), daily WPS frequency (aPR: 1.98; 95%CI: 1.39-2.23), spending more than 50% of daily allowance on WPS (aPR: 1.37; 95%CI: 1.10-1.64), and morning WPS sessions (aPR: 1.97; 95%CI: 1.31-2.27). The study highlighted the influence of social factors, such as peers' approval and perceived prevalence, on WPS dependence. CONCLUSIONS: WPS dependence is prevalent among university students, and it is associated with morning WPS, dual smoking, and increased WPS frequency. Notably, peer and cultural factors are essential primary motivators. As a result, it is critical to incorporate WPS considerations into Palestine's antismoking health promotion program. Therefore, it is vital to incorporate WPS into the Palestinian antismoking health promotion policy, and the health education of adolescents regarding the dangers of WPS should coincide with antismoking initiatives.

Growing a peritoneal dialysis program in Palestine from zero to 178 patients in 5 years: a single-center experience.

INTRODUCTION: Kidney failure is rapidly rising in Palestine, as the number of patients receiving maintenance dialysis has quadrupled in the last 15 years. In this study, we share an overview of our experience growing a peritoneal dialysis (PD) program from zero to 178 patients in 5 years at An-Najah National University Hospital in Palestine, presenting some challenges and ways to overcome them. METHODS: This was a single-center retrospective study of patients treated with PD from November 2016 to December 2021. Demographic and clinical data were obtained for each patient. In addition, PD discontinuation, peritonitis, and mortality rates were calculated and presented as the primary patient outcomes. RESULTS: A total of 158 patients were eligible for the study. The mean age was 51.8 ± 16.4 years, and 53.8% of patients were male. Diabetic nephropathy was the most common cause of kidney failure. 63 episodes of peritonitis were diagnosed in 48 patients (30.4%) for a rate of 1 episode/ 38.2 patient-months (0.31 episodes/ patient-years). 20 patients had their PD treatment discontinued, mainly due to psychosocial reasons and infectious and mechanical complications. Death was the fate of 27 patients, with cardiovascular disease and COVID-19 being the two main causes. CONCLUSION: The outcomes of this experience proved favorable and showed that PD could serve as a viable option for kidney failure patients in Palestine. Moreover, this study can serve as an example for other places where circumstances are challenging to take the initiative of starting their PD programs.

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

BACKGROUND: Diabetes is one of the most common chronic illnesses worldwide, and it is increasing in prevalence. Urinary incontinence is another worldwide health problem, with a reported prevalence that ranges from 9% to 67%. It decreases quality of life for men and women and has been associated with many poor outcomes, such as longer hospital stays, recurrent or persistent urinary tract infection, and a higher mortality rate. Previous studies have suggested that diabetes is an independent risk factor for urinary incontinence. In addition, the patients' background and clinical characteristics such as age, obesity, and child-bearing history have been found to increase the risk. The aim of this study was to determine the prevalence of urinary incontinence in women with type 2 diabetes in the north West Bank and to assess the role of potential risk factors, including age, marital status, weight, and diabetes control. METHODS: Women with diabetes attending the six governmental primary health care centres in the north West Bank (Jenin, Tubas, Tulkarem, Nablus, Qalqilya, and Salfit) were interviewed using the CDC National Health and Nutrition Examination Survey (NHANES) standardised incontinence questionnaire. SPSS version 22 was used for data entry and analysis. The prevalence of urinary incontinence was estimated and differences between groups (variables of interest) were evaluated using the chi squared test. The study was approved by the Institutional Review Board of An-Najah National University, and permission to conduct the study was obtained from the Ministry of Health. FINDINGS: 400 Palestinian women with diabetes were invited to participate in the study by convenience sampling, of whom 381 were recruited (a sample size that was chosen with a sample size formula, based on the population of the north West Bank). The participants were aged 30-83 years, and 44% (165 of 381; 95% CI 39-49) reported incontinence, regardless of the type. The prevalence of stress and urge incontinence were 34% (128) and 35% (133), respectively. 30% of women with urinary incontinence (49 of 165) reported that it did not affect their quality of life, and 34% (56 of 165) stated that it did not affect their daily activity. The presence or absence of urinary incontinence was studied in relation to the background and clinical variables by use of the chi squared test. The analysis showed a significant relationship between urinary incontinence status and age (p=0·0011), previous abdominal and genitourinary surgeries (p=0·0037), and caffeine consumption (p=0·041). There was no relationship between urinary incontinence and the duration, type of treatment, or complications of diabetes. INTERPRETATION: The prevalence of urinary incontinence (regardless of the type) is high among Palestinian women with diabetes. This is similar to reported prevalence in women with diabetes in neighbouring countries, such as Jordan (44%) and Qatar (21%). The majority of participants in this study (70%) reported that urinary incontinence did not affect their quality of life. This may suggest that patients consider the problem to be ordinary, that it does not require medical advice, or that the symptoms are mild. The findings highlight the importance of educating women with diabetes about urinary incontinence. The primary health care medical teams, general practitioners, and nurses who care for patients with diabetes should focus on this neglected problem, and physicians should be alert to urinary incontinence as it may often go unreported and therefore undertreated. To understand whether non-reporting of urinary incontinence reflects mild symptoms, investigating a potential association between non-reporting and the severity or frequency of urinary incontinence may be of interest for future study. FUNDING: None.

Distal Radial Artery Access in comparison to Forearm Radial Artery Access for Cardiac Catheterization: A Randomized Controlled Trial (DARFORA Trial).

Background: In our clinical practice, conventional radial access has been employed routinely for coronary procedures. The distal radial artery (DRA) access site has recently emerged as a novel technique in cardiac procedures. Objectives: This study compares distal radial access to standard forearm radial access (FRA) in terms of feasibility, outcomes, and complications. Method: This prospective, randomized trial was conducted at a single center. The patients were chosen from An-Najah National University Hospital's catheterization laboratory between December 2019 and November 2020. A total of 209 patients were randomized into two groups: DRA group (n = 104) and FRA group (n = 105). Results: Access was successful in 98% of patients in both the groups. The DRA group had a longer puncture duration and a higher number of attempts (duration: 56.6 ± 61.1 s DRA vs. 20.0 ± 18.4 s FRA, p < 0.001, attempts: 1.9 ± 1.3 DRA vs. 1.2 ± 0.60 FRA, p < 0.001). Puncture-associated pain was greater in the DRA group (4 ± 2.2 DRA vs. 3 ± 2.1 FRA, p=0.001). There were two radial artery occlusions in the FRA group and none in the DRA group (p=0.139). Percutaneous coronary intervention (PCI) was performed in 26% of the DRA group and 37.1% of the FRA group. The DRA group had significantly shorter procedure times (p=0.006), fluoroscopy times (p=0.002), and hemostasis times (p=0.002). Over time, the learning curve demonstrated improved puncture duration and a decrease in the number of puncture attempts. Conclusions: DRA is a safe and practical alternative to FRA for coronary angiography and intervention. The overtime learning curve is expected to improve puncture-related outcomes.

Epidemiological and clinical characteristics of headache among medical students in Palestine: a cross sectional study.

BACKGROUND: Headache is one of the most disturbing complaints worldwide, negatively impacting social and regular life activities. In the background of stressful life in medical schools, adding to the stressful situation in Palestine, a developing country under occupation, this study investigated the prevalence and clinical characteristics of migraines and tension- type headaches among medical students from the Palestinian Universities in West Bank and Gaza. METHODS: A questionnaire-based cross-sectional study was conducted on all Palestinian Medical Students. Students were diagnosed based on ICHD-3 criteria. Demographic characteristics were compared by gender for each type of headache. Frequency, percentage, and mean ± SD. Pearson's chi-squared test, independent t-test, and one-way ANOVA were used where needed. P-value < 0.05 was considered significant. RESULTS: The study included 806 medical students; 476 (59.0%) of them were female. TTH and migraine's prevalence was 59.8 and 22%, respectively, with a higher prevalence among basic year students. The female to male ratio was 1:0.6 for both types of headaches. Sleep deprivation, physical activities, and altered sleep patterns were reported as the top triggering factors. CONCLUSIONS: The results demonstrate that the prevalence of both subtypes' primary headache is high among Palestinian medical students, with a higher prevalence among basic year students. The study also showed that these findings are higher than other studies among medical students in other countries.

Tolerability and epidemiology of nephrotoxicity associated with conventional amphotericin B therapy: a retrospective study in tertiary care centers in Palestine.

BACKGROUND: In the light of recent years, an increase in the number of life-threatening infections due to various fungi has been observed, especially in tertiary care centres. With Amphotericin B labelled as the first choice in treating these infections, one of its common side effects, nephrotoxicity, along with hypokalemia, were studied to determine the epidemiology, risk factors, and protective measures. METHODOLOGY: The study was a retrospective observational chart review study in which patients were receiving conventional Amphotericin B in two tertiary hospitals in Palestine from January 2018 to December 2020 were evaluated for the development of hypokalemia and nephrotoxicity; according to the KDIGO criteria. A total of 117 patients were included in the study. Patients who have received the drug intermittently, in fewer than two doses, through non-IV routes and patients under the age of 12 were excluded. The data collected included, but were not limited to, age, gender, comorbidities, Amphotericin B treatment details, medications, COVID-19 status, risk factors, and hypothesized protective measures. RESULTS: The incidence of conventional Amphotericin B nephrotoxicity and hypokalemia was 46% and 33%, respectively. With a roughly equal representation of both genders and a median age of 52 years in a range of 13-89. No association between the variables and the development of nephrotoxicity was found. However, a 3.4 increased risk (p-value = 0.01) of developing hypokalemia in females compared to males was observed. CONCLUSION: Our research has shown a relatively lower yet consistent, incidence of conventional amphotericin B nephrotoxicity and hypokalemia compared to literature with gender being a risk factor for developing hypokalemia.

Virtual class room as a learning format in a family medicine residency program: Lessons learned in Palestine.

PURPOSE: Due to geopolitical and socioeconomic challenges, the Family Medicine (FM) speciality in Palestine is in early stages of development. Volunteer British General Practitioner (BGP) trainers worked with FM faculty to develop an online tutorial program (OTP) and a novel evaluation framework E-QUaL (Evaluation-Quality, Utilization and Learning) to enhance residents' patient-centered communication and clinical skills. MATERIALS AND METHODS: Three OTP cycles were facilitated and evaluated at An Najah National University (ANNU) in Palestine between 2017-2020. Qualitative data were collected during focus groups and online chats and analysed. RESULTS AND CONCLUSIONS: The development and joint facilitation of the OTP developed faculty skills and enhanced clinically oriented education. The collaborative (BGPs and ANNU faculty) approach and the use of the EQUaL framework helped to identify and address strengths and opportunities as well as the challenges and threats of the educational content and the virtual learning format with each iteration. The COVID pandemic provided a new and inexpensive platform which improved training quality. Issues such as the volunteer nature of BGPs, internet instability, and differing cultural approaches and expectations between physicians and patients were addressed in a continuous quality improvement approach and continues today. This may be a useful model in other low resourced settings.

Perceived barriers to Palestinian pregnant women's acceptance of COVID-19 vaccination using the Health Believe Model: a cross-sectional study.

This study aims to explore pregnant women's attitudes to COVID-19 vaccination and determinants of vaccine acceptance. We conducted a cross-sectional study among pregnant women attending PHC clinics and hospitals in the West-bank of Palestine. We used an interviewer-administered questionnaire based on Health Belief Model. The study's primary outcome was COVID-19 vaccination acceptance. We used the Chi-square test to compare those who accepted the vaccine versus those who refused it and conducted binary logistic regression to explore independent determinants of vaccination acceptance. Among the 728 pregnant women who took part in the study, 20.7 percent showed positive attitudes (acceptance) toward COVID-19 vaccination. Employment (aOR 4.0; 95 percentCI: 2.2-7.3), a history of COVID-19 (aOR 1.9; 95 percentCI: 1.2-3.1), and having a relative who died from COVID-19 (aOR 2.3; 95 percentCI: 1.2-4.7) increased the likelihood of vaccine acceptance, as did vaccine perceived effectiveness (aOR 1.9; 95 percentCI: 1.2-3.2) and perceived protection from severe disease (aOR 2.0; 95 percentCI: 1.2-3.5). On the other hand, perceived limited access (aOR 0.540; 95 percentCI: 0.31-0.87) and perceived harm to the baby (aOR 0.346; 95 percentCI 0.22-0.54) remained the main barriers toward vaccine acceptance. In conclusion, pregnant women's acceptance of the COVID-19 vaccine is unsatisfactory. Concerns about its effect on unborn babies were major barriers to vaccination.

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

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

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

BACKGROUND: Retinitis pigmentosa (RP) is a heterogeneous group of inherited ocular diseases that result in progressive retinal degeneration. This study aims to describe different Swept-source Optical Coherence Tomographic (SS-OCT) changes in Palestinian RP patients and to explore possible correlations with Visual Acuity (VA). METHODS: A cross-sectional observational study was conducted on Retinitis Pigmentosa patients diagnosed with RP in a tertiary eye hospital. Full history and ocular examination were made. SS-OCT imaging was done for all eyes assessing the presence of cystoid macular edema, epiretinal membrane, macular holes, and external limiting membrane, ellipsoid zone status. Also, central macular thickness and choroidal vascular thickness were measured. RESULTS: The study was run on 161 eyes of 81 patients; 53 males and 28 females. The average age at examination was 26.1 (6-78) years. Twenty-six eyes (16.1%) were of syndromic RP patients, mostly Usher syndrome; 20 eyes (12.4%). The mean Logaritmic minimal angle of resolution (LogMAR) of Best Corrected Visual Acuity (BCVA)of the study sample was 0.66 ± 0.7. The most prevalent change was cystoid macular edema [28 eyes, (17.4%)], followed by epiretinal membrane [17eye, (10.6%)]. A macular hole was noted only in one eye (0.6%). Ellipsoid zone and external limiting membrane were absent in 55 eyes (35.0%) and 60 eyes 37.5%. Vitreous hyperreflective foci were found in 35 eyes (43.8%). LogMAR of BCVA was associated significantly with cystoid macular edema (p = 0.001), ellipsoid zone(p = 0.001), and external limiting membrane (p = 0.001). CONCLUSIONS: Detailed SS-OCT assessment in Palestinian patients diagnosed with RP identified different morphologies from other populations. Cystoid macular edema and vitreous hyperreflective foci may reflect signs of early or intermediate stages of the disease. Disease progression can be monitored by measuring the length/width (area) of ellipsoid zone +/- external limiting membrane and choroidal vascular thickness, which should be evaluated serially using high-resolution OCT.

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

BACKGROUND: Many primary health care (PHC) clients come in with medically unexplained complaints, leading to frequent consultations and high usage of services and healthcare costs. This study aimed to determine the prevalence of somatic symptom disorder (SSD) among PHC attendees and explore its relation to other mental conditions and risk factors. METHODS: A cross-sectional design was used to interview 400 attendees. Men and women aged over 18 years old without a psychiatric diagnosis were invited to participate. The Somatization scale of the Four-Dimensional Symptom Questionnaire was used to assess somatic symptom disorders. It is a valid tool to be used in a PHC setting. We used the Chi-square test and multivariable logistic regression to explore determinant variables. RESULTS: Prevalence of SSD was 32.5% (95%CI = 27.9-37.1%). The most common symptoms were painful muscles (61.5%) followed by back pain (52.3%). Female gender [adjusted OR = 2.1 (95% CI = 1.2-3.7)], chronic diseases [adjusted OR = 2.4 (95%CI = 1.3-4.5)], depression [adjusted OR = 3.3 (95%CI = 2.0-5.5)], and anxiety [adjusted OR = 2.1 (95%CI = 1.2-3.6)] were all associated with SSD. In addition, frequent primary health care attendance was found to be associated with SSD [adjusted OR = 2.4 (95%CI = 1.4-4.1)]. CONCLUSIONS: SSD significantly higher among females, patients with chronic diseases, clients with anxiety and depressive disorders, and patients with frequent doctors' visits. Painful muscles and back pain are the most common symptom presented by patients, and this could be used initially by PHC physicians as a signal to consider for screening.

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

OBJECTIVE: To measure COVID-19 vaccine acceptance and related factors to undercover nurses' concerns and fears. DESIGN: A cross-sectional study. SAMPLE: The study included 639 nurses; 83% were women and 80% under 50 years. MEASUREMENT: A self-administered questionnaire was used. It included demographic characteristics, COVID-19-related fears and concerns, COVID-19 vaccine perceived benefits, and intention toward getting the vaccine. RESULTS: Forty percent of the nurses planned to get the vaccine when available, 41% would take it later when adequate protection and safety were presented, and 18% would never take it. Significant factors associated with vaccination intention were as follows: age (adjusted OR 1.42, 95% CI: 1.02-1.99); lack of knowledge about the vaccine (adjusted OR 2.6, 95% CI 1.81-3.8); concern about long-term side effects (adjusted OR 2.0, 95% CI 1.4-2.9); fear of injection (adjusted OR 1.5, 95% CI 1.04-2.13); natural immunity preference (adjusted OR 5.8, 95% CI 4.5-8.3); media misrepresentation (adjusted OR 1.7, 95% CI 1.2-2.4); and getting COVID-19 from the vaccine (adjusted OR 1.5, 95% CI 1.1-2.1). CONCLUSION: COVID-19 vaccine safety and side-effects concerns impact nurses' intentions to accept the vaccine and may result in low acceptance rates. Urgent action is needed to address these fears and raise confidence, as nurses' vaccine-related decisions can affect the public's vaccine acceptance.

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

BACKGROUND: Chronic kidney disease (CKD) is a global public health concern and diabetes is one of the main risk factors for its occurrence and progression. The aim of this research is to determine the prevalence of chronic kidney disease in a cross-sectional population of patients with type 2 diabetes in primary health centers in North West Bank. METHODS: Patient data including patient characteristics, creatinine level, blood pressure, HbA1c, and hypertension and period of diabetes were obtained from primary health care centers. The eGFR has been determined using the CKD-EPI equation. CKD was staged according to the 2012 Kidney Disease Improving Global Outcomes Framework (KDIGO) guideline. Both univariable and multivariable statistical analysis was conducted using SPSS. RESULTS: The prevalence of chronic kidney disease among diabetic adults in North West Bank was found to be 23.6% (95% CI: 19.4-28.1%) divided as follows: 19.7% had stage 3 CKD, 2.6% had stage 4 CKD and 1.3% had stage 5 CKD. In multivariable logistic regression, CKD was significantly associated with Age ≥ 60 years [adjusted OR: 3.2, 95% CI: 1.8-5.9], hypertension [adjusted OR: 5.7, 95% CI: 2.2-15.2], and smoking [adjusted OR: 2.3, 95% CI: 1.3-4.2]. CONCLUSIONS: CKD is very prevalent among diabetic adults in Palestine. Co-morbid hypertension, smoking and older age has been shown to increase the risk of developing CKD. Extensive screening for diabetic patients to diagnose CKD at an early stage and to follow more aggressive treatment methods for diabetes as well as other important risk factors, especially hypertension and smoking, is recommended.

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

BACKGROUND: Sepsis syndrome is an emerging healthcare problem, especially in critically ill patients, regardless whether it's community- or hospital-acquired sepsis. This study evaluates the characteristics of these patients, in addition to the type, source, and outcome of sepsis and septic shock, in a university tertiary hospital in Palestine. It also studies the most common organisms encountered in these patients. MATERIALS AND METHODS: This is retrospective observational chart review study of all adult admissions to the intensive care unit over a period of 2 years. The presence of sepsis and septic shock was assessed and documented based on the Third International Consensus Definitions (Sepsis-3). Data regarding demographics, severity, comorbidities, source of infection, microbiology, length of stay, and outcomes (dead/alive at discharge from ICU) were recorded. RESULTS: A total number of 174 patients were included. The mean age was 57.4 years, with cardiovascular diseases and diabetes being the leading comorbidities encountered in them. Respiratory infections were the most common site of sepsis, found in around 71% of patients, followed by urinary tract infections. More than 70% of cases were due to hospital-acquired infections (HAIs). Acinetobacter species were the most common gram-negative organisms encountered, while Enterococcus was the most common gram-positive organisms. Around 54% of patients had multidrug-resistant organisms. The average length of stay in the ICU was 8 days. The average mortality rate was 39.7%, which is higher among septic shock patients. CONCLUSION: Both sepsis and septic shock carry high morbidity and mortality rates, and they are very frequent among critically ill patients. Special care and developing management bundles are crucial in controlling and preventing this threat. HOW TO CITE THIS ARTICLE: Rabee HA, Tanbour R, Nazzal Z, Hamshari Y, Habash Y, Anaya A, et al. Epidemiology of Sepsis Syndrome among Intensive Care Unit Patients at a Tertiary University Hospital in Palestine in 2019. Indian J Crit Care Med 2020;24(7):551-556.

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

BACKGROUND: Mammography screening is an effective tool for early detection and management of breast cancer. Female health-care workers' awareness of breast cancer screening is important because their beliefs and behaviours could influence other women. The aim of this study was to assess mammography screening uptake by female health-care workers at primary health-care centres and to identify the primary motivators and barriers that affect uptake. METHODS: This cross-sectional study included all governmental primary health-care centres in the West Bank. Governorates were grouped into three regions as follows: north West Bank (Nablus, Jenin, Tulkarm, Tubas, Qalqiliya, and Salfit), middle West Bank (Jerusalem, Jericho, and Ramallah), and south West Bank (Hebron, and Bethlehem). The study population included all female health-care workers older than 40 years. Those who performed mammography for a suspected mass or other breast abnormalities were excluded. A self-administered questionnaire was used to collect data on demographic characteristics, knowledge about mammography screening, the extent and regularity of mammography screening, and motivators and barriers influencing their mammography screening uptake. The rate of mammography screening uptake was calculated. χ2 test and t tests were used to assess screening motivators and barriers. The study was approved by the Institutional Review Board of the An-Najah National University. Participation was voluntary, and written consent was obtained from each participant. FINDINGS: 299 female health-care workers completed a self-administered questionnaire. The mean age of the participants was 46 years (SD 4·7). 284 (95%) women had adequate knowledge about breast cancer and mammography screening, and 149 (50%) women reported having had at least one mammogram. 62 (21%) women had had regular scheduled mammograms. The most frequent reported motivators were the perceived benefit that early detection of breast cancer is important for its management (269 [90%] women) and the belief that mammography can detect breast cancer before its symptoms appear (251 [84%] women). The most frequent barrier to mammography screening was being busy (140 [47%] women) and the lack of perceived susceptibility (125 [42%] women). INTERPRETATION: Mammography screening was suboptimal in a population of female health-care workers. Educational interventions are needed to remove barriers that limit compliance to recommendations and to emphasise the importance of early detection in breast cancer management. Ensuring the availability and accessibility of screening services, particularly for health-care workers within their work settings, would improve the acceptance and compliance for mammography screening programmes. FUNDING: None.

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

BACKGROUND: Mortality data are essential for many aspects of everyday public health practices at both national and international levels. Despite the current developments in various aspects of the medical field, the apparent inability of physicians to complete death notification forms (DNF) accurately is still worldwide concern. The aim of this study is to assess the physicians' knowledge and practice on completing the DNF. METHODS: A self-administered questionnaire was distributed to 200 physicians in governmental and non-governmental hospitals in the North West-Bank in Palestine. Furthermore, a case scenario was included in the questionnaire and physicians were asked to fill the cause of death section. The percentage of errors committed while completing the cause of death section were computed. A Chi square test was used to assess the association between physicians' characteristics and their responses. RESULTS: Only 40.6% of the participants completed the cause of death section correctly. The immediate and underlying causes of death were correctly identified by 48.7% and 71.3% of physicians, respectively. Almost one-fifth (17.3%) of physicians wrote the mechanism of death without reporting the underlying cause of death and 14.7% of them reported the sequence of events leading to death incorrectly. CONCLUSIONS: Physicians' knowledge and practice on completing the DNF is poor and insufficient, which may seriously affect the accuracy of mortality data. Complicated cases, problems in the current design of the DNFs and lack of training were the most common factors contributing to inaccuracy in death certification. We recommend offering periodical training workshops on completing the DNF to all physicians, and developing a manual on completing the DNFs with clear instructions and guidelines.

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

PURPOSE: The aim of this study is to evaluate the role of the non-fusion instrumented procedure with compression adjunct to lengthening by distraction in facilitating spinal modulation of the wedged peak vertebra, in patients with congenital thoracolumbar kyphosis/kyphoscoliosis according to the Hueter-Volkmann law. The authors seek to address the progressive modulation of the most wedged vertebra by analyzing the subjects' pre-operative and latest follow-up sagittal radiograph. METHODS: Ongoing data collection of 14 peak wedged vertebra modulation during surgical management of 13 patients with Type I congenital thoracolumbar kyphosis (5 patients) or kyphoscoliosis (8 patients). Age at initial surgery averaged 58.6 months, with mean follow-up of 55.6 months (24-78). All were done with hybrid rib construct with clawing fashion through a single posterior approach with at least 4 lengthenings. RESULTS: Two vertebral bodies were selected, the peaked deformed vertebrae within the instrumentation compression level (WICL) and the vertebrae nearest but outside the instrumentation compression process (OICL). Anterior vertebral body height (AVBH) and posterior vertebral body height (PVBH) were measured in both vertebral bodies. Regarding measured vertebrae (WICL), average preoperative AVBH/PVBH ratio significantly increased from 0.54 to 0.77 in the final follow-up. Regarding measured vertebrae (OICL), the average preoperative AVBH/PVBH ratio increased from 0.76 to 0.79 in the final follow-up. Modulation can be confirmed in the most deformed vertebrae (WICL) as the difference between the change in AVBH/PVBH ratio between vertebrae (OICL) and (WICL) was statistically significant (P < 0.001). CONCLUSIONS: Through the compression model adjunct to lengthening through distraction implemented in the surgical management of early-onset scoliosis, wedging improves through vertebral modulation (WICL) in comparison with the (OICL). This calls for further studies on the impact of surgical correction of EOS on modulation of the vertebrae.