The effect of a simulation-based training program in basic life support on the knowledge of Palestinian nurses: a quasi-experimental study in governmental hospitals.

BACKGROUND: Basic Life Support (BLS) plays an important role in increasing the survival rate of hospitalized heart attack patients. There are no previous studies on the effect of BLS training among Palestinian nurses. This study aimed to evaluate the effect of simulation-based BLS training program on nurses' knowledge Palestinian nurses at governmental hospitals. METHODS: A quasi-experimental, pre & post-test design was used. 700 nurses were recruited proportionally using a simple random sampling method among 2980 nurses from 13 public hospitals in the Gaza Strip. This study was conducted from June to August 2022. A practical BLS test consisting of 10 multiple-choice questions according to American Heart Association guidelines (2020) was collected and sociodemographic characteristics. SPSS software, version 24 was used for the statistical analysis. Descriptive statistics and weighted mean were used. T-Test and One-way analysis of variance (ANOVA) were applied to determine differences in means among groups. RESULTS: Most of the participating nurses (55.7%) were male, while (44.3%) were female. The majority of nurses (84.4%) are under 40 years of age. The weighted mean scores in the pre-test ranged from 52.2 to 75.1% and the mean scores was (6.16 ± 1.97). After applying conventional BLS training, the weighted mean scores ranged from 85.6 to 97.3% and the mean scores was (9.19 ± 1.04). The study revealed that the nurses' knowledge increased after applying simulation-based training program. The mean of knowledge scores was statistically significant between the pre and post-test on the basis of the current work hospital (P-value < 0.001). CONCLUSION: This study affords significant evidence of the positive effects of the BLS training program in improving nurses' knowledge; we recommend advanced BLS training for all healthcare providers, doctors, and nurses working in hospitals and healthcare centers. Nursing managers can implement systematic strategies to enhance nurses' knowledge and practice in BLS to target low-scoring Governorates.

Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 Items (DASS-21) in a sample of health professionals: a cross-sectional study.

BACKGROUND: Although the Depression Anxiety Stress Scale-21 Items (DASS-21) has been used in different countries and translated into different languages, the Persian version of this scale has not been validated for healthcare professions in Iran. Therefore, the purpose of this study was to examine the psychometric properties of the Persian version of DASS-21 for nurses. METHODS: This cross-sectional study was conducted among 1135 nurses working in public hospitals, who were selected through convenience sampling. DASS-21, which consists of 21 items and three dimensions (depression, anxiety, and stress), has been translated into Persian, and there is an online version available. A confirmatory factor analysis (CFA) was performed to examine the factor structure of this scale. Cronbach's alpha coefficient was also measured to establish internal consistency. Besides, the intraclass correlation coefficient (ICC) was calculated to assess the test-retest reliability. RESULTS: The Cronbach's alpha coefficient was acceptable for anxiety (0.79), stress (0.91), and depression (0.93). An acceptable test-retest reliability (0.740-0.881, P < 0.01) was also reported for DASS-21 and its three dimensions. The results of CFA showed acceptable model fit (χ2/(df) = 1457/(186), P < 0.001), root mean square error of approximation (RMSEA = 0.078), Tucker-Lewis index (TLI = 0.906), comparative fit index (CFI = 0.917), and standardized root mean square residual (SRMR = 0.047). Fifty-seven nurses were included in the test-retest. The ICCs for all dimensions ranged from 0.75 to 0.86, indicating the acceptable test-retest reliability of the scale. CONCLUSION: The Persian version of DASS-21 showed good psychometric characteristics, and it was confirmed as a valid and reliable tool for evaluating depression, anxiety, and stress among Iranian nurses. However, further validation studies of the Persian DSASS-21 are needed among other healthcare professionals, including physicians, midwives, and allied health professionals.

The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review.

BACKGROUND: Defensive Medicine (DM) concept refers to all medical care provided by physicians without increasing the benefits to the patient, the primary purpose of which is to prevent the risk of litigation. Although several studies have been published investigating the occurrence of DM around the world, no review conducted on DM among physicians. Therefore, this study aims to summarize and map the available evidence on occurrence, types of behaviors, and reasons for practicing of DM among physicians and possible solutions and strategies to reduce DM in the literature. METHODS: This is a scoping review in which we searched Web of Science, Scopus, and PubMed in December 2021. Our target was original studies of any type that included data on DM among physicians between 2000 and 2021. We followed the JBI guideline for conducting a scoping review and for increasing the rigor of the study. First, the percentage was used to summarize the occurrence of DM, and then, findings related to types of behaviors and reasons for practicing DM and mitigation strategies were analyzed inductively in NVivo 10 in three stages. RESULTS: Twenty-seven studies were included in the review. The overall occurrence of DM practice ranged from 6.7 to 99.8%. Two types of DM behaviors including assurance and avoidance behaviors have been identified. The common reasons for practicing DM were categorized into four themes, patient-related reasons, physician-related reasons, organization-related reasons, and society-related reasons. The main strategies to prevent or reduce DM are structured training and education, restoring physician-patient relationships, reform of the health system, and reform of the liability system. CONCLUSIONS: The vast majority of research studies were conducted in high-income countries, and studies are needed to measure this phenomenon and its consequences in depth in low- and middle-income countries. Various solutions and strategies are needed to reduce defensive behaviors such as structured training and education, restoring physician-patient relationships, reforming the health system, and reforming the liability system.

Patient safety culture in Iranian teaching hospitals: baseline assessment, opportunities for improvement and benchmarking.

BACKGROUND: Patient safety culture is an essential factor in determining the ability of hospitals to treat and reduce patient risks. Healthcare professionals, especially nurses, play an important role in patient safety because they are responsible for direct and ongoing patient care. Few studies in Iran examine the patient safety culture in Iranian teaching hospitals, particularly from the perspective of nursing staff. This research assessed patient safety culture in teaching hospitals in Iran from the nurses' point of view and compared the outcomes with similar regional and global studies. Furthermore, the study identified the factors influencing patient safety culture and its association with outcomes. METHODS: A cross-sectional study was accomplished in thirty-two teaching hospitals in five provinces of Iran. A total of 2295 nurses were chosen through convenience sampling. Collection data were done using the Hospital Survey of Patient Safety Culture (HOPSC) from October 2018 and September 2019. We analyzed the data using descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis. RESULTS: The results demonstrated the overall percentage of positive response rate for the HOPSC tool (36.4%). The average percentage of positive responses among all dimensions ranged from 27.1% in "Staffing" to 53.8% in "Teamwork across Hospital Units". Benchmarking analysis shows that Iranian hospitals are equal or better performance than the benchmark on several composites compared to regional and global findings. The results of multiple linear regression analysis showed that the age, gender, total years of experience in nursing, work area or unit, work hours, and size of the hospital were significant predictors of the perceptions patient safety culture of nurses (p <  0.05). CONCLUSIONS: This is one of few studies that examine nurses' perceptions of patient safety culture in public hospitals in Iran. Although the results of the present study showed that the results of Iran were at or better than the many composites in Jordan, Turkey, KSA, and the Philippines. The findings confirmed that all 12 dimensions can be considered as areas requiring improvement, and these results demonstrated that there was a severe shortage in patient safety culture among the included hospitals.

The impact of nurses' perceptions of systems thinking on occurrence and reporting of adverse events: A cross-sectional study.

AIMS: To assess systems thinking level and its relationship with occurrence and reporting of adverse events in Iranian nurses. BACKGROUND: Systems thinking has recently emerged as an important element of patient safety and quality improvement in health care systems. It helps health care professionals to understand the different elements of health care systems, the interrelatedness and interdependencies of these elements in the health care systems. METHODS: This cross-sectional survey was carried out in 10 teaching hospitals in Tehran, Iran. A total of 511 nurses were selected using simple random sampling. Systems thinking was measured using the validated Systems Thinking Scale. Data analysis was performed by descriptive analyses, independent t test and logistic regression analysis. RESULTS: The average score for total systems thinking was a mean of 49.45 (SD = 12.10; range 0-80). In total, 67.5% of participants reported the experience of the occurrence of adverse events leading to harm to patients, and 65.2% of them responded as having appropriate adverse events reporting behaviours. Nurses who had higher scores in systems thinking were found to be more likely to report adverse events (odds ratio = 1.07; 95% CI = 1.05-1.09), whereas they were less prone to experience adverse events (odds ratio = 0.97; 95% CI = 0.95-0.98). CONCLUSION: Our results indicated that the nurses' systems thinking level was moderate. Systems thinking had a significant role in preventing the occurrence of adverse events as well as improving the reporting of adverse events. Therefore, it is recommended to enhance the competency of nurses' systems thinking to prevent the occurrence of adverse events and to improve the reporting of adverse events. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers need to focus on the systems thinking weaknesses and the occurrence and the reporting of adverse events in policymaking, practice and research. Also, systems thinking should be integrated with the health care system for preventing the occurrence of adverse events and improving reporting of adverse events. They should support, lead and allocate the essential pragmatic strategies and resources for the involvement of all health care members in policymaking.

Capacity of Palestinian primary health care system to prevent and control of non-communicable diseases in Gaza Strip, Palestine: A capacity assessment analysis based on adapted WHO-PEN tool.

The prevalence of non-communicable diseases (NCDs) are increasing in low-income countries including Palestine. This study was conducted to assess the capacity of Palestinian primary health care system to prevent and control of NCDs. This cross-sectional study in which, the World Health Organization package of essential NCDs interventions (WHO-PEN) tool, was used to assess the capacity of primary health care centers (PHCs) to prevent and control of NCDs. All governmental PHCs (n = 52) in Gaza Strip, Palestine were included in the final analysis. The centers readiness score was calculated as the average of domains indices. Then, the indices were compared to an agreed cutoff at 70%. Statistical analysis was performed using SPSS version 22. Out of 52 PHCs, only 21 (40.4%) were considered ready to prevent and control of NCDs; the highest readiness score was 79.4% and the lowest score was 29.2%. Furthermore, all governorates were not ready to prevent and control of NCDs (The readiness scores were < 70%), distributed as follow: 68.6%, 68.1%, 67.7%, 62.5% and 56.4%, for Rafah, Gaza, Khan-Yunis, Deir Al Balah and North Gaza, respectively. The governorates were differed significantly in terms of availability of aneroid blood pressure measuring devices, electrocardiography devices, Glibenclamide and Salbutamol tablets, patients counseling for diabetes self-management, patients education for self-administration of insulin (P values <.05 for all). The current study demonstrated critical gaps in the governmental PHCs capacity to prevent and control of NCDs, as most of PHCs failed to reach the minimum threshold of the WHO-PEN standards.

Nurses' perceptions of patient safety competency: A cross-sectional study of relationships with occurrence and reporting of adverse events.

Although, strengthening patient safety competencies in nursing has been emphasized for enhancing quality care and patient safety. However, little is known about the association of nurses' perceptions of patient safety competency with adverse nurse outcomes in Iranian hospitals. This study aimed to measure nurses' levels of patient safety competency in the hospitals of Iran and examines the relationship between patient safety competency with the occurrence and reporting of adverse events (AEs). This cross-sectional research was applied in eight teaching hospitals in Tehran, Iran, between August and December 2021. A sample of 511 nurses was randomly selected using the table of random numbers. The validated Patient Safety Competency Self-Evaluation questionnaire was used. Furthermore, two questions were used to measure the incidence and reporting of AEs. Data analysis was performed using descriptive statistics, independent t-tests, and two binary logistic regression models through SPSS version 24.0. The mean patient safety competency score was 3.34 (SD = 0.74) out of 5.0; 41.5% of nurses rated their patient safety competency as less than 3. Among subscales, "skills of patient safety" scores were the highest, and "knowledge of patient safety" scores were the lowest. Nurses with higher Knowledge and Attitude scores were less likely to experience the occurrence of AEs (OR = 1.50 and OR = 0.58, respectively). Regarding AEs reporting, nurses with higher Skill and Attitude scores were 2.84 and 1.67 times, respectively, more likely to report AEs (OR = 2.84 and OR = 3.44, respectively). Our results provide evidence that enhancing PSC leads to reduced incidence of AEs and increased nurses' performance in reporting. Therefore, it is recommended that managers of hospitals should enhance the patient safety competency of nurses in incidents and reporting of patient safety adverse outcomes through quality expansion and training. Additionally, researchers should carry out further research to confirm the findings of the current study and identify interventions that would strengthen patient safety competencies and reduce the occurrence of AEs, and rise their reporting among nurses.

Occupational stress and associated sources and risk factors among nurses in Gaza strip, Palestine: A cross-sectional survey.

AIM: To determine the occurrence of occupational stress among Palestinian nurses, and their associated sources and risk factors. DESIGN: A cross-sectional descriptive design. METHODS: A total of 250 registered nurses from eight governmental hospitals, using a convenience sampling method. Data collection were conducted using the 30-items self-reported Occupational Stress Scale from December 2022 to March 2023. Descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis were applied to analysis data. Data analysis included descriptive statistics, independent sample t-test, one-way ANOVA, and multiple linear regression analysis. RESULTS: The prevalence of high occupational stress levels was 64.8% (Mean = 3.9 out of 5). The main sources of stress are too much responsibility and work, understaffing, lack of promotion and recognition, inadequate pay, time pressure, and management style. The results regression analysis demonstrated that male nurses with a Masters or PhD degree and those working in fixed shifts experienced higher occupational stress. Moreover, participants who worked overtime hours were more susceptible to stress. CONCLUSIONS: The research indicates that occupational stress presents a notable challenge for nurses in the Gaza Strip, Palestine. It suggests that in order to alleviate this stress, decision-makers in healthcare policy and hospital management should prioritize the execution of strategies aimed at addressing the primary stressors and risk factors identified. REPORTING METHOD: This study adhered to the STROBE guidelines. PUBLIC CONTRIBUTION: A total of 250 registered nurses were taken part in this study by answering a self-administered study survey.

Biomass use and its health effects among the vulnerable and marginalized refugee families in the Gaza Strip.

Introduction: Biomass fuel remains the most common type of fuel used in many developing countries, leading to indoor air pollution and serious health impacts. Objective: The objective of this study was to compile evidence on the impact household fuel combustion has on child and adult health, with an emphasis on solid fuel use in Gaza. Methods: In this cross-sectional study, 110 structured self-administered questionnaires were distributed in April 2019 among families living in the Al-Maghazi refugee camp. Results: Participants reported that the main fuel used were wood, coal, cardboard, and a mix of wood, cardboard, and plastic, which were used for cooking, heating, baking, boiling water, and lighting. The most common symptoms were nasal irritation (71.8%), followed by headache (66.4%) and dizziness (65.4%). The results of logistic regression showed that the participants who used wood fuel had a higher chance of feeling eye irritation than those who used a mix of wood, cardboard, and dried grass (OR = 1.316; 95% CI = 1.54-8.99). The participants who opened windows during the burning process of biomass fuel were five times more likely to develop pneumonia than those who closed windows (OR = 5.53; 95%CI = 11.60-19.0). Conclusion: there is an urgent need for community awareness campaigns designed to inform people about the risks of exposure to biomass fuel smoke and how to better implement household ventilation.

Effect of ISBAR Clinical Handover Application on Nurses' Perception of Communication and Attitudes toward Patient Safety at Emirates Maternity Hospital in Gaza Strip, Palestine.

Background: Good communication is necessary for safety and quality of health. This study aims to determine the effect of ISBAR communication on nurses' perception of communication and attitudes toward patient safety in the Emirates Maternity Hospital in the Gaza Strip, Palestine. Method: A single-group hospital-based intervention study (pre and posttest) was conducted. A census sample was used Participants opinions about the effect of ISBAR were gathered using two tools established by Shortell, Rousseau, Sexton, and Helmreich to assess the communication awareness and nurses' attitudes towards safety, respectively, before and after the use of the ISBAR program. Results: After the ISBAR application, nurses' perception of communication demonstrated a positive and significant increase in the three sub-items (openness, accuracy and understanding, and shift communication) in the nurse-nurse communication. Moreover, in four sub-items (openness, accuracy, and understanding, timeliness, and satisfaction) in nurse-doctor communication, (p < 0.05). Further, the nurses' attitudes toward patient safety showed a significant and positive increase in teamwork climate (p<0.001), safety climate (p = 0.007), job satisfaction and working condition (p<0.001), stress recognition (p= 0.008), and perception of management (p = 0.001). Conclusion: The results provide significant evidence of the positive effects of the ISBAR program in improving nurses' perceptions of communication and attitudes toward patient safety. It is recommended that healthcare providers use ISBAR communication in their practice. Moreover, periodic training programs are required for effective ISBAR communication among the healthcare team.

Knowledge, Attitudes, and Practice towards Occupational Health and Safety among Nursing Students in Gaza Strip, Palestine.

Background: Health and safety in the workplace are critical components in healthcare institutions. Unsafe working conditions are among the causes of poor quality of care and burnout. This study aims to assess the knowledge, attitudes, and practice of occupational health and safety among nursing students at Al-Israa University. Methods: In this cross-sectional study, a structured online questionnaire was distributed from March to May 2021. Of the 350 eligible students, 219 students answered the questionnaire (Response rate=62.6). Data were analyzed using the statistical software IBM-SPSS version 22. Descriptive statistic, Independentsamples T-Test, and ANOVA tests were used. Results: The majority of participants were female (81.7%) and studying in a diploma program. 21% of nursing students have experienced a needle stick injury. The mean scores for knowledge, attitudes, and practice were (M±SD:78.2% ±12.9, M±SD:80.6% ±7.1, and M±SD:81.2% ±7.6) respectively. In terms of knowledge, attitudes, and practice the mean scores were statistically significant between nursing students who attended a safety precautions course and those who didn not (P-value <.05). In terms of attitudes, the mean scores were statistically significant between diploma and bachelor students (P-value =.026). In terms of practice, the means scores were statistically significant between males and females (Pvalue =.017), nursing students who had experience with needle sticks and those who didn't (P-value =.015). Conclusions: The authors recommend that clinical training departments and universities continue to offer occupational health and safety courses and training for health science students. Since the training had a positive impact on the students' practices.

Prevalence of physical activity using validated tools among adults during the COVID-19 pandemic in the Eastern Mediterranean region: A systematic review and meta-analysis.

Many interventions have been taken around the world to limit the spread of COVID-19. These interventions have affected people's lifestyles such as physical activity. The aim of this systematic review and meta-analysis was to determine the prevalence of physical activity using validated tools among adults during the COVID-19 pandemic in the Eastern Mediterranean region. A systematic literature review and meta-analysis were conducted in October 2021. We searched three electronic databases (Web of Science, Scopus, and PubMed) for English-language original articles of observational studies (cross-sectional, case-control, and cohort studies) with original data reporting the prevalence of physical activity among adults in 22 countries from EMR during the COVID-19 pandemic. Hoy's risk of Bias tool was applied to assess the biases in individual studies. The result was reported as a percentage for prevalence. A meta-analysis was conducted using the random-effect model with a 95% confidence interval. A total of 363 articles were retrieved. Finally, 15 articles were selected and included in the statistical analysis. The selected studies included 16,585 participants. The result of the meta-analysis showed that the overall physical activity was 51.6% (95% confidence interval: 42.1, 61: p = 0.745). The result of subgroup analysis based on different tools was 60.2%, 39.5%, 36.3%, 39.4%, and 55.2% for Global Physical Activity Questionnaire , The Godin-Shephard Leisure-Time Physical Activity Questionnaire, International Physical Activity Questionnaire, International Physical Activity Questionnaire-BREF, and International Physical Activity Questionnaire-short form, respectively. Our study highlights the urgent need for large-scale measurement and reporting of physical activity and the use of standard tools that can allow for the regular assessment and screening of the PA prevalence to support evidence-informed policy and programs development at both national and regional levels.

Do Patients with Major Non-Communicable Diseases Receive Advice on Health Behaviors from Healthcare Professionals in the Gaza Strip, Palestine?

BACKGROUND: NCDs tend to be long-term and are caused by genetic, physiological, environmental, and behavioral factors. Currently, NCDs account for 71% of deaths globally. The current study aimed to explore whether patients with NCDs receive advice on health behaviors from healthcare professionals in the PHCs in the Gaza Strip, Palestine. METHODS: This research applied a cross-sectional survey design in five PHCs from October 2019 to December 2019, with 360 patients selected using a convenience sampling technique. A structured questionnaire on sociodemographic, history and patients' views on receiving advice on health behaviors from health care professionals was developed and collected. Data were analyzed using descriptive analyses and a One-way ANOVA test through SPSS-v22. RESULTS: The patients reported receiving advice as follows: in terms of regular physical activity (54.5% ±13.6), in terms of eating a heart-healthy diet (49.3% ±11.5), in terms of treatment adherence (86.1% ±8.1), and in terms of stop tobacco for smokers' patients (43.9% ±16.8). Statistically significant differences were found between the five Gaza strip governorates in terms of regular physical activity, eating heart-healthy, and treatment adherence (P values <.05 for all). CONCLUSION: Participants claimed that the vast majority of them had received advice from healthcare professionals regarding attending regular follow-up and treatment adherence. In contrast, participants reported receiving advice from health care professionals regarding regular physical activity, eating a healthy diet, and stopping tobacco are suboptimal. There is a need to develop a strategy to ensure that healthcare professionals are committed to providing advice on health behaviors.

The fear of COVID-19 outbreak among health care professionals in Gaza Strip, Palestine.

INTRODUCTION: The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals, particularly among healthcare professionals. The present study aimed to assess the fear of COVID-19 among different healthcare professionals in the Gaza Strip, Palestine. METHODS: A cross-sectional, snowball sampling technique and an online questionnaire were employed among healthcare professionals. A total of 300 participants completed the questionnaire. The validated fear of COVID-19 Scale Arabic version was used. Statistical analysis was performed using SPSS version 22. RESULTS: The sample fear mean score was 17.53 ± 5.78; more than half of the study participants (54.3%) consider it as low levels of fear and 45.7% of the participants consider it as high levels of fear. Statistically significant differences were found between males and females, and different healthcare professional's disciplines. Females have a higher mean score compared to males. The highest fear mean scores were found among Lab-Technicians (20.19 ± 7.42), followed by X-ray-Technicians (17.95 ± 3.96), Nurses (17.1 ± 5.55), and Physicians (16.25 ± 4.66). CONCLUSION: The fear of COVID-19 was high among female healthcare professionals compared to males, as well as, among Lab-Technicians compared to Physicians and Nurses. There is a need to establish a strategy to continues measuring the psychological effect of COVID-19 among healthcare professionals especially females.

Barriers toward the practice of healthy behaviors among patients with non-communicable diseases in Gaza Strip, Palestine.

OBJECTIVES: Non-communicable diseases are non-infectious health conditions caused by genetic, physiological, environmental, and behavioral factors. Currently, non-communicable diseases account for almost two-thirds of deaths globally. This study aimed to explore the patients' adherence level to the key recommendations, and the main barriers toward the practice of healthy behaviors among non-communicable diseases patients. METHOD: This cross-sectional study was conducted among a representative sample of non-communicable diseases patients, receiving care in five primary healthcare centers in the Gaza Strip, Palestine. An interview-based questionnaire about demographics, medical history, and barriers toward the practice of healthy behaviors was developed and collected based on the health belief model and the theory of planned behaviors. Independent samples t-test, one-way analysis of variance, chi-square, and Fisher's exact test were used for analysis. RESULTS: Four hundred patients with non-communicable diseases, aged (53.06 ± 10.03) years old, (56.8% females and 43.3% males) were included in this study. The patient's adherence was reported as 50.1%, standard deviation = 18.3 in terms of attended regular physical activity, and 44.0%, standard deviation = 15.4 in terms of eating a healthy diet. The main barriers to being active among patients were lack of accessibility to materials, lack of social support, and lack of reminder; while in terms of eating a healthy diet were lack of accessibility to materials, lack of social support, and lack of self-efficacy. CONCLUSION: The non-communicable diseases patients' adherence to healthy behaviors is suboptimal. Varied implementation strategies targeting the main barriers are extremely required to enhance the access to physical activity infrastructure, affordable healthy diet options, and to reinforce the change toward healthy behaviors at all levels.

Barriers of Adherence among Palestinian Healthcare Professionals towards the Protocol of Health Education and Counselling on Healthy Behaviours for Non-Communicable Diseases.

BACKGROUND: Despite the huge numbers of the universally produced and employed protocols, the adherence with them is still low to moderate in the healthcare settings. This study was employed to assess the attitudes of Palestinian healthcare professionals in Gaza Strip to health education and counseling on healthy behaviours protocol (WHO-PEN Protocol 2), for patients with non-communicable diseases in the Ministry of Health primary healthcare centers. METHODS: This cross-sectional study was conducted with a census sample of all governmental family physicians and nurses (n=175). The study questionnaire was developed based on Cabana theoretical framework. The Arabic version questionnaire was developed based on the cross-cultural adaptation framework. The psychometric properties of the Arabic version questionnaire was finally evaluated. RESULTS: The psychometric properties of the Arabic version questionnaire showed good construct validity and internal consistency reliability. The overall adherence level to WHO-PEN Protocol 2 was 70.0, SD=6.9. The main perceived barriers were lack of incentive, patients' factors, and lack of time. In general, most of healthcare professional respondents had a positive attitude toward the protocol, but this attitude was not predictor to protocol adherence. CONCLUSION: The good validity and reliability of the questionnaire can provide support for the accuracy of the study results. Varied implementation strategies targeting the major barriers derived from the study are extremely required for addressing the lack of incentives, patients' factors and time constraints.

Public Sector Capacity to Prevent and Control of Noncommunicable Diseases in Twelve Low- and Middle-Income Countries Based on WHO-PEN Standards: A Systematic Review.

This review was conducted to assess the capacity of the public sector to prevent and control noncommunicable diseases (NCDs) in low-and middle-income countries (LMIC) based on WHO-PEN standards. A PRISMA systematic search appraisal of PubMed, Scopus, and Embase was conducted during May-2020 for original articles conducted in LMIC and reported the capacity of the public sector to prevent and control NCDs. The country readiness score was calculated as the mean score of items for each domain. The indices were compared to an agreed cutoff at 80% the WHO optimal target of availability of affordable essential medicines and basic technologies required to treat NCDs. The literature search yielded 5 original studies, conducted in twelve countries, and surveyed 304 public health facilities. All countries failed to reach the WHO optimal target of availability of affordable essential medicines and basic technologies. The readiness index score according to WHO-PEN standards among countries in terms of essential medicines, diagnostic investigations, and basic equipment were range from 13.5% to 51%, 0.0% to 59.4%, and 29.2% to 51.2% respectively. This review revealed critical gaps in the twelve LMIC public sector capacity to prevent and control of NCDs in terms of essential medicines, basic equipment, and diagnostic investigations.

The antidiabetic and antilipidemic effects of Hibiscus sabdariffa: A systematic review and meta-analysis of randomized clinical trials.

Hibiscus sabdariffa (HS) is a woody-based subshrub of the Malvaceae family which has various uses in traditional medicine. This review systematically evaluates the evidence from clinical trials on the antidiabetic activity of HS. A random-effects model was used to obtain summary estimates. Five outcome measure, including fasting plasma glucose (FPG), total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoproteins (LDL), and triglyceride (TG) were assessed in the study. The results of the overall pooled statics for the FPG level showed that there was a significant reduction in FPG (WMD = -3.964 mg/dL; 95% CI: -6.227 to -1.702 and P-value was 0.001) and in the level of LDL (WMD = -7.843 mg/dL; 95% CI: -14.337 to -1.350 and P-value was 0.018). However, the pooled estimate showed that there was no statistically significant change on the TC (WMD = -30.382 mg/dL; 95% CI: -66.752 to 5.989 and P value was 0.102), the HDL (WMD = 0.074 mg/dL; 95% CI: -1.986 to 2.135 and P value was 0.944) and the TG (WMD = -9.050 mg/dL; 95% CI, -30.819 to 12.719 and P value was 0.102) compared to the placebo. Egger's weighted regression P values suggested that there was no potential publication bias in the FPG (P = 0.664), HDL (P = 0.065), LDL (P = 0.677) and TG (P = 0.232) but there was a publication bias in the TC (0.056). Therefore, the result of this meta-analysis clearly shows that HS has antidiabetic activity, whereas its lipid-lowering effect needs further study.