A multicenter descriptive analysis of anemia management in hemodialysis patients and its association with quality of life.

BACKGROUND: Appropriate management of anemia in patients with hemodialysis (HD) involves the administration of iron supplementation and erythropoietin-stimulating agents (ESAs), in addition to monitoring the response. This study aimed to evaluate the treatment of anemia in patients with HD and describe the factors associated with it and its effect on health-related quality of life (HRQOL). METHODS: The study was cross-sectional in design. The patients were included from three dialysis centers in Palestine from June to September 2018. The data collection instrument consisted of two portions; the initial portion contained demographic and clinical information on the patients, while the second consisted of the European Quality of Life 5-Dimension Scale (EQ-5D-5 L) and the visual analog scale EQ (EQ-VAS). RESULTS: The study included 226 patients. Their mean age (± SD) was 57 ± 13.9 years. The mean level of hemoglobin (Hb) (± SD) was 10.63 ± 1.71 g/dl, and 34.1% of the patients had a Hb level of 10-11.5 g/dl. All patients who required iron supplementation received it intravenously with a dose of 100 mg of iron sucrose. Almost 86.7% of the patients received darbepoetin alfa intravenously at 0.45 mcg/kg a week, and 24% had a Hb level > 11.5 g/dl. There were significant associations between the level of Hb and the number of comorbid diseases and the ESA that was received. However, other demographics and clinical factors did not significantly affect Hb levels. Certain variables, such as exercise, were a predictor of a higher quality of life. It should be noted that there is a significant impact of a low Hb value on the EQ-VAS scale. CONCLUSIONS: Our study found that more than half of the patients had a Hb level below the recommended goal of Kidney Disease Improving Global Outcomes (KDIGO). Furthermore, a significant association was found between patients' Hb level and HRQOL. Therefore, the appropriate treatment of anemia in patients with HD should be followed by adherence to the guideline recommendations, which consequently improves the HRQOL of HD patients, in addition to obtaining optimal therapy.

Complementary and alternative medicine use among pediatrics in Palestine: a cross-sectional study.

BACKGROUND: Recent use of complementary and alternative medicine (CAM) is growing in children worldwide, so there is a need to evaluate CAM's use among pediatrics in Palestine. This study aimed to estimate the prevalence of CAM use among a sample of Palestinian children, investigate the factors that affect the use of CAMs, identify the types of CAM used, and assess the purposes of using them. METHODS: A cross-sectional descriptive study of parents who had children aged 6 years and below was carried out. A convenient sample of about 420 participants was collected; from Primary care to Motherhood and Childhood Centers in Nablus city in Palestine. Parents who agreed to participate were asked to answer a survey that consists mainly of closed-ended questions. The analysis was performed using SPSS version 16.0. RESULTS: The use of CAM was detected in all interviewers 420 (100%). The most common treatment used was herbal therapy (n = 400, 95.2%), and anise was the most common herbal therapy used (n = 334; 79.5%). A total of 371 (88.3%) of the respondents used CAM for digestive system problems. The main reason for using CAM was making the child more comfortable (n = 365; 86.9%). Parents who are 30 years or older were significantly using more CAM than younger parents (P = 0.001). In addition, regarding the number of children in the family, parents who have five children or more used more CAM subtypes significantly more than parents with less than this number (P = 0.025). Moreover, parents living in a refugee camp used more CAM than parents who lived in urban or rural areas (P = 0.031). CONCLUSIONS: Parents of children use CAM frequently. All parents used CAM, and physicians were not mainly among the sources of CAM information, and almost all parents were unaware of the side effects of CAM. Future research is necessary to direct pediatricians in formulating recommendations for children on CAM modalities, including possible risks and benefits and interactions with conventional medications.

The use of complementary and alternative medicine during pregnancy: a cross-sectional study from Palestine.

BACKGROUND: The use of complementary and alternative medicine (CAM) is increasing worldwide. To the best of knowledge, there is a lack of studies that assess CAM use by Palestinian women during pregnancy. This research aims to determine the prevalence of Palestinian women's use of CAM during pregnancy, the most frequently used CAM products during the pregnancy period, the main sources that encourage the use of CAM among pregnant women, and the causes of CAM use. METHODS: A descriptive, cross-sectional study was conducted in Palestine using a questionnaire from April 2018 to March 2019. The samples were selected by convenience sampling, including currently pregnant or previously pregnant women in the Obstetrics and Gynecology (OBGYN) clinic at Rafedia Hospital and in primary health care clinics in Nablus city-Palestine. The questionnaire covered socio-demographic variables, health status, types and frequency of CAM used, patients' sources of information, causes of their usage, attitudes, and beliefs. RESULTS: Four hundred currently or previously pregnant women participated. Three hundred fifty-five (91.5%) used at least one method of CAM during pregnancy. Most women used at least one method of biologically-based therapies during pregnancy (87.7%). One hundred and one pregnant women (26.7%) utilised at least one type of herb during pregnancy. The most-reported herb used by 12.3% of participants was anise. Of the mind-body therapies, prayer was the most commonly used method during pregnancy (8.3%). Two hundred and sixty-one (65.3%) participants used CAM because they believed CAM was not harmful to them or their babies during pregnancy. Participants gained most of their information about CAM from their families (43.8%) and friends (24.3%). Approximately two-thirds of participants (64.0%) thought that obstetricians should be able to advise on commonly used CAM. CONCLUSIONS: During pregnancy, CAM products are commonly used, and it is important to determine what types are being used by women in Palestine. These findings supplement the body of knowledge on the use of CAM by pregnant women. Pregnancy care providers need to be aware to the familiar types of CAM that women use.

A Descriptive Study of Pain Relief Practices Among Student-Athletes in Palestine: Focus on Non-Steroidal Anti-Inflammatory Drugs, and Complementary Medicine and Alternative Medicine Use.

Many athletes suffering from musculoskeletal pain and dysfunction will use some types of complementary and alternative medicine (CAM) or Non-steroidal anti-inflammatory drugs (NSAIDs). Therefore, this study aimed to determine the prevalence, awareness, and behaviors related to NSAIDs and CAM use in Palestinian student-athletes. This was a cross-sectional study that involved 227 students from the Faculty of Sports at An-Najah National University. A self-administered questionnaire was designed in Arabic; it had six sections and a number of open-ended and closed-ended questions. SPSS version 21 was used to analyze the results. Descriptive statistics (i.e., frequencies, percentages) were used to describe the results including demographic characteristics. Overall, 79.3% of the student-athletes had used NSAIDs in the past and 89.0% had used CAM. The CAM methods used by participants were: herbals (57.3%), supplements (32.2%), cupping (11.9%), acupuncture (2.2%), massage (51.5%), yoga (4.0%), praying (18.1%) and ice packs (20.7%). The herbs commonly used by participants were: sage (20.7%), Menthol (21.1%), Aniseed (10.6%), Chamomile (4.0%), Cinnamon (1.3%), Turmeric (4.0%), Ginger (35.7%), and a mixture of herbs (18.5%); Regarding the perceived advantages of CAM use, 82.2% thought that CAM is beneficial for their health, 79.7% thought CAM is safe, 71.3% used it because of the successful experience of others, and 60.9% used it because it's more available than medical therapy. Among NSAIDs users, 17.2% reported recent use of over-the-counter (OTC) NSAIDs, and 33.9% of users used prescribed NSAIDs within the last three months for sport-related reasons. When asked to report any side-effect of NSAIDs they knew, only 22.6% were able to list at least one side-effect. This study shows a high prevalence of NSAIDs and CAM use among student-athletes in Palestine with a low level of knowledge and awareness of their side-effects. Therefore, education strategies that focus on enhancing and improving student-athletes' knowledge of the proper use and the possible side-effects of NSAIDs and CAM are needed.

Complementary and alternative medicine use in coronary heart disease patients: a cross-sectional study from Palestine.

BACKGROUND: There is a lack of data on the use of complementary and alternative medicine (CAM) in patients with coronary heart disease (CHD). This study examined the use of CAM among patients with CHD, the reasons and factors influencing their use, the types of CAM used, and the relationship between patient's demographics and the use of CAM. METHODS: In order to determine the prevalence and usage of CAM among Palestinian patients with CHD, a cross-sectional descriptive study was performed from three different hospitals. Using a convenient sampling method, a questionnaire was completed in a face-to-face interview with the patients. Descriptive statistics were used for socio-demographic, and clinical variables. Siahpush scale was used to examine the attitude of CHD patients toward CAM use. RESULTS: Of the 150 patients that were interviewed, 128 (85.3%) of the patients completed the questionnaire. The majority of CAM users reported CAM use for health problems other than CHD, while a total of 59 (45.9%) patients have used CAM for their heart problems. On the other hand, it was found that the place of residency and pattern of CHD were significantly associated with CAM use (p = 0.039 and 0.044, respectively). In addition, religious practices were found to be the most common form of CAM used by patients, while body and traditional alternative methods were the least being used. A significant association between the attitudes of patients with CHD and their use of CAM was found (patients' attitudes towards alternative medicine and natural remedies were p = 0.011 and 0.044, respectively). CONCLUSIONS: CAM use among our respondents is common. Despite a lack of evidence-based research supporting its potential benefits and side effects. Understanding the factors that affect CAM use by CHD patients offers healthcare workers and policymakers an opportunity to better understand CAM use and ultimately improve patient-physician interactions.

Nursing and midwifery research activity in Arab countries from 1950 to 2017.

BACKGROUND: Nursing and midwifery research activity is an important indicator of the quality of healthcare services and the status of nursing profession. The main aim of this study was to assess the research activity in nursing and midwifery field in Arab countries. METHOD: The current study implemented bibliometric method using Scopus database. The search strategy used country affiliation or journal name or keywords as a strategy to retrieve the required documents. The study period was from 1950 to2017. Analysis included a presentation of bibliometric indicators and VOSviewer mapping of the retrieved data. RESULT: 2935 documents were retrieved making up less than 1% of global nursing and midwifery research output. Of the retrieved documents, 25% were published in high rank (first quartile = Q1) journals. The majority (56.7%) of the retrieved documents were published in the last five years of the study period. The retrieved documents received an average of 6.9 citations per document with an h-index of 47. The total number of authors who took part in publishing the retrieved documents was 10,572, giving an average of 3.6 authors per article. Jordan ranked first in research output. Researchers from Jordan took part in over than one third (1023; 34.9%) of the retrieved documents. Lebanon (35.5%) ranked first in the percentage of documents published in Q1 journals. The United Arab Emirates ranked first in the percentage (67.4%) of publications with international authors. The most active journal involved in publishing nursing research from Arab countries was Life Science Journal (158; 5.4%). The University of Jordan was the most productive institution while the American University of Beirut ranked first in the percentage (36.9%) of documents published in Q1 journals. Author keyword analysis and10 most cited articles showed that non-communicable diseases and nursing education were the focus of nursing research in Arab countries. CONCLUSIONS: Nursing and midwifery research activity in Arab countries has dramatically increased especially over the past five years. Despite this, nursing research is still in its infancy, lagging in quantity and quality compared to developed countries.

Use of complementary and alternative medicines in haemodialysis patients: a cross-sectional study from Palestine.

BACKGROUND: Complementary and alternative medicine (CAM), and herbal therapies, are accepted worldwide, and have been important from medical, sociological and economic perspectives, among haemodialysis (HD) patients. The primary aim of this study was to evaluate the use of CAM among patients with end-stage renal disease (ESRD) who are undergoing HD. METHODS: Face-to-face interviews of patients with ESRD undergoing HD from ten outpatient renal departments at a national level in Palestine were conducted from June 2014 to January 2015. A survey questionnaire, which included questions on socio-demographic and clinical characteristics, and on the CAM therapies that were used, was administered. RESULTS: Out of 267 patients interviewed, 172 patients used at least one type of CAM in the last month prior to the interview, and thus the utilisation rate was 64.4 %. Forty one (15.4 %) patients reported using one type of CAMs, while 18.7 % used two different CAMs and 30.3 % used more than two types of CAMs for their health status. Of the patients who used CAM, herbal therapies were used most often (43.5 %), followed by honey (35.6 %), diet (22.8 %), and exorcism in Islam (16.9 %). The herbal therapies mentioned most often were Nigella sativa L. (18.7 %), followed by Salvia officinalis L. (16.9 %), and Pimpinella anisum L. (10.5 %). CONCLUSIONS: In conclusion, the prevalence of CAM is relatively high in the selected population. Most patients used biological therapies such as herbal remedies, thus highlighting a greater need for patient education regarding CAM therapies and possible herb-drug interactions. Health care providers must be aware of the potential benefits and risks related to CAM use. There is a need for more clinical research pertaining to CAM to reach stronger evidence regarding potential benefits and risks related to CAM use.

Scientific publications from Arab world in leading journals of Integrative and Complementary Medicine: a bibliometric analysis.

BACKGROUND: Bibliometric analysis is increasingly employed as a useful tool to assess the quantity and quality of research performance. The specific goal of the current study was to evaluate the performance of research output originating from Arab world and published in international Integrative and Complementary Medicine (ICM) journals. METHODS: Original scientific publications and reviews from the 22 Arab countries that were published in 22 international peer-reviewed ICM journals during all previous years up to December 31(st) 2013, were screened using the Web of Science databases. RESULTS: Five hundred and ninety-one documents were retrieved from 19 ICM journals. The h-index of the set of papers under study was 47. The highest h-index was 27 for Morocco, 21 for Jordan, followed by 19 for each Kingdom of Saudi Arabia (KSA), and Egypt, and the lowest h-index was 1 for each of Comoros, Qatar, and Syrian Arab Republic. No data related to ICM were published from Djibouti, and Mauritania. After adjusting for economy and population power, Somalia (89), Morocco (32.5), Egypt (31.1), Yemen (21.4), and Palestine (21.2) had the highest research productivity. The total number of citations was 9,466, with an average citation of 16 per document. The study identified 262 (44.3 %) documents with 39 countries in Arab-foreign country collaborations. Arab authors collaborated most with countries in Europe (24.2 %), followed by countries in the Asia-Pacific region (9.8 %). CONCLUSION: Scientific research output in the ICM field in the Arab world region is increasing. Most of publications from Arab world in ICM filed were driven by societal use of medicinal plants and herbs. Search for new therapies from available low cost medicinal plants in Arab world has motivated many researchers in academia and pharmaceutical industry. Further investigation is required to support these findings in a wider journal as well as to improve research output in the field of ICM from Arab world region by investing in more national and international collaborative research project.

Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine.

BACKGROUND: Fever is an extremely common occurrence in paediatric patients and the most common cause for a child to be taken to the doctor. The literature indicates that parents have too many misconceptions and conflicting information about fever management. The aim of this study was to identify parents' beliefs and practices regarding childhood fever management. METHODS: We conducted a cross-sectional survey among parents whose children were enrolled and presented for health care at primary health care clinics in the Nablus region of Palestine. Data were collected using structured questionnaire interviews with parents. The questionnaire consisted of 'yes/no' responses and multiple-response questions. Descriptive statistics were used. RESULTS: Overall, 402 parents were interviewed. All parents believed that fever could cause at least one harmful effect if left untreated. The harmful effects most frequently reported by parents were brain damage (38.1%), dehydration (15.7%), and other organs damage such as liver and kidney damage (14.2%). The study showed that 65.4% of parents would recognise fever by only touching the child, 31.6% would measure the temperature and 3.0% would assess temperature by touching and measuring the child. Antipyretic was preferred to be used by 34.8% of parents, while 49.8% stated that they preferred cold sponges, and 3.2% stated that they preferred homeopathic methods to treat fever. The most common factors influencing frequency of medication administration included physician's instruction (61.7%), the degree of elevated temperature (14.9%) and instructions on the medication leaflet (13.7%). Of the participant parents, 53.2% believed antipyretics used to reduce fever were harmful. Parents reported the most harmful outcomes from these antipyretics to be allergic reactions (20.9%), effects on the stomach (16.9%), kidney damage (16.2%) and overdose (11.4%). CONCLUSIONS: Parents were anxious when dealing with a feverish child, which resulted in incorrect or inappropriate practices. Parents require reliable evidence-based information about the care of feverish children. These results indicate a need to develop and evaluate educational programs in our setting that will provide parents with education on fever and fever management.