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.

Bibliometric analysis of global migration health research in peer-reviewed literature (2000-2016).

BACKGROUND: The health of migrants has become an important issue in global health and foreign policy. Assessing the current status of research activity and identifying gaps in global migration health (GMH) is an important step in mapping the evidence-base and on advocating health needs of migrants and mobile populations. The aim of this study was to analyze globally published peer-reviewed literature in GMH. METHODS: A bibliometric analysis methodology was used. The Scopus database was used to retrieve documents in peer-reviewed journals in GMH for the study period from 2000 to 2016. A group of experts in GMH developed the needed keywords and validated the final search strategy. RESULTS: The number of retrieved documents was 21,457. Approximately one third (6878; 32.1%) of the retrieved documents were published in the last three years of the study period. In total, 5451 (25.4%) documents were about refugees and asylum seekers, while 1328 (6.2%) were about migrant workers, 440 (2.1%) were about international students, 679 (3.2%) were about victims of human trafficking/smuggling, 26 (0.1%) were about patients' mobility across international borders, and the remaining documents were about unspecified categories of migrants. The majority of the retrieved documents (10,086; 47.0%) were in psychosocial and mental health domain, while 2945 (13.7%) documents were in infectious diseases, 6819 (31.8%) documents were in health policy and systems, 2759 (12.8%) documents were in maternal and reproductive health, and 1918 (8.9%) were in non-communicable diseases. The contribution of authors and institutions in Asian countries, Latin America, Africa, Middle East, and Eastern European countries was low. Literature in GMH represents the perspectives of high-income migrant destination countries. CONCLUSION: Our heat map of research output shows that despite the ever-growing prominence of human mobility across the globe, and Sustainable Development Goals of leaving no one behind, research output on migrants' health is not consistent with the global migration pattern. A stronger evidence base is needed to enable authorities to make evidence-informed decisions on migration health policy and practice. Research collaboration and networks should be encouraged to prioritize research in GMH.

Bibliometric analysis of worldwide scientific literature in mobile - health: 2006-2016.

BACKGROUND: The advancement of mobile technology had positively influenced healthcare services. An emerging subfield of mobile technology is mobile health (m-Health) in which mobile applications are used for health purposes. The aim of this study was to analyze and assess literature published in the field of m-Health. METHODS: SciVerse Scopus was used to retrieve literature in m-Health. The study period was set from 2006 to 2016. ArcGIS 10.1 was used to present geographical distribution of publications while VOSviewer was used for data visualization. Growth of publications, citation analysis, and research productivity were presented using standard bibliometric indicators. RESULTS: During the study period, a total of 5465 documents were published, giving an average of 496.8 documents per year. The h-index of retrieved documents was 81. Core keywords used in literature pertaining to m-Health included diabetes mellitus, adherence, and obesity among others. Relative growth rate and doubling time of retrieved literature were stable from 2009 to 2015 indicating exponential growth of literature in this field. A total of 4638 (84.9%) documents were multi-authored with a mean collaboration index of 4.1 authors per article. The United States of America ranked first in productivity with 1926 (35.2%) published documents. India ranked sixth with 183 (3.3%) documents while China ranked seventh with 155(2.8%) documents. VA Medical Center was the most prolific organization/institution while Journal of Medical Internet Research was the preferred journal for publications in the field of m-Health. Top cited articles in the field of m-Health included the use of mobile technology in improving adherence in HIV patients, weight loss, and improving glycemic control in diabetic patients. CONCLUSION: The size of literature in m-Health showed a noticeable increase in the past decade. Given the large volume of citations received in this field, it is expected that applications of m-Health will be seen into various health aspects and health services. Research in m-Health needs to be encouraged, particularly in the fight against AIDS, poor medication adherence, glycemic control in Africa and other low income world regions where technology can improve health services and decrease disease burden.

Bibliometric analysis of global scientific research on carbapenem resistance (1986-2015).

BACKGROUND: Antimicrobial resistance is a global public health challenge and carbapenem resistance, in particular, is considered an urgent global health threat. This study was carried out to give a bibliometric overview of literature on carbapenem resistance. In specific, number of publications, top productive countries and institutes, highly cited articles, citation analysis, co-authorships, international collaboration, top active authors, and journals publishing articles on carbapenem resistance were analyzed and discussed. METHODS: Specific keywords pertaining to carbapenem resistance were used in Scopus database. Quantitative and qualitative analysis of retrieved data were presented using appropriate bibliometric indicators and visualization maps. RESULTS: A total of 2617 journal articles were retrieved. The average number of citations per article was of 21.47. The growth of publications showed a dramatic increase from 2008 to 2015. Approximately 9 % of retrieved articles on carbapenem resistance were published in Antimicrobial Agents and Chemotherapy journal. Retrieved articles were published by 102 different countries. The United States of America (USA) contributed most with 437 (16.70 %) articles followed by China with 257 (9.82 %) articles. When productivity was stratified by population size, Greece ranked first followed by France. Greece also ranked first when data were stratified by gross domestic product (GDP). Asian countries have lesser international collaboration compared with other countries in the top ten list. Five of top ten productive institutes were Europeans (France, the UK, Greece, Italy, and Switzerland) and two were Asians (China and South Korea). Other active institutes included an Israeli and a Brazilian institute. Four of the top ten cited articles were published in Antimicrobial Agents and Chemotherapy journal and two were published in The Lancet Infectious Diseases. CONCLUSION: There was a dramatic increase in number of publications on carbapenem resistance in the past few years. These publications were produced from different world regions including Asia, Europe, Middle East, and Latin America. International collaboration needs to be encouraged particularly for researchers in Asia. Molecular biology and epidemiology dominated the theme of the top ten cited articles on carbapenem resistance. This bibliometric study will hopefully help health policy makers in planning future research and allocating funds pertaining to carbapenem resistance.

A bibliometric analysis of literature on malaria vector resistance: (1996 - 2015).

BACKGROUND: Emergence of insecticide resistance in malaria vectors is a real threat to future goals of elimination and control of malaria. Therefore, the objective of this study was to assess research trend on insecticide resistance of Anopheles mosquito. In specific, number of publications, countries, institutions, and authors' research profile, citation analysis, international collaborations, and impact of journals publishing documents on insecticide resistance will be presented. It was conducted via Scopus search engine which was used to retrieve relevant data. Keywords used were based on literature available on this topic. The duration of study was set from 1996-2015. RESULTS: A total of 616 documents, mainly as original research articles (n = 569; 92.37%) were retrieved. The average number of citations per article was 26.36. Poisson log-linear regression analysis indicated that there was a 6.00% increase in the number of publications for each extra article on pyrethroid resistance. A total of 82 different countries and 1922 authors participated in publishing retrieved articles. The United Kingdom (UK) ranked first in number of publications followed by the United States of America (USA) and France. The top ten productive countries included seven African countries. The UK had collaborations mostly with Benin (relative link strength = 46). A total of 1817 institution/ organizations participated in the publication of retrieved articles. The most active institution/ organization was Liverpool School of Tropical Medicine. Retrieved articles were published in 134 different scientific peer reviewed journals. The journal that published most on this topic was Malaria Journal (n = 101; 16.4%). Four of the top active authors were from South Africa and two were from the UK. Three of the top ten cited articles were published in Insect Molecular Biology journal. Six articles were about pyrethroid resistance and at least two were about DDT resistance. CONCLUSION: Publications on insecticide resistance in malaria vector has gained momentum in the past decade. International collaborations enhanced the knowledge about the situation of vector resistance in countries with endemic malaria. Molecular biology of insecticide resistance is the key issue in understanding and overcoming this emerging problems.

Contribution of Arab countries to breast cancer research: comparison with non-Arab Middle Eastern countries.

BACKGROUND: Breast cancer is one of the most common types of cancers affecting women worldwide. The main objective of this study was to assess and compare research activity in breast cancer in Arab countries with non-Arab Middle Eastern countries. METHODS: Publications about "breast cancer" as a research topic were retrieved using the ISI Web of Science database. Analysis was confined to original research and review articles. Research productivity was assessed by assessing number of publications and time trend of these publications, names of journals, citation analysis, top 10 active institutions as well as country contribution to breast cancer research. The quantity and quality of publications from Arab countries in addition to 3 other Middle East countries (Turkey, Iran and Israel) were assessed and compared using the h-index tool. RESULTS: A total of 1658 original research and review articles about "breast cancer" were published from Arab countries. Annual research productivity from Arab countries in the field of "breast cancer" was negligible but showed a significant increase in the last decade. Retrieved documents had relatively high citation parameters as measured by h-index of 61 and average citations of 17.46 per document. The highest research productivity was from Egypt with a total publication of 582 (35.10%). Cairo University with a total of 149 (8.99%) publications had the highest research productivity among institutions in Arab world. Forty four documents (2.65%) of breast cancer documents were published in Saudi Medical Journal. Arab researchers collaborated mostly with researchers from the United States of America (305; 18.40%) in breast cancer research. Compared with other non-Arab Middle Eastern countries, Arab countries had higher research productivity than some countries and lower than others, particularly Israel. CONCLUSIONS: The present data reveals a good contribution of some Arab countries to the field of "breast cancer" research. There is a gap between Arab countries and Israel in the quality of breast cancer research.

Parental knowledge, attitudes and practices regarding antibiotic use for acute upper respiratory tract infections in children: a cross-sectional study in Palestine.

BACKGROUND: In primary health care centres, upper respiratory tract infections (URTIs) in children are commonly encountered by physicians. Viruses cause most URTIs, but parents' attitudes often represent an important reason for antibiotic abuse, which leads to the development and spread of antimicrobial resistance. The goal of this study was to examine parents' knowledge, attitudes, and practices (KAP) about antibiotic use for children with URTIs in Palestine. METHODS: A cross-sectional study was performed in primary health care centres in Nablus city from 1 June to 31 October 2012. A questionnaire was developed and administered to determine parents' KAP regarding antibiotic use for their children with URTIs. RESULTS: Three hundred and eighty-five parents completed the questionnaire. A total of 79.7% of the parents were attentive to the truth that antibiotic misuse is responsible for bacterial resistance. Only 18.9% of parents thought that antibiotics did not have any harmful side effects. Fifty nine per cent of parents did not agree that URTIs are mostly viral in origin and are self-limited. Almost 73% of parents choose antibiotics as a treatment for URTIs, while earache (68%) and fever (64%) were the most common reasons for which parents expected antibiotics. However, more than 38% of the parents never asked the paediatrician to prescribe antibiotics, and only 6% congratulated their paediatricians for not prescribing antibiotics. CONCLUSIONS: Although there is a trusted relationship between parents and paediatricians, Palestinian parents have insufficient knowledge related to antibiotic use for URTIs in children, which results in inappropriate attitudes and practices. Educational interventions for both parents and physicians will reduce unnecessary antibiotic use and resistance.

Quantity and quality of obesity-related research in Arab countries: assessment and comparative analysis.

BACKGROUND: Obesity is a serious worldwide medical condition, considered by some researchers as one of the most serious public health problems of the 21st century. The main objective of this study was to assess the quantity and quality of obesity-related research from Arab countries and compare it with that from non-Arab Middle Eastern countries. METHODS: Original scientific articles or reviews published by Arab countries about obesity up until 2011 were screened using the ISI Web of Science database. Research activity was assessed by analyzing the annual research productivity, journals names, citations, top 10 active institutions, and the contribution of each Arab country to obesity research. RESULTS: The total number of original and review research articles published globally about obesity was 110,167. The leading country in obesity research was United States of America (42.47%). Turkey, Israel, and Iran were in the top 30 countries while Kingdom of Saudi Arabia (KSA), Egypt, and Kuwait ranked 39th, 43rd, and 47th, respectively. A total of 1,121 documents about "obesity" were published by Arab countries, representing 1.0% of the global research output, with 13,343 citations (average citation of 11.9 per document) and an h-index of 44. The Arab countries' research output was very low until the mid-1990s and then increased steadily. Of the 1,121 documents, 107 (9.55%) were published in the Saudi Medical Journal. KSA, with a total of 318 publications ranked first among Arab countries in research quantity while Kuwait ranked first after adjustment based on population size. King Saud University in KSA was the most productive institution with a total of 140 documents. Compared with other non-Arab Middle Eastern countries, the research productivity from Arab countries was lower than that from Turkey, higher than that from Iran, and close to that from Israel. However, the h-index of documents about obesity published from Arab countries was lower than that of Turkey and Israel, but slightly higher than that from Iran. CONCLUSIONS: The present data reveals a good contribution by some Arab countries, particularly Arab gulf countries, to obesity research. More efforts are needed by other Arab countries to bridge the gap in this topic and to improve the quality of obesity-related research originating from Arab countries.

Evaluation of Defined Daily Dose, percentage of British National Formulary maximum and chlorpromazine equivalents in antipsychotic drug utilization.

OBJECTIVE: The present study was carried out to investigate and compare the three methods for calculating total antipsychotic dose among outpatients with schizophrenia attending primary psychiatric health care centers. The three methods were: Defined Daily Doses (DDDs), chlorpromazine equivalents (CPZeq) and percentages of the British National Formulary (BNF) maximum. METHODOLOGY: Antipsychotic drug dosing data for 250 patients with schizophrenia were investigated by calculating Spearman's rank correlation coefficients. Factors associated with antipsychotic dose, expressed as DDDs, CPZeq and percentages of the BNF maximum recommended daily dose, were investigated by means of linear regression analysis. RESULTS: Spearman's correlation showed that there is a significant relationship between all pairs of the three dosing methods. In all three methods, coherence was strongest when dealing with first generation antipsychotics (FGA). Linear regression analyses showed a high degree of coherence between antipsychotic doses expressed as DDDs, CPZeq and percentages of the BNF maximum recommended daily dose. CONCLUSION: All three tested methods are reliable and coherent for calculating antipsychotic dosing.

Conformance to schizophrenia treatment guidelines in North West-Bank, Palestine: focus on antipsychotic dosing and polytherapy.

BACKGROUND: Analysis of the prescribing patterns of antipsychotic drugs can improve therapeutic outcomes. The purpose of this study was to evaluate the prescribing pattern of antipsychotics and its conformance to international treatment guidelines. METHODS: A cross sectional study at primary psychiatric centers was carried out. Patients' medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. All statistical analyses were conducted using Statistical Package for Social Sciences. RESULTS: 250 patients were included in this study. A total of 406 antipsychotic agents were used; 348 (85.7%) were first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n=126). There was no significant difference in positive (p=0.3), negative (p=0.06) and psychopathology (p=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose of (300 - 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Analysis showed that use of depot, use of anticholinergic agents and increasing amount of total CPZeq were significant factors associated with antipsychotic combination. CONCLUSIONS: This study indicated that antipsychotic prescribing was not in conformance with international guidelines with respect to maintenance dose and combination therapy. Type of antipsychotic treatment regimen, combination versus monotherapy, was not associated with better clinical or economic outcome.

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.

Estimation of 10-year probability bone fracture in a selected sample of Palestinian people using fracture risk assessment tool.

BACKGROUND: The Fracture Risk Assessment (FRAX) tool has been developed by the World Health Organization (WHO) to calculate 10-year probability hip fracture (HP) or major osteoporotic fracture (MOF). The objective of this study was to assess the 10-year probability of MOF and HF among a selected sample of Palestinian people. METHODS: A sample of 100 subjects was studied. Dual energy X-ray absorpitometry was performed to measure bone mineral density (BMD) which was then inserted into FRAX Palestine online WHO tool to calculate the 10-year probability of MOF and HF. RESULTS: The median age of participants was 61.5 years and the majority (79%) were females. The median (interquartile range) of femoral hip BMD was 0.82 (0.76-0.92) g/cm². The mean vertebral and hip T scores were -1.41 ± 0.13 SDs and -0.91 ± 0.10 SDs respectively. About one fifth of the sample (21%) had vertebral osteoporosis and 5% had hip osteoporosis. The median (interquartile range) 10-year probability of MOF and HF based on BMD were 3.7 (2.43-6.18)%, and 0.30 (0.10-0.68)% respectively. CONCLUSION: Osteoporosis is common among Palestinian people above 50 years old. Bone fracture prevention strategies and research should be a priority in Palestine. Using FRAX might be a helpful screening tool in primary healthcare centres in Palestine.

Prevalence of metabolic syndrome among patients with schizophrenia in Palestine.

BACKGROUND: Metabolic syndrome (MS) is a cluster of the most dangerous cardiac risk factors and is associated with high mortality. Ethnic differences in metabolic syndrome (MS) criteria and prevalence rates have been reported. The purpose of this study was to investigate the MS prevalence among patients with schizophrenia in Palestine. METHODS: We recruited 250 patients with schizophrenia from 4 psychiatric primary healthcare centers in Northern Palestine. The MS prevalence was assessed based on National Cholesterol Education Program Adult Treatment Panel III Adapted criteria. RESULTS: The overall MS prevalence was 43.6%, with 39% in male and 55.9% in female patients. On average, the study patients had 2.3 ± 1.3 metabolic abnormalities. Univariate analysis showed that MS was significantly higher with older age, female gender, longer duration of the illness, smoking, abdominal obesity, high systolic and diastolic blood pressure, high triglycerides, low HDL-C, and high fasting plasma glucose. Multiple logistic regression analysis showed that only systolic blood pressure, high triglycerides, high fasting plasma glucose, and low HDL-C were significant predictors of MS in schizophrenic patients. CONCLUSIONS: MS is common among Arab patients with schizophrenia. Patients with schizophrenia should receive regular monitoring and adequate treatment of cardio-metabolic risk factors.

Deliberate self-poisoning: a study from Nablus.

AIM: Arab Palestinians have experienced intense political, domestic and economic stressful conditions, which can increase the risk of self-harm. No previous studies haves been published to describe the patterns and rates of deliberate self-harm, particularly self-poisoning, in the Palestinian Authority. The objective of this study was to investigate deliberate self-poisoning in the Palestinian Authority. METHODS: All patients admitted to the emergency department of Al-Watani Governmental Hospital from May 2008 to April 2009 and identified as deliberate self-poisoning were investigated. The demographic and clinical data of the subjects were analyzed using SPSS16. RESULTS: A total of 54 individuals were identified. The mean age of these patients was 23.8±7.9 years and less than one-third (16; 29.6%) were under 18 years of age. The majority of the patients were female (35; 64.8%). Two-thirds (37; 68.5%) of the patients were Nablus city residents. An overdose of pharmaceutical products (39; 72.2%) was the most common method of self-poisoning. Significant associations were found between the type of material used in self-poisoning and place of residence (p=0.008) as well as gender (p=0.021). Gastric lavage was performed for 23 (42.6%) individuals, while only four (7.4%) received activated charcoal, and six (11.1%) had both. CONCLUSION: Rates of deliberate self-poisoning in the Palestinian Authority are lower than those reported from developed countries, but higher than that reported from other Arab countries. Regulations regarding the sale and storage of poisonous agricultural chemicals are needed in the Palestinian Authority.

Self-reported medication adherence and treatment satisfaction in patients with epilepsy.

OBJECTIVE: Reports about medication adherence and satisfaction in patients with epilepsy in Arab countries are lacking. The objective of this study was to assess medication adherence and its relationship with treatment satisfaction, number of antiepileptic drugs (AEDs) taken, and epilepsy control in a sample of Palestinian patients. METHODS: This cross-sectional descriptive study was carried out at Al-Makhfya Governmental Outpatient Center in Nablus, Palestine, during the summer of 2010. A convenience sampling method was used to select patients over the study period. Medication adherence was measured using the eight-item Morisky Medication Adherence Scale (MMAS); treatment satisfaction was measured using the Treatment Satisfaction Questionnaire for Medication (TSQM 1.4). Epilepsy was arbitrarily defined as "well controlled" if the patient had had no seizures in the last 3 months and was defined as "poorly controlled" if he or she had had at least one seizure in the last 3 months. RESULTS: A convenience sample of 75 patients was studied. On the basis of the MMAS, 11 patients (14.7%) had a low rate, 37 (49.3%) had a medium rate, and 27 (36%) had a high rate of adherence. Adherence was positively and significantly correlated with age (P=0.02) and duration of illness (P=0.01). No significant difference in adherence was found between patients with well-controlled and those with poorly controlled epilepsy. Similarly, there was no significant difference in adherence between patients on monotherapy and those on polytherapy. Mean satisfaction with respect to effectiveness, side effects, convenience, and global satisfaction were 73.6±20.7, 82.4±29.8, 69.5±15.5, and 68.4±18.3, respectively. There were significant differences in mean values in the effectiveness (P<0.01) and convenience (P<0.01) domains, but not the side effect (P=0.1) and global satisfaction (P=0.08) domains among patients with different levels of adherence. Patients on monotherapy had significantly higher satisfaction in the effectiveness domain (P=0.04) than patients on polytherapy. Similarly, patients with well-controlled epilepsy scored significantly higher in the Effectiveness (P=0.01) and Global Satisfaction (P=0.01) domains than those with poorly controlled epilepsy. CONCLUSION: In our convenience sample, we found that adherence to and satisfaction with AEDs were moderate and were not associated with seizure control or number of AEDs.

Knowledge and practices of pesticide use among farm workers in the West Bank, Palestine: safety implications.

OBJECTIVES: The objectives of this study were to assess the knowledge and practices associated with pesticide use in an agricultural community in Palestine, and to determine the prevalence of self-reported health symptoms related to pesticide exposure. METHODS: In this cross-sectional questionnaire study, agricultural farm workers in Nablus district, Palestine, were interviewed on their knowledge and practices of pesticide use. Comparisons of knowledge and practices of pesticide use between various groups were performed using the Mann-Whitney U-test or the Kruskal-Wallis rank test of variance. The program of the Statistical Package for Social Sciences (SPSS) version 15 was used for data analysis. RESULTS: The questionnaire was completed by 381 farm workers. The mean age ± SD of the participants was 38.8 ± 11.8 years. The majority (97.9%) of the participants were male. The mean participant scores for knowledge and safety procedures were 2.8 ± 3.2 out of 8 and 9.8 ± 2.4 out of 15, respectively. There was a significant positive correlation (r = 0.323; P < 0.001) between the knowledge and safety procedure scores. Unsafe behaviors were identified as the storage of pesticide products at home, the preparation of pesticides in the kitchen, inadequate disposal of empty pesticide containers, eating and drinking during pesticide application, and using inadequate protective clothing. The most frequent self-reported toxicity symptoms associated with pesticide use were skin rash (37.5%), headache (37%), excessive sweating (24.9%), and diarrhea (21.3%). There was a strong significant negative correlation (r = -0.83; P < 0.001) between self-reported toxicity symptoms and scores for protective measures. CONCLUSION: The results of this study indicate that most farm workers in this district need more educational programs regarding the safety and use of pesticides. Legislation promoting the use of safer pesticides is also needed.

Discharge medications among ischemic stroke survivors.

BACKGROUND: The aim of this study was to analyze the types and cost of medications prescribed at discharge for ischemic stroke survivors. METHODS: This is a descriptive study of medications prescribed for ischemic stroke survivors admitted to Al-watani hospital during a 6-month period. RESULTS: A total of 95 consecutive stroke patients were included in the study period; 78 (82.1%) survivors were having ischemic stroke subtype and were designated the study group. The average age of the survivors was 66.9 +/- 12.7 years. Survivors had prevalent risk factors such as diabetes mellitus (70%), hypertension (68%), and ischemic heart disease (34.6%). On average, survivors experienced a minimum of 0.73 complications (range 0-3) with the most common being infections (n = 35, 44.8%). Forty-two per cent of the ischemic stroke survivors were taking antiplatelet drugs prior to the current attack. At discharge, ischemic stroke survivors were prescribed an average of 4.9 medications from 4.3 different drug classes. All ischemic stroke survivors were prescribed antiplatelet therapy at discharge. Aspirin monotherapy was prescribed for 61 survivors while the combination of aspirin/clopidogrel antiplatelet therapy was prescribed for 17 survivors. The average monthly cost for prophylactic therapy and for medications used to treat post-stroke complication was approximately 52 USD per survivor. CONCLUSION: Most of the patients in the study group were having the traditional risk factors for ischemic stroke and were suffering form typical post-stroke complications. Lack of medical insurance will impose a heavy financial burden on stroke survivors in Palestine.

Optimal dosing of angiotensin-converting enzyme inhibitors in patients with chronic heart failure: a cross-sectional study in Palestine.

BACKGROUND AND OBJECTIVE: Because high-dose angiotensin-converting enzyme (ACE) inhibitor therapy is desirable in patients with chronic heart failure (CHF), we sought to determine the usage and dosing patterns of ACE inhibitors in CHF patients at a governmental hospital in Palestine. METHODS: This cross-sectional study was conducted between September 2006 and August 2007. All patients admitted with a confirmed diagnosis of CHF and an ejection fraction <40% were evaluated. After excluding patients with a caution/contraindication to ACE inhibitor use or not taking an ACE inhibitor, we determined the number of patients receiving optimal (captopril 150-300 mg/day, enalapril 20-40 mg/day, ramipril 5-10 mg/day) and suboptimal doses. We then conducted statistical analyses to evaluate associations between ACE inhibitor use and dosing and various demographic and clinical factors. RESULTS: Of the 165 patients initially evaluated, 69 (41.8%) had a caution/contraindication (n=28, 40.6%) or were not using an ACE inhibitor (n=41, 59.4%). Of the remaining 96 patients (70.1%), 49/96 (51%) were given an optimal dose while 47/96 (49%) were given a suboptimal dose. Of all patients with CHF and no contraindication (n=137), 88 (64.2%) were either receiving no ACE inhibitor or a suboptimal dose. Only the presence of hypertension was significantly associated with the use of an ACE inhibitor (P=.009, odds ratio=2.7). The use of an optimal dose was not significantly associated with any of the tested factors (age, gender, presence of hypertension, diabetes mellitus, renal dysfunction, ischemic heart disease or number of diagnosis) . CONCLUSION: Underutilization and suboptimal dosing of ACE inhibitors was common. Since there is an abundance of evidence in favor of using high-dose ACE inhibitor therapy in patients with CHF, physicians need to be educated about proper dosing of these agents.

Bibliometric analysis of global publications in medication adherence (1900-2017).

OBJECTIVES: Medication non-adherence is a worldwide problem. The aim of this study was to assess the global research output, research trends and topics that shaped medication adherence research. METHODS: A bibliometric methodology was applied. Keywords related to 'medication adherence' were searched in Scopus database for all times up to 31 December 2017. Retrieved data were analyzsd, and bibliometric indicators and maps were presented. KEY FINDINGS: In total, 16 133 documents were retrieved. Most frequently encountered author keywords, other than adherence/compliance, were HIV, hypertension, diabetes mellitus, schizophrenia, depression, osteoporosis, asthma and quality of life. The number of documents published from 2008 to 2017 represented 62.0% (n = 10 005) of the total retrieved documents. The h-index of the retrieved documents was 223. The USA ranked first (43.1%; n = 6959), followed by the UK (8.6%; n = 1384) and Canada (4.5%; n = 796). The USA dominated the lists of active authors and institutions. Top active journals in publishing research on medication adherence were mainly in the field of AIDS. Top-cited articles in the field focused on adherence to anti-HIV medications, the impact of depression on medication adherence and barriers to adherence. CONCLUSION: Adherence among HIV patients dominated the field of medication adherence. Research on medication adherence needs to be strengthened in all countries and in different types of chronic diseases. Research collaboration should also be encouraged to increase research activity on medication adherence in developing countries.

Poison Control and the Drug Information Center: the Palestinian experience.

BACKGROUND: The Palestinian Poison Control and Drug Information Center was established in 2006 to provide up-to-date information on medications and to help in the early diagnosis and management of poisoning cases. OBJECTIVES: To summarize the activities carried out by the PCDIC in the past 2 years. METHODS: Documented inquires received at the PCDIC were analyzed and the Center's activities were extracted from the files. RESULTS: During the first 2 years of the Center's existence, 323 enquiries were received, mainly (67.2%)from physicians; 70% of the calls were from the city of Nablus. Unintentional poisoning was the leading type of call (62.8%) followed by suicidal poisoning (20.7%). Medications were the major category of toxicants encountered (48.9%), followed by pesticides (23.5%). In 67.9% of the cases, the calls were initiated before any treatment was provided. The advice provided by the PCDIC was based on the nature of the call. During these 2 years the PCDIC has conducted both academic and non-academic activities. The Center introduced the concept of poison prevention weeks in Palestine and has conducted two so far. The PCDIC has published several articles in the fields of toxicology, rational drug use, complementary and herbal therapy, pharmacoepidemiology, and self-medication. CONCLUSIONS: Documentation of all enquiries is mandatory for analysis, evaluation, comparative purposes and quality assurance. More information campaigns are needed to encourage people to use the services provided by the PCDIC.