Association of Perceived Stress and Physical Activity Level with Severity of Coronary Artery Disease in Gaza Strip, Palestine: A Cross-Sectional Study.

BACKGROUND: The association between life-event stressors and low physical activity linked to the severity of coronary artery disease (CAD) is poorly understood. Therefore, this study aimed to determine the perceived stress status and physical activity level associated with the severity of CAD. METHODS: The study was conducted among 423 patients with newly discovered CAD (both sexes, aged 35-65 years) confirmed by coronary angiography results. CAD severity was classified according to the Gensini score as severe or non-severe. The fasting blood glucose and lipid profiles were also investigated. Anthropometric and brachial blood pressure measurements were obtained. A structured questionnaire including participants' characteristics, the Perceived Stress Scale (PSS-14), and the International Physical Activity Questionnaire were used via face-to-face interviews. Multivariable binary logistic regression was used to assess the predictors of CAD severity using IBM SPSS ver. 24.0 (IBM Corp., Armonk, NY, USA). RESULTS: Most participants were classified as having severe CAD (63.8%). Adjusting for age, sex, smoking status, systolic blood pressure, body mass index, and history of hypertension, the severity of CAD increased by 9% for a onescore increase in the PSS (odds ratio [OR], 1.09; 95% confidence interval [CI], 1.01-1.14; P=0.030). Moreover, sufficiently active (600-1,500 metabolic equivalents [METs]/wk) patients had lower odds of severe CAD (OR, 0.43; 95% CI, 0.23-0.72; P=0.027) than those with insufficient activity. However, no significant association was found between physical activity (≥1,500 METs/wk) and CAD severity. CONCLUSION: The odds of CAD severity significantly increased with increasing perceived stress score but decreased with sufficient physical activity.

COVID-19 Routes of Transmission, Protection Aids, and Immunity Enhancement: Community-Based Online Knowledge Survey Among Palestinians.

AIM: Coronavirus disease in 2019 has been defined as a pandemic by the World Health Organization. This study aimed to assess the level of knowledge toward the coronavirus disease 2019 among the Palestinian population. METHOD: A cross-sectional online survey among 554 Palestinians was designed. A structured self-administered online questionnaire was distributed among 190 participants from West Bank and 364 from Gaza Strip during the outbreak through social media. The survey was conducted between 10th and 24th of October, 2020. RESULTS: Of the total enrolled participants, 401 were males and 153 were females; the mean age was 28.4 years with a standard deviation of 10.97. Results showed that the means of knowledge about coronavirus disease 2019 were: 76.7% (standard deviation = 12.8), 72.2 (standard deviation = 10.3), 77.7% (standard deviation = 11.0) for general knowledge, the transmission of coronavirus disease 2019, and immunity and protection aids, respectively. Univariate regression revealed significant associations among the level of knowledge and gender, governorates, education levels, and employment status. However, only gender remained a significant explanatory variable in multivariable analysis, as females were nearly four times more knowledgeable than males (OR = 3.94; 95% CI =1.71, 9.07; p = .001). CONCLUSION: In general, Palestinians had good knowledge about coronavirus disease 2019, modes of transmission, and immunity knowledge. Knowledge was less among males than females. This may need more effort by using different tools of communication to reach more to the male gender.

Nontraditional risk factors of coronary artery disease among Palestinians: A case-control study.

BACKGROUND: Coronary Artery Disease (CAD) is one of the most common causes of death in Palestine. This study aimed to assess the nontraditional risk factors among CAD patients underwent invasive coronary angiography in Gaza-Palestine. METHODS: Unmatched one-to-one case-control study was conducted among 200 participants. Cases were recruited from newly discovered CAD patients after a confirmed diagnosis of CAD by interventional cardiologist post catheterization "coronary angiography" in Al-Shifa Cardiovascular Catheterization Center. Controls were enrolled from individuals with no history of CAD. An interview-based questionnaire was used to assess patient's characteristic data and medical history; anthropometric, and the Ankle Brachial Index(ABI) was measured and calculated. Furthermore, biochemical analysis of high sensitivity C-reactive protein (hs-CRP) level and Random blood glucose level (RBG) and Leukocyte count (WBCs)were investigated. All required ethical approvals were obtained. Data were managed and analyzed by STATA version 14. Correlation analysis by multivariate logistic regression was done. RESULTS: hs-CRP, RBG, and WBCs remained significant predictors for CAD adjusted for age, education level, employment status, and monthly income. As, the odds of CAD increased by 3% for each unit increased in hs-CRP (Odd Ratio (OR)=1.03; 95% confidence interval (CI):1.01, 1.06; P = 0.020); and the odds of CAD was augmented by 30% for each unit increased in WBCs (OR= 1.30; 95% CI: 1.07, 1.67; P = 0.010); While the odds of CAD was 5 times more for each unit increased in RBG (OR=5.04; 95% CI: 1.17, 14.88; P = 0.003). Still, age remained a significant risk factor as the odds of CAD was 19% more for each increased year in age (OR=1.19; 95%CI: 1.13, 1.26; P<0.001). CONCLUSION: Nontraditional factors (hs-CRP, RBG, and WBCs) are significant predictors of CAD, and should be considered in adult patients coming with attacks of angina pain.

Undiagnosed Depression among Hypertensive Individuals in Gaza: A Cross-sectional Survey from Palestine.

BACKGROUND: The aim of this study was to estimate the prevalence and to determine the associated factors of undiagnosed depression amongst hypertensive patients (HTNP) at primary health care centers (PHCC) in Gaza. METHODS: A cross-sectional survey was conducted including 538 HTNP as a recruitment phase of a clustered randomized controlled trial. Data were collected through face-to-face structured interview, and depression status was assessed by Beck's Depression Inventory (BDI-II). Data were analyzed by STATA version 14 using standard complex survey analyses, accounted for unresponsiveness and clustering approach. Generalized linear regression analysis was performed to assess associations. RESULTS: The prevalence of undiagnosed clinical depression was 11.6% (95% confidence interval [CI]: 8.1, 16.3). Moreover, prevalence of 15.4% (95% CI: 10.8, 21.6) was found for mild depression symptoms. We found that non-adherence to antihypertensive medications (AHTNM) (ß = 0.9, 95% CI: 0.17, 1.7), having more health-care system support (ß = 2.8, 95% CI: 1.6, 3.9) and number of AHTNM (ß = 1.5, 95% CI: 0.6, 2.5) remain significantly positively associated with BDI-II score. On the other hand, older age (ß = -0.1, 95% CI: -0.2, -0.02), having better social support (ß = -6.8, 95% CI: -8.9, -4.7) and having stronger patient-doctor relationship (ß = -4.1, 95% CI: -6.9, -1.2) kept significantly negative association. CONCLUSION: The prevalence of undiagnosed depression was about one-quarter of all cases; half of them were moderate to severe. Routine screening of depression status should be a part of the care of HTNP in PHCC.

Effectiveness of motivational interviewing on medication adherence among Palestinian hypertensive patients: a clustered randomized controlled trial.

BACKGROUND: This trial aimed to evaluate the effectiveness of motivational interviewing (MINT) among medication non-adherent hypertensive patients attending primary healthcare centres in Gaza Strip. METHODS AND RESULTS: A clustered randomized controlled trial was run among 355 hypertensive participants; who were identified as non-adherent by a self-reported adherent scale and were recruited from 10 centres by two stages cluster random sampling approach (five centres were randomly allocated to each group). Standard of hypertension care was provided to 173 participants, parallel to 182 one who received their standard of care including non-blinded MINT sessions for 3 months. The change in medication adherence status was the primary outcome and within-patient changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), self-efficacy and intrinsic motivation were the secondary outcomes. Data were collected via an interview-based structured questionnaire and were analysed by generalizing equation estimation model adjusting for covariates. The results showed a significant improvement in medication adherence status among participants in the intervention group (n = 159) [OR= 6.28; 95% confidence interval (CI): 3.20, 12.33; P < 0.001] compared with those in the control group (n = 151). Moreover, there were significant drops in both SBP (OR = 0.18; 95% CI: 0.06, 0.55; P = 0.002) and DBP (OR = 0.26; 95% CI: 0.09, 0.76; P = 0.013) and significant positive changes in both within-patient's self-efficacy (OR = 15.4; 95% CI: 3.9, 60.6; P < 0.001) and intrinsic motivation (OR = 31.7; 95% CI: 13.9, 71.9; P < 0.001). CONCLUSION: Standard of care including MINT is an effective client-centred approach which promoted medication adherence, decreased mean blood pressure, and improved self-efficacy and intrinsic motivations among hypertensive patients.

Multidrug resistant tuberculosis treatment outcome in children in developing and developed countries: A systematic review and meta-analysis.

BACKGROUND: We aimed to compare and contrast the proportions of treatment outcome between developing and developed countries in children treated for multidrug resistance tuberculosis (MDR-TB). METHODS: We conducted a systematic review and meta-analysis of articles published on children treated for MDR-TB. We searched published articles from electronic databases: PubMed/Medline, EMBASE, Scopus and Web of Science for English articles without restricting publication year. We employed random-effects meta-analysis model to estimate the pooled proportions of treatment success, death, treatment failure and lost to follow up. RESULTS: We pooled data of 1,343 children obtained from 17 included studies, and the overall pooled treatment success was 77.0% (95% Confidence Interval (CI), 69.0-85.0). Pooled treatment success in developing countries was 73.0% (63.0-83.0), while in developed countries 87.0% (81.0-94.0). The overall pooled treatment failure was 3.0% (1.0-6.0), while death 8.0% (4.0-11.0) and lost to follow up 10.0% (6.0-4). CONCLUSION: MDR-TB treatment success in children is well achieved in both developed and developing countries by currently available drugs. Improving MDR-TB treatment programme is vital to achieve the maximum treatment successful. Promoting research on pediatric MDR-TB treatment outcome could also help to fill evidence gap.

Intimate partner violence against Palestinian women in Gaza strip: Prevalence and correlates.

CONTEXT: Intimate partner violence (IPV) affects gravely the victims and is resulting in negative physical and psychological consequences. AIMS: This paper aimed to determine the prevalence of IPV against women in Gaza strip and associated factors. Moreover, to explore women's seeking behaviors to help. SETTINGS AND DESIGN: Cross-sectional study. METHODS AND MATERIALS: Community internet-based survey was conducted using the Heart Insult Threat Scout questionnaire and the reporting behavior of respondent to violence act. STATISTICAL ANALYSIS USED: A number of 517 ever married women responded and data were entered and analyzed using SPSS software version 23. RESULTS: About 517 women participated. Of which, 23% (119/517) reported exposure to any types of IPV. Multivariate logistic regression showed factors associated with IPV were as follows: husbands who are drug user (OR = 27.577, CI95%: 5.153-147.591; P < 0.001), husband exposure to violence in childhood (OR = 9.174, CI95%: 4.753-7.727; P > 0.001), and family with a special needs child (OR = 2.956, CI95%: 1.131-8.607; P < 0.05). Approximately, two-thirds of the victims tended to keep silent toward violence and dealt with it as a private and family issue; hence, they hesitated to communicate with others or seek any help to protect themselves. CONCLUSIONS: About 23% from the study participants experience violence in their life time. Factors associated with IPV are husband's drug abuse, having a child with special needs, and husband's childhood experience of violence. Qualitative researches are needed to understand the women experience to violence and sociocultural barrier for disclosure.

Post-Traumatic Stress Disorder Among Health Care Providers Following the Israeli Attacks Against Gaza Strip in 2014: A Call for Immediate Policy Actions.

PURPOSE: This study aimed to assess the level of posttraumatic stress disorder and to examine the relationship between exposure to war stress and posttraumatic symptoms among health care providers following Israeli offensives against Gaza Strip in 2014. METHODOLOGY: A cross-sectional design was used for this study. We targeted all nurses and doctors working in three governmental hospitals in the Gaza Strip and worked with victims of the last war, more specifically, those who were working in emergency departments, intensive care units, operating rooms, surgical departments, and burn units. A demographic sheet and Impact Event Scale-Revised were used in this study. The Impact Event Scale-Revised has three sub-scales; intrusion, avoidance, and hyper-arousal. RESULTS: The results showed that 291 (89.8%) of 324 participants had scores more than 35 (threshold cut-off point) on the Impact Event Scale-Revised. Scores ranged from zero to 80 with a mean of 52.13. Females had higher levels of stress (55.79) than males (51.63) and nurses (54.85) had more stress than physicians (47.38). The most frequent symptoms of trauma subscales was "avoidance" (mean=20.04), followed by "intrusion" (mean=17.83), and then "hyper-arousal" (mean=14.27). Levels of trauma symptoms were not affected by place of living, hospital of work, while level of education had impacted level of trauma. CONCLUSION: The findings showed that health care providers suffered from severe posttraumatic symptoms after exposure to prolonged war stress. This level of trauma among health care providers warrants intervention programs to reduce stress and trauma among Gaza health care providers after the war.