Epidemiology of multiple sclerosis in West bank of Palestine.

BACKGROUND: Multiple sclerosis (MS) is the most common demyelinating disease of the central nervous system, and the major neurologic cause of disability in young adults. Its incidence and prevalence vary significantly between different ethnic groups and geographical regions. It is thought that MS is more frequent as we go further from the equator. In Palestine, there is yet no published data concerning its incidence and prevalence. So, in this article, we aim to study the epidemiological and clinical characteristics of MS in the West Bank of Palestine. METHODS: A retrospective observational study was conducted from year 2010 to 2019 among MS patients in West Bank. Demographic and clinical records of concerned patients were collected from the database of the Palestinian Ministry of Health. Age, sex, onset of symptoms, first symptom, year of diagnosis, family history, and smoking were noted. The crude 2019 prevalence and incidence rate were calculated. RESULTS: We identified 1652 MS patients with 1074 (65.01%) females and 578 (34.99%) males. In 2010, the crude incidence rate was 1.96 cases per 100,000. Peaked in 2017 to 6.08, and then dropped unexpectedly in 2018 to 2.91 before it re-rose again to 3.54 in 2019. The incidence rates among females were higher than in males from 2010 to 2019. 802 and 730 patients were diagnosed at age groups (below 30) year and (30-45) year respectively, which comprises 92.74% of all patients. Males were slightly more affected at a later age group (30-45), whereas females were more affected at age group below 30. The most common symptom at disease onset was motor presentation (16.04%) followed by blurring of vision (15.74%). CONCLUSION: This is the first epidemiological study regarding MS disease in the West Bank of Palestine. Our results showed that crude incidence rate is increasing from 2010 to 2017. This is in part due to increasing awareness of the disease as well as the availability of diagnostic tools. Further researches will be necessary to closely monitor this increasing trend of the disease amongst Palestinian population in the coming future. Clinical features of the disease were similar to those described in the literature.

Depression and anxiety symptoms in cardiac patients: a cross-sectional hospital-based study in a Palestinian population.

BACKGROUND: Mental health problems have an adverse effect on the course of cardiac disease. The integration of their diagnosis and treatment into cardiology care is generally poor. It is particularly challenging in cultural environments where mental health problems are stigmatized. The objective of the current study was to investigate the proportion of cardiac patients with depression and anxiety as well as factors associated with the presence of these symptoms in a Palestinian population. METHODS: This cross-sectional hospital-based study was conducted on patients consecutively admitted with a new or existing cardiac diagnosis to one of the four main hospitals in Nablus, Palestine over an eight-month period. Data was obtained from hospital medical charts and an in-person interview, using a structured questionnaire with a sequence of validated instruments. All subjects were screened for depression and anxiety using the Cardiac Depression Scale (CDS) and the Depression Anxiety Stress Scale (DASS-42). Multivariate ordered logistic regression analyses were performed to identify factors among four categories (socio-demographic, clinical, psychosocial, lifestyle) independently associated with depression and anxiety. RESULTS: In total, 1053 patients with a confirmed cardiac diagnosis were included in the study with a participation rate of 96%. Based on the CDS and DASS-42, 54% met the criteria for severe depression (CDS > 100) and 19.2% for severe-to-very severe anxiety (DASS-anxiety > 15), respectively. Symptoms of depression and anxiety were more prevalent among females and less educated patients. Factors independently associated with both depressive and anxiety symptoms were post-traumatic stress disorder symptoms, low level of self-esteem, high somatic symptoms, low physical and mental health component scores, active smoking, physical inactivity, and longer disease duration. Patients with depressive and anxiety symptoms also reported poor social support and lower resilience. CONCLUSION: There was a high level of depression and anxiety in this sample of cardiac patients. The results point to characteristics of patients in particular need for mental health screening and suggest possible targets for intervention such as strengthening of social support and of physical activity. The integration of mental health services into cardiac rehabilitation in Palestine and comparable cultural settings is warranted from the time of first diagnosis and onward.