Knowledge and practice of community pharmacists regarding the safety of drugs during pregnancy: a cross-sectional study from a developing country.

BACKGROUND: Drug use during pregnancy can cause unfavorable fetal and maternal outcomes. Information sharing is essential for pharmacists' role within intricate, modern healthcare systems. Community pharmacists (CPs) have demonstrated unsatisfactory knowledge across various pharmacological domains in most developing countries. This study aimed to explore the knowledge and practices of CPs regarding medications and herb safety during pregnancy. METHODS: A cross-sectional study was conducted in a developing country using a self-administered questionnaire. A sample of CPs working in the northern governorates of the West Bank was selected by convenience sampling. The questionnaire included questions on sociodemographic characteristics, practices and knowledge. Descriptive and inferential statistics were calculated using the Statistical Package for the Social Sciences (SPSS) to analyze the data. RESULTS: A total of 207 questionnaires were completed. Most respondents had only a bachelor's degree (89.9%) but did not participate in continuous professional development (CPD) (71.0%). Almost one-third of the CP workload involved dispensing drugs to pregnant women. The majority of the participants reported that they inquire about pregnancy status (59.9%), refer to scientific sources (82.6%), and contact a prescribing physician (51.2%) in cases of uncertainty. A higher knowledge score was associated with receiving a master's degree and CPD programs. Most CPs identified folic acid, paracetamol and amoxicillin as safe, while tetracycline, isotretinoin, enalapril, pseudoephedrine and ibuprofen were among the drugs mostly reported as unsafe. Castor oil, Senna, St. John's wort and ginseng were the most frequently reported herbs as unsafe. CONCLUSIONS: Despite the gaps in knowledge about herb pharmacology, CPs demonstrated acceptable knowledge and practice regarding drug safety during pregnancy. CPD is recommended for addressing gaps in knowledge and practice. Future research evaluating knowledge and practice may benefit from developing a specific, accurate, validated instrument.

Mapping the global research landscape on nutritional support for patients with gastrointestinal malignancy: visualization analysis.

BACKGROUND: Early nutritional treatment is crucial for the care of patients with operable and advanced gastrointestinal malignancies. Therefore, much research has focused on nutritional support for patients with gastrointestinal malignancies. Therefore, this study aimed to evaluate the global scientific output and activity with respect to nutritional support and gastrointestinal malignancy. METHODS: We searched in Scopus for publications on gastrointestinal cancer and nutritional assistance published between January 2002 and December 2021. Then, using VOSviewer 1.6.18 and Microsoft Excel 2013, we conducted bibliometric analysis and visualization. RESULTS: A total of 906 documents were published between 2002 and 2021, including 740 original articles (81.68%) and 107 reviews (11.81%). China ranked first (298 publications, 32.89%), Japan ranked second (86 publications, 9.49%) and the USA ranked third (84 publications, 9.27%). The organisation with the highest number of publications was the Chinese Academy of Medical Sciences & Peking Union Medical College from China, with 14 articles, followed by the Peking Union Medical College Hospital from China and the Hospital Universitari Vall d'Hebron from Spain (13 publications for each). Before 2016, most studies focused on 'nutrition support for patients undergoing gastrointestinal surgery'. However, the latest trends showed that 'nutrition support and clinical outcomes in gastrointestinal malignancies' and 'malnutrition in patients with gastrointestinal cancer' would be more widespread in the future. CONCLUSIONS: This review is the first bibliometric study to provide a thorough and scientific analysis of gastrointestinal cancer and nutritional support trends worldwide over the last 20 years. This study can aid researchers in decision-making by helping them understand the frontiers and hotspots in nutrition support and gastrointestinal cancer research. Future institutional and international collaboration is expected to accelerate the advancement of gastrointestinal cancer and nutritional support research and investigate more efficient treatment methods.

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.

Assessment of practices and awareness regarding the disposal of unwanted pharmaceutical products among community pharmacies: a cross-sectional study in Palestine.

BACKGROUND: The improper disposal of pharmaceutical preparations substantially threatens human health and environmental safety. Pharmacists are responsible for properly disposing of unwanted medications and educating patients about how to do so themselves. This study aimed to assess community pharmacists' knowledge, determine their views on how to dispose of unwanted pharmaceuticals, and assess the extent to which they realize that it is their responsibility to guide patients toward the safe disposal of expired medications. METHODS: A descriptive cross-sectional study was conducted between December 2021 and April 2022 among 400 practicing pharmacists who were chosen to participate by random cluster sampling. Community pharmacists' practices, awareness, and beliefs about disposing of unused drugs were evaluated. The Statistical Package for Social Sciences (IBM-SPSS) version 21 was used for data entry and analysis. RESULTS: Of 400 pharmacists, 348 stated that they did not participate in courses on the safe disposal of unwanted medications. Disposal of drugs in the garbage, an unsafe method, was very frequently recommended by pharmacists to patients, especially regarding inhalers, antibiotics, hormonal drugs, and solid and semisolid drugs. However, many pharmacists advised patients to return their hormonal, category B, and category C drugs to the pharmacy. A total of 61.3% of pharmacists agreed and 26% strongly agreed that unsafe disposal of drugs negatively affects the environment. A total of 54.3% of the participants agreed that improper disposal of antibiotics might be a reason for increased antimicrobial resistance, and 54.5% of them agreed that improper disposal of hormonal drugs might contribute to the development of certain cancers. A total of 80.3% of the participants perceived that most unwanted drugs in pharmacies were those returned from patients. A total of 97.3% of the participants supported establishing a drug disposal system, with 77.5% choosing to have the district health board responsible for funding this system. A total of 48.5% of the participants indicated that a lack of education and awareness on the issue of getting rid of unused drugs constitutes a challenge to the safe disposal of medicines, and 66% of them said that a lack of law enforcement constitutes another challenge. A total of 95.5% of the participants agreed or strongly agreed that good training for health sector workers and organizing workshops to develop knowledge on this subject would improve practices. A total of 93.3% supported distributing educational brochures, and 92.8% supported placing special containers in every pharmacy to collect unwanted drugs. CONCLUSIONS: Most pharmacists in our study returned drugs to manufacturing companies and stores, and few followed the correct methods of incineration and return of drugs to the Ministry of Health. Current data emphasize the issue of improper disposal of medicine in Palestine and the need for improved education among healthcare workers.

Assessment of drug interactions and their associated factors among patients with cardiovascular diseases: a cross-sectional study from the occupied Palestinian territory.

BACKGROUND: Cardiovascular diseases (CVDs) are the leading cause of death in the West Bank and worldwide. Potential drug-drug interactions (pDDIs) contribute to a significant proportion of adverse drug reactions, which have been shown to be a major cause of morbidity and mortality. Patients with CVD require more attention regarding these interactions owing to the complexity of their conditions and therapeutic regimens. The purpose of this study was to assess the prevalence and types of pDDIs, and their associated factors in patients with CVD. METHODS: A cross-sectional study was conducted at two large referral hospitals for patients with CVD in the northern West Bank. Inpatients who were diagnosed with any CVD during the period of the study (from Sept 1, 2016, to Feb 28, 2017) were selected by convenience sampling. Data were collected from patients' medical records and in a face-to-face interview with each of the patients (by use of a standardised data collection form). The sample size was calculated using the Raosoft calculator. pDDIs between medications prescribed at discharge were identified using the Lexicomp interaction checker. Data were analysed with SPSS version 16. FINDINGS: The study included 400 patients with CVDs. According to the Lexicomp interaction checker, 94% (375 of 400) of the patients were discharged with medications with pDDIs. Patients had an average of 3·14 (SD 1·41) diseases, and were prescribed 1-16 medications on discharge (mean 7·08, SD 2·76). The most common comorbid disease was diabetes (in 51% of patients; 205 of 400), followed by chronic kidney disease (in 14% of patients; 56 of 400). Aspirin was the most frequently prescribed medication. The most frequent pDDI was furosemide and aspirin, which were prescribed simultaneously for 37% of patients (148 of 400), followed by angiotensin-converting-enzyme inhibitor and aspirin, which were prescribed simultaneously for 33% of patients (131 of 400), and statins and proton pump inhibitors, which were prescribed simultaneously for 32% of patients (129 of 400). The number of pDDIs was associated with the number of diseases (p<0·0001), the total number of discharge medications (p<0·0001), and the length of hospital stay (p=0·0012). INTERPRETATION: The prevalence of pDDIs is very high among discharge medications for patients with CVDs. These interactions were associated with the number of diseases, the number of medications prescribed, and the length of hospital stay. Monitoring for pDDIs should be performed regularly. To prevent the risks of pDDIs, work is required to raise awareness, and clinical pharmacists should be involved in reviewing medications at discharge. FUNDING: None.

Global research trends on the links between the gut microbiome and cancer: a visualization analysis.

BACKGROUND: Significant links between the microbiota and human health have emerged in the last 20 years. A correlation has recently been demonstrated between changes in the gut microbiota and the development of cancer. This study aimed to use bibliometric analysis of the published gut microbiome and cancer literature to present the research status and summarize the hotspots for frontier studies. METHODS: A literature search for research on the gut microbiome and cancer research from 2001 to 2020 was conducted using the Scopus database on 20 March 2021. VOSviewer software (version 1.6.16) was used to perform the visualization analysis. RESULTS: From 2001 to 2020, a total of 2061 publications were retrieved. Annual publication output grew from 10 in 2001 to 486 in 2020. The USA had the largest number of publications, making the largest contribution to the field (n = 566, 27.46%). Before 2016, most studies focused on the 'effect of probiotics on cancer'. The latest trends showed that 'microbiota composition and gene expression' and 'host-microbiome interaction in cancer immunotherapy' would be more concerned more widely in the future. CONCLUSIONS: Research on 'microbiota composition and gene expression' and 'host-microbiome interaction in cancer immunotherapy' will continue to be the hotspot. Therefore, this study provides the trend and characteristics of the literature on the gut microbiota and cancer literature, which provided a useful bibliometric analysis for researchers to conduct further research.

The relationship between self-efficacy and treatment satisfaction among patients with anticoagulant therapy: a cross-sectional study from a developing country.

BACKGROUND: Thromboembolic events are a common complicated health problem. Although anticoagulants have several positive effects on these conditions, they also have several characteristics that strongly affect compliance and satisfaction. The purpose of this investigation is to explore the association between treatment satisfaction and self-efficacy in a sample of patients using anticoagulation therapy and determine the influence of sociodemographic and clinical factors on both aspects. METHODS: This was a cross-sectional exploratory study carried out in Palestine. The Arabic version of the Anti-Coagulant Treatment Satisfaction Scale (ACTS) assessed treatment satisfaction. In addition, the Arabic version of the 6-Item Self-Efficacy for Managing Chronic Diseases (SES6C) was used to assess self-efficacy. RESULTS: A total of 300 patients using anticoagulants (average age 51.95 and SD 17.98) were included. There is a modest correlation between treatment satisfaction and self-efficacy (r = 0.345; p <  0.001). The mean and median self-efficacy scores were 38.41 ± 9.88 and 39.00 (interquartile range: 33.00-46.00), respectively. Overall, patients reported a moderate burden and benefit score. The mean and median of the acting burden were 43.30 ± 10.45, and 43.30 (interquartile range: 36.00 to 51.00), respectively. The results showed that young age, higher education, employment, use of fewer medications, and having fewer diseases were significantly associated with higher self-efficacy behaviors. The results also showed that new oral anti-coagulants (NOACs) had a higher degree of self-efficacy and ACTS benefit scores (41.00 (33.75-47.00), p = 0.002; 13.00 (12.00-15.00), p <  0.001, respectively), than vitamin k antagonists (VKA). CONCLUSIONS: The results demonstrated a significant relationship between treatment satisfaction and self-efficacy, and certain sociodemographic and clinical characteristics influence both. We found that there is a higher degree of self-efficacy and treatment satisfaction among patients who use NOACs than those who use UFH / VKA. Therefore, patients should be motivated to increase their knowledge about anticoagulant therapy. Healthcare providers should play an active role in educating patients, increasing their self-esteem, and awareness about anticoagulant drugs. Importantly, this study was an explanatory one, and it includes a low proportion of patients with venous thromboembolism. This encourages future research on a large scale of patients, considering the indications of anticoagulant therapy.

Nurses' knowledge and understanding of obstacles encountered them when administering resuscitation medications: a cross-sectional study from Palestine.

BACKGROUND: Medication errors (ME) are one of the most important reasons for patient morbidity and mortality, but insufficient drug knowledge among nurses is considered a major factor in drug administration errors. Furthermore, the complex and stressful systems surrounding resuscitation events increase nursing errors. AIMS: This study aimed to assess the knowledge about resuscitation medications and understand the obstacles faced by nurses when giving resuscitation medications. Additionally, errors in the reporting of resuscitation medication administration and the reasons that prevented nurses from reporting errors were investigated. METHODS: A cross-sectional study was conducted in the West Bank, Palestine. Convenient sampling was used to collect data, which was collected via a face-to-face interview questionnaire taken from a previous study. The questionnaire consisted of five parts: demographic data, knowledge of resuscitation medications (20 true/false questions), self-evaluation and causes behind not reporting ME, with suggestions to decrease ME. RESULTS: A total of 200 nurses participated in the study. Nurses were found to have insufficient knowledge about resuscitation medications (58.6%). A high knowledge score was associated with male nurses, those working in the general ward, the cardiac care unit (CCU), the intensive care unit (ICU) and the general ward. The main obstacles nurses faced when administering resuscitation medication were the chaotic environment in cardiopulmonary resuscitation (62%), the unavailability of pharmacists for a whole day (61%), and different medications that look alike in the packaging (61%). Most nurses (70.5%) hoped to gain additional training. In our study, we found no compatibility in the definition of ME between nurses and hospitals (43.5%). CONCLUSIONS: Nurses had insufficient knowledge of resuscitation medications. One of the obstacles nurses faced was that pharmacists should appropriately arrange medications, and nurses wanted continuous learning and additional training about resuscitation medications to decrease ME.

Impact of socio-demographic and clinical characteristics on functional disability and health-related quality of life in patients with rheumatoid arthritis: a cross-sectional study from Palestine.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic autoimmune disorder, which has a significant impact on patients' health-related quality of life (HRQoL), and limits physical function as well as increases pain and fatigue. Therefore, this study aimed to evaluate the HRQoL and functional disability profile of patients with RA in Palestine to determine the socio-demographic and clinical features associated with low HRQoL and functional disability in patients with RA and to investigate the impact of drugs used on functional disability and HRQoL. METHODOLOGY: A cross-sectional, observational study conducted at rheumatology clinics in Northern West-Bank, Palestine (Alwatani Hospital-Nablus, Khalil Suleiman Hospital-Jenin, Thabet Thatbet Hospital-Tulkarem, and Darweesh Nazzal Hospital-Qalqilia). EuroQoL-5 Dimension scale (EQ-5D-5L) was used to evaluate HRQoL, Health Assessment Questionnaire, Disability Index (HAQ-DI) to evaluate the functional disability, and the Health Assessment Questionnaire pain visual analog scale (HAQ-VAS) to evaluate pain. RESULTS: 300 patients were included in the study, 229(76.3%) were females, the mean ± standard deviation age was 49 ± 13.10 years, and the median RA duration (lower-upper quartiles) was 6 (4-12) years. The median EQ-5D-5L index value and Euro QOL visual analogue scale (EQ-VAS) scores were 0.56 and 60, respectively. There was a significant strong positive correlation (R = 0.773; p < 0.001) between the EQ-5D-5L index values and the reported EQ-VAS scores. The median HAQ-DI and HAQ-VAS were 0.94 and 40, respectively. The results of multiple linear regression showed that treatment with biological DMARD (Etanercept), having work, higher income, absence of night pain, and absence of comorbid diseases were significantly associated with higher EQ-5D-5L index score (better HRQoL) and lower HAQ-DI scores (less disability). On the other hand, older age and the presence of morning stiffness were significantly associated with higher HAQ-DI scores (more disability). CONCLUSIONS: This study revealed the impact of treatment, clinical variables, and socio-demographic factors on disability and HRQoL in RA patients. Healthcare providers should be aware of the association between treatment with biological DMARD and improved HRQoL and functional status to make early interventions that reduce disability and improve HRQoL in susceptible patients.

The impact of pain on the quality of life of patients with end-stage renal disease undergoing hemodialysis: a multicenter cross-sectional study from Palestine.

BACKGROUND: Chronic kidney disease is considered as a global health problem. Hemodialysis (HD), following renal transplantation, is the most common form of renal replacement therapy. However, HD may impact the quality of life (QOL). Pain is a frequent complaint among this population that also affects their QOL. The purposes of this study were to assess pain and QOL among end-stage renal disease (ESRD) patients on HD and to examine their association. METHODS: This was a multicenter, cross-sectional study that occurred in Palestine between August and November 2018. Brief Pain Inventory and European Quality of Life scale 5 dimensions (EQ-5D) scale, including its European Quality of Life visual analogue scale (EQ-VAS) component, were used to assess pain and QOL, respectively. RESULTS: A total of 300 participants were included in the final study. The average age of the subjects was 54 ± 16 years. Their median EQ-5D score was 0.68 [0.54-0.88], whereas their median EQ-VAS score was 60 [40-75]. A statistically significant association of pain severity score with EQ-5D score was found (r = - 0.783, p < 0.001). The association between pain interference score and EQ-5D score was also found to be statistically significant (r = - 0.868, p < 0.001). Similarly, pain severity score was significantly assocsiated with EQ-VAS score (r = - 0.590, p < 0.001), the same as was the pain interference score (r = - 0.647, p < 0.001). Moreover, age, gender, BMI, employment, educational level, income level, dialysis vintage, previous kidney transplantation, and chronic medication use were all significantly correlated with QOL. Regression analysis showed that patients aged < 60 years (p < 0.001), those with lower pain severity scores (p = 0.003), and those with lower pain interference scores (p < 0.001) had significantly higher QOL scores. CONCLUSIONS: Pain has a significant negative impact on QOL in ESRD patients undergoing HD. The subgroups that were at higher risk included elderly patients, females, those with higher BMI, those without a formal education, those unemployed, those living with low monthly income, smokers, those who have multiple comorbidities, and patients with longer dialysis vintage. Our findings provide reliable data for educators and clinicians working with HD patients.

Exploring factors associated with pain in hemodialysis patients: a multicenter cross-sectional study from Palestine.

BACKGROUND: Chronic kidney disease (CKD) is a rising medical concern around the world. End-stage kidney disease (ESKD) is the last stage of CKD stages that necessitates renal replacement therapy (RRT), such as hemodialysis (HD), which seems to be the most commonly used type. However, patients on HD still suffer from high mortality and morbidity rates compared to those who receive a kidney transplant. Therefore, we aimed in this study to assess the prevalence of pain among ESKD patients on HD, as well as to explore the factors that were associated with this complaint. METHODS: We conducted a multicenter cross-sectional study in the West Bank, Palestine, between August and November 2018. We used questionnaire-based direct interviews with subjects. After reviewing previous studies in the field, we developed our questionnaire and included items on patients' social, demographic, and clinical characteristics, including dialysis-related data. It also contained the Brief Pain Inventory (BPI) to assess different aspects of pain symptoms. A convenience sampling technique was used to collect data. RESULTS: Of the 300 participants, 66.3 % reported having chronic pain. HD sessions themselves were the most commonly cited cause for pain (21.6 %). The most commonly cited site of pain was the upper and lower limbs (37.3 %). Paracetamol was the most frequently used pharmacotherapy for pain alleviation. Multiple regression analysis showed that BMI (p = 0.018), gender (p = 0.023), and the number of comorbidities (p < 0.001) were independently associated with pain severity score. CONCLUSIONS: Pain is a highly prevalent symptom among HD patients in Palestine. Subpopulations with higher pain severity include females, patients with higher BMI, and those with multiple comorbidities. Healthcare providers should routinely assess pain in HD patients as it is considered a significant concern. This would involve pain assessment and development of a treatment plan to improve clinical outcomes. The nephrology associations should also push for pain management in HD patients as a clinical and research priority to improve pain-related disability.

An assessment of parents' knowledge and awareness regarding paracetamol use in children: a cross-sectional study from Palestine.

BACKGROUND: Paracetamol, also known as acetaminophen, is one of the most common antipyretic and analgesic over-the-counter (OTC) medicines administered to children due to its efficacy, safety, and availability in many pharmaceutical forms, including suppositories, syrup, and drops. Parents frequently administer the wrong dose of paracetamol by mistake for their children, as reported by many previous studies. We aimed in this study to assess parents' knowledge, attitudes, and practice regarding paracetamol dosing and toxicity, as well as their awareness regarding paracetamol-containing products. METHODS: This was a cross-sectional study that targeted parents of children seeking healthcare services at primary health care centers in the Nablus area in the West Bank, Palestine. We used questionnaire-based interviews with parents for data collection. RESULTS: A total of 300 parents were included in the study. Most of the caregivers surveyed were (87%) females (mothers). About half the parents (50.9%) reported previously using paracetamol as an antipyretic in children under the age of six. A quarter (25.4%) preferred the syrup forms, while 33.8% preferred the suppository dosage form. Medical personnel was the primary source of information for half the caregivers (51.2%). The mean knowledge score about paracetamol was 2.1 (SD = 1.4) out of 6, and the median was 2.0 with an interquartile range of 1.0-3.0. Two hundred seventy-four (95.5%) of the participants scored less than 80% and were considered to have insufficient knowledge. Only 50.9% of parents recognized that paracetamol overdose could result in serious harm. CONCLUSIONS: We found a serious lack of knowledge regarding paracetamol dosing, administration, and potential toxicity among Palestinian parents. We recommend raising awareness regarding this problem among healthcare providers and authorities and working on plans that aim to provide caregivers with accurate and adequate information on dosing, formulation, side effects, and other aspects of paracetamol use, as well as developing effective educational plans targeting healthcare providers, as well as the public.

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.

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.

Mapping the situation of research on coronavirus disease-19 (COVID-19): a preliminary bibliometric analysis during the early stage of the outbreak.

BACKGROUND: The novel coronavirus, named as 2019-nCoV or coronavirus disease 2019 (COVID-19), has recently appeared in China and has spread worldwide, presenting a health threat to the global community. Therefore, it is important to understand the global scientific output of COVID-19 research during the early stage of the outbreak. Thus, to track the current hotspots, and highlight future directions, we performed a bibliometric analysis to obtain an approximate scenario of COVID-19 to date. METHODS: Relevant studies to COVID-19 were obtained from the Scopus database during the early stage of the outbreak. We then analysed the data by using well-established bibliometric indices: document type, country, collaboration patterns, affiliation, journal name, and citation patterns. VOSviewer was applied to map and determine hot topics in this field. RESULTS: The bibliometric analysis indicated that there were 19,044 publications on Scopus published on COVID-19 during the early stage of the outbreak (December 2019 up until June 19, 2020). Of all these publications, 9140 (48.0%) were articles; 4192 (22.0%) were letters; 1797 (9.4%) were reviews; 1754 (9.2%) were editorials; 1728 (9.1%) were notes; and 433 (2.3%) were others. The USA published the largest number of publications on COVID-19 (4479; 23.4%), followed by China (3310; 17.4%), Italy, (2314; 12.2%), and the UK (1981; 10.4%). British Medical Journal was the most productive. The Huazhong University of Science and Technology, Tongji Medical, and Harvard Medical School were the institutions that published the largest number of COVID-19 research. The most prevalent topics of research in COVID-19 include "clinical features studies", "pathological findings and therapeutic design", "care facilities preparation and infection control", and "maternal, perinatal and neonatal outcomes". CONCLUSIONS: This bibliometric study may reflect rapidly emerging topics on COVID-19 research, where substantial research activity has already begun extensively during the early stage of the outbreak. The findings reported here shed new light on the major progress in the near future for hot topics on COVID-19 research including clinical features studies, pathological findings and therapeutic design, care facilities preparation and infection control, and maternal, perinatal and neonatal outcomes.

Bibliometric profile of global scientific research on digoxin toxicity (1849-2015).

Digoxin is a cardiac glycoside derived from the common foxglove digitalis purpurea and has been available for several centuries as a medicinal agent. Despite extensive patient experience over many years, there remains some controversy regarding the possibility that digoxin might have a deleterious effect on survival. This study was constructed to assess trends in digoxin toxicity research using well-established qualitative and quantitative bibliometric indicators. The current study is based on publications that have been indexed in Scopus. Articles referring to the subject of digoxin toxicity between 1849 and 2015 were assessed according to the document type, publication language, countries/territories, institutions, journal, impact factors, total number of citations, h-index, average number of citations per publication, and international collaborations. There were 2900 publications that included 2542 (87.7%) original research articles, while 5.3% were reviews and 4.6% letters. The country of origin was the USA in 849 publications, Germany in 241, the UK in 150, and France in 143. The USA and the UK had the highest number of international collaborations. The average number of citations per publications related to digoxin toxicity was 8.1, and the h-index was 59. The USA and Canada had the highest h-indices by country at 46 and 22, respectively. This study presents the first bibliometric analysis on digoxin toxicity publications. The USA was the most important contributors to digoxin toxicity literature with the greatest international collaboration, largest number of articles and highest h-index, followed by Germany and the UK. There has been a trend towards reduced publication numbers related to digoxin toxicity at global level, although it is still an important issue and we present the current research themes related to digoxin toxicity that were identified.

Depression in patients treated with haemodialysis: a cross-sectional study.

BACKGROUND: The increasing incidence of end-stage renal disease in the Palestinian population and the effect of the disease on the psychological status of the patient underlie the importance of increasing knowledge about the mental health status of patients with end-stage renal disease. The aim of this study was to estimate the prevalence of depression in Palestinian patients treated with haemodialysis and its correlation with patients' clinical characteristics, health-related quality of life (HRQoL), and adherence to medications. METHODS: In this cross-sectional study, we collected a convenience sample from ten haemodialysis centres in the West Bank, occupied Palestinian territory, over 3 months in 2015. The Beck Depression Inventory-II scale (BDI-II) was used to assess depression, the EuroQol-5 Dimension scale was used to assess HRQoL, and the Morisky Medication Adherance-8 scale was used to assess compliance. We used SPSS version 16.0 for all statistical analyses. The study was approved by the Institutional Review Board at the An-Najah National University. Informed verbal consent was obtained from the participants before the start of the study. FINDINGS: We interviewed 286 patients who were treated with haemodialysis. The mean age was 52·0 years (SD 14·3), and 172 (60%) patients were men. The median number of years of dialysis was 2 years (IQR 1-4). 209 (73%) patients had depression. Most participants were non-compliant with their drug regimens and had low HRQoL. High depression scores were associated with old age (p<0·0001), female sex (p=0·036), low income (p=0·041), living in rural areas or in a camp (p=0·032), not doing regular exercise (p<0·0001), unemployment (p<0·0001), having multiple comorbidities (p<0·0001), and low adherence to medications (p=0·0075). We found an inverse correlation between depression and HRQoL (p<0·0001). INTERPRETATION: This study is to our knowledge the first of its kind in the West Bank. The incidence of depression is higher than reported in other communities. Most patients treated with haemodialysis were moderately to severely depressed and had low HRQol. There is a need to provide for a patient's needs in term of psychologist interviews and pharmacological and non-pharmacological interventions. FUNDING: None.

Global research trends in microbiome-gut-brain axis during 2009-2018: a bibliometric and visualized study.

BACKGROUND: The pathways and mechanism by which associations between the gut microbiome and the brain, termed the microbiome-gut-brain axis (MGBA), are manifest but remain to be fully elucidated. This study aims to use bibliometric analysis to estimate the global activity within this rapidly developing field and to identify particular areas of focus that are of current relevance to the MGBA during the last decade (2009-2018). METHODS: The current study uses the Scopus for data collection. We used the key terms "microbiome-gut-brain axis" and its synonyms because we are concerned with MGBA per se as a new concept in research rather than related topics. A VOSviewer version 1.6.11 was used to visualize collaboration pattern between countries and authors, and evolving research topics by analysis of the term co-occurrence in the title and abstract of publications. RESULTS: Between 2009 and 2018, there were 51,504 published documents related to the microbiome, including 1713 articles related to the MGBA: 829 (48.4%) original articles, 658(38.4%) reviews, and 226 (13.2%) other articles such as notes, editorials or letters. The USA took the first place with 385 appearances, followed by Ireland (n = 161), China (n = 155), and Canada (n = 144).The overall citation h-index was 106, and the countries with the highest h-index values were the USA (69), Ireland (58), and Canada (43). The cluster analysis demonstrated that the dominant fields of the MGBA include four clusters with four research directions: "modeling MGBA in animal systems", "interplay between the gut microbiota and the immune system", "irritable bowel syndrome related to gut microbiota", and "neurodegenerative diseases related to gut microbiota". CONCLUSIONS: This study demonstrates that the research on the MGBA has been becoming progressively more extensive at global level over the past 10 years. Overall, our study found that a large amount of work on MGBA focused on immunomodulation, irritable bowel syndrome, and neurodevelopmental disorders. Despite considerable progress illustrating the communication between the gut microbiome and the brain over the past 10 years, many issues remain about their relevance for therapeutic intervention of many diseases.

Arab world's growing contribution to global leishmaniasis research (1998-2017): a bibliometric study.

BACKGROUND: Leishmaniasis is a parasitic disease caused by a protozoan of the Leishmania genus, and is considered a neglected tropical disease. It still remains a main public health concern at global level and in Arab world mainly in low-income countries. Therefore, this study was designed to evaluate the Arab world's growing contribution to global leishmaniasis research. METHODS: This study describes a bibliometric review of all leishmaniasis research publications published between January 1998 and December 2017 indexed on the Scopus database. RESULTS: The total number of publications published at global level was 17,570 papers, which achieves an average annual productivity of 878.50 papers publications. Brazil was responsible for the greatest output with the total number of publications of 3865 followed by the Unites States (n = 2729), India (n = 2119), the United Kingdom (n = 1363), and Spain (n = 1274). By limiting the analysis to the publications that have been published by Arab world, the research productivity was 993 papers, which represents 5.65% of total research output at global level in research regarding leishmaniasis. Tunisia was responsible for the greatest output from Arab world with the total number of publications of 297 followed by Sudan (n = 192), Saudi Arabia (n = 131), Morocco (n = 119) and Egypt (n = 67). Since 1998, the growth of publications on leishmaniasis fluctuates, overall showing a rising trend in both global and Arab world. There is a highly significant correlation between publication productivity related to leishmaniasis at global level and the Arab world (r = 0.936; p-value< 0.001). Leishmaniasis treatment, intracellular mechanism of infection, and lifecycle of leishmania are the major current hot topics for the research in this subject at global level and the Arab world. CONCLUSIONS: The current study presents a novel review of the current Arab leishmaniasis-related research, and how these results are related to worldwide output. In comparison to the global research output, the Arab world produced less leishmaniasis research. The data presented in the current study by this innovative approach may serve relevant researchers to direct the global leishmaniasis research to Arab counties in which leishmaniasis is endemic.

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.