Graduate Studies

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Acupressure For Chemotherapy-Induced Nausea And Vomiting In Breast Cancer Patients: A Multicenter, Randomised, Doubleblind, Placebo-Controlled Clinical Trial
(2009) Zaida Mohamad Othman Said; Dr. Ayman Hussein; Dr. Aidah Abu ELsoud Alkaissi
Purpose: To examine the efficacy of P6-acupressure in preventing chemotherapy- induced nausea and emesis associated with highly emetogenic chemotherapy (i.e. doxorubicin as adjuncts to standard 5-HT3 receptor antagonist (granisetron) and dexamethasone as antiemetic given as part of routine care in reducing acute nausea (during the day of treatment) and delayed nausea (2-5 days) following the day of chemotherapy. The second aim is to examine the efficacy of the acupressure bands with stimulation of P6 in reducing vomiting and in maintaining Quality of Life(QOL). Patients and methods: A randomized, double-blind, placebo controlled trial. One group received acupressure with bilateral stimulation of P6 (n=42), a second group received bilateral placebo stimulation, (n=42) and a third group received no acupressure wrist band and served as a control group, (n=42). Acupressure was applied using a Sea-Band (Sea- Band UK Ltd., Leicestershire, England) that patients to wear for the 5 days following the chemotherapy administration. Assessments of acute and delayed nausea and emesis, quality of life(OOL), patients’ satisfaction, recommendation of treatment and requirement of rescue antiemetic were obtained Results: Significant difference was found in the severity of early nausea >3 (0-6 scale) in the acupressure group M (SD) 1.62 (2.04) as compared to placebo group 2.17 (2.09), p=0.0006. Astatically significant decrease was found with the proportion of patients who had a moderate to very sever nausea 24hs following chemotherapy>3(0-6) scale in the acupressure group,43%(18/42)as compared to placebo group,67%(28/42), p=.0284. Table 4.3 The acupressure group had a statistically significant reduction in the incidence of delayed nausea 40% (17/42) as compared to the control group 62% (26/42) (p= 0.0495). Further analyses indicated that significant difference existed in the intensity of delayed nausea by acupressure group M (SD) 1.45 (1.73), p= 0.0002 as compared to control 2.03 (1.91). Significant difference also existed in the intensity of delayed nausea by placebo group 1.33 (1.66), p= 0.0010 as compared to control 2.03 (1.91). Here a placebo effect was noted.Astatically significant decrease was found with the proportion of patients who had a moderate to very sever nausea days 2-5 >3(0-6) scale, in the acupressure group,55%(23/42),(p=0.0206),and in the placebo group52% (22/42), p= 0.0116,as compared to the control group79% (33/42). Aplacebo effect was noted.The mean number of delayed emetic episodes days 2-5 was significally less in the acupressure groupM(SD) 2.7(1.87) as compared to placebo 3.3(1.9), p= 0.0022 and control group 2.07(1.20), p= 0.0005 Requirement of rescue antiemetic was significantly lower in P6- acupressure (55%, 23/42), as compared to control group (76%, 32/42) (p= 0.0389).Eight one percent (35/42) of the patients in acupressure group were significantly satisfied with P6-acupressure as compared to placebo group 64% (27/42), p= 0.0471. Seventy nine percent (34/42) of the patients in acupressure group would recommend P6-acupressure to another patients as compared to placebo group 62% (26/42), p= 0.0533 . CONCLUSIONS: P-6 Acupressure is efficacious for the control of delayed chemotherapy induced nausea and emesis and is a value-added method in addition to pharmaceutical management for women undergoing treatment for breast cancer.
Adequacy of Hemodialysis among End Stage Renal Disease Patients at Al-Watani Hospital
(2006) Allam Muhammad Abdel-Hafiz Rizqallah; Dr. Nael Abu -Hasan; Dr. Hasan Hijaz
End stage renal disease is defined as total loss of kidney function, it is common problem worldwide caused by multitude of kidney disease either diabetes or hypertension, it is diagnosed by several laboratory and imaging diagnostic procedures. Hemodailysis is one of the treatment options in renal replacement therapy and many studies have shown strong correlation between hemodialysis dose and clinical outcome measured by kt/v. In the West Bank area of Palestine there are 8 dialysis centers serving 350 patients (at present), these units lack well trained technicians nephrologists and machines. The nurse patient ratio is 1:5 and due to limited access to dialysis units patients are noncompliance. The current study, aimed at evaluating hemodialysis adequacy among hemodialysis patients (88; 56.8% males, 43.2% females) enrolled at Al-Watani Hospital center at the city of Nablus. Data collected during June through July 2006 in a specially designed questionnaire. Data collected through direct interview after reviewing medical records of each patient and recirculation test carried out at the same dialysis session. The results showed inadequate dialysis dose among 64% of the enrolled patients. Females showed a better clearance rate (44.7%) compared to males (32%). Percentage differences for kt/v values among males and females were statistically insignificant (P = 0.429). It was difficult to link between the other tested demographic variables and clearance rates estimated by kt/v value. A strong association between higher clearance rates and both increased dialysis duration of each session (4hours; 69.2%) and frequency of dialysis per week (3 times/week; 48.3%) was noted and differences for both variables were statistically significant (P = 000). There was clear trend in improvement in kt/v values with increased ultra filtration. Low recirculation resulted in better dialysis adequacy (0-10%; 70.8% with kt/v ≥ 1.2). Diabetic nephropathy represented 44.3% with a clearance rate of 28.2% (kt/v ≥ 1.2). Clearance rates of 42.9% and 71.4% found among those suffering from glomerulonephrities and gouty, respectively. Hypertension cases represented by 2.3% of the study population, thus indicating that hypertension is not a major cause of ESRD among our population. The results also showed that 68.2% of the study population was with AVF access for circulation and 42.3% of this group was with an acceptable clearance rates (kt/v ≥ 1.2). Subclavian access was the major access among the rest of the patients with a clearance rate of 28.5%. Better clearance rates found in association with absence of patient complains (45.8% versus 29.7%). The findings of better clearance rates among those without any residual kidney function (44.3%) compared to those with some residual function (22.2%) was not clear and requires further investigations. Our findings clearly showed that with increasing time and frequency of dialysis, blood flow rates, low recirculation percentages and reduction of intradialytic complain are associated with better dialysis adequacy. In accordance with such findings, the need for adoption and implementation of internationally used practice guidelines is essential in our dialysis system.
Administrative Decentralization Practical Model for Jenine Hospital
(2006) Majdoline Abdalla Yousef Nuarat; Dr Suleiman Khalil; Dr Qasim Maani
Decentralization has become popular management strategy in many health care systems all over the world. The strategy of applying decentralization in many institutions in the world seems as away to dissolve major problems that face these institutions in finance, social, technical, and mainly administrative manner. Many studies make distinctions between high quality assurance and decentralization to mange services in any organization. Palestinian authority was made concern about decentralization concepts and techniques ,so many institutions in different fields was try to study an apply parts of its strategies as decentralization manner. Today, academics, practitioners and development stakeholders universally recognize the importance of good governance practices for alleviating chronic poverty and injustice .Simultaneously, the world has increasingly turned towers the practice of decentralization to assure democratic governance for human development The main question of the study is: How can decentralization increase the quality of heath team and work by improving the administrative frame work of the institution? And what is their opinion on that? This study contains six sections, the first one deal with subject and describes the place and the main problem. The second section was assessed the structures and types of decentralization, and assess the political, economical, social, clinical, and equity impacts of alternative decentralization strategies in Jenine hospital. The third section of the study, was evaluated the existing patterns of the implementation of decentralization in different regions in the world and as contrast on the theoretical advantages of decentralization found in the literature with practical experience in the hospital.The fourth section of this study was deal with the methodology and research out line. The fifth section of study was translated the main results of the collected data that was discussed the purpose of applying decentralization in the hospital, and the benefits of implemented this type of administrative strategy. The methodology of this was discussed in section four, which contains the data collection and data analysis by statistical systems on (SPSS). The study has number of annexes contains proposed frame works to be hold out in the process of institutional development .The sixth section was presented some recommendations to be taken in considerations. The target population of this study was contained about of (73) of Jenine hospital members only (36)who picked up as target group, and (3)of them was hold off because of technical points ,and (33) questionnaires was banked on to be as target group, divided as (23)mails, and(10) females. The study depends on four variables ;sex, qualification, license, experience. AT the end of study concluded in some recommendations as ;there is need to change the managerial system of the hospital, the administrative manner and policy couldn’t meet the hospital and team needs ,and to be part of hospital basic development this system must be changed to decentralization one. It proposed managerial frame work, to be presented to health policy makers, and to form a centralize board to follow up the decentralization process in the hospital, and drown the decentralization map in order to promote health sector reform, and hospital quality of team and work.
The Adsorption of Lead using Olive Cake Ash
(An-Najah National University, 2018-11-22) سودي, ميساء ابراهيم يونس
The adsorption of Pb(II) ions from aqueous solution using olive cake ash was carried out. The effect of various parameters on the adsorption process such as pH, contact time and temperature were studied. Performed experiments included; binding capacity, stripping, hard cations interferences and adsorption isotherms on adsorption process. Results showed that the maximum adsorption of Pb(II) ions occurred at pH 5, equilibrium was achieved at 40 minutes. The removal of Pb(II) ions increased from 91.3% to 94.5% as the temperature increased from 0°C to 70°C. The binding capacity was determined to be 0.29 mg/g at 28°C. The highest total stripping for Pb(II) ions reached 100 % by 0.5 M HCl. The presence of combined Ca(II) and Mg(II) with Pb(II) ions causes a significant increase in binding. This increase in binding reached maximum (higher by 22%) when the following concentrations of Ca(II) and Mg(II) were present at 2 mM, 4 mM, 20 mM and 400 mM higher than when no Ca(II) and Mg(II) present. The isotherms results showed that the experimental data best obeys Fruindlich and Dubbinin models. Values of ΔG° at different temperatures (13°C, 23°C and 35°C) were 19.87 KJ/mol, 10.29 KJ/mol and 20.45 KJ/mol, respectively. This indicates that the adsorption process is non spontaneous. In addition, the negative value of ΔHº means that the adsorption of Pb(II) ions onto treated ash was exothermic, also the value of ΔSº was negative indicating a decrease in entropy. The values of mean free energy E per molecule sorbate at different temperatures are in the range (8 – 16) KJ/mol. This indicates a chemical adsorption.
The Amalgamation Policy of Palestinian Income and Added Tax Department, and its Effect on Commitment and Treasury Collection
(2015) Eyad Husein A-Salman; Dr. Ghassan D’aas
The main objective of preparing and conducting this study is to measure the possibility of success of applying the amalgamation Strategy on one of the most important resources of the Treasury for the State of Palestine, which stands for consolidating, both, the income tax and the value-added tax. Especially that the consolidation process has started already, and it has been applied in one of the most important Tax Departments which includes the largest files of taxpayers in Palestine, which is the Department of Senior Taxpayers. To achieve the goal of the study, the work firstly is to measure the consolidation status that is occurring in this Department, and then explore the reached outcomes, whether they were positive or negative in terms of the role of this consolidation in reducing the operationalexpenditures, limiting the level of tax evasion in Palestine, and in raising the level of provided services for the Taxpayers, which is reflected on increasing and expanding the base of commitment to voluntary tax, and on increasing the collection and tax outturn received by the Treasury. Therefore, the researcher has used the Descriptive and Analytical Approach, and developing the research toola questionnaire for two communities: The First Community: all of the taxpayers in the Department of Taxpayers in the West Bank, except for the files of the financial institutions subsidiary to the sector of banks, and sector of insurance, This community consists of (304) taxpayers as per the statistics of the Palestinian Unified Revenues Management System (RMS), conducted in June, 2014. An amount of (169) taxpayers, (55.5%) were selected as a random sample from this community. The Second Community: all of the staff working in the departments of income tax and value-added tax, who are working in the field of taxes directly, including (managers, mangers’ deputies, departments’ heads, estimators, and accounts’ examiners) in all of the governorates of the West Bank including the employees of the department of senior taxpayers, where the size of this community has reached (412) employees, and a random sample with an amount of (184) employees, was selected from it, constituting approximately 44.6% of both departments, after the data was collected, it was processed statistically using SPSS program. The study was concluded after the Ministry of Finance in Palestine has truly applied the strategy of consolidation since approximately three years. The following are the main conclusions and recommendations: First: The taxpayers give approval on the process of consolidation of both taxes, the approval range has come in from medium to low in its fields of contributions, starting from limiting the tax evasion or expanding the base of voluntary commitment, or in increasing the outturn and collection,and ending with not contributing in the reduction or facilitation of the procedures of dealing with taxpayers.Based on that, we can see that “the consolidation of both taxes did not contribute a lot in raising the rate of tax compliance nor the income of General Treasury”. Secondly: The approval of the employees who were included in the sample in the other field related to the consolidation contribution of reducing and diminishing the level of operational expenditures, and the fifth field related to raising tax awareness among senior taxpayers was on a medium level. Thirdly: the approval of the staff in the first field which is related to the consolidation contribution in limiting tax evasion, and the third field which is related to the role of consolidation in reducing and facilitating the procedures of registration and reconciliation for the taxpayers files and in the fourth field which is related to increasing the outturn and collection, was on a high level. Based on the approval level that the employees expressed on the fields of the study, we can say that “tax consolidation did not contribute in raising the tax compliance of the taxpayers; on the other hand, it contributed to a great extant in raising the income of General Treasury”. Our recommendation to the administration of unification, in terms of the employees to seek achieving the satisfaction of the staff and acting fairly to them as much as possible, so that this could be a motivation for them to do their tasks and duties assigned to them. As for the taxpayers, this future administration- in the light of this consolidation- has to do all the necessary procedures and instructions that shall guarantee achieving a better level of the services provided to taxpayers, raising and enhancing the level of dealing regarding reconciliation of their files and reducing the tax burdens off their shoulders, in order to build the bridges of trust with them, and to change their feelings of being targeted for collection purposes only, without considering justice in their accountability.
Assessing Water Quality of Cisterns in Sha'rawiya Area "Tulkarm Governorate" for Drinking Purposes
(2016) Saja Asa'd Almur; Dr. Sameer Shadeed; Dr. Abdelrahim Abusafa
This study was undertaken to assess the quality of rainwater harvesting (RWH) cisterns for drinking purposes at Sha'rawiya rural area. Fifty water samples were collected from tested cisterns at 12 rural areas. All samples were analyzed for physiochemical parameters (pH, EC, TDS, alkalinity, hardness, turbidity, Ca+2, Mg+2, K+, Na+, Cl-, NO3-, SO4-2, PO4-2, and HCO3-), microbial parameters (TC and FC), and some heavy metals (Ag, Al, Ba, Be, Cd, Co, Cr, Cu, Fe, Mn, Ni, Pb, and Zn) using standard procedures. The results were compared with Palestinian standards (PS) and world health organization (WHO) standards of drinking water. Among the analyzed samples, all results of tested physiochemical parameters were within acceptable limits of PS and WHO standards except (4%) of NO3- results, (4%) of turbidity results, (2%) of alkalinity results, (2%) of electric conductivity (EC) results, (2%) of Ca+2 results, and (28%) of Mg+2 results exceeded the PS and WHO standards. The percentage of contamination with TC and FC was 86%, 80%, respectively. All heavy metals were within PS except the iron (Fe) in which (33%) of results exceeded the permissible limits. Cistern characteristics and sources of contamination were studied by the distribution of 100 questionnaires along the study area. The highest percentage of contamination sources: (78%) was detected due to the presence of trees around the cistern, and storage of the first storm of rainwater in the cistern. Almost (36%) of contamination was due to withdrawing water manually. In general, the obtained results of water quality parameters show that some parameters have values higher than standards especially the microbial parameters (TC and FC), this explained the unsuitable use of RWH systems for direct drinking purposes without disinfection processes. This is an indication of contamination hazards and weak drinking water treatment practices in the study area, which in turn have an important effect on human health. Based on total dissolved solids (TDS) as a salinity hazard, the obtained results indicate the possibility to use RWH for irrigation purposes. This study therefore, recommends the responsible authorities to raise public awareness for cistern owners about the best practices to collect and store rainwater, and to take appropriate corrective measures to get high water quality for drinking purposes.
Assessing Water Quality of Harvested Rainwater in Tubas Governorate and Evaluation of Local Public Awareness Regarding Water Pollution
(ِAn-Najah National University, 2019-07-08) Abbas, Ahd
تهدف هذه الدراسة لتقييم جودة مياه الأمطار في آبار الجمع المنزلية لأغراض الشرب في محافظة طوباس، بالمزامنة مع تقييم الوعي البيئي للسكان المحليين بخصوص قضايا تلوث المياه . تم أخذ 47 عينة بشكل عشوائي من 11 منطقة مختلفة ضمن محافظة طوباس وأجريت لها بعض الفحوصات المخبرية التي تتضمن درجة الحموضة، الموصلية الكهربائية، البايكربونات، العسر الكلي، الكلورايد، المغنيسيوم، الكالسيوم، الصوديوم، النيترايت، الصوديوم، الفوسفات، الكبريتات، البوتاسيوم، القاعدية، العكورة، بالإضافة للفحوصات المايكروبية حيث شملت فحص وجود القولونات الكلية والبرازية. لقد أظهرت النتائج التي تم الحصول عليها بعد التحاليل الفيزيائية و الكيميائية والمايكروبية أن هناك تجاوزاً للمعايير المحلية والعالمية، بحيث تجاوزت جميع نتائج العينات للتحاليل الفيزيائية المعايير المحلية والعالمية ، إذ تجاوزت 17 ٪ من العينات المعايير الفلسطينية ومعايير منظمة الصحة العالمية لمياه الشرب لدرجة الحموضة،2% من العينات تجاوزت المعايير بالنسبة لمجموع المواد الصلبة الذائبة في المياه، وكذلك 4% من العينات بالنسبة للتعكر.أما بالنسبة للتحاليل الكيميائية فتجاوزت نتائج التحاليل المعايير بنسب مختلفة كالتالي (البوتاسيوم 30 ٪ ، الفوسفات 28 ٪ ، المغنيسيوم 21 ٪) ، بينما كانت نسبة تلوث القولونيات الكلية والبرازية (98٪ ، 92٪) ، على التوالي. تمت دراسة خصائص آبار الجمع ومصادر التلوث بواسطة استبيانات تم الإجابة عليها من قبل أصحاب الآبار أنفسهم، ووفقًا للمعلومات التي تم جمعها وتحليلها من خلال الاستبيانات ، كانت أهم مصادر التلوث هي وجود النباتات والأشجار بالقرب من الآبار بنسبة (66٪) ، وكذلك تخزين مياه الأمطار الأولى في بداية الموسم بحيث تكون محملة بالغبار والملوثات والمايكروبات بنسبة (53 ٪) ، بالإضافة الى الاحتفاظ بمياه الأمطار التي تم تجميعها في الموسم السابق داخل البئر بنسبة (34 ٪) ، ويعزى حوالي (24 ٪) من أسباب التلوث الى عدم تنظيف منطقة تجميع المياه ومداخل البئر قبل تخزينها. وبالنسبة لنتائج التقييم المتعلقة بدراسة مستوى الوعي البيئي للأفراد ضمن منطقة الدراسة فقد أشارت النتائج إلى أن (58%) من أصحاب الآبار ليس لديهم معرفة أو دراية حول الملوثات التي تؤول الى تلوث آبارهم بالإضافة إلى فقدان الاهتمام والوعي البيئي من قبل الجهات المختصة ضمن المنطقة التي تمت دراستها ، وكما أن (70%) من أصحاب الآبار فضلو اللقاءات التوعية من قبل الجهات المختصة كوسيلة لرفع الوعي البيئي وزيادة الثقافة العامة بخصوص قضايا تلوث الماء وكيفية التعامل مع هذه المشكلة. النتائج بشكل عام تشير الى وجود تلوث فعلي والذي بدوره يؤثر سلباً على صحة الإنسان مسبباً مخاطر صحية تهدد حياة الأفراد حيث أن أهم مسببات التلوث هي الممارسات الخاطئة في عملية حصاد مياه الأمطار وتخزينها لأغراض الشرب الناتجة عن غياب الوعي البيئي لدى الأفراد ملَاك الآبار . تهدف هذه الدراسة بشكل عام إلى تحديد الخصائص والظروف الحالية والأسباب الرئيسية للتلوث لآبار الجمع التي تم دراستها خلال منطقة الدراسة، وكذلك تقييم جودة مياه الأمطار في الآبار التي تم دراستها وفقًا للمعايير المحلية والدولية ، واقتراح أفضل الأدوات والأساليب المتاحة لرفع الوعي البيئي المتعلق بقضايا تلوث المياه للمواطنين المحليين. بالإضافة إلى ذلك، تهدف هذه الدراسة بشكل عام لتوفير الفرص لتجميع المعرفة العلمية ضمن إطار دولة نامية ومن ثم تعمل على تعزيز جدول أعمال للسياسات في نظام إدارة المياه ، وذلك بهدف رفع الوعي العام لأصحاب الآبار للقيام بأفضل الممارسات لجمع وتخزين مياه الأمطار مع الأخذ بعين الاعتبار الحصول على أفضل جودة من مستوى المياه المستخدمة لأغراض الشرب.
Assessing Water Quality of Harvested Rainwater in Tubas Governorate and Evaluation of Local Public Awareness Regarding Water Pollution
(جامعة النجاح الوطنية, 2019-07-08) محمد عباس, عهد
تهدف هذه الدراسة لتقييم جودة مياه الأمطار في آبار الجمع المنزلية لأغراض الشرب في محافظة طوباس، بالمزامنة مع تقييم الوعي البيئي للسكان المحليين بخصوص قضايا تلوث المياه . تم أخذ 47 عينة بشكل عشوائي من 11 منطقة مختلفة ضمن محافظة طوباس وأجريت لها بعض الفحوصات المخبرية التي تتضمن درجة الحموضة، الموصلية الكهربائية، البايكربونات، العسر الكلي، الكلورايد، المغنيسيوم، الكالسيوم، الصوديوم، النيترايت، الصوديوم، الفوسفات، الكبريتات، البوتاسيوم، القاعدية، العكورة، بالإضافة للفحوصات المايكروبية حيث شملت فحص وجود القولونات الكلية والبرازية. لقد أظهرت النتائج التي تم الحصول عليها بعد التحاليل الفيزيائية و الكيميائية والمايكروبية أن هناك تجاوزاً للمعايير المحلية والعالمية، بحيث تجاوزت جميع نتائج العينات للتحاليل الفيزيائية المعايير المحلية والعالمية ، إذ تجاوزت 17 ٪ من العينات المعايير الفلسطينية ومعايير منظمة الصحة العالمية لمياه الشرب لدرجة الحموضة،2% من العينات تجاوزت المعايير بالنسبة لمجموع المواد الصلبة الذائبة في المياه، وكذلك 4% من العينات بالنسبة للتعكر.أما بالنسبة للتحاليل الكيميائية فتجاوزت نتائج التحاليل المعايير بنسب مختلفة كالتالي (البوتاسيوم 30 ٪ ، الفوسفات 28 ٪ ، المغنيسيوم 21 ٪) ، بينما كانت نسبة تلوث القولونيات الكلية والبرازية (98٪ ، 92٪) ، على التوالي. تمت دراسة خصائص آبار الجمع ومصادر التلوث بواسطة استبيانات تم الإجابة عليها من قبل أصحاب الآبار أنفسهم، ووفقًا للمعلومات التي تم جمعها وتحليلها من خلال الاستبيانات ، كانت أهم مصادر التلوث هي وجود النباتات والأشجار بالقرب من الآبار بنسبة (66٪) ، وكذلك تخزين مياه الأمطار الأولى في بداية الموسم بحيث تكون محملة بالغبار والملوثات والمايكروبات بنسبة (53 ٪) ، بالإضافة الى الاحتفاظ بمياه الأمطار التي تم تجميعها في الموسم السابق داخل البئر بنسبة (34 ٪) ، ويعزى حوالي (24 ٪) من أسباب التلوث الى عدم تنظيف منطقة تجميع المياه ومداخل البئر قبل تخزينها. وبالنسبة لنتائج التقييم المتعلقة بدراسة مستوى الوعي البيئي للأفراد ضمن منطقة الدراسة فقد أشارت النتائج إلى أن (58%) من أصحاب الآبار ليس لديهم معرفة أو دراية حول الملوثات التي تؤول الى تلوث آبارهم بالإضافة إلى فقدان الاهتمام والوعي البيئي من قبل الجهات المختصة ضمن المنطقة التي تمت دراستها ، وكما أن (70%) من أصحاب الآبار فضلو اللقاءات التوعية من قبل الجهات المختصة كوسيلة لرفع الوعي البيئي وزيادة الثقافة العامة بخصوص قضايا تلوث الماء وكيفية التعامل مع هذه المشكلة. النتائج بشكل عام تشير الى وجود تلوث فعلي والذي بدوره يؤثر سلباً على صحة الإنسان مسبباً مخاطر صحية تهدد حياة الأفراد حيث أن أهم مسببات التلوث هي الممارسات الخاطئة في عملية حصاد مياه الأمطار وتخزينها لأغراض الشرب الناتجة عن غياب الوعي البيئي لدى الأفراد ملَاك الآبار . تهدف هذه الدراسة بشكل عام إلى تحديد الخصائص والظروف الحالية والأسباب الرئيسية للتلوث لآبار الجمع التي تم دراستها خلال منطقة الدراسة، وكذلك تقييم جودة مياه الأمطار في الآبار التي تم دراستها وفقًا للمعايير المحلية والدولية، واقتراح أفضل الأدوات والأساليب المتاحة لرفع الوعي البيئي المتعلق بقضايا تلوث المياه للمواطنين المحليين. بالإضافة إلى ذلك، تهدف هذه الدراسة بشكل عام لتوفير الفرص لتجميع المعرفة العلمية ضمن إطار دولة نامية ومن ثم تعمل على تعزيز جدول أعمال للسياسات في نظام إدارة المياه ، وذلك بهدف رفع الوعي العام لأصحاب الآبار للقيام بأفضل الممارسات لجمع وتخزين مياه الأمطار مع الأخذ بعين الاعتبار الحصول على أفضل جودة من مستوى المياه المستخدمة لأغراض الشرب.
Assessment of Data Quality for Maternal and Child Health Department at Primary Health Care Directorate-Tulkarm
(2015) Tamara Sameer Rafiq Awwad; Dr. Zaher Nazzal
Introduction: The information associated to maternal and child health (MCH) is an important pointer for health communities and outlines the situation of the health of generations. Perhaps more importantly, this information must be accurate, timely, and consistent for enabling communities in managing their health systems effectively. Objectives: The study aimed to provide an assessment for the quality of MCH information at Primary Health Care (PHC) Directorate in Tulkarm, Palestine. This was achieved by observing the performance of PHC staff (nurses and midwives) for MCH data collection protocol in PHC, checking completeness of protocol components in MCH files and assessing the completeness, timeliness and accuracy of monthly MCH reports for 2014. Methods: This assessment was carried out from December 2014 to January 2015 at 10Antenatal care (ANC) and child care clinics in the Tulkarm district: Northern, Shwiekeh, Anabta, Beet Lied, Ateel, Sida, Baqa Sharqia, Nazlet Esa, Kofr Jammal and Kofr Sour. A cross-sectional study was conducted within a health facility context. We observed the performance of 25 nurses within the data collection process for 476 cases (mothers and children) in 40 days. We compiled a systematic random sample of MCH files in 2014 and assessed it for their completeness and documentations (338 files). Also all MCH monthly reports (240) in 2014 were assessed for their completeness, accuracy and timeliness. Data was collected using checklists. A pilot study was conducted in October 2014 in Beet Foreek clinic at Nablus Health Directorate. Results: Data was collected using manually filled formats. Overall performance for nurses’ tasks was very good, ranging from 91% to 99% in ANC and child care clinics, except filling registration book; only 23% of ANC clinics, and 89% of child care clinics were found complete) and daily statistic book (DSB) where 35% of ANC clinics and 86% of child care clinics were found complete. The level of privacy in MCH and ANC clinics was unacceptable (31%, 54% respectively). Some of those low percentages significantly associated with workload (p value ≤0.001 or =0.01), also with the total number of nurses and clients in the observation days (p value < 0.001, 0.003, or 0.043). A good level of documentations (98% to100%) was achieved for ANC and child files in 2014, except some items like general data (66%) and doctors’ note (87%) in ANC files, as well as hemoglobin level (49%) and supplements given (67%) in children files. Some of those items are significantly associated with some of clinics characteristics that we have studied; doctor attendance, midwives existence, nurse attendance per month, days of nurse attendance in 2014 and number of clients in 2014(p value 0.01, 0.029, 0.002 or <0.001). For ANC clinics, only Baqa Sharqiya clinic had one incomplete report. Baqa Sharqiya and Kofr Jammal clinics have one unmatched reports. At Anabta clinic, DSB for the year of 2014 wasn’t found so we couldn’t assess their reports. In contrast, there were one to five uncompleted and unmatched reports per every child clinic. Unfortunately, we were unable to assess the timeliness of all reports. Conclusion: This assessment gives us an obvious idea about the MCH information system in Tulkarm, which reinforces the need for improvements and additional monitoring. Applying routinely assessment for MCH information in PHC clinics with MOH direct supervision is recommended so as to make an effective and evidence based decision-making.
Assessment of iodine level in breast milk samples, and in urine of mother and infant: A pilot study in Palestine
(An-Najah National University, 2017-09-13) نعيرات, سندس هاشم; صوالحة, مآثر
Iodine is an essential trace element, required for biosynthesis of thyroid gland hormones which are directly related to growth and development of human being. Both deficiency and excess of iodine intake can cause thyroid function disorder. Pregnant, lactating women and infant are the most vulnerable group to this disorder. This research is a pilot study was conducted in Palestine in Jenin district. The main objectives were to determine maternal and infant iodine levels and also to determine the breast-milk iodine concentration. The study was carried out using ninety purposive urine samples that were collected from three groups: thirty pregnant women, thirty lactating women and thirty infants. The collected samples were analyzed by Sandell–Kolthoff method. This method is a combination of digestion technique and manual spectrophotometric reading. And data was collected using a questioner. Breast milk iodine concentration was investigated, using thirty purposive milk samples that were collected from the same mothers, the milk samples were also analyzed by sandell Kolthoff method. The main outcomes of the research are: median iodine concentration of pregnant women, lactating women and infant 23.5µg/L, 28.3µg/L, 50.4µg/L respectively. Compare this medians with WHO epidemiologic criteria for assessing iodine nutrition based on median urinary iodine concentrations for different groups, indicates that iodine deficiency was prevalent among pregnant, lactating women and their infant. This deficiency could be explained using the questioner results which revealed that studied women consumption of iodine rich foods were low. Other important outcome of the research is the median of milk iodine concentration which was 20.8µg/L. When this value is compared with the optimal range that is supposed to meet the infant’s iodine requirement (100–200 µg/L) reveals that, content of breast milk of targeted lactating women don’t meet the infant’s iodine requirement. The results of the study indicant that, infant’s iodine status in the present study affected by their mother’s iodine status, and it depend on their mother’s breast milk iodine concentration.
Assessment of Medical Waste Management in Jenin District Hospitals
(2009) Abdul-Salam A. Khalaf; Dr. Suleiman Al-Khalil; Dr. Issam A. Al-Khatib
Medical waste management is of great importance due to its infectious and hazardous nature that can cause undesirable effects on humans and the environment. The objective of this study was to analyze and evaluate the present status of medical waste management in the light of medical waste control regulations recommended by the WHO in Jenin district. A comprehensive field survey was conducted for three hospitals. Field visits and a questionnaire survey method were implemented to collect information regarding different medical waste management aspects, including medical waste generation, segregation and collection, storage, training and education, transportation, disposal, and safety of cleaning personnel. The results indicated that the average hazardous healthcare waste generation rate ranges from 0.54 to 1.82 kg/bed/day with a weighted average of 0.78 kg/bed /day. There was no waste segregation of various types of healthcare wastes in all hospitals. All hospitals still use some of the unqualified staff for medical waste collection, and all of the hospitals do not have temporary storage areas. Additionally, 67.9% of cleaning personnel at the three hospitals have reported that they received training about healthcare waste handling; however, none of the hospitals have ongoing training and education. It was found that healthcare waste is finally disposed in a centralized sanitary landfill (Zahrat al Finjan) that has been constructed for domestic solid waste disposal and is not specialized for healthcare waste disposal. The management of Medical waste in Palestine was not given the proper attention. Still there are lacks of legislation and defined policy regarding this issue . The entire Medical waste generated is dumped within general waste. The results also suggested that there is need for sustained cooperation among all key actors (government, hospitals and waste managers) in implementing a safe and reliable medical waste management strategy, not only in legislation and policy formation but also particularly in its monitoring and enforcement. This can be achieved through the cooperation between the Ministry of Health, Environmental Quality Authority, Ministry of Local Government, and Non-Governmental Organizations working in related fields. Additional remediation measures are proposed to tackle the problematic areas of medical waste management in Jenin district hospitals by proposing some recommendations that will ensure that potential health and environmental risks of medical waste are minimized.
Assessment of Microbial Quality of Food Samples in Nablus District
(2004) Omayya Morshed Mohammad Hammad; Dr.Yahya R. Faidy; Dr. Issam A. Al –Khatib
Data of microbiological food examination recorded between 1995- 2003 at Environmental Health Department of Ministry of Health were analyzed and studied for microbial contamination in order to assess the variations of bacterial quality of food by type, source, months, seasons, years. A total of 1052 samples were collected from Environmental Health Department of Ministry of Health for routine test of microbiological quality for public health issue by Environmental Health Inspectors of Nablus district during the period 1995-2003. This study showed that salads, meats and chickens and diary products had the highest percentages of unaccepted samples tested for TAC: these percentages are (62.1%), (14%) and (5.6%) respectively. This study showed that the restaurants had the highest percentages of unacceptable samples tested for TAC, TC, S aureus, Yeast and Moulds These percentages are (56.9%), (65.6%), (1%), (75.9%), and (3%) respectively. This study conclude that lack of monitoring in restaurants, and food factories, and unsystematic food sampling system, due to the current situation such as closure and separation of the Palestinian territories by military checkpoints has created a lot of difficulties facing reporting, food sampling and consequently food control. The study recommends conducting health education programs about food safety to food handlers, holding educational programs for public, and increasing the numbers of trained food inspectors.
Assessment of Milk Quality and Antibiotic Residues Detection in Milk Samples from Palestinian Market
(An-Najah National University, 2019-09-08) Hamdan, Dalal
This study was conducted to evaluate the quality of milk in the Palestinian market during a period of 8 months, from June 2017 to January 2018. A total of 118 milk samples, of which 79 pasteurized, 14 raw and 25 (UHT) were collected randomly from the market, using the production date as the collection criteria. The samples were screened for antimicrobial residues using Delvotest SP-NT, and their osmolality was measured using Vapor Pressure Osmometer (VAPRO). In addition, the pasteurized and UHT milk samples were evaluated for physicochemical properties (fat, solids not fat; SNF; protein, lactose, ash, freezing point and pH), using (Ultrasonic Milk Analyzer) and pH meter. The results of the antibiotic screening test SP-NT showed that (36%) raw milk samples contained antibiotic residues above MRL. Meanwhile, the pasteurized milk samples (27%) were contaminated with antibiotic residues above MRL. None of 25 UHT milk samples were contaminated with antibiotic residue. The average content of fat and solids in pasteurized milk samples was higher during winter (3.38%, 0.65%, respectively). The Freezing point and pH average were higher during summer (-0.5048°C, 6.78, respectively). Moreover, the average content of SNF, Protein and lactose were higher in autumn (8.04%, 2.96%, and 4.41%, respectively). The average content of (fat, SNF, ash, protein, lactose) and FP of pasteurized milk samples revealed non-significant differences (P>0.05) between seasons. Meanwhile, the average pH showed significant differences (P<0.05) between seasons. The results showed that the average content of fat and protein in UHT milk samples were higher in spring (3.28%, 3.18%, respectively), the average content of solids and freezing point were higher in summer (0.65%, -0.5087°C, respectively). Moreover, the average of SNF and pH were higher in autumn (8.01%, 6.74, respectively). The Physiochemical properties average (fat, solids not fat; SNF; protein, lactose, ash, freezing point and pH) of UHT milk samples revealed non-significant differences (P>0.05) between seasons. The osmolality average of raw milk samples, pasteurized and UHT was (309±37.86, 273±24.08, 271.76±7.46 mOsmol/kg, respectively). Moreover, the osmolality average of milk samples revealed significant differences (P<0.05) between raw and heat-treated milk samples. The present study concluded that physiochemical properties and the osmolality of milk were affected by seasonal variation. Also, the study showed that the percentage of contaminant raw milk samples by antibiotic residue above MRLs is higher compared to that heat-treated milk samples.
Assessment of Myocardial Infarction Risk Among Patients in Nablus District
(2006) Mamoun Abdel-Raheem Taher Aubeidia; Dr. Suleiman Al-Khalil; Dr. Jamal Al-Aloul
The idea of assessment of myocardial infarction risk factors among patients comes while more and more patients in Palestine are dying from accelerated cardiovascular disease. While myocardial infarction has been described to have an epidemic-like spread all over the world with special emphasis on countries experiencing the transition to western lifestyle, it is important to evaluate the life style and behaviors of those patients after the onset of myocardial infarction. The risk factors of myocardial infarction among patients life in Nablus district were assessed. About 150 patients were selected randomly from Nablus community to participate in this study (108 Male, 42 Female). Those are patients with myocardial infarction selected from three main hospitals in Nablus city. Al-Watani hospital (MOH) n=50, Nablus specialty hospital, (private sectors) n=50, and CCU unit in Al-Arabi hospital, (private sectors). n=50. Microsoft Excel and SPSS software were used to analyze the data collected and to obtain results. Most of sample study participants were more than 50 years old. The majorities of participants live in Nablus city, finished their secondary level of education and had no university degree level. The results according to the gender were 64.81%of males and 66.67% of females of the study sample were diabetic, and 80.56% of males and 71.42% of female of the study sample were hypertensive, while 59.26% of males and 64.29% of females of the study sample relatives had cardiac diseases. All participants were surveyed for diet, physical activity, smoking, stress, knowledge, attitude, practice, and drugs compliance. They were also tested for blood pressure, FBS, cholesterol, triglyceride, HDL, LDL, weight, length, and BMI. Most of patients have no physical activity (86% of males and 98% of females), no control diet (65% of males and 48% of females),while percent of smoking patients were high according to their health situation (60% of males and 21% of females), they also had impaired fasting blood sugar, and high fasting lipids. The political and economical situations of Patients in Nablus city, and lack of health education among patients and their families, were the major reason of the lifestyle impairment. Patients who survived acute myocardial infarction need more attention and rehabilitation programs, this needs the efforts of both primary health care physicians and cardiologists.
Assessment of Perceived Health Care Service Quality at Palestinian Hospitals: A Model for Good Hospital Management Practice (GHMP)
(2004) Majd Abd Al-Rhman Fareed Al-Adham; Dr. Amjed Al- Ghanim
Over the last 20 years, the increasing complexity and technical intensiveness of healthcare in Palestine hospitals have increased the level of uncertainty in the process of care. The variables within the health care environment (demand, cost, system deregulation) are undergoing rapid changes. This study is the first of its kind to investigate beyond quality management approaches, the most important issue in health care management, and the need to implement new organizational model in response to the dynamic changes that are transforming the health care process in Palestine. The study was conducted during January-June 2004 and involved all hospitals working within the City of Nablus. The primary aim of this study was to investigate the possibility of applying quality management approaches into the health care system through the identification of the level of offered services in Nablus hospitals (Public, private and charity) and to search for possible factors affecting level of offered services. The study also aimed at finding out to what extent these hospitals implements the criteria and the standards of quality management system. To achieve our goals, two structured questionnaires especially designed for this purpose were used targeting both staff and patients. Collected data was analyzed using SPSS. Several hypotheses were formulated and tested based upon TQM principles. The results of the current study showed significant differences in the assessment of both staff members and patients and the level of offered services in the various departments within the same hospital and between different hospital sectors.Based upon the criteria level (Likert Scale) set for all hypothesis (3.5 out of 5 points, for good evaluation) most departments showed levels less than 3.5 indicating areas of weakness in most working departments with the exception of working departments in the private sector. A direct relationship between overall hospital delivery care processes and patient satisfaction, where patient satisfaction is directly related to the attitudes and perception of employee as they, in turn related to the hospital and its management practices was found. The results also showed that total quality management criteria are not considered as hospital priorities. With the exception of Rafidia hospitals none of the operating hospitals is applying any of the TQM principles. Departments applying such principles in Rafidia hospital (only 4) scored higher levels compared to Al-Watani hospital, thus indicating clear advantages in favor of TQM application. Furthermore, correlation analysis confirmed suggestions that further work is required for the establishment of a health care quality management model in hospitals. In conclusion, based upon the findings of the current study a proposed model for the improvement of the existing system was suggested.
Assessment of Rehabilitation Services in the North Districts of West Bank in Palestine
(2002) Nasir Abu Khader; Dr. Suleiman Al-Khalil; Dr. Varsen Aghabekian
The purpose of this study was to assess the rehabilitation services in the North districts (Nablus, Salfit, Tulkarm, Qalqiliya, Tubas, and Jenin) of the West Bank in Palestine. The study population consisted of (43) providers who represented the institutions providing rehabilitation services. Exploratory descriptive design utilizing a structured questionnaire designed by the researcher and reviewed by 4 advisers with a research background was utilized. The questionnaire consisted of (13) sections: The first section was related to socio demographic variables (age, gender, education and experience.) Sections two to section eight covered types of rehabilitation, quality and quantity, size of rehabilitation services, financial matters, human resources, relation with administrative system, patient referring system, cooperation and coordination, national policies and rehabilitation policies. Section nine covered priority rehabilitation needs. Section ten covered the most serious problems that restrict development of services. Section eleven and twelve covered suggestions to develop rehabilitation policies, while section thirteen covered measures to improve quality of rehabilitation services. Data were collected through face-to-face interviews. The analysis of the data revealed that the majority of providers of rehabilitation services were young less than 35 years (58.1%). the majority (62.8%) had a Bachelor degree; with more than 10 years of experience (53.3%). • Physiotherapy is the most rehabilitation service provided in the north districts (86%). • There is duplication in providing services by different institutions, while some services are nonexistent such as Occupational therapy. • About90.6% of providers indicated needed to develop their work force. • Results indicated weak administrative measures and lack of laws. This restricts development of rehabilitation services. • In general the majority of providers suggested that the rehabilitation policy and services should be comprehensive and nationwide. There should be social assimilation of the disabled in their society and, studying of the factors that affect policy-making in the field of rehabilitation and to support rehabilitation institutions. Accordingly, an accepted policy and protocols by different settings: UNRWA, NGO's, government, and private sectors should be targeted in order to improve the quality of rehabilitation services and to ensure a better rehabilitation and well being of the Palestinians with special needs.
Assessment of the Actual Treatment Abroad Department at Palestinian Ministry of Health (MOH)
(2006) Marwa Abd Al-Raziq Saleh Kharouf; Dr. Suleiman Al-Khalil; Dr.Qasem Al-Ma'ani
Based on the policy of Health for all in the twenty-first century adopted by the world community in May 1998, to realize the vision of the World Health Assembly at the Alma-Ata conference in 1978, World Health Organization (WHO) had develop the World Health Survey (WHS) as a mean of providing low-cost, valid, reliable and comparable information. (WHS) served as an evidence base to monitor the efficiency of different health systems in meeting the desired goals. Thus providing policy makers with the evidence they might need to adjust their policies, strategies, and programs as necessary. This study aims to assess the performance of treatment abroad department in the Ministry of Health (MOH), to rationalize spending cost and to find options to decrease this cost by providing alternatives for replacing treatment abroad by treatment in Palestinian health care facilities to demonstrate the importance of having centers of excellence and comprehensive health care services in Palestine. The study was conducted during the period of January-May, 2006. To achieve our goal and objectives, data was collected through structured interviews utilizing a questionnaire for five key informants, one for decision maker of MOH, another for chairperson of treatment abroad department, physicians and policy makers in public sector (governmental), physicians and administrative persons in private sector, NGOS and UNRWA, and the last one for patients who receive treatment abroad inside Palestine (in private sector, NGOS, UNRWA hospitals), and outside Palestine (in Jordan and Israel). The sample of the study was (191) patients, (92) collected from Jordan hospitals, (99) patients from west bank, (40) employees from private and public sector, one for decision maker and one for chairperson of treatment abroad department. Quantitative collected data was analyzed using SPSS while other qualitative data was analyzed manually. Several hypotheses were formulated and tested, the results of the current study showed the highest percent of reason for referral abroad have been tumor disease with 33%, then cardiac disease with 17%, organs transplantation with 5.8%and 1.6%invitro fertilization. IN relation to reason of referral cases abroad, the highest cause that the treatment not available in Palestine with percent 43.6%, second because services were not of good quality26.7%, the third reason there was a long waiting list for intervention 14.1%, 4.7%no trust for medical team in Palestine. From analysis of patient questionnaire there was relationship between disadvantages of referral abroad and suggestions to avoid referral treatment abroad, ministry of health should provide an inclusive medical health system. The result also showed that questionnaire for other key informant illustrate the importance and need of integration between all health care providers sectors in Palestine and encourage treatment abroad inside Palestine rather than outside Palestine.
The Association of Lifestyle Determinants and Body Mass Index with School Achievement of Ninth Grade Students in the District of Tulkarm, Palestine
(2012) Mayadah Husni Mohammad Al-Demah; Dr. Jihad Abdallah
Abstract This study was conducted to investigate the impact of some lifestyle determinants and body mass index on school achievement of ninth grade students in the district of Tulkarm and study the factors associated with them. The study was carried out on 781 ninth grade students (407 females, 374 males) attending governmental schools of the district. The data were collected via personal interviews. Descriptive statistics, ANOVA, and Fisher’s exact test were employed in the analyses. The results showed that 62.9% of the students (46.7% of females, 80.6% of males) take breakfast before going to school, but no relationship was found with school achievement. Of all interviewed students, 27% (29% of females, 24.7% of males) suffered from low concentration in the first three lessons. Low concentration in class was associated with skipping breakfast, smoking, non-daily consumption of fruits, tiredness, psychological stress at school, and waking up late and was associated with poor school achievement. Daily consumption of fruits improved student scores in Technology, English language, and the overall average. Students suffering from psychological stress at home had lower average scores than their peers in some subjects and overall average. About 6% of male students were smokers (none of the females declared smoking) and smoking was associated with low school achievement. About 72% of students (82.5% of females, 61.5% of males) don’t receive any help from their parents in their lessons and homeworks and these students achieved higher scores in all subjects (except General Science) than those who received assistance. About 32% of students had average night sleeping hours of 8 to 9 hours per day and these students had higher scores in General Science and Technology, as well as overall average than students sleeping less than 8 hours or more than 9 hours. There were no differences in school achievement between students with regard to eating lunch and dinner, BMI status, weekly physical activity, daily time spent watching TV, daily time spent using computer and method of transport. These results should raise awareness among students and parents for the need to follow healthy lifestyle such as eating breakfast and focus on eating fruits daily, to avoid smoking, to have good sleep-wake up habits, to have enough family time and avoid factors which cause stress to students
ATTITUDE OF OPERATING SURGICAL ROOMS TEAMS TOWARDS THE IMPLEMENTATION OF WHO SURGICAL SAFETY CHECKLIST AND EVALUATION OF THE COMPLIANCE OF FILLING OUT THE CHECKLIST IN HOSPITALS OF PALESTINE
(2023-06-11) Sana Jaber Ali Yaseen
Background: The World Health Organization introduced the surgical safety checklist (SSC) to promote patient safety in surgery. This study was carried out to assess the attitudes of the operating room team members toward implementing the SSC in governmental and non-governmental hospitals in Palestine. Another objective was to determine the adherence to the currently used SSC in government and nongovernmental hospitals in Palestine. Methods: This study was carried out in two parts. The attitudes part was conducted in a cross-sectional design using a questionnaire adopted and modified from previous studies. The adhesion part was conducted in a retrospective design. The surgical files of the patients were audited against items in the SSC. Results: Participants had positive attitudes toward the SSC. The members of the operating room team who the non-governmental hospital employed were 76.23-fold (95% CI: 8.08 to 718.84) more likely to score ≥ 80% in the norm domain, 4.15-fold (95% CI: 1.23 to 13.94) to score ≥ 80% in the initiating domain, and 3.96-fold (95% CI: 1.13 to 13.93) to score ≥ 80% in the support domain. Participants who worked in a government hospital had 46.69-fold (95% CI: 6.25 to 348.65) to score ≥ 80% in the barrier domain. The SSC was completed (completely filled out) for 95 (27.9%) patients. SSC was left blank (complete) for 0 (0.0%) patients in the non-governmental hospital. On the other hand, the SSC was completed fully for 0 (0.0%) patients included in the governmental hospital. Conclusions: The operating room team members who the nongovernmental hospital employed had a more positive attitude toward the SSC. However, the adhesion to filling out the SSC in all hospitals was suboptimal. Keywords: Surgical checklist, Surgery, Patient safety
Audit and Adjustments for the purposes of Value Added Tax (VAT) and its impact on Income tax in the West Bank
(2014) Basil Mas'od Dawood Mohammad; Dr. Mohammad Shoraqa; Dr. Sameh Al-at'out
This study is aimed at identifying inspection, adjustment, and audit procedures followed by the VAT Department and its impact on the income tax in the West Bank. This study addressed the importance of imposing the value added tax and its characteristics, objectives, advantages, and flaws. As well as identifying how inspection and adjustment operations are conducted and to illustrate its impact on the income tax through applying these procedures on a variety of active sectors registered at the Tax Department, in addition to identifying the compatibility of the inspection procedures and processes with the VAT system and instructions applied at the State of Palestine, and illustrate the impact of these measures on income tax revenues. By looking at previous studies it was clear that there is an apparent shortcoming in addressing this issue. These studies did not address inspection and adjustment procedures in a way that reflects the reality of these procedures and the extent of their impact on income tax. In order to achieve this objective, the relevant literature to the research had been reviewed which helped in developing the theoretical framework, in addition to developing a questionnaire and verify its authenticity and consistency factor, and then it was distributed to a random sample consisting of ( 98 ) respondents from the staff of income tax and value-added tax departments and the auditing and accounting offices, who make up the study’s community. The questionnaire was processed using the Statistical Package for Social Sciences (SPSS). The study reached a set of results in terms of the different paragraphs and variables of the study. The paragraphs of the questionnaire show that the effect percentage of the audit and adjustments for the purposes of value added tax on the income tax in the West Bank, according to the paragraphs combined is 60.2 %, which is considered moderate. In terms of the study variables, following are the results that were reached: Firstly: The results on the effect of variables independent from variables measuring the impact of audit and adjustments for value added tax purposes on the income tax in the West Bank: No statistically significant differences at the level of (a = 0.05) when exploring the impact of the audit and adjustments for the purposes of VAT and on the income tax in the West Bank. This is due to the variable of applying the VAT law, planning the audit process, tax inspection requirements, goals of tax inspection, objectives and reasons of tax inspection, the extent to which the staff of the income tax department rely on data provided by the value-added tax department, and how the estimation officer handles customs classifications. This is because the significance level is higher than (a = 0.05). Secondly: Key results that have been reached are: 1. The Income Tax Department relies greatly in its work on the adjustments and files of the VAT department and not the other way around. 2. Any error that appears in the accounts of a licensed business in VAT will most likely be followed by an error in estimating the financial status for the purposes of income tax. 3. There is a directly proportional correlation between income tax and VAT, where the final estimation of income tax is greatly based on the taxpayer’s work that appears through the VAT department. 4. There aren’t any significance level differences in terms of significance level (alpha = 0.05) in the effect of audit and adjustments for VAT purposes and its impact on the income tax in the West Bank, due to the variables of academic qualification, age, years of experience, specialization, and the nature of work . 5. The study shows that there is tax audit and tax adjustments at the department of VAT which are always resorted to when law is violated or when taxpayers do not completely and properly declare transactions. Thirdly: Key recommendations that have been reached are: 1. Stakeholders must seek to unify the income tax and customs and excise department and the value-added tax for all businesses so that they become one department similar to senior taxpayers department. 2. The tax inspector should possess extensive knowledge in tax legislations and instructions, in addition to relevant legislations, and should also carry extensive knowledge in the bookkeeping system. He/she should have integrity and self-confidence, and should be objective, intelligent, logical, and patient, and shall efficiently utilize time and be able to work within a group . 3. There should be great coordination between departments and the general administration when developing instructions or applying certain legal provisions, and not rely only on the general administration; because it is those departments that interact with the taxpayers not the general administration. 4. In order for the tax inspection process to be effectively conducted, it should rely on a group of elements such as: the employee should be qualified, and the inspection process shall be conducted according to the rules of tax legislation. 5. The tax inspector should collect data and information about the facility subject to inspection both from within the tax administration, from external sources, or through extensive private investigations before conducting the inspection process.

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