Public Health

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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.
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 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 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
Body Perceptions and Weight Control Behaviors among An-Najah National University female Students, 2015
(2015) Watan Majid Nazzal; Dr. Zaher Nazzal
Introduction: Eating behaviors and body perceptions is an increasingly relevant and important topic in public health; due to its ultimate impact on health and human well-being in general. Objectives: The aim of this study is to assess the current body perceptions and dieting behaviors among female students at An-Najah National University in Palestine. Furthermore, it tried to assess the relation between the body weight and image perceptions and weight control practices among the female students. Materials and methods: A cross-sectional study was conducted among the university female students on April 2015. The study included 420 female students aged 17-27 years. A convenient sample was selected to achieve the study objectives. We invited students from all faculties; including the faculty of medicine and health sciences, economic and social studies, educational sciences and teachers' training, engineering and information technology, fine arts, humanities, Islamic law, science and faculty of law. The data collection tools included questionnaire, body image perceptions scale, and measurement scale for weight and height. The questionnaire contained three major parts: socio-demographic variables, perception of body weight and eating attitude test (EAT-26), all were completed. Results: About 37% of female students had participated in risky eating behaviors, and reported a great level of concern about diet and weight (95% CI: 32% - 41%).In general, most of the study sample was dissatisfied with their bodies; in particular, 55.7% of participants were suffering from negative body image, while 24.5% showed positive body image. The majority of participants who were engaging in risky eating behaviors were in a normal BMI category, and 15.5% were either overweight or obese and 9% underweight. Regarding body weight perception, most of participants had an accurate estimation to their body weight. The logistic regression analysis revealed that, weight control behaviors were mainly associated with perception of body image. Conclusion: The results showed a high level of concern about food and weight by the female students. Additionally, it showed that they are prone to risky eating behaviors. Therefore, interventions are needed in order to promote healthy eating behaviors and body image among university students.
Burnout amongst Governmental Mental Health Professionals in West Bank, Palestine
(An-Najah National University, 2019-02-07) Abul-Hawa, Niveen Maher
Burnout in general is a gradual process of feeling the loss of motivation and energy to deal with daily issues that occurs over an extended period of time, where it might effects on the mental, social, or physical well-being, and reduces the productivity. Purpose: This study aims to assess the level of Burnout amongst mental health Professionals in the West Bank governmental mental health workplaces, to investigate Burnout presence and the significant differences between the Burnout level on the three dimensions of emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA) with the socio- demographic factors. Methods: This cross – sectional study is utilizing a socio-demographic sheet and (MBI-HSS) to investigate the presence and level of Burnout, in addition to the significant difference between the independent variables (socio-demographic factors) and dependent variables (the level of Burnout on EE, DP, & PA) amongst a convenient sample of 149 mental health workers that include: Psychologists, Psychiatrists, Social Workers, Psychiatric nurses, or occupational therapists who are working in the governmental mental health workplaces in the West Bank, in the middle region (Ramallah, Jericho), south region (Bethlehem, Hebron),and north region (Tubas, Qalqilia, Tulkarm, Jenin, Salfit, and Nablus) . The 138 valid questionnaires were analyzed using SPSS version 20. One way ANOVA test is used to analyze groups which contain more than two socio-demographic variables such as age, marital status, workplace location, educational level, years of experience, and specialty, while an independent t- test is used to analyze socio-demographic groups which contain two variables such as gender, and monthly income. Results: Moderate level of Burnout on EE and DP, while nearly moderate on PA. Professionals have reported the mostly high level on (EE) (37%), low level on (PA) (47%), and low level on (DP) (51%). Tests showed significant differences on the three subscales due to marital status, specialization, gender, and age. Conclusion: The lack of resources along with the high demand impulse Burnout in the WB mental health workplaces. This study recommends future research to investigate the reasons behind the Burnout prevalence amongst the mental health professionals who work in the governmental mental health workplaces in the West Bank.
Cardiovascular Diseases and Risk Factors Among Diabetic Patients in Nablus District, West Bank, Palestine: case-control study
(2009) Huda Nimer Mohammad Lahham; Prof. Hisham Darwish; Dr. Samer Hamidi
Aim of the study The study aimed to compare cardiovascular diseases and risk factors among diabetic patients and nondiabetic individuals living in Nablus district. Methods This case control study was carried out in 7 diabetes clinics of MoH and UNRWA in Nablus district. The 299 diabetic patients and 159 nondiabetic controls were included in the study. Body mass index, waist circumference, waist hip ratio and blood pressure were measured after conducting face to face interview for each participant. Blood sample was collected to measure fasting blood glucose, total cholesterol and triglyceride. Results All cardiovascular risk factors, except systolic blood pressure, diastolic blood pressure and smoking, were significantly higher in diabetic patients than nondiabetic controls. The best predictors of diabetes using logistic regression analysis were total cholesterol, family history of diabetes, waist circumference and triglyceride. About 78 % of diabetic patients had at least one diabetes complications; hypertension was in diabetic patients as twice as nondiabetics (55.2% vs 27.0%). Diabetic females were more obese and less physically active. But diabetic males were more ex- and current smokers than diabetic females. Frequencies of diabetes complications were more in diabetic male than diabetic females. Diabetic patients living in the city showed higher prevalence of almost all cardiovascular risk factors. Similarly, the diabetic complications were higher in diabetics living in the city except systolic blood pressure and body mass index which were higher in diabetics living in the refugee camps. Awareness of cardiovascular complications was comparable and low in both diabetic patients 56.9% and nondiabetic controls 57.2%, (p=1.000). Conclusion As urbanization and obesity especially are high in Palestine and awareness is low, more risk factors and complications of diabetes are expected in the next years. So effective interventions must be developed and implemented in the national level.
CATARACT SURGERY RATE EYE CARE CENTERS IN THE OCCUPIED PALESTINE: A RETROSPECTIVE STUDY
(جامعة النجاح الوطنية, 2022-07-27) Fayez Rabbaa, Ru’a
Introduction: Nearly half of vision impairment and blindness among elderly people are due to cataract, but fortunately, this decreased vision is reversible as advancing technology allows for cataract surgery to be conducted with high accuracy and precision. Despite the fact that cataract is easily treated, cataract was reported to be the major cause of blindness in Occupied Palestine among people over the age of 55. Cataract surgery rate is one of the indicators used to measure cataract service delivery in countries. It is a quantifiable measure of the cataract surgical services accessibility to those who need it. The World Health Organization has set a cataract surgery rate of 3,000 per million people per year as the minimum rate required to eliminate blindness due to cataract. As there is limited information on the cataract surgery rate in Occupied Palestine, them this study has sought to measure the cataract surgery rate in Occupied Palestine. Methods: A retrospective records review study was conducted in 2019 and 2020 to determine the cataract surgery rate at all cataract surgery hospitals and medical centers in Occupied Palestine. Results: Cataract surgery rate decreased from 2, 297 operations per million in 2019 to 1, 885 due to corona virus pandemic in 2020. Out of 211 cataract-operated eyes with corrected visual acuity, 93.84% of them achieved good visual acuity (≥6/18), 5.21% of them had borderline acuity (<6/18–6/60). Only 0.95% had poor visual acuity (<6/60). Conclusion and Recommendations : Cataract surgery rates in 2019 and 2020 were lower than the minimum rate set by the World Health organization. Therefore, there is a need to increase cataract surgery rate across the country. Visual outcomes of cataract surgery have improved in Occupied Palestine and have been found to be very close to World Health Organization satisfactory outcomes. Keywords: Cataract; cataract surgery; cataract surgery rate; cataract surgery outcome; visual impairment; cataract blindness
Colon Cancer in Palestine: Associated risks, Perceived Causes, Patterns of Distress, and Help Seeking Behaviors
(An-Najah National University, 2018-07-17)
Background: With cancer being the second leading cause of death in West Bank and colon cancer being the second common cancer, attention should be drawn to it in order to better understand all the aspects of this diseases in the Palestinian settings. Among what attention should be drawn to are colon cancer risk factors and how the illness affects the patients’ lives. Objectives: To identify the risks associated with colon cancer among Palestinian patients. To better understand the illness experience of the colon cancer patients in terms of perceived causes, patterns of distress, and help seeking behaviors. Methods and Materials: A mixed method was used to achieve the purpose of this study, in the first phase, a total of 103 cases and 116 control were conveniently selected to participate in the case control study were they were asked to fill a questionnaire consisting of 3 sections: the socio-demographics, the colon cancer section, and the food frequency section. In the second phase, a qualitative study was conducted on 20 colon cancer patients who participated in the first phase of the study; data was collected via face-to-face Explanatory Model Interview Catalogue (EMIC) interview consisting of 3 sections: perceived causes, patterns of distress, and help seeking behavior. Results of the Case-Control Phase: Analysis showed that family history of colon cancer, regular screening, personal history of cancer, diabetes, constipation, constipation duration, cooked cereals, fruits, vegetables, legumes, red meat, cold meats, fats, type of fats, and fast foods were found to be different between cases and controls but following logistic regression, family history (OR=3.543), constipation (OR=29.989), hot cereals (OR=0.557), fats (OR=1.615), and fast food (OR=1.501) were the only factors found be significantly associated with colon cancer with only hot cereals as a protective factor. Results of the Qualitative Phase: Colon cancer patients went through a variety of challenges and hardships but chemotherapy and psychological distress was the most common among the sample. Few had an answer to what was the cause of their illness and the majority reported their low level of knowledge regarding that matter. Each patient had his/her own unique journey through the illness, but all agreed that surgery was the most effective step as it alleviated their physical symptoms and gave them back their movement abilities which is what defines the general health according to those patients. Conclusion: Study had found that having a family history of colon cancer, suffering from constipation, consuming fats and fast food increase the risk of developing colon cancer while consuming hot cereals such as oatmeal works as a protective factor against colon cancer. When looking at colon cancer as an illness, patients were unaware of the possible causes for their cancer, physical and psychological pain is considered a source of distress with chemotherapy being the hardest distress of all. Contradiction was noticed when patients used fatalistic phrases while showing high level of psychological distress. As for seeking help, patients’ surgery, faith, and family support had positive impact on their wellbeing.
Comparison of Compressive Dressing with Gauze and Elastic Crepe Bandage Versus Transradial Band in the Management of the Radial Approach for Cardiac Catheterization and Interventions. A Prospective, Randomized, Controlled Observational study
(An Najah National University, 2021-09-08) Raed Awwad, Fateh
Introduction: TR BAND® Radial Compression Device like bracelet designed to assist hemostasis of the radial artery after the transradial cardiac catheterization. The crepe bandage is a medical material that is essential for wound dressing, but theoretically, bandage can compromise peripheral circulation. Both of these methods are used for maintaining the hemostasis of the puncture site of the radial artery. So, comparison between these methods in reference to hemostasis, vascular complications such as bleeding, hematoma, Acute radial artery occlusion (RAO) and the cost effectiveness in term of Price of these methods are warranted. Aim: This study aims to determine the differences between TR Band and compressive dressing with gauze swab and elastic Crepe bandage after cardiac catheterizations and interventions in terms of benefits, complications, and cost effectiveness concerning the price of these methods. Methodology: A prospective, randomized, and observational study at An-Najah National University Hospital (NNUH). A number of 400 patients who would be admitted at NNUH for cardiac catheterization and interventions, and whom would voluntarily accept to participate. They were randomly allocated according to the randomization list generated by the GraphPad® software, developed by GraphPad Software Inc, San Diego, California, USA. Results: of the 417 patients, 200 were randomized to the TR band group and 200 to the gauze swab and crepe bandage group.17 patients were excluded due to different exclusion criteria. Demographic and Procedural characteristics were similar. Both hands were equally effective in fulfilling hemostasis, incidence of hematoma and Acute RAO was higher in the TR band group (2.50% vs. 0.5%; p = 0.100), also time to hemostasis was less in the gauze swab and TR band group (1.67 h vs. 1.11 h ; p = 0.000).
Critical Care Nurses Burn Out: Sociodemographic Factors, Leveling and Mitigation in Palestinian Governmental Hospitals
(An Najah National University, 2021-09-01) Ahmad Mahmoud Zakarneh, Maram
Aims: Continuous nurses working under stressful situations with critically ill patients decrease their ability to cope with stress, and increase job turnover which expose them to burnout syndrome. So our study aimed to measur the level of critical care nurse’s burnout, verify and find the relationship between sociodemographic risk factors and burnout syndrome, and the effect of break on burnout level among critical care nurses in Palestinian governmental hospitals. Method: Quazi experimental study utilizing a self-report questionnaire, was used to collect data from the critical care nurses in Palestinian governmental hospitals, burnout was measured using Maslach Burnout Inventory- Human Services Survey (MBI-HSS) questionnaire, distributed pretest for both control and intervention groups, intervention was a 20 minutes outdoor break at each shift for 6 weeks, then questionnaire redistributed again posttest for both groups. Result: Result showed total of 110 critical care nurses filled the questionnaire, critical care nurses, of Palestinian governmental hospitals, complained of moderate to high level of emotional exhaustion and depersonalization, while medium to high level of decreased personal achievement. There was a significant difference between burnout and gender and shift rotation also, while there in no significant difference with other sociodemographic factors. There is a significant difference between break and intervention group posttest. Discussion: This study demonstrates that most of the Palestinian critical care nurses complaining of moderate to high level of burnout. Burnout syndrome affected by some sociodemograhic factors such as gender where female had higher level of burnout, and for shift rotation nurses who worked in rotated shifts had higher level of burnout than fixed shifts, and A shift burnout higher than B&C shits, also outdoor break can mitigate level of nurses burnot.
Cross-Infection and Infection Control in Dental Clinics In Nablus and Tulkarm Districts
(جامعة النجاح الوطنية, 2021-02-20) بسام الصباح, أريج
الخلفية: شهدت مكافحة العدوى العديد من التطورات في السنوات الماضية، لا سيما في جائحة كوفيد 19، وعلى الرغم من ذلك، هناك العديد من المضاعفات في مرافق الرعاية الصحية المختلفة وكذلك طبيعة عمل عيادات أطباء الأسنان بسبب نقص المعرفة بمكافحة العدوى وفشل الامتثال بها. الهدف: هو تقييم مستوى المعرفة والاتجاه والامتثال المتعلقة بتدابير مكافحة العدوى في عيادات طب الأسنان العامة والخاصة في منطقتي نابلس وطولكرم، فلسطين. الطريقة: تم استخدام عينة عالمية لتقييم برنامج مكافحة العدوى في عيادات الأسنان في محافظة نابلس وطولكرم. لقد تم التخطيط لإجراء الدراسة في ظل الظروف الصحية الطبيعية‘ ولكن بسبب جائحة كورونا 19 في فترة جمع المعلومات فان هذه الدراسة قد تأثرت في هذه المرحلة الصعبة. حيث عكست الدراسة مدي الالتزام بتدابير مكافحة العدوى في عيادات الاسنان في فترة جائحة كورونا 19. شملت عينة الدراسة على 265 طبيب أسنان. تم جمع البيانات باستخدام استبيان تم إرساله عبر البريد الإلكتروني بين شهري تموز وآب 2020. أجريت دراسة تجريبية على عينة عشوائية من 20 طبيب أسنان من منطقة جنين بعد الحصول على الإذن. ولقد تم استخدام الإحصاء الوصفي واختبار Chi-square واختبار ANOVA أحادي الاتجاه واختبار Post-Hock. تم تعيين الدلالة الإحصائية عند " ″ P <0.05. بالإضافة الى إجراء اختبار كرونباخ ألفا والصلاحية الداخلية لضمان موثوقية وصحة الاستبيان. النتائج: شملت عينة الدراسة 265 طبيب أسنان. فيما يتعلق بالخصائص الديموغرافية للمشاركين، فإن ثلثي العدد الإجمالي لحجم العينة هم من الذكور، وشكلت نسبة الممارس العام من حيث مستوى التعليم (75.1٪) من حجم العينة الكلي كما شكل المشاركون من مدينة (نابلس) (56.2٪). اتسم المشاركون في الدراسة بسنوات مختلفة من الخبرة بين (5> و<20). وأخيرًا، فيما يتعلق بمتغير الملكية، بلغت نسبة المشاركين من العيادات الخاصة (89.1٪)، (الحكومية) (9.1٪) ومن الأنروا (1.8( من إجمالي حجم العينة. بالنسبة لأهم نتائج الاستبانة، يعتقد (78.50٪) من المشاركين أنهم بحاجة لمعرفة المزيد عن تدابير مكافحة العدوى. بينما يعتقد (85.7٪) من المشاركين بأن التطعيم هو الطريقة الأكثر توقعًا لمنع انتشار فيروس التهاب الكبد HBV. أظهرت النتائج أن إجمالي الاستجابة الإيجابية فيما يتعلق بجميع مجالات ضبط العدوى المذكورة في الدراسة كانت (70.0٪). حيث أعطى المشاركون أعلى نسبة استجابة للقفازات (96.10٪)، تطهير الأسطح (78.00٪)، واقي الوجه (77.70٪)، ارتداء الملابس الواقية، غطاء الرأس والمعطف الأبيض (76.30٪)، غسل اليدين (76.10٪)، التطعيم ضد فيروس التهاب الكبد 74.50)٪) وواقي العين (74.30٪). ثمة كانت النتائج أقل في مكافحة العدوى بما يتعلق بالاحهزة المستخدمة في عيادات الأسنان؛ اذ كانت نسبة الالتزام بتعقيم الأدوات (59.40٪)، السيطرة على الهباء الجوي وإدارة الحوادث ومراقبة الأوتوكلاف (55.1٪، 55.30٪، 47.20٪) على التوالي. أظهرت النتائج أن هناك اختلافات كبيرة بين الذكور والإناث من حيث إدارة الحوادث″ 0.016p=″، أظهر اختبار T أن مجموعة الذكور (M) (Mean= 0.73) أفضل مما هي عليه في مجموعة الإناث (F) (متوسط = 0.64). النتائج أظهرت أيضا أن هناك فرقا كبيرا بين الممارس العام و المتخصصون في ارتداء القفازات ″ p= 0.009″، اذ ان المجموعة المتخصصة من أطباء الأسنان (متوسط = 2.70) هي أفضل من مجموعة الممارس العام (G.P) (متوسط = 2.48). الأخصائيون الذين يطبقون تعقيم الأدوات ″p= 0.004″ (متوسط = 0.55) أقل من (G.P) (متوسط = 0.62). وبينت الدراسة أن هناك فرقاً كبيراً بين المحافظتين (نابلس وطولكرم) في سبعة مجالات وهي: ارتداء القفازات ″p=0.001″، ارتداء ملابس واقية ″p=0.035″، وغسل اليدين ″p=0.000″، وتعقيم الأدوات ″p=0.001″، و استخدام حواجز الحماية المتاح لتغطية بعض الأسطح ″p= 0.001″، والتحكم في الهباء الجوي ″p=0.008″. بالاضافة الى إدارة الحوادث ″p=0.003″. وكانت جميع النتائج حول الامتثال لمجالات مكافحة العدوى أفضل دائما في طولكرم منها في محافظة نابلس. كما أظهرت الدراسة أيضا أن هناك اختلافات كبيرة في ارتداء واقي العين ″p=0.005″، وارتداء الملابس الواقية ″p= 0.000″، غسل اليدين ″p=0.000″، أدوات التعقيم ″p=0.000″، ومراقبة الأوتوكلاف ″p=0.02″، وإزالة التلوث وتنظيف الأسطح، استخدام حواجز الحماية القابلة للتصرف لتغطية بعض الأسطح ″p=0.000″، والتحكم في الهباء الجوي ″p=0.035″ وإدارة الحوادث ″p=0.001″ تعزى إلى متغيرسنوات الخبرة ″P-<0.05″. وأظهر اختبار Post-Hoc أن مجموعة (<5 سنوات) كانت الأفضل في كثير من الأحيان بين جميع المجموعات الأخرى في المجالات (ارتداء القفازات، وغسل اليدين، وتعقيم الأدوات، وإزالة التلوث وتنظيف الأسطح، وذلك باستخدام حواجز الحماية التي يمكن التخلص منها لتغطية بعض الأسطح، وإدارة الحوادث، ومجالات التحكم في الهباء الجوي). وبينت الدراسة أن هناك اختلافات كبيرة في ارتداء قناع الوجه أثناء رعاية الأسنان p=0.033″″، ارتداء واقي العين ″p=0.003″، ارتداء الملابس الواقية ″p=0.001″، غطاء الرأس والمعطف الأبيض ″p= 0..001″، غسل اليدين ″p=0.000″، مراقبة الأوتوكلاف ″p=0.009″، إزالة التلوث وتنظيف الأسطح، استخدام حواجز الحماية القابلة للتخلص منها لتغطية بعض الأسطح ″p=0.000″ والتحكم في الهباء الجوي ″p=0.04″ المنسوبة إلى متغير الملكية ″P<0.05″. أظهر اختبار Post-Hoc أن مجموعة الأونروا كانت الأسوأ في تطبيق بعض تدابير مكافحة العدوى، كارتداء قناع الوجه ″p=0.033″، واقي العين ″p=0.003″، ارتداء ملابس واقية، غطاء الرأس ومعطف أبيض ″p= 0.001″، غسل اليدين ″p=0.000″، مراقبة الاوتوكلاف ″″p=0.00، إزالة التلوث وتنظيف الأسطح، باستخدام الألواح الحماية القابلة للتصرف لتغطية بعض الأسطح ″p=0.000″، و إدارة الحوادث ″p= 0.047″. الخلاصة: تظهر نتائج هذه الدراسة أن هناك التزام متوسط النسبة لبروتوكول مكافحة العدوى في عيادات طب الأسنان في نابلس وطولكرم. وهناك حاجة إلى تعزيز الالتزام بتدابير مكافحة العدوى.
Determinant of Neonatal Mortality in Palestine - 2012 (Northern West Bank)
(2014) Rawya Ibrahim Issa Lahaseh; Dr. Amira Shaheen; Prof. Anwar Dudin
Background: Although the world has recently achieved significant declines in under-five and infant mortality rates, progress in neonatal mortality is less marked, where neonatal mortality accounts for about 40% of the world under-five child mortality. In Palestine, high ratio of infant mortality (67%) is due to neonatal mortality, determinants of which are still not well studied. Objectives: The aim of this study is to determine the major risk factors contributing to neonatal mortality, and to describe the health reporting system regarding mortality of neonates and infants in the northern districts of the West Bank. Methods: A case-control design was adopted. Cases were obtained from all available officially reported cases of neonatal death that died after birth within 28 days after delivery in the northern West Bank in 2012. Control data were obtained through interviewed questionnaires of mothers of live neonates born in 2012. Cross tabulation, odds ratio, and multilevel, bivariate logistic regression was done to explore the risk factors associated with neonatal mortality. Results: First, this study explores defects in the health reporting system regarding NM in different aspects. Also, the lack of communication between primary health care units and the health information system was found, as well as the lack of a health information data base for the analysis and interpretation of those reported cases. Second, this study showed that a higher level of mother education (p-value= 0.042, odd=1.280, CI=1.098 - 1.642); numbers of antenatal visits more than 4 visits, (p-value=0.001, odd=2.980, CI=2.504 - 6.656); and the place of ANC in the private sector (p-value=0.007, odd=43.3, CI=2.82-665.13) were associated with fewer neonatal deaths. Breast feeding (p-value= <0.001, odd=1.18, CI=1.007-1.55) and early initiation of breast feeding immediately after birth (p-value= 0.027, odd=5.609, CI=5.25 - 125.911)were a protective factor for neonatal survival, whereas prematurity and low birth weight increased the risk of neonatal death. The main causes related to the death of neonates in this study were prematurity (36%); congenital malformation (31.5%), from which 17.1% was due to Congenital heart disease and 3.6 % as Chromosomal/Genetic disorders Conclusion: There is a need for the development of focused and evidence-based interventions to prevent neonatal deaths in Palestine. These interventions should be at all levels, and address risk factors of neonatal death. To strengthen reporting and the health information system is a major step in developing these strategies.

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