Medical and Health Sciences

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https://hdl.handle.net/20.500.11888/18295

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    ADHERENCE TO HEMODIALYSIS AND MEDICAL REGIMENS AMONG PATIENTS WITH END-STAGE RENAL DISEASE IN PALESTINE: A CROSS-SECTIONAL QUANTITATIVE MULTICENTER STUDY
    (An-Najah National University, 2025-06-24) Issa, Muneer
    Abstract Introduction: Chronic Kidney Disease (CKD), particularly End-Stage Renal Disease (ESRD), poses a significant public health challenge globally, with hemodialysis (HD) being a primary treatment modality. Adherence to medical regimens, dietary restrictions, and fluid management is critical for improving patient outcomes. However, adherence levels among ESRD patients vary due to multifactorial influences, including sociodemographic and health-related factors. This study aimed to assess adherence levels among Palestinian ESRD patients undergoing HD and identify associated factors. Objectives: Measure adherence rates to medications, dietary recommendations, and HD sessions among ESRD patients. Also, to identify sociodemographic and health-related factors influencing adherence. Finally, to investigate barriers to adherence, such as socioeconomic status and health literacy. Methodology: A cross-sectional quantitative study was conducted on 260 ESRD patients from three hospitals in northern West Bank, Palestine. Data were collected using the validated End-Stage Renal Disease Adherence Questionnaire (ESRD-AQ), which assessed adherence to HD sessions, medications, fluid restrictions, and diet. Descriptive and analytical statistics, including Kruskal-Wallis and Mann-Whitney tests, were employed to analyze the data. Results: The majority of participants (68.5%) exhibited good adherence, with a median score of 1100 (IQR = 250). Higher adherence was significantly associated with higher educational levels (p < 0.001), ESRD due to inflammatory causes (p = 0.009), prior peritoneal dialysis (PD) (p = 0.012), and no history of kidney transplant (p = 0.033). Lower adherence correlated with higher serum potassium (r = -0.352, p < 0.001) and phosphorus levels (r = -0.330, p < 0.001). Peri-dialytic weight differences were greater among patients with higher education (p < 0.001). Conclusions: Adherence levels among Palestinian ESRD patients are influenced by educational background, disease etiology, and prior treatment modalities. Nurse-led interventions and tailored educational programs are recommended to enhance adherence, particularly for patients with lower health literacy or congenital ESRD causes. Future research should explore the impact of such interventions on long-term health outcomes. Key words: Adherence, Chronic Kidney Disease, End-Stage Renal Disease, Hemodialysis, Palestine, ESRD-AQ, Medical Regimens.
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    MARITAL QUALITY AND ITS RELATIONSHIP TO SYMPTOMS OF PSYCHOLOGICAL DISORDERS AMONG MOTHERS OF AUTISTIC CHILDREN IN NABLUS GOVERNORATE
    (An-Najah National University, 2025-07-16) Nasrallah, Lama Yousef
    The study aimed to identify marital quality and its relationship to symptoms of psychological disorders among mothers of autistic children in Nablus Governorate. In addition to examine the effect of demographic variables of (child's gender, mother's age, child's age, educational qualification, severity of autism diagnosis, and marital status) on marital quality and its relationship to symptoms of psychological disorders. To achieve the study purpose, marital quality and psychological disorders scales were used. The indicators of the validity and reliability of the study tools were confirmed, and the study sample consisted of (97) mothers of autistic children, and the descriptive correlational approach was used. The results indicated the presence of an inverse relationship, meaning that the higher the marital quality, the lower the psychological disorders. Marital quality was average, and psychological disorders (anxiety, depression, stress) were low. There were no differences in the study sample’s attitudes towards marital quality and its relationship to psychological disorders according to the variables of the child’s gender, mother’s age, child’s age, educational qualification, and marital status. Based on the results reached by the study, a number of recommendations were made, including conducting more research on other psychological and social factors that may have an impact and increase marital quality and reduce psychological disorders among mothers of children with autism spectrum disorder.
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    EFFICACY OF PROPHYLACTIC ANTIEMETICS IN PATIENTS UNDERGOING LAPAROSCOPIC SURGERIES: A DESCRIPTIVE STUDY
    (An-Najah National University, 2025-08-31) Atieh, Raghad
    Background: Postoperative Nausea and Vomiting (PONV) are popular, inconvenient surgical complications, in particular under general anaesthesia; in addition, no functional pharmacologic antiemetics have been developed. Aims: This study aimed to compare the efficacy of prophylactic intravenous metoclopramide (10 mg) administered prior to extubation with dexamethasone (8 mg) given at the induction of anaesthesia in preventing PONV within the first 24 hours following laparoscopic surgery. The study also sought to assess their influence on the necessity for rescue antiemetic medicine, postoperative pain incidence and severity, occurrence of side effects, and patient satisfaction throughout the recovery phase. Methods: The study was conducted in a Northern West Bank hospital from October 2024 to April 2025, including 90 patients scheduled for elective laparoscopic surgery. The patients were divided into two groups: one group received 8 mg of intravenous dexamethasone at anaesthesia induction, and the other received 10 mg of metoclopramide before extubation. Nausea severity was measured using a Likert scale, and postoperative pain was assessed using a VAS. Outcomes were evaluated in the PACU and at 6, 12, and 24 hours post-surgery. Results: The Metoclopramide group manifested significantly less favorable outcomes, with higher nausea intensity (1.82 vs. 1.07), more rescue antiemetic use (44.4% vs. 15.6%), and more side effects like headache (73.3% vs. 42.2%), fatigue (77.8% vs. 46.7%), blurred vision (33.3% vs. 8.9%), and tremor (35.6% vs. 0%) in the PACU. In the ward (0–24 hours), they also had high nausea incidence (84.4% vs. 60%), greater nausea intensity (1.78 vs. 1.16), and more blurred vision and tremor. However, the Dexamethasone group required a higher rescue of antiemetics later (at 6 hours: 17.8% vs. 0%; 6.7% vs. 33.3% from arrival to 24 hours). Pain scores at 2 and 4 hours were higher with Metoclopramide, and satisfaction scores were lower (2.78 vs. 2.96). Conclusion: Dexamethasone is better than Metoclopramide in to forbid postoperative nausea and vomiting, reducing nausea severity, frequency of adverse effects, and improving patient satisfaction. It also minimize the necessity for rescue antiemetic medications in the PACU, confirming its preference for elective surgery patients.
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    EVALUATION OF DENTAL HEALTH INDICATORS IN PREGNANCY : SALIVA PH AND CARIES RISK
    (An-Najah National University, 2025-06-17) Raddad, Riham
    Purpose: This study aims to investigate the relationship between pH levels, dental caries, and pregnancy by comparing the dental health of pregnant and non-pregnant women. The focus is on assessing the impact of pH levels, age, and pregnancy experience on dental health perceptions and practices, as well as examining the relationship between the DMFT (Decayed, Missing, Filled Teeth) index and dental health during pregnancy. Design/methodology/approach: A cross-sectional study was conducted with 80 women from the Salfit Health Directorate, divided into pregnant and non-pregnant groups. Data on dental health perceptions, pH impact, and the DMFT index were collected and analysed using statistical methods, including F-tests and T-tests, to compare the groups. Findings: The findings indicate no significant difference in dental health perceptions between pregnant and non-pregnant women based on pH levels (F = 0.542, p = 0.705). Age also had no significant impact on dental health perceptions and practices (F = 1.449, p = 0.226). However, significant differences were found in dental health perceptions related to pregnancy experience (T = 2.476, p = 0.015) and in the DMFT index between women exposed and not exposed to pregnancy indicators, with p-values of 0.011, 0.001, and 0.008, respectively. Research Limitation/implications: The study was limited to a specific population in one region, which may affect the generalizability of the results. Further research is needed to explore additional factors influencing dental health during pregnancy. Practical implications: The results emphasize the importance of integrating tailored dental health education and interventions into prenatal care, focusing on pregnancy-related factors that affect dental health. Originality/value: This study contributes to understanding the relationship between pregnancy, pH levels, and dental health, highlighting the significant role of pregnancy experience and the DMFT index in shaping dental health outcomes. It underscores the need for targeted dental care strategies for pregnant women.
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    PHARMACIST-LED ECONOMIC STUDIES: A SCOPING REVIEW OF RANDOMIZED CLINICAL TRIALS
    (An-Najah National University, 2025-08-18) Abu Eisheh, Haneen
    Background: Pharmacist-led interventions have gained recognition for their role in enhancing patient outcomes and healthcare efficiency. However, a comprehensive understanding of their economic impact, particularly within randomized controlled trials (RCTs), remains limited. Objective: This scoping review aimed to systematically map the global literature on economic evaluations (EEs) of pharmacist-led interventions in RCTs published between 2003 and 2023. Methods: A systematic search of PubMed, Scopus, and Embase was conducted to identify RCTs featuring pharmacist-led interventions and reporting full EEs. Data were charted on study characteristics, intervention types, EE methods and outcomes. Results: A total of 48 studies were included. Most evaluated pharmacist-led medication review and patient education interventions. The majority employed cost-effectiveness analysis (CEA) and consistently demonstrated that pharmacist-led interventions were cost-effective. However, notable evidence gaps remain, particularly the absence of studies from low-income countries and in public health areas such as immunization and screening. Conclusion: Pharmacist-led interventions in RCTs consistently demonstrate positive economic value, especially in chronic disease management. To maximize their impact on health systems, policymakers should prioritize integrating pharmacists into multidisciplinary care and support the implementation of pharmacist-driven services. Nevertheless, critical evidence gaps remain. Future research should focus on low-income settings and broaden the evaluation of pharmacist roles in public health promotion, including immunization, screening, and preventive care, using rigorous EE frameworks.