The association between parenting styles, maternal self-efficacy, and social and emotional adjustment among Arab preschool children

Abstract Parenting styles and parental self-efficacy are major factors that affect the overall adjustment of children. The current study examined parenting styles and maternal self-efficacy and their association with social-emotional adjustment among Arab preschool children living in Israel. Parenting Styles Questionnaire , Maternal Self-Efficacy Questionnaire , and Adjustment Questionnaire were administered to 420 Arabic-speaking mothers of 3- to 4-year-old children. After employing multiple regression analyses, the results indicated that parenting styles and the overall adjustment of children were significantly correlated. More precisely, a significant association between authoritative parenting style and higher levels of social-emotional adjustment among preschool children was found. Furthermore, maternal self-efficacy was significantly correlated to the overall adjustment of children. In this regard, higher maternal self-efficacy is associated with increased social-emotional adjustment among preschool children. The findings of our study show the applicability of these constructs found relevant across numerous cultures in a unique sample of Arab children living in Israel. Lastly, this study supports intervention programs that promote authoritative parenting style and parental self-efficacy in Arab communities.

Vulnerabilities of Arab refugees in primary health care: a scoping review / Vulnerabilidades de refugiados árabes na atenção primária à saúde: uma revisão de escopo

ABSTRACT OBJECTIVE To map and analyze the vulnerabilities of Arab refugees in the context of primary health care. METHOD Scoping review in which studies published in English, Spanish and Portuguese languages from 2011 onwards were reviewed. The following databases were surveyed: Cochrane, Scopus, Health System Evidence, MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science, SciELO, NYAM Grey Literature, BVS, Capes Thesis and Dissertation Database, Refworld and Journal of Refugee Studies. Data were analyzed in light of the concept of vulnerability. RESULTS Of the 854 studies identified, 40 articles were held for analysis and extraction of vulnerability indicators in the individual, social and programmatic dimensions. Regarding the individual dimension, the main indicators identified were unemployment, unstable and overcrowded housing, lack of sanitation and access to water, mental disorders, communicable and chronic noncommunicable diseases, etc. In the programmatic dimension, were identified, mainly, health teams with work overload, lack of preparation to deal with cultural and linguistic barriers, and delays in providing care. In relation to the social dimension, lack of access to schools, to information about health programs in the host countries, and to rights, among others, were found. CONCLUSION Vulnerabilities found highlight the disadvantage of refugees regarding health programs, services and system in host countries, in addition to highlighting the deep inequalities that affect this group. It is pointed out the need for programs and policies that promote actions, within the scope of primary health care, which recognize and respond to the health needs of refugees.

RESUMO OBJETIVO Mapear e analisar as vulnerabilidades de refugiados árabes no contexto da atenção primária à saúde. MÉTODO Revisão de escopo em que foram analisados estudos publicados nos idiomas inglês, espanhol e português, a partir de 2011. As bases foram Cochrane, Scopus, Health System Evidence , MedLine-PubMed, CINAHL, Embase, Lilacs, Web of Science , SciELO, NYAM Grey Literature , BVS, Banco de teses e dissertações Capes, Refworld e Journal of Refugee Studies. A análise dos dados foi realizada à luz do conceito de vulnerabilidade. RESULTADOS Dos 854 estudos identificados, restaram 40 artigos para análise e extração dos indicadores de vulnerabilidade nas dimensões individual, social e programática. Em relação à dimensão individual, os principais indicadores identificados foram desemprego, moradias instáveis e superlotadas, falta de saneamento e de acesso à água, agravos mentais, doenças transmissíveis e crônicas não transmissíveis etc. Na dimensão programática foram identificadas, principalmente, equipes de saúde com sobrecarga de trabalho, falta de preparo para lidar com as barreiras culturais e linguísticas, demora para o atendimento. Em relação à dimensão social, constatou-se falta de acesso às escolas, à informação sobre os programas de saúde dos países de acolhida, aos direitos, entre outros. CONCLUSÃO As vulnerabilidades constatadas evidenciam desvantagem dos refugiados perante os programas, serviços e sistema de saúde nos países de acolhida, além de colocar em evidência as profundas desigualdades que incidem nesse grupo. Aponta-se a necessidade de programas e políticas que promovam ações, no âmbito da atenção primária à saúde, que reconheçam e respondam às necessidades de saúde de refugiados.

Maternal metal concentration during gestation and pediatric morbidity in children: an exploratory analysis

BACKGROUND@#The majority of studies linking exposure to metals with certain health outcomes focus on known toxic metals. Alternatively, this study assesses the extent to which exposure to a wider range of metals during gestation is associated with childhood morbidity.@*METHODS@#We analyzed the concentrations of 25 metals found in urine samples of 111 pregnant women of Arab-Bedouin origin collected prior to birth. In addition, we collected medical records on their offspring for six years following birth, including every interaction with HMOs, local hospitals, and pharmacies.@*RESULTS@#The main types of morbidities diagnosed and treated during this period were preterm births, malformations, asthma-like morbidity, cardiovascular and behavioral problems, and obesity. Multivariable analysis showed that offspring born before term were more likely to have been exposed to elevated maternal concentrations of zinc, thallium, aluminum, manganese, and uranium, all with adjusted relative risk above 1.40 for an increase by each quintile. Likewise, children with asthma had been exposed to higher levels of magnesium, strontium, and barium at gestation, while behavioral outcomes were associated with elevated biometals, i.e., sodium, magnesium, calcium, selenium, and zinc, as well as higher levels of lithium, cobalt, nickel, strontium, cadmium, vanadium, arsenic, and molybdenum. A heatmap of adjusted relative risk estimates indicates the considerable implications that exposure to metals may have for preterm birth and developmental outcomes.@*CONCLUSIONS@#The current study shows that perinatal exposure to metals is adversely associated with pediatric morbidity. Further such analyses on additional samples are warranted.

Para além dos retratos comuns sobre a condição de refúgio e de migração: narrativas de mulheres palestinas sobre seu protagonismo no Brasil / Beyond the common traits on the condition of refuge and migration: narratives of palestinian women about their activism in Brazil / Más allá de los retratos comunes sobre la condición de refugio y migración: narrativas de mujeres palestinas sobre su activismo en Brasil

Este artigo versa a respeito de processos de superação das situações de refúgio e migração. Partimos da constatação de que ambas as situações são caracterizadas, em geral, pela vulnerabilidade, haja visto a exposição das pessoas envolvidas a situações limites de sobrevivência. Porém, demonstrando um lado menos conhecido deste contexto, pretendemos dar visibilidade e voz a exemplos de superação e de protagonismo feminino árabe-palestino destas situações, através dos relatos de experiências de duas mulheres de origem palestina, que se refugiaram no Brasil e atualmente auxiliam refugiados/as que aqui chegam. Como metodologia utilizamos pesquisa bibliográfica e entrevistas estruturadas, cujas narrativas iremos interpretar com base nos depoimentos. Os relatos corroboram a necessidade de um olhar longitudinal sobre as implicações dos processos de migração e de refúgio onde se manifesta a capacidade de resiliência e superação de mulheres que vivenciaram tais processos e a despeito de seu estado de vulnerabilidade, apontam que os/as principais apoiadores/as das ações são pessoas e entidades civis, haja vista o atual descaso do poder público para com estes projetos. (AU)

This article deals with processes of overcoming refuge and migration situations. We start from the observation that both situations are characterized, in general, by vulnerability, having seen the exposure of the people involved to situations of survival limits. However, by demonstrating a lesser known side of this context, we intend to give visibility and voice to examples of overcoming and female Arab-Palestinian protagonist of these situations, through the reports of experiences of two women of Palestinian origin, who took refuge in Brazil and currently assist refugees. / the ones that arrive here. As methodology we use bibliographic research and structured interviews, whose narratives we will interpret based on the statements. The reports corroborate the need for a longitudinal look at the implications of migration and refuge processes in which the resilience and overcoming capacity of women who have experienced such processes is manifested and despite their state of vulnerability, point out that the main supporters the actions are people and civil entities, given the current disregard of the public power towards these projects. (AU)

Este artículo trata sobre los procesos de superación de situaciones de refugio y migración. Partimos de la observación de que ambas situaciones se caracterizan, en general, por la vulnerabilidad, habiendo visto la exposición de las personas involucradas a situaciones límite de supervivencia. Sin embargo, demostrando un lado menos conocido de este contexto, pretendemos dar visibilidad y voz a ejemplos de superación y protagonismo femenino árabe-palestino de estas situaciones, a través de los relatos de las experiencias de dos mujeres de origen palestino, refugiadas en Brasil. y actualmente asisten a los refugiados / aquellos que llegan aquí. Como metodología utilizamos la investigación bibliográfica y las entrevistas estructuradas, cuyas narrativas interpretaremos en base a los testimonios. Los informes confirman la necesidad de una mirada longitudinal a las implicaciones de los procesos de migración y refugio donde se muestra la capacidad de resiliencia y superación de las mujeres que vivieron dichos procesos y a pesar de su estado de vulnerabilidad, señalan que los principales apoyadores de las acciones son personas y entidades civiles, dado el desconocimiento actual de los poderes públicos por estos proyectos. (AU)

Supernumerary Teeth: A Retrospective Cross-Sectional Study from Palestine

Abstract Objective: To investigate the prevalence and characteristics of supernumerary teeth among patients attending the students' dental clinics at the Faculty of Dentistry of the Arab American University, Jenin, Palestine. Material and Methods: This is a descriptive, cross-sectional, retrospective study of 1970 digital panoramic radiographs of patients, age ranging between 12 and 50 years. The radiographs and dental records were reviewed for supernumerary teeth. For each patient with supernumerary teeth, were recorded the demographic variables, number, location, eruption status, type, and morphology, the developmental stages. Descriptive statistics were performed and results were tabulated. Results: Supernumerary teeth were detected in 17 subjects (0.86%), of which 13 were males and 4 were females with a male to female ratio of 3.25:1. Of the 17 patients, 64.7% had one supernumerary tooth while the others had two. The majority (78.3%) of the supernumeraries were located in the maxilla. Around 56.5% of the supernumeraries found in this study were located in the premaxilla. Half of the supernumeraries (52.2%) were erupted, and 47.8% were impacted. Mesiodens was the most frequently seen supernumerary teeth followed by distomolars and premolars. Most of the supernumeraries were fully developed, while 21.7% displayed only crown formation. Conclusion: The prevalence of supernumerary teeth in the study sample was found to be 0.86% and the most frequent type was mesiodens. Supplemental morphology was found to be the most common form of supernumerary teeth.

YKL-40 Levels in Rheumatoid Arthritis and Their Correlation with Disease Activity: A Meta-analysis

OBJECTIVE: To examine the relationship of serum/plasma YKL-40 levels with rheumatoid arthritis (RA) and their correlation with RA activity and rheumatoid factor (RF) level. METHODS: We performed a meta-analysis comparing the serum/plasma YKL-40 levels between patients with RA and controls and examined the correlation coefficients of the circulating YKL-40 level with the RF level and RA activity based on the 28-joint disease activity score (DAS28), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level. RESULTS: Nine studies (707 patients with RA and 1,041 controls) were included in the meta-analysis. The YKL-40 levels were significantly higher in the RA group than in the control group (standardized mean difference [SMD]=1.071, 95% confidence interval [CI]=0.726~1.417, p100) populations. Meta-analysis of correlation coefficients showed a significant positive correlation between the YKL-40 levels and DAS28, ESR, CRP level, and RF level (DAS28: correlation coefficient=0.381, 95% CI=0.044~0.640, p=0.028; RF level: correlation coefficient=0.341, 95% CI=0.176~0.487, p<0.001). CONCLUSION: The circulating YKL-40 levels are high in patients with RA and positively correlate with RA activity and RF level.

Dietary Application for the Management of Patients with Hemodialysis: A Formative Development Study / 대한의료정보학회지

OBJECTIVES: To describe the step-by-step person-centered, theory-based development of the KELA.AE app for Arabic speaking hemodialysis patients. METHODS: A step-by-step person-driven theory-based approach was conducted to develop a self-monitoring and educational dietary app for hemodialysis patients. The development follows the Integration, Design, Assessment, and Sharing (IDEAS) framework. Qualitative, semi-structured interviews with 6 hemodialysis patients and 6 healthcare practitioners (dietitians and nephrologists) were performed to assess the need for an app, the willingness to use an app, and features desired in an app. RESULTS: The KELA.AE app, which includes a self-monitoring feature, CKD-friendly recipes, and a theory-based, evidence-based educational feature was developed. Qualitative analysis of interviews revealed two predominant themes from patient interviews ‘Experience with the diet’, ‘App evaluation’, and one theme from interviews with healthcare practitioners ‘App evaluation’. Patients expressed frustration with current accessibility of dietary information along with the need for educational materials in the app. The review of the KELA.AE prototype was positive overall, and patients reported a willingness to use the app. Healthcare practitioners considered the app accurate, simple, and culturally sensitive but expressed concerns about app misuse and the replacement of healthcare practitioners. CONCLUSIONS: The KELA.AE app was found to be satisfactory and supportive of the participants' needs. Changes were made to the app as suggested during the interviews.

Sírios e libaneses no oeste paulista - décadas de 1880 a 1950 / Syrian and Lebanese in Western São Paulo / Sirios y libaneses en el oeste de San Pablo

O artigo busca explorar os condicionantes e características distintivas da inserção socioeconômica de sírios e libaneses no interior paulista, entre as décadas de 1880 e 1950. Do início difícil como mascates, portadores de uma cultura distante, os sírios e libaneses lograram se firmar como comerciantes, aproveitando as oportunidades que suas redes (de parentes e conterrâneos) e a economia cafeeira em expansão ofereciam, estabelecendo-se sobretudo nos ramos de roupas, tecidos e armarinhos de secos e molhados e de gado e cereais. Tomando como fonte principal uma série de obras - acadêmicas e memorialísticas -, nas quais o imigrante sírio e libanês é retratado no interior, o artigo indica ainda as principais regiões do oeste paulista nas quais o grupo se concentrou, discute trajetórias que ilustram algumas das possibilidades de mobilidade, a formação de lideranças, o modo como as práticas religiosas se transformaram e a mobilidade acentuada - como doutores e políticos - conquistada por estratos da primeira geração nascida no Brasil.

The article seeks to explore the conditions and distinctive characteristics of the socioeconomic insertion of Syrians and Lebanese in the interior of São Paulo between the 1880s and 1950s. From the difficult beginning as peddlers with a distant culture, Syrians and Lebanese managed to establish themselves as merchants, seizing the opportunities that their networks (of relatives and of countrymen) and the expanding coffee economy offered, establishing themselves mainly in the sectors of clothing, linen and fabrics, cattle and cereals. Taking as main source a series of works in which the Syrian and Lebanese immigrants are portrayed in the interior, the article also indicates the main regions of west of São Paulo where the group mainly concentrated, and discusses trajectories which illustrate some of the possibilities of mobility, formation of leadership, the way religious practices have been transformed and the marked mobility - as doctors and politicians - achieved by strata of the first generation born in Brazil.

El artículo busca explorar los condicionantes y las características distintivas de la inserción socioeconómica de sirios y libaneses en el interior paulista entre la década del ochenta del siglo XIX y la del cincuenta del siglo XX. Del inicio difícil como vendedores ambulantes, portadores de una cultura distante, los sirios y libaneses lograron establecerse como comerciantes, aprovechando las oportunidades que sus redes;de parientes y de compatriotas; y que la economía cafetalera en expansión ofrecía se establecieron sobre todo en las ramas de ropa y tejidos, de mercería, y de ganado y cereales. Tomando como fuente principal una serie de obras en las que el inmigrante sirio y libanés es retratado en el interior, el artículo indica además las principales regiones del oeste paulista en las que el grupo se concentró, discute trayectorias que ilustran algunas de las posibilidades de movilidad, la formación de los líderes, el modo en que las prácticas religiosas se transformaron y la movilidad acentuada;como doctores y como políticos; conquistada por estratos de la primera generación nacida en Brasil.

Vulnerabilidades de refugiados árabes na atenção primária à saúde: uma revisão de escopo / Vulnerabilities of Arab Refugees in Primary Health Care: Scope Review

Introdução: A crise global do refúgio do final do século XX e início do século XXI constitui a pior crise nesse campo desde a Segunda Guerra Mundial. Há cerca de 244 milhões de migrantes internacionais no mundo, dos quais 25,9 milhões são refugiados. Devido aos conflitos ocorridos na Síria, o refúgio dos árabes tornou-se um dos epicentros do problema. A Síria hoje é o país que mais apresenta refugiados no mundo, com 6,7 milhões. A Síria, a Palestina, o Iraque e Líbano são os países de origem que mais solicitaram refúgio no Brasil entre os anos 2007 a 2017. A própria condição de refúgio e suas diferentes fases são condicionantes de vulnerabilidade que incidem sobre o processo saúde-doença. Objetivo: Mapear e analisar as vulnerabilidades de refugiados árabes no contexto da Atenção Primária à Saúde. Método: Trata-se de uma Revisão de Escopo. Foram analisados estudos publicados nos idiomas inglês, espanhol e português, no período de 2011 a 2019, nas bases de dados: COCHRANE, SCOPUS, Health System Evidence, MedLine-PubMed-, CINAHL, EMBASE, LILACS, Web of Science, SciELO, NYAM Grey Literature, Banco de teses e dissertações CAPES, Refworld e Journal of Refugee Studies. A análise dos dados foi realizada à luz do conceito de vulnerabilidade. Resultados e discussão: Após buscas realizadas com duas estratégias, foram encontrados 854 estudos. Com base nos critérios de inclusão e de exclusão restaram 40 artigos para análise e extração dos indicadores de vulnerabilidade. Em relação à dimensão individual foram constatadas altas taxas de desemprego, moradias instáveis e superlotadas, falta de saneamento e de acesso à água, agravos de saúde mental, gastrointestinais, nutricionais, dermatológicos, neurológicos, musculoesqueléticos, odontológicos, relacionados à gestação e à primeira infância, além de doenças transmissíveis e doenças crônicas não transmissíveis. Na dimensão programática foram identificadas equipes de saúde com sobrecarga de trabalho, com falta de preparo para lidar com as barreiras culturais e linguísticas. Também se verificou longas horas de espera para o atendimento, alto custo da Atenção Primária à Saúde, falhas na atualização do calendário vacinal e na busca ativa de pacientes em programas voltados às doenças crônicas, assim como políticas de saúde que revogam direito ao acesso a saúde. Em relação à dimensão social, constatou-se falta de acesso às escolas, à informação sobre os programas de saúde dos países de acolhida, aos direitos, e participação limitada na economia local. Conclusão: Todas as dimensões de vulnerabilidade se fizeram presentes, identificadas por meio dos indicadores estudados. Os elementos de vulnerabilidade evidenciam desigualdade e desvantagem dos refugiados perante os programas, serviços e sistema de saúde nos países de acolhida. Nesse sentido, aponta-se a necessidade de programas e políticas que considerem tais elementos de vulnerabilidade, e promovam ações, no âmbito da Atenção Primária à Saúde, que reconheçam e respondam às necessidades de saúde dos refugiados. Também se aponta a necessária abordagem em saúde na perspectiva do conceito de vulnerabilidade, sobretudo na dimensão social, o que implica em reconhecer que a situação desse grupo social decorre fundamentalmente, de processos estruturais que envolvem embate de poder entre países.

Introduction: The global crisis of the late twentieth and early twenty-first century refuge is the worst crisis in this field since World War II. There are about 244 million international migrants in the world of which 25.9 million are refugees. Due to the conflicts in Syria, the refuge of the Arabs has become one of the epicenters of the problem. Today, Syria is the world's largest refugee country with 6.7 million. Syria, Palestine, Iraq and Lebanon are the countries of origin that most sought asylum in Brazil between 2007 and 2017. The condition of refuge itself and its different phases are conditions of vulnerability that affect the health-disease process. Objective: To map and analyze the vulnerabilities of Arab refugees in the context of Primary Health Care. Methodology: This is a Scope Review. Studies published in English, Spanish and Portuguese from 2011 to 2019, have been analyzed in the following databases: COCHRANE, SCOPUS, Health System Evidence, MedLine-PubMed-, CINAHL, EMBASE, LILACS, Web of Science, SciELO, NYAM Grey Literature, Bank of theses and dissertations CAPES, Refworld e Journal of Refugee Studies. Data analysis was performed in light of the concept of vulnerability. Results and discussion: After researching with two strategies, 854 studies were found. Based on the inclusion and exclusion criteria 40 articles remained for analysis and extraction of vulnerability indicators. Regarding the individual dimension, high unemployment rates, unstable and overcrowded housing, poor sanitation and access to water, mental health, gastrointestinal, nutritional, dermatological, neurological, musculoskeletal, dental, pregnancy-related and early childhood problems were found as well as communicable diseases and non-communicable chronic diseases. In the programmatic dimension health teams were identified with work overload, lack of preparation to deal with cultural and language barriers. There were also long waiting hours for care, high cost of Primary Health Care, failures to update the vaccination schedule and the active search of patients in programs focused on chronic diseases besides health policies that revoke the right to access to health. Regarding the social dimension, there was a lack of access to schools, information about the health programs of the host countries, rights and limited participation in the local economy. Conclusion: All dimensions of vulnerability were presented, identified through the indicators studied. The elements of vulnerability highlight the inequality and disadvantage of refugees towards the program, services and health system in the host countries. In this sense, there is a need for programs and policies that consider such elements of vulnerability and promote actions within the scope of Primary Health Care that recognizes and responds to the health needs of refugees. It also points out the necessary approach to health from the perspective of the concept of vulnerability especially in the social dimension, which implies recognizing that the situation of this social group derives fundamentally from structural processes that involve a clash of power between countries.

A Gerontologia e a Gastronomia: Uma experiência com imigrantes árabes / Gerontology And Gastronomy: An experience with arab immigrants / La Gerontología y la Gastronomía: Una experiencia con inmigrantes árabes

A Gastronomia é uma forma de expressão cultural. A cozinha árabe chegou ao Brasil no século XIX por meio dos imigrantes árabes da Síria e do Líbano. Partindo da atual definição de saúde, entende-se que a alimentação e as técnicas de culinária do idoso representam grande papel em seu estado de bem-estar e, com isso, a Gerontologia tende a utilizar a mesma como um espaço de socialização e expressão durante o envelhecer. O povo árabe tem em sua gastronomia um forte apego familiar e um anseio de conservar a sua cultura tradicional, visto que suas receitas são antiquíssimas e preservadas em sua forma original, firmando, assim, através dos seus hábitos alimentares, a importância da vida em família, a valorização da herança culinária de filhos, pais e avós. O objetivo deste artigo é identificar a propagação da gastronomia árabe e sua relação com a saúde dos imigrantes idosos, principalmente no estado do Rio Grande do Sul.

Gastronomy is a form of cultural expression. Arab cuisine arrived in Brazil in the 19th century through Arab immigrants from Syria and Lebanon. Based on the current definition of health, it is understood that the elderly's food and cooking techniques play a large role in their well-being, and with this gerontology tends to use it as a space of socialization and expression during the age. The Arab people have in their gastronomy a strong family attachment and a desire to conserve their traditional culture, since their recipes are very old and preserved in their original form, thus establishing through their eating habits, the importance of family life, valuing the culinary heritage of children, parents and grandparents. The objective of this article is to identify the propagation of Arab gastronomy and its relation with the health of the elderly immigrants, mainly in the state of Rio Grande do Sul.

La gastronomía es una forma de expresión cultural. La cocina árabe llegó a Brasil en el siglo XIX por medio de los inmigrantes árabes de Siria y del Líbano. A partir de la actual definición de salud, se entiende que la alimentación y las técnicas de culinaria del anciano representan un gran papel en su estado de bienestar y, con ello, la Gerontología tiende a utilizar la misma como un espacio de socialización y expresión durante el envejecimiento. El pueblo árabe tiene en su gastronomía un fuerte apego familiar y un anhelo de conservar su cultura tradicional, ya que sus recetas son antiquísimas y preservadas en su forma original, firmando así, a través de sus hábitos alimenticios, la importancia de la vida en familia, la valorización de la herencia culinaria de hijos, padres y abuelos. El objetivo de este artículo es identificar la propagación de la gastronomía árabe y su relación con la salud de los inmigrantes ancianos, principalmente en el estado de Rio Grande do Sul.

Hematological parameters, serum iron and vitamin B12 levels in hospitalized Palestinian adult patients infected with Helicobacter pylori: a case-control study

ABSTRACT Objective: This study aimed to investigate the relationship between hematological parameters, serum iron, and vitamin B12 levels in adult hospitalized Palestinian patients infected with Helicobacter pylori. Methods: This case-control study included 150 adult (18-50 years old) patients infected with H. pylori and 150 healthy adults. A complete blood count was performed, and serum iron and vitamin B12 levels of the patients were measured, statistically analyzed and compared with the control group. All parameters in cases were reassessed after the triple treatment of omeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and clarithromycin 500 mg b.i.d. for 14 successive days. The triple treatment was the same for males and females. Results: The results revealed that the mean levels of hemoglobin, red cell count, white cell count and hematocrit were significantly lower and the red blood cell distribution width significantly higher in cases compared to controls, while no significant differences were found for mean corpuscular volume, mean corpuscular hemoglobin and platelet count. Serum vitamin B12 and iron levels were significantly lower in cases compared to controls (262.5 ± 100.0 vs. 378.2 ± 160.6 pg/mL and 71.6 ± 24.8 vs. 80.1 ± 20.7 µg/dL, respectively). Vitamin B12 and serum iron increased significantly and was restored to close to normal levels after medical treatment. Conclusions: H. pylori infection appears to cause decreases in vitamin B12, iron levels and some hematological parameters. However, these were almost normalized after treatment with omeprazole, amoxicillin and clarithromycin. H. pylori is associated with vitamin B12 and iron deficiency, thus, this may be a useful marker and a possible therapeutic agent of anemic patients with gastritis.

Palestinian pharmacists' knowledge of issues related to using psychotropic medications in older people: a cross-sectional study / 보건의료교육평가

PURPOSE: The purpose of this study was to assess the knowledge of pharmacists practicing in Palestine of issues related to using psychotropic medications in older people. METHODS: The study was conducted with a cross-sectional observational design using a questionnaire. A total of 400 pharmacists responded to a 19-statement knowledge test related to the use of psychotropic medications in older people. The study was conducted from July 2016 to February 2017. The reliability and internal consistency of the study tool was assessed using the test-retest method and the Cronbach alpha. Categorical groups were compared using the chi-square test and the Spearman rank correlation. RESULTS: On the 19-statement knowledge test, the median score was 55.3% with an interquartile range of 21.9%. In a comparison of the demographic and practice-related variables of the pharmacists who scored ≥ 50% on the 19-statement knowledge test with those who scored < 50%, age, gender, and having taken a course on psychotropic medications were found to be significantly associated with performance, as shown by the chi-square test and Spearman correlation. CONCLUSION: Pharmacists practicing in Palestine possess less than optimal knowledge of issues related to the use of psychotropic medications in older people. Continuing educational interventions and/or training might be helpful in improving pharmacists' knowledge of issues related to using psychotropic medications in older people.

Leu72Met and Other Intronic Polymorphisms in the GHRL and GHSR Genes Are Not Associated with Type 2 Diabetes Mellitus, Insulin Resistance, or Serum Ghrelin Levels in a Saudi Population

BACKGROUND: Ghrelin (GHRL), a gastric peptide encoded by the GHRL gene, is known to be involved in energy homeostasis via its G protein receptor, encoded by the growth hormone secretagogue receptor (GHSR) gene. Some studies have shown associations between plasma GHRL levels and GHRL single-nucleotide polymorphisms (SNPs), namely the Leu72Met polymorphism (rs696217 TG), with type 2 diabetes mellitus (T2DM) and insulin resistance (IR), while others have not. The controversies in these associations raise the issue of ‘which SNPs in which populations.’ The aim of this study was to investigate whether SNPs in GHRL and/or GHSR genes were associated with T2DM, IR, or plasma GHRL levels among Arab Saudis. METHODS: Blood was collected from 208 Saudi subjects with (n=107) and without (n=101) T2DM. DNA samples from these subjects were analyzed by real-time polymerase chain reaction to genotype five intronic SNPs in the GHRL (rs696217 TG, rs27647 CT, rs2075356 CT, and rs4684677 AT) and GHSR (rs509030 GC) genes. In addition, plasma GHRL levels were measured by a radioimmunoassay. RESULTS: None of the SNPs were associated with T2DM, IR, or plasma GHRL levels. The frequencies of the alleles, genotypes, and haplotypes of the five SNPs were comparable between the T2DM patients and the non-diabetic subjects. A large number of the GHRL haplotypes indicates the molecular heterogeneity of the preproghrelin gene in this region. CONCLUSION: Neither the Leu72Met polymorphism nor the other intronic GHRL and GHSR SNPs were associated with T2DM, IR, or GHRL levels. Further investigations should be carried out to explain the molecular basis of the association of the GHRL peptide with T2DM and IR.

Cross-cultural adaptation, validity and reliability of the arabic version of the Falls Efficacy Scale-international [FES-I]

Objective: The aim of this study was to evaluate the validity and reliability of an Arabic language version [Ar] of the Falls Efficacy Scale-International [FES-I] with respect to its use with Arabic-speaking elderly subjects

Subjects and Methods: For cross-cultural adaptation, the translation of the original English version of the scale was conducted based on the protocol of the Prevention of Falls Network Europe [ProFaNE]. The FES-I [Ar] was administered via face-to-face interviews to 108 community-dwelling elderly Palestinians [61 women and 47 men, aged 60-84 years]. Statistical analyses were used to determine group differences with respect to age, gender and fall history. To assess validity, Spearman's rank correlation coefficient was used to examine the correlation between the total scores of FES-I [Ar] and the Timed Up and Go [TUG] test, gait speed and balance. Test-retest reliability between the two test occasions was assessed in accordance with Svensson's method

Results: The FES-I [Ar] total scores were positively correlated with TUG [r[s] = 0.641, p < 0.001] and negatively correlated with gait speed [r[s] = -0.670, p < 0.001] and balance [r[s] = -0.592, p < 0.001]. All items of the FES-I [Ar] indicated a high percentage agreement [from 88 to 93%], and the relative position ranged from 0.01 to 0.06

Conclusion: In this study, the FES-I [Ar] was shown to be a comprehensible, valid and reliable measure of the concern about falling among community-dwelling elderly subjects. In clinical practice and future research, the FES-I [Ar] instrument could be used to effectively assess concern about falling in Arabic-speaking elderly persons

Analysis of Sacrococcygeal Morphology in Koreans Using Computed Tomography

BACKGROUND: The sacrococcygeal morphology of Arabs and Europeans has been studied using computed tomography (CT) or magnetic resonance imaging to determine the cause of coccydynia. Studies have suggested differences in sacrococcygeal morphology among ethnic groups. However, there are no data on the sacrococcygeal anatomy of Koreans. METHODS: We conducted a retrospective analysis of 606 pelvic CT scans that were taken at Cheju Halla General Hospital between 2008 and 2014. Fractures of the sacrum or coccyx were excluded. Differences in the sacrococcygeal morphology among age groups stratified by decade of life and between genders were analyzed using sagittal plane pelvic CT scans. The morphological parameters studied were the sacral and coccygeal curved indexes, sacrococcygeal angle, intercoccygeal angle, coccygeal type, coccygeal segmental number, and sacrococcygeal fusion. RESULTS: The average sacral and coccygeal curved indexes were 6.15 and 7.41, respectively. The average sacrococcygeal and intercoccygeal angles were 110° and 49°, respectively. Type II coccyx was most common, and the rate of sacrococcygeal fusion was 34%. There was a moderate positive correlation between age and the sacral curved index (r = 0.493, p = 0.000) and a weak negative correlation between age and the coccyx curved index (r = −0.257, p = 0.000). There was a weak negative correlation between age and the intercoccygeal angle (r = −0.187, p = 0.000). The average intercoccygeal angle in males and females was 53.9° and 44.7°, respectively. CONCLUSIONS: The sacrum tended to be more curved and the coccyx straighter with age. The coccyx was straighter in females than males. Knowledge of the sacrococcygeal anatomy of Koreans will promote better understanding of anatomical differences among ethnicities and future studies on coccydynia.

Contribution of Arab countries to pharmaceutical wastewater literature: a bibliometric and comparative analysis of research output

BACKGROUND: Recently, the pharmaceutical manufacturing industry has been growing rapidly in many countries in the world, including in Arab countries. Pharmaceuticals reach aquatic environments and are prevalent at small concentrations in wastewater from the drug manufacturing industry and hospitals. Such presence also occurs in domestic wastewater and results from the disposal of unused and expired medicines. Therefore, the objective of this study was to analyze and compare the quantity and quality of publications made by researchers in Arab countries on pharmaceutical wastewater. METHODS: To retrieve documents related to pharmaceutical wastewater, we used the Scopus database on November 21, 2015. All documents with terms related to pharmaceutical wastewater in the title or abstract were analysed. Results obtained from Arab countries were compared with those obtained from Turkey, Iran and Israel. RESULTS: Globally, a total of 6360 publications were retrieved while those from Arab countries, Iran, Turkey and Israel, were 179, 113, 96 and 54 publications respectively. The highest share of publications belonged to Kingdom of Saudi Arabia (KSA) with a total of 47 (26.2 %) publications, followed by Egypt (38; 21.2 %), Tunisia (17; 9.5 %) and Morocco (16; 8.9 %). The total number of citations was 1635, with a mean of 9.13 and a median (inter quartile range) of 3 (1.0–10.0). The study identified 87 (48.6 %) documents with 32 countries of international collaboration with Arab countries. It was noted that Arab researchers collaborated mainly with authors in Western Europe (54; 30.2 %), followed by authors from the Asiatic region (29; 16.2 %) and Northern America (15; 8.4 %). The most productive institution was King Saud University, KSA (13; 7.3 %), followed by the National Research Centre, Egypt (10; 7.3 %). CONCLUSIONS: This study showed that KSA has the largest share of productivity on pharmaceutical wastewater research. Bibliometric analysis demonstrated that research productivity, mainly from Arab countries in pharmaceutical wastewater research, was relatively lagging behind. More research effort is required for Arab countries to catch up with those of non-Arab Middle Easter countries on pharmaceutical wastewater research.

Israeli Arabs develop diverticulitis at a younger age and are more likely to require surgery than Jews / Árabes israelitas desenvolvem diverticulite em idade mais jovem e estão mais sujeitos ao tratamento cirúrgico do que os judeus

BACKGROUND: Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. AIM: To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. METHODS: Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. RESULTS: Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. CONCLUSIONS: Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis. .

RACIONAL: Somente poucos estudos examinaram o impacto das diferenças raciais na idade de início, curso e os resultados da diverticulite. OBJETIVO: Fornecer dados sobre a epidemiologia da diverticulite no norte de Israel, e determinar se a etnia é preditor de idade de início, complicações e necessidade de tratamento cirúrgico. MÉTODOS: Foi realizado estudo retrospectivo dos prontuários de todos os pacientes diagnosticados com um primeiro episódio de diverticulite em nosso hospital entre 2005 e 2012. RESULTADOS: Foram encontrados 638 pacientes com um primeiro episódio de diverticulite aguda no intervalo de oito anos. Os árabes israelenses desenvolveram o primeiro episódio de diverticulite em idade mais jovem em comparação com os judeus (51,2 vs 63,8 anos, p<0,01). Árabes que vivem em áreas rurais a diverticulite foi desenvolvida em idade mais jovem do que os árabes que vivem em centros urbanos (49,4 vs 54,5 anos, p=0,03). Homens judeus e árabes desenvolveram diverticulite em idade mais jovem em comparação com os seus homólogos do sexo feminino (59,9 vs 66,09, p<0,01, e 47,31 vs 56,93, p<0,01, respectivamente). Os árabes eram mais prováveis ​​do que os judeus de necessitar de tratamento cirúrgico (urgência ou eletiva) para a diverticulite [odds ratio (OR)=1,81, intervalo de confiança de 95% (CI) 1,12-2,90, p=0,017]. CONCLUSÕES: Os árabes israelenses tendem a desenvolver diverticulite em idade mais jovem e são mais propensos a necessitar de tratamento cirúrgico para a diverticulite em comparação com os judeus. Árabes que vivem em áreas rurais desenvolvem diverticulite em idade mais jovem do que os árabes que vivem em centros urbanos. Estes resultados destacam a necessidade de abordar a causa raiz para diferenças étnicas em início, o curso e o resultado da diverticulite aguda. .

Examining health care spending trends over a decade: the Palestinian case

An analysis was made of recent health care spending patterns in the occupied Palestinian territory, in order to inform future health policy-making and planning. Data were obtained from the national health accounts for the period 2000-2011. The current level of resource allocation to the health care sector is higher than in many developed countries and is not sustainable. The private sector represents the largest source of health financing [61%] and the burden falls disproportionally on individual households, who account for 63% of private health care expenditure. Key recommendations include: building capacity in the government sector to reduce the outsourcing of health services; modifying inequitable financing mechanisms to reduce the burden on households; and allocating more resources for health promotion and disease prevention programmes. Reorientation of the health system is also needed in terms of reducing the share of spending on inpatient services in favour of more day surgery, outpatient and home-based services

cystic fibrosis symptom progression survey [CF-SPS] in arabic: a tool for monitoring patients' symptoms

Our study aimed to develop a survey that could be used by nurses during regular cystic fibrosis [CF] clinic visits, providing clinicians with a standardized means of longitudinally assessing and monitoring symptom progression in their patients. In addition, the use of this survey would provide an opportunity for patient engagement and relationship building, thereby enhancing patient education and improving adherence to treatment. This is the first such survey designed specifically for use in Arab populations. The Cystic Fibrosis Symptom Progression Survey [CF-SPS] was developed using previously published patient reported outcomes relating to pulmonary exacerbations in CF. It contains 10 items that provide a patient-focused account of symptoms. The survey was translated into Arabic and was completed by 12 patients on 139 occasions over 22 months. The psychometric properties of the survey were evaluated, as was the relationship between the survey findings and other known clinical measures of health status in CF. The CF-SPS performs well as a psychometrically valid clinical tool, with good internal consistency as determined by Cronbach's alpha analysis. Our results suggest that the CF-SPS is able to identify significant declines in health status in line with routine clinical patient assessment [chest sounds, body mass index and admissions]. As such it is a useful tool that can support clinical decision making in the care of Arabic speaking CF patients. We recommend the CF-SPSa [Arabic version] as a valid tool for the longitudinal monitoring of symptom progression in CF in Arabic speaking populations