Barriers faced by primary healthcare providers in addressing emergencies in the Northern region of Palestine before and during the Gaza war.

INTRODUCTION: Physicians working in primary health care (PHC) centers are the first contact for patients and expected to deal with emergencies. Emergency care training in PHC settings has been neglected globally, especially in low to middle income countries. Adequate preparation becomes especially important during periods of conflict. The study objectives are to identify the barriers facing PHC physicians when dealing with emergency cases in the northern region of Palestine during the current conflict. METHODS: A cross-sectional study was conducted with 179 physicians working in the 10 PHC centers distributed among 5 northern governances in Palestine. The study period was from July through December 2023. Data were collected electronically using a self-administered questionnaire, which was adapted from a comprehensive literature review. The questionnaire's internal validity was confirmed by a Cronbach's alpha coefficient of [0.85], indicating high reliability. RESULTS: The ages of the physicians ranged from 25 to 60 years, with a mean ± SD of 35.3 ± 8.15 years. A significant majority (91.6%) were not boarded in any specialty. Most physicians (85.5%) had attended Basic Life Support (BLS) courses, whereas 45.2% and 72% had never attended Advanced Cardiovascular Life Support (ACLS) or Advanced Trauma Life Support (ATLS) courses, respectively. Physicians with emergency department experience (P = 0.002) and those who had attended ACLS courses (P < 0.001) reported significantly higher perceived competence in managing emergency cases. CONCLUSION: Emergency services at PHC centers in northern Palestine are operational but require significant enhancements. There is a critical need for increased availability of essential equipment, supplies, and medications. Additionally, implementing comprehensive training programs in emergency management, particularly ACLS, is essential to improve the competence and performance of PHC physicians in emergency situations.

Prevalence and risk factors of postpartum depression among women attending primary healthcare centers in northern of West Bank/ Palestine: a cross-sectional study, 2022.

BACKGROUND: Postpartum depression (PPD) has a huge negative impact on the health of the mother and the family, both physically and mentally. Few postpartum depression studies have been done in Palestine. This study aimed to examine the prevalence and the most probable risk factor of PDD among Palestinian women in the northern West Bank. METHODS: This is a cross-sectional study of 380 mothers, ages 18 and 44 years, visiting vaccination clinics with their infants after 7-12 weeks of delivery between 1 May 2022 and 30 June 2022. Postpartum women seeking care at the seven largest primary health care centers of the Ministry of Health in four cities in the Northern West Bank in Palestine were asked to complete a self-administered questionnaire that included the Edinburgh Postnatal Depression Scale and demographic and birth details. A score of 13 or higher was used to indicate PPD risk. Descriptive and analytical analyses were performed using SPSS version 20. The level of significance was set at 5%. RESULTS: The median age of the participants was 27 years with a range of 26 years. A total of 129 women had an EPDS score of 13 or more, giving a prevalence rate of post-partum depression of 33.9%. The predictors of postpartum depression were stressful life events during pregnancy (p-value 0.003, OR: 2.1, 95% CI [1.27-3.4]), vacuum use during delivery p-values 0.002, OR: 4, 95% CI: [1.64-9.91]), low social support (p-value less than 0.001, OR: 2.5, 95%CI: [1.7-4.2]) and husband's low level of education (p-value less than 0.001, OR: 5.2, 95%CI: [2.7-10]). CONCLUSION: The study showed a high prevalence of PPD among Palestinian mothers in the northern West Bank. Our study found that PPD risk factors include lack of social support, the husband's low education, and stressful events during pregnancy. This will emphasize the importance of PPD screening and early intervention, especially among vulnerable women.

Adolescents' electronic devices use during the COVID-19 pandemic and its relationship to anxiety and depression levels: a cross-sectional study.

BACKGROUND: The aim of this study is to assess the prevalence of anxiety and depression symptoms among adolescent students in the West Bank region of Palestine, with a particular focus on the impact of electronic device usage on their mental well-being. METHODS: This cross-sectional study included a representative sample of 1,140 adolescents enrolled in governmental secondary schools. We targeted schools located in Nablus, Ramallah, and Hebron districts, which, respectively, represent the northern, central, and southern regions of the West Bank. We collected data on their sociodemographic characteristics, patterns of electronic device usage, scores from the Beck Depression Inventory-II, and the 7-item Generalized Anxiety Disorder scale, all gathered through a self-administered online questionnaire. To explore the independent relationship between anxiety, depression, and various factors, we calculated odds ratios and their corresponding 95% CI using a binary logistic regression model. RESULTS: The study revealed a prevalence of moderate to severe anxiety at 35.4% [95% CI: 32.7-38.3%] and moderate to severe depression at 23.9% [95% CI: 21.4-26.4%]. Notably, anxiety scores were significantly higher among females [OR = 3.8, 95% CI: 2.5-5.9], individuals with lower academic performance [OR = 3.4, 95% CI: 2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.1-3.0]. Similarly, significantly elevated depressive scores were observed among females [OR = 2.0, 95% CI: 1.3-3.1], those with lower academic performance [OR = 3.4, 95% CI: 2.1-5.4], and smokers [OR = 1.9, 95% CI: 1.3-2.8]. Conversely, students who used electronic devices for shorter durations were less likely to experience depression [OR = 0.49, 95% CI: 0.32-0.76] or anxiety [OR = 0.47, 95% CI: 0.32-0.69]. CONCLUSION: Considering the alarming rates of anxiety and depression in adolescents, along with their connection to the time spent using electronic devices, we strongly recommend the creation of initiatives and support networks to alleviate this issue's impact. Encouraging healthier lifestyles, such as reducing screen time and increasing physical activity, could potentially enhance the mental well-being of adolescents.

Palestinian physicians' self-reported practice regarding antibiotic use for upper respiratory tract infections in primary healthcare.

Background: The main objective of this study was to evaluate the antimicrobial therapy knowledge, attitudes, and practices of primary care physicians in the West Bank and Gaza. Methods: Between January and April 2021, this cross-sectional survey was conducted. A link to the online survey was sent via confidential email lists to 336 primary care physicians who treated patients in Ministry of Health clinics. The survey questions scoring system was devised in order to evaluate the physicians' practice, knowledge, and attitudes. Our scoring system identified favorable (good) and unfavorable (average and poor) antibiotic practices. In addition to independent t-test, the Chi-square test was used to compare the two groups of physicians' knowledge, attitudes, and practices with their background characteristics. A multivariate analysis was performed to identify potential confounding variables having significant relationships. Results: Of the 336 distributed questionnaires, 316 were completed, with a response rate of 94%. More than half (54.7%) were males, half (51.6%) were between 30 and 45 years of age, and most were general practitioners (74.1%). The overall good knowledge and attitude scores were 125 (39.6%) and 194 (61.4%), respectively. More than half (58.2%) had good antibiotic prescription practices. Females reported significantly more favorable practices than males, as did family medicine specialists compared with general practitioners. Finally, knowledge about antibiotic prescriptions had a substantial impact on changing their practices. However, physicians' attitudes toward antibiotic prescriptions did not have a significant role in shaping their practices. Conclusion: Overuse of antibiotics is a significant health issue in Palestine and worldwide. Most physicians know that improper antibiotic usage can cause antimicrobial resistance. More than two-thirds avoided needless antimicrobial prescriptions. In practicing antimicrobial stewardship, most prescribed fewer antibiotics and did not prescribe because of patient pressure. Family medicine specialists, female doctors, and those with high knowledge scores regardless of caseload were more likely to have good practices.

Prevalence of depression and anxiety among elderly primary care patients in Palestine.

Background and objectives: Depression and anxiety are common mental health disorders among the elderly worldwide. In this study, we estimated the prevalence of depression and anxiety and related risk factor among elderly attending Primary Health care (PHC) centers in Palestine. Methods: A cross-sectional study was conducted from February to July 2021 with a sample size of 380 participants aged ≥60 attending PHC centers in West Bank, using an interviewer-administered questionnaire. We used the Geriatric Depression Scale-15 and the Geriatric anxiety Scale to screen for depression and anxiety, respectively. Logistic regression models were used to identify predictors of depression and anxiety. Results: The prevalence of depression and anxiety was 41.1 and 39.2%, respectively. Elderly people living in rural areas (aOR = 2.63; 95% CI: 1.72-4.20), uneducated (aOR = 2.92; 95% CI: 1.41-6.13), and without monthly income (aOR = 3.42; 95% CI: 1.52-7.61) were more likely to have depression. On the other hand, anxiety was independently associated with living in rural areas (aOR = 1.93, 95% CI: 1.23-3.04) and having non-communicable diseases (aOR = 2.01; 95% CI: 1.13-3.49). Conclusion: Depression and anxiety are common in Palestine, a developing country with a lack of elderly related services. This should be emphasized at the national and regional levels where geriatric health care services are scarce. Such information is required by policymakers and external funding agencies in order to develop future agendas.

Virtual class room as a learning format in a family medicine residency program: Lessons learned in Palestine.

PURPOSE: Due to geopolitical and socioeconomic challenges, the Family Medicine (FM) speciality in Palestine is in early stages of development. Volunteer British General Practitioner (BGP) trainers worked with FM faculty to develop an online tutorial program (OTP) and a novel evaluation framework E-QUaL (Evaluation-Quality, Utilization and Learning) to enhance residents' patient-centered communication and clinical skills. MATERIALS AND METHODS: Three OTP cycles were facilitated and evaluated at An Najah National University (ANNU) in Palestine between 2017-2020. Qualitative data were collected during focus groups and online chats and analysed. RESULTS AND CONCLUSIONS: The development and joint facilitation of the OTP developed faculty skills and enhanced clinically oriented education. The collaborative (BGPs and ANNU faculty) approach and the use of the EQUaL framework helped to identify and address strengths and opportunities as well as the challenges and threats of the educational content and the virtual learning format with each iteration. The COVID pandemic provided a new and inexpensive platform which improved training quality. Issues such as the volunteer nature of BGPs, internet instability, and differing cultural approaches and expectations between physicians and patients were addressed in a continuous quality improvement approach and continues today. This may be a useful model in other low resourced settings.

Hypomagnesemia and Poor Glycemic Control among Type 2 Diabetic Patients: A Cross-Sectional Study.

Background/Aim: Hypomagnesaemia has been shown to have a significant impact on both glycaemic control and diabetes complications in type 2 diabetes mellitus (T2DM) patients. This study aims to assess the prevalence of hypomagnesaemia in T2DM patients and find the association between serum magnesium levels and outcomes relevant to glycaemic control and diabetic complications in primary care unit. Methods: A cross-sectional study was conducted and included 373 patients (222 males and 151 females) from primary care unit. Serum magnesium levels were measured by the colorimetric endpoint method using the Cobas C501 system. Hypomagnesaemia was determined to be a serum magnesium level <1.6 mg/dL. In addition, the following data was also obtained: patients' characteristics, anthropometric measurements, smoking status, HbA1c, comorbidities and therapeutic management. Results: Patients' mean age was 56.2 ± 10.8 years, 24.6% were smokers, and most were overweight or obese. About 60% have a history of hypertension, and the majority have had diabetes for more than 10 years. Their mean HbA1c level was 8.5 ± 2%. The prevalence of hypomagnesaemia was 11% (95% CI: 8%-14.6%). It was found to be significantly higher among females (adjusted OR: 2.7, 95%CI: 1.2%-5.8%), patients with HbA1c ≥8% (adjusted OR: 2.4, 95%CI: 1.1%-5.5%) and patients with a history of diabetic retinopathy (adjusted OR: 2.7, 95%CI: 1.1%-7.1%). Conclusion: The study showed that hypomagnesaemia is more prevalent in females and is associated with diabetic retinopathy and poor glycaemic control. Having a sufficient magnesium level may be associated with better glycaemic control and a reduced occurrence of complications.

Mammogram uptake and barriers among Palestinian women attending primary health care in North Palestine.

BACKGROUND: Breast cancer affects women's lives worldwide, yet early detection is an effective strategy for reducing mortality. The participation of women in mammography screening is linked to their knowledge, attitudes and perceived barriers. OBJECTIVES: Our study aims to assess mammography screening uptake and barriers among women attending primary healthcare centres (PHCs) in northern Palestine. METHODS: Using an interviewer administered questionnaire, we used a cross-sectional study design to determine mammography screening uptake, knowledge and barriers among 357 women attending PHCs in Northern Palestine between December 2018 and March 2019. RESULTS: The mean age was 50 years. The majority (69.2%) were considered to have adequate knowledge about breast cancer and mammography screening. Mammography screening uptake among the participants was 37%. Almost 85% of the women had a positive attitude towards breastfeeding as a prophylaxis factor against breast cancer, while the most frequent barrier to mammography screening was that the participants believed they did not have any symptoms (28.6%), followed by 22.1% of them who did not want to know if they had breast cancer. CONCLUSION: The findings of this study highlighted the low mammography uptake among Palestinian women despite the adequate knowledge of those women and the fully accessible and free screening programme. Hence, interventional strategies should be implemented at several levels to enhance mammogram uptake.