Healthcare workers' attitudes toward and factors influencing their acceptance of an annual COVID-19 booster vaccine: a cross-sectional study in Palestine.

BACKGROUND: The emergence of several SARS-CoV-2 variants may necessitate an annual COVID-19 booster vaccine. This study aimed to evaluate healthcare workers' (HCWs) acceptance of a COVID-19 yearly booster vaccine if recommended and its association with their attitudes and burnout levels. METHODS: We used an online self-administered questionnaire to conduct a cross-sectional study of all HCWs in the West Bank and Gaza Strip of Palestine between August and September 2022. We used the Vaccination Attitudes Examination scale to assess HCWs' vaccination attitudes and the Maslach Burnout Inventory to assess work-related Burnout. In addition, we conducted logistic regression to identify factors independently associated with the acceptance of the booster vaccine. RESULTS: The study included 919 HCWs; 52.4% were male, 46.5% were physicians, 30.0% were nurses, and 63.1% worked in hospitals. One-third of HCWs (95% CI: 30.5%-36.7%) said they would accept an annual COVID-19 booster vaccine if recommended. HCWs who are suspicious of vaccine benefits [aOR = .70; 95%CI: .65-.75] and those concerned about unforeseeable future effects [aOR = .90; 95%CI: .84-.95] are less likely to accept the booster vaccine if recommended, whereas those who receive annual influenza vaccine are more likely to get it [aOR = 2.9; 95%CI: 1.7-5.0]. CONCLUSION: Only about a third of HCWs would agree to receive an annual COVID-19 booster vaccine if recommended. Mistrust of the vaccine's efficacy and concerns about side effects continue to drive COVID-19 vaccine reluctance. Health officials need to address HCWs' concerns to increase their acceptance of the annual vaccine if it is to be recommended.

Exploring the prevalence, knowledge, attitudes and influencing factors of e-cigarette use among university students in Palestine: a cross-sectional study.

OBJECTIVES: E-cigarettes have gained popularity, especially among young adults. This study aims to determine the prevalence of e-cigarette smoking, assess knowledge and attitudes and identify associated factors among Palestinian university students. DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: The study was conducted among Palestinian university students in early 2023.A self-administered questionnaire was used to survey 1792 students from six Palestine universities in the West Bank. The questionnaire covered various aspects, including sociodemographic information, daily habits, exposure to smoking, attitudes and knowledge about e-cigarettes. Data were analysed using descriptive statistics, χ2 tests and multivariate regression analysis. RESULTS: The study revealed a high prevalence of tobacco use (41.2%), with e-cigarette use prevalent among 19.7% of participants. Knowledge about e-cigarettes was suboptimal, with misconceptions regarding their safety and health effects. Negative attitudes towards e-cigarettes were common, and students with negative attitudes were more likely to use e-cigarettes (aOR=2.6, 95% CI: 1.9 to 3.6). Gender (aOR=2.1, 95% CI: 1.4 to 3.0), waterpipe smoking (aOR=4.5, 95% CI: 3.2 to 6.3), physical inactivity (aOR=1.4, 95% CI: 1.1 to 1.9), high coffee consumption (aOR=1.6, 95% CI: 1.1 to 2.3), spending time with friends (aOR=2.4, 95% CI: 1.5 to 3.7), having a mother who is a smoker (aOR=1.5, 95% CI: 1.1 to 2.2) and having a friend who uses e-cigarettes (aOR=1.5, 95% CI: 1.1 to 2.1) were significantly associated with e-cigarettes use. CONCLUSIONS: E-cigarette use is a growing concern among Palestinian university students. Combating this trend should include educational initiatives, social interventions and policy measures to promote informed decision-making and discourage e-cigarette use. Comprehensive tobacco control programs considering various tobacco and nicotine products and involving multiple stakeholders are warranted.

Factors contributing to the rising prevalence of waterpipe smoking dependence among university students: a cross-sectional study.

INTRODUCTION: Waterpipe smoking (WPS) has been associated with a variety of adverse health effects, consequences, and symptoms of nicotine dependence. This study aims to determine the prevalence of WPS dependence among Palestinian university waterpipe smoking students, their normative beliefs about WPS, and their relationship to dependence. METHODS: A cross-sectional study of current WPS university students at five major Palestinian universities was conducted from September to December 2022. Participants were recruited using convenient sampling, and data collection was carried out via an interviewer-administered questionnaire. We assessed students' WPS dependence using the Lebanese Waterpipe Dependence Scale. We used the Poisson regression model with robust variance to analyze factors independently associated with high WPS dependence. RESULTS: The study included 746 current WPS university students. Results revealed a high prevalence of WPS dependence, with 69.4% (95%CI: 66.0-72.7%) exhibiting high dependence. Factors contributing to high WPS dependence included dual cigarette smoking (aPR: 1.18; 95%CI: 1.12-1.25), studying medical sciences (aPR: 1.13; 95%CI: 1.10-1.18), friends' approval of WPS (aPR: 1.25; 95%CI: 1.17-1.34), daily WPS frequency (aPR: 1.98; 95%CI: 1.39-2.23), spending more than 50% of daily allowance on WPS (aPR: 1.37; 95%CI: 1.10-1.64), and morning WPS sessions (aPR: 1.97; 95%CI: 1.31-2.27). The study highlighted the influence of social factors, such as peers' approval and perceived prevalence, on WPS dependence. CONCLUSIONS: WPS dependence is prevalent among university students, and it is associated with morning WPS, dual smoking, and increased WPS frequency. Notably, peer and cultural factors are essential primary motivators. As a result, it is critical to incorporate WPS considerations into Palestine's antismoking health promotion program. Therefore, it is vital to incorporate WPS into the Palestinian antismoking health promotion policy, and the health education of adolescents regarding the dangers of WPS should coincide with antismoking initiatives.

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.

Exploring the Perceptions of Nurses on Receiving the SARS CoV-2 Vaccine in Palestine: A Qualitative Study.

BACKGROUND: Uncertainty about vaccination among nurses are major barriers to managing the ongoing COVID-19 pandemic worldwide. PURPOSE: To explore nurses perceptions about receiving the SARS CoV-2 vaccine to inform the upcoming Palestinian Ministry of Health (MOH) vaccination efforts. METHODS: Four focus groups were conducted with nurses between January 18 and 30, 2021, before MOH launched vaccinations in Palestine. Participants working in government and private facilities were invited to participate and completed an online or paper form to provide demographics, review the study purpose, and give consent. Meetings were facilitated in Arabic either online via the Zoom platform or face-to-face using the same interview guide. Transcripts were translated into English and coded using a template analysis approach. RESULTS: Forty-six nurses, with a median age of 29.5y (range, 22-57) from across Palestine participated. Three major themes emerged: uncertainty, trust, and the knowledge needed to move forward. Uncertainty related to the evolving nature of COVID-19, the rapidity of vaccine development, the types and timing of available vaccines. The need for trusted experts to share scientific information about the vaccines to counteract the misinformation in social media. Moreover, reliable vaccine information may help vaccine-hesitant nurses move to vaccine-acceptors and to convince others, including their patients. CONCLUSION: The negative perception of nurses towards vaccines is problematic in Palestine and uncertainty about which vaccine(s) will be available adds to the lack of education and mass-media misinformation. Other countries with vaccination efforts that are not wholly planned or implemented and may be struggling with similar concerns.

Coverage and Determinants of COVID-19 Vaccination Among Pregnant Women: An Experience From a Low-Income Country.

PURPOSE: to determine COVID-19 vaccination coverage among pregnant women and investigate the factors affecting vaccine uptake. DESIGN: Analytical cross-sectional study. SETTING: Palestinian health care facilities. Between October and November 2021 - eight months after the country's first COVID-19 vaccination. SAMPLE: We needed 820 people to estimate vaccination coverage among pregnant women with a precision rate of 3%. Therefore, we invited 950 pregnant Palestinian women who were eligible and had a response rate of 91.6%. MEASURES: An interviewer-administered questionnaire examined vaccination uptake, attitudes, and concerns about the COVID-19 vaccine. ANALYSIS: Bivariable and multivariable analysis using SPSS. RESULTS: vaccination uptake was reported by 219 pregnant women [25.5%, 95% CI: 22.6% -28.5%]. Knowledge (aOR=2.0; 95% CI: 1.2-3.1), perceived benefits (aOR=1.1; 95% CI: 1.06-1.16), employment (aOR=5; 95% CI: 3.1-8.1), and underlying medical condition (aOR=2.1; 95% CI: 1.1-4.1) predicted uptake. Reporting vaccine barriers reduces vaccine uptake (aOR=.92; 95% CI: .89-95). CONCLUSIONS: Pregnant women's COVID-19 vaccination rates are low. Concerns regarding the COVID-19 vaccine for infants affected their decision. COVID-19 vaccination regulations and legislative nudges drove maternal vaccination. Vaccine fears and misconceptions among pregnant women should be addressed.

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.

Perceived barriers to Palestinian pregnant women's acceptance of COVID-19 vaccination using the Health Believe Model: a cross-sectional study.

This study aims to explore pregnant women's attitudes to COVID-19 vaccination and determinants of vaccine acceptance. We conducted a cross-sectional study among pregnant women attending PHC clinics and hospitals in the West-bank of Palestine. We used an interviewer-administered questionnaire based on Health Belief Model. The study's primary outcome was COVID-19 vaccination acceptance. We used the Chi-square test to compare those who accepted the vaccine versus those who refused it and conducted binary logistic regression to explore independent determinants of vaccination acceptance. Among the 728 pregnant women who took part in the study, 20.7 percent showed positive attitudes (acceptance) toward COVID-19 vaccination. Employment (aOR 4.0; 95 percentCI: 2.2-7.3), a history of COVID-19 (aOR 1.9; 95 percentCI: 1.2-3.1), and having a relative who died from COVID-19 (aOR 2.3; 95 percentCI: 1.2-4.7) increased the likelihood of vaccine acceptance, as did vaccine perceived effectiveness (aOR 1.9; 95 percentCI: 1.2-3.2) and perceived protection from severe disease (aOR 2.0; 95 percentCI: 1.2-3.5). On the other hand, perceived limited access (aOR 0.540; 95 percentCI: 0.31-0.87) and perceived harm to the baby (aOR 0.346; 95 percentCI 0.22-0.54) remained the main barriers toward vaccine acceptance. In conclusion, pregnant women's acceptance of the COVID-19 vaccine is unsatisfactory. Concerns about its effect on unborn babies were major barriers to vaccination.

COVID-19 vaccine uptake and its associated factors among Palestinian healthcare workers: Expectations beaten by reality.

BACKGROUND: In response to this extraordinary outbreak, many countries and companies rush to develop an effective vaccine, authorize, and deliver it to all people across the world. Despite these extensive efforts, curbing this pandemic relies highly upon vaccination coverage. This study aimed to determine SARS-COV-2 vaccine uptake among Palestinian healthcare workers, the factors that influence vaccination uptake, and the motivators and barriers to vaccination. METHODS: A cross-sectional study was conducted using an online anonymous self-administered questionnaire during April and May 2021, after the Palestinian Ministry of Health launched the COVID-19 vaccination campaign. The questionnaire collected socio-demographic characteristics, vaccination attitude and vaccination uptake status, and motivators and barriers towards vaccination. In addition, multivariate logistic regression was performed to identify the influencing factors of vaccination uptake. RESULTS: The study included 1018 participants from different professions, including 560 (55.0%) females. Of the participants, 677 (66.5%; 95% CI: 63.5-69.4%) received the vaccine. Higher uptake was observed among males (aOR = 1.5; 95 %CI: 1.1-2.1), single HCWs (aOR = 1.3; 95 %CI: 1.1-1.8), HCWs working in the non-governmental sector (aOR = 1.6; 95 %CI: 1.2-2.4), higher monthly income (aOR = 1.9; 95 %CI: 1.4-2.8) and smoking (aOR = 1.5; 95 %CI: 1.1-3.5). The lower level of negative vaccination attitudes predicted higher intake; mistrust of vaccine belief (aOR = 1.6; 95 %CI: 1.4-1.7) and worries over unforeseen future effects (aOR = 1.2; 95 %CI: 1.1-1.3). CONCLUSION: In conclusion, the COVID-19 vaccination uptake was comparable to other studies worldwide but still needs to be improved, especially in the context of this ongoing global pandemic. It is imperative to invest resources to promote vaccination uptake and target all the vaccine misconceptions and fears.

The practice of COVID-19 preventive measures in Palestine on the limits of vaccine provision: a population-based study.

INTRODUCTION: Despite discovery of effective vaccines, healthy behaviors and good practices remain the cornerstone of the prevention and control of COVID-19 and the mitigation of adverse impacts. This study aimed to assess the Palestinian population's COVID-19 prevention measures and correlate them with their knowledge, attitude, and background characteristics. METHODOLOGY: A cross-sectional study was performed between Dec 2020 and Jan 2021 on 1,451 respondents ≥18 years via an interviewer-administered questionnaire, comprising 35 questions assessing knowledge, attitude, and practice toward COVID-19. Data were analyzed using univariate and multivariable regression analyses. RESULTS: Of the 1,451 respondents, 768 were females (52.9%), the mean age was 32.8 ± 13.7 years, and 161 (11.1%) reported having been infected with the coronavirus. Overall, 38.7% (95%CI: 36.2-41.2%), 23.4% (95%CI: 21.3-25.7%), and 50.2% (95%CI: 47.6-52.9%) reported good knowledge, attitude, and practice, respectively. Respondents over 50 [aOR 1.9, 95%CI: 1.3-2.8], females [aOR 1.7, 95%CI: 1.4-2.2], and people who had COVID-19 infection [aOR1.7, 95%CI: 1.2-2.5] were more likely to report good practice. Participants with good attitude were 5. times more likely to report good practice than those with poor attitude [p-value < 0.001, aOR 5.7, 95%CI: 3.9-8.4]. CONCLUSIONS: The knowledge, attitude, and practice of the participants are no ideal. A positive attitude is a crucial predictor of good practices for COVID-19 prevention and control. Public health interventions are essential for developing and sustaining positive attitudes and good practices and preventing misconceptions.

Epidemiological and clinical characteristics of headache among medical students in Palestine: a cross sectional study.

BACKGROUND: Headache is one of the most disturbing complaints worldwide, negatively impacting social and regular life activities. In the background of stressful life in medical schools, adding to the stressful situation in Palestine, a developing country under occupation, this study investigated the prevalence and clinical characteristics of migraines and tension- type headaches among medical students from the Palestinian Universities in West Bank and Gaza. METHODS: A questionnaire-based cross-sectional study was conducted on all Palestinian Medical Students. Students were diagnosed based on ICHD-3 criteria. Demographic characteristics were compared by gender for each type of headache. Frequency, percentage, and mean ± SD. Pearson's chi-squared test, independent t-test, and one-way ANOVA were used where needed. P-value < 0.05 was considered significant. RESULTS: The study included 806 medical students; 476 (59.0%) of them were female. TTH and migraine's prevalence was 59.8 and 22%, respectively, with a higher prevalence among basic year students. The female to male ratio was 1:0.6 for both types of headaches. Sleep deprivation, physical activities, and altered sleep patterns were reported as the top triggering factors. CONCLUSIONS: The results demonstrate that the prevalence of both subtypes' primary headache is high among Palestinian medical students, with a higher prevalence among basic year students. The study also showed that these findings are higher than other studies among medical students in other countries.

The Mental Health Impact of the COVID-19 Pandemic on Healthcare Workers in the Eastern Mediterranean Region: A Scoping Review.

Objectives: This scoping review is to investigate the existing literature on the mental health of Healthcare workers, including stress or distress, anxiety, depression, burnout, insomnia, and fear or phobia within the different countries in the Eastern Mediterranean region (EMR) during the COVID-19 pandemic. Methods: We systematically searched to consolidate studies across EMR countries regarding the mental health morbidity studied, the scales, and the methodology used. The review focused on peer-reviewed academic literature published from March 2020 to November 2021. Results: One hundred sixty-seven articles were included in the review. Most publications came from lower-middle-income countries such as Iran, Pakistan, and Egypt. Most of the literature was specific to Stress/Distress (n = 94), followed by anxiety (n = 93), depression (n = 66), burnout (n = 27), insomnia (n = 20), and fear/phobia (n = 12). Conclusion: Fear, phobia, and insomnia have all been examined extensively worldwide, yet they were among the Eastern Mediterranean region's least explored outcomes. In addition, most underdeveloped countries have a low rate of publication.

Palestinian analysis of COVID-19 vaccine compliance and reported death by vaccination type.

Background: This study aims to compare mortality and adherence to the second dose between different types of vaccines administered in Palestine. Methods and Participants: A retrospective cohort study of individuals vaccinated against COVID-19 from February 14, 2021 through January 2022. Data were retrieved from the Palestinian Ministry of Health database and included identity number, date of birth, vaccination date, vaccine type, and mortality. Results: The study included 16,726 individuals who were vaccinated and later diagnosed with COVID-19. The mean age was 42.1 years, and females comprised 48.5% (8,112) of the population. Only 62.7% of individuals adhered to receiving the second dose of a vaccine, and the average duration of effectiveness of all vaccines was 126 days after completing the double dose. Seventy-five COVID-related deaths were recorded among vaccinated individuals who were significantly older ages. Conclusion: Our study design demonstrated the disparity in vaccine uptake and adherence due to delay in vaccination and dependence on COVAX and other countries for the donated vaccines. It highlights the importance of a global approach and higher-income countries assisting lower-income countries in securing vaccine.

Prevalence of SARS-CoV-2 antibodies in the Palestinian population: A primary health center-based cross-sectional study.

This study aimed to assess the prevalence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) total antibodies in the north, middle, and south regions of West Bank and the prevalence of SARS-CoV-2 specific antibodies (IgA, IgM, and IgG) in the Palestinian population. This was a cross-sectional study. The serological and epidemiological data of 1269 persons were assessed. Participants were selected randomly among primary health care center attendees in Palestine between November 1, 2020 and December 31, 2020. All serum samples were tested for total antibodies using an enzyme-linked immunosorbent assay (ELISA) test. IgM, IgG, and IgA-specific antibody titers were measured using ELISA. The overall prevalence (with 95% confidence intervals [CIs]) of SARS-CoV-2 total antibodies and specific antibodies were estimated. A multivariate regression model was used to assess the predictive factors for SARS-CoV-2-specific antibodies. The overall seroprevalence of SARS-CoV-2 antibodies was 24·0% (95% CI, 21·7%-26·5%). Seroprevalence was significantly higher among people living in south West Bank (adjusted Odds ratio [aOR], 2·22; 95% CI: 1·58-3·11), people who had COVID-19 symptoms (aOR, 3·92; 95% CI, 2·83-5·43), people with a COVID-19 contact history (aOR, 1·44; 95% CI, 1·03-2·03), patients with hypertension (aOR, 1·57; 95% CI, 1·06-2·33), and non-smokers (aOR, 0·47; 95% CI, 0·31-0·72). A total of 171 blood samples from SARS-CoV-2-positive patients were chosen at random for additional serological testing. Specific IgM, IgG, and IgA antibodies were positive in 14·0% (95% CI, 9·2%-20·2%), 88·3% (82·5%-92·7%), and 42·1% (34·6%-59·9%) of the samples, respectively. SARS-CoV-2 antibodies were common among PHC center attendees and were significantly associated to sex, smoking, and COVID-19 contact history. However, considering that almost three-quarters of this population remains susceptible, maintaining public health measures and encouraging access to immunization is critical in protecting this population.

Somatic symptom disorders and utilization of health services among Palestinian primary health care attendees: a cross-sectional study.

BACKGROUND: Many primary health care (PHC) clients come in with medically unexplained complaints, leading to frequent consultations and high usage of services and healthcare costs. This study aimed to determine the prevalence of somatic symptom disorder (SSD) among PHC attendees and explore its relation to other mental conditions and risk factors. METHODS: A cross-sectional design was used to interview 400 attendees. Men and women aged over 18 years old without a psychiatric diagnosis were invited to participate. The Somatization scale of the Four-Dimensional Symptom Questionnaire was used to assess somatic symptom disorders. It is a valid tool to be used in a PHC setting. We used the Chi-square test and multivariable logistic regression to explore determinant variables. RESULTS: Prevalence of SSD was 32.5% (95%CI = 27.9-37.1%). The most common symptoms were painful muscles (61.5%) followed by back pain (52.3%). Female gender [adjusted OR = 2.1 (95% CI = 1.2-3.7)], chronic diseases [adjusted OR = 2.4 (95%CI = 1.3-4.5)], depression [adjusted OR = 3.3 (95%CI = 2.0-5.5)], and anxiety [adjusted OR = 2.1 (95%CI = 1.2-3.6)] were all associated with SSD. In addition, frequent primary health care attendance was found to be associated with SSD [adjusted OR = 2.4 (95%CI = 1.4-4.1)]. CONCLUSIONS: SSD significantly higher among females, patients with chronic diseases, clients with anxiety and depressive disorders, and patients with frequent doctors' visits. Painful muscles and back pain are the most common symptom presented by patients, and this could be used initially by PHC physicians as a signal to consider for screening.

Demographic factors associated with COVID-19-related death in Palestine.

OBJECTIVES: Understanding the case and death rates of COVID-19 in different countries should include socio-demographic variables to better guide health policies. We analysed COVID-19 cases in the Occupied Palestinian Territories (OPT) with attention to socio-demographic factors. STUDY DESIGN: A retrospective chart review of laboratory confirmed COVID-19 cases was conducted between March and September 2020. METHODS: Demographic data such as age, gender, place of residence, pregnancy, and symptoms were analysed. Patients were divided into two outcome groups: discharged from quarantine restrictions and dead. RESULTS: A total of 15,338 confirmed cases was examined. COVID-19 cases tended to be young (48.2% were less than 30 years of age) with an average age of 34.3 ± 27.3, most were female (55.5%),and 20% smoked. Overall, 5183 (38%) were symptomatic and if pregnant, symptoms were more commonly reported (65.3%). The overall case-fatality was 0.93 [95% CI 0.83-1.04]. Males had a greater risk of death (OR = 2.7 [95%CI = 1.7-2.8], P < 0.001), as did those 60 years of age and older (OR = 52.0 [30.5-89.7], P < 0.001). CONCLUSION: Early detection of socio-demographic risk factors helps understand the case distribution and guide better planning, especially in countries with limited resources. Better targeting of interventions may help to limit more expensive interventions such as intensive care admissions and avoid deaths. Such data are also important for planning vaccination campaigns.

Determinants of smoking cessation counseling favorable practice for primary care physicians: A cross-sectional study from Palestine.

BACKGROUND: Smoking cessation counseling is not well established in Middle East countries including Palestine. This study assesses the practice of smoking cessation counseling among primary healthcare (PHC) physicians in Palestine and its determinants. METHODS: Over the period from April to September 2019, general practitioners, family medicine physicians, obstetricians and gynecologists, and dentists working at the PHC Centers in Palestine were approached through a cross-sectional design using a self-reported questionnaire. Proportionate stratified random sampling approach has been used. Sociodemographic, medical background, smoking cessation counseling training, smoking history, practice, knowledge, attitude, and confidence were evaluated. The proportion of favorable practice has been determined and its relationship with all variables has been evaluated. Ethical approval was received from the National University of An-Najah. RESULTS: 295 physicians were enrolled in the study with an 86% response rate. 75.5% (n = 222) were males with a mean age of 39.9 ± 9 years. The majority were General Practitioners (76.5%, n = 252). Most of them (84.3%, n = 215) had not received any training. The favorable practice was seen in 36.6% (95% CI 31-41%). Attitude is the main predictor of favorable practice (P value = 0.002, adjusted OR = 1.1). CONCLUSION: Palestinian PHC physicians have a low level of counseling for smoking cessation. Given the efficacy of counseling for smoking cessation and the high level of the tobacco epidemic in the area, health policy to ensure all healthcare personnel-especially physicians-receive training in cessation counseling and call for a public health campaign for control of tobacco should be taken into account.

COVID-19 vaccine hesitancy among health care workers in Palestine: A call for action.

With the planned COVID-19 vaccine, vaccine hesitation is a great challenge, particularly for healthcare professionals. In this study, we examined the acceptance of the COVID-19 vaccine by health care workers, their concerns about it, and the reasons that might prevent them from getting vaccinated. We conducted a cross-sectional study using an anonymous online survey from December 25, 2020, to January 6, 2021. The questionnaire consisted of demographic characteristics (age, gender, profession, sector, medical history, and general health), COVID-19 related knowledge, and personal history of influenza vaccination. The intention to get the vaccine once it is available was directly asked, and attitudes towards the diseases and the vaccine were studied using a four-point Likert scale statement based on the health belief model's constructs. The study included 1159 HCWs; 62.9% were females, and 52.5% were between the ages of 30-49 years. The intention to get vaccinated was only 37.8% [95%CI: 35.0%-40.6%], while 31.5% were undecided, and 30.7% planned to refuse it. Higher levels of intention were reported among males (OR; 2.7, 95%CI: 2.0-3.7), younger ages (OR 1.7, 95%CI: 1.1-2.8), physicians (OR; 2.9, 95%CI: 2.0-4.0), HCWs at non-governmental settings (OR; 1.4, 95%CI: 1.1-1.9), those who previously received the influenza vaccine (OR 4.0, 95%CI: 2.3-7.1), and those who had higher COVID-19 related knowledge (OR; 1.7, 95%CI: 2.3-7.1). In conclusion, vaccine acceptance among HCWs was much lower than expected, which would greatly diminish the role of vaccination in reducing the burden of the COVID-19 pandemic throughout the community.

Factors affecting nurses' intention to accept the COVID-19 vaccine: A cross-sectional study.

OBJECTIVE: To measure COVID-19 vaccine acceptance and related factors to undercover nurses' concerns and fears. DESIGN: A cross-sectional study. SAMPLE: The study included 639 nurses; 83% were women and 80% under 50 years. MEASUREMENT: A self-administered questionnaire was used. It included demographic characteristics, COVID-19-related fears and concerns, COVID-19 vaccine perceived benefits, and intention toward getting the vaccine. RESULTS: Forty percent of the nurses planned to get the vaccine when available, 41% would take it later when adequate protection and safety were presented, and 18% would never take it. Significant factors associated with vaccination intention were as follows: age (adjusted OR 1.42, 95% CI: 1.02-1.99); lack of knowledge about the vaccine (adjusted OR 2.6, 95% CI 1.81-3.8); concern about long-term side effects (adjusted OR 2.0, 95% CI 1.4-2.9); fear of injection (adjusted OR 1.5, 95% CI 1.04-2.13); natural immunity preference (adjusted OR 5.8, 95% CI 4.5-8.3); media misrepresentation (adjusted OR 1.7, 95% CI 1.2-2.4); and getting COVID-19 from the vaccine (adjusted OR 1.5, 95% CI 1.1-2.1). CONCLUSION: COVID-19 vaccine safety and side-effects concerns impact nurses' intentions to accept the vaccine and may result in low acceptance rates. Urgent action is needed to address these fears and raise confidence, as nurses' vaccine-related decisions can affect the public's vaccine acceptance.

Microbes on the Mobile Phones of Healthcare Workers in Palestine: Identification, Characterization, and Comparison.

BACKGROUND: Healthcare workers (HCWs) may be using their mobile phones (MPs) to carry microbes that cause hospital-acquired and community infections in general. With antibiotic resistance problem emergence, these infections can be challenging to eradicate. Hence, this study aimed to determine the microbial contamination of HCW MPs and identify and classify bacterial isolates in Palestine. METHODS: This was a 7-month comparative cross-sectional analysis of 200 HCW MPs from 2 hospitals and 100 MPs from university students (non-HCWs). Data collection was done using a self-administrated questionnaire, and a swab sample from both HCW and non-HCW MPs was obtained and transferred to An-Najah National University (NNU) microbiology lab for bacterial identification and antibiotic susceptibility. Data were analyzed using Social Sciences Statistical Package (SPSS) version 22.0. RESULT: Among HCWs, the microbial contamination was 87.5%. Coagulase-negative staphylococci (CoNS; 67.3%), methicillin-sensitive Staphylococcus aureus (MSSA; 17.5%), Gram-positive bacilli (4.1%), methicillin-resistant Staphylococcus aureus (MRSA; 1.6%), and Gram-negative species (1.6%) were the most predominant bacterial isolates. More than half of staphylococci isolates were resistant to penicillin and erythromycin. Male gender, using a mobile phone in the bathroom, and entry to the operating theatre were associated with mobile phone contamination and increased resistance against specific antibiotics. Among non-HCWs, the contamination was 86%. The most predominant bacterial isolates were CoNS, MSSA, and Gram-positive bacilli, with a contamination of 66.8%, 28.5%, and 2.6%, respectively. No MRSA or Gram-negative species were detected in this group. Antibiotic resistance percentage of staphylococci was nearly half of that yielded in the HCW group against each antibiotic. CONCLUSION: Significant numbers of bacteria have been isolated from HCW MPs. Working in a hospital environment frequently raises the probability of presence of antibiotic-resistant bacteria on a MP. Therefore, infection control teams should discuss methods to prevent the transmission of drug-resistant pathogens from HCW MPs.