Exploring the link between adverse childhood experiences and mental and physical health conditions in pregnant Palestine refugee women in Jordan.

OBJECTIVES: Adverse childhood experiences (ACEs) are linked to negative pregnancy outcomes. However, little is known about the prevalence of ACEs and their relationship to mental and health outcomes among pregnant Palestine refugee women. STUDY DESIGN: This was a cross-sectional study. METHODS: Data were collected from 772 pregnant Palestine refugee women with a median (interquartile range) age of 27 (23, 32) years, attending five antenatal clinics in Jordan between February and June 2021. The modified 33-item ACE International Questionnaire was used to assess eight domains of ACEs: (1) marriage and family, (2) relationship with parents, (3) neglect, (4) household dysfunction/domestic violence, (5) abuse, (6) peer violence, (7) community violence, and (8) collective violence. Multivariate logistic regression was used to examine the association between ACEs and mental and health outcomes. The ethical approval was obtained from United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) Research Review Board in May 2020. RESULTS: Eighty-eight percent of women experienced at least one type of ACE, and 26% of women experienced ≥4 types of ACEs. Compared with women with 0-3 types of ACE exposure, those with ≥4 types of ACEs had 1.58 (95% confidence interval [CI] 1.10-2.28) times higher prevalence of obesity before pregnancy, 3.28 (95% CI 1.79-6.03) times higher prevalence of depression during pregnancy, and 2.01 (95% CI 1.39-2.91) times higher prevalence of ever been smoking cigarettes or hookah. CONCLUSIONS: Exposure to ACEs is prevalent among pregnant Palestine refugee women. Exposure to multiple types of ACEs was associated with obesity, mental health conditions, and smoking.

Cardiovascular disease research in the Arab world: a scoping review from seven Arab countries (2000-2018).

OBJECTIVES: The objective of this study is to map cardiovascular disease (CVD) research productivity in Arab countries and identify gaps and opportunities that would inform future research agenda. STUDY DESIGN: This is a scoping review. METHODS: A review of research output between January 2000 and December 2018 in seven Arab countries, selected to represent various economies and epidemiological transitions, was conducted. Data on quantity and quality, study design, setting and focus were extracted and analysed for trends by time and place. RESULTS: Over the study period, a total of 794 articles were published, with an average of 7.3 publications per million population. While time trends showed a 6-fold increase in the number of publications over the study period, a decreasing trend in mean journal impact factor was noted (from 2.3 in 2000 to 1.5 in 2018). Most studies (71%) were observational, 56% were conducted in medical facilities (hospitals or clinics) and most of the experimental studies (10%) were based in laboratory settings. Behavioural risk factors were addressed in 52% of the studies, and there was a dearth of studies examining associations with diet, physical inactivity or family history. CONCLUSIONS: Findings from this review indicate gaps in robust methods and pertinent themes in CVD research in the Arab region. Greater attention should be paid to high-quality evidence and implementation research. Also, there is a need for a more targeted CVD research agenda that is responsive to local and regional health burden and needs.

Needlestick injury among interns and medical students in the Occupied Palestinian Territory.

The aim of this study was to determine the prevalence of needlestick injury (NSI) among interns and medical students as well as their knowledge of, attitude towards and their protective strategies against exposure to bloodborne pathogens. A cross-sectional study was conducted among 272 participants using a self-administered questionnaire. Just over 40% of the participants had experienced at least 1 NSI. Wound suturing was the most common cause of injury (33.5%), and the highest incidence (55.5%) was in the emergency room. Failure to report the injury to health representatives was recorded for 48.6% of NSIs. Only 46.7% of the interns had received the hepatitis B vaccine whereas most of the students (76.8%) had completed their vaccination schedule (P < 0.001). Participants were found to be at a high risk of NSIs and bloodborne infections.

Needlestick injury among interns and medical students in the Occupied Palestinian Territory

The aim of this study was to determine the prevalence of needlestick injury [NSI] among interns and medical students as well as their knowledge of, attitude towards and their protective strategies against exposure to bloodborne pathogens. A cross-sectional study was conducted among 272 participants using a selfadministered questionnaire. Just over 40% of the participants had experienced at least 1 NSI. Wound suturing was the most common cause of injury [33.5%], and the highest incidence [55.5%] was in the emergency room. Failure to report the injury to health representatives was recorded for 48.6% of NSIs. Only 46.7% of the interns had received the hepatitis B vaccine whereas most of the students [76.8%] had completed their vaccination schedule [P < 0.001]. Participants were found to be at a high risk of NSIs and bloodborne infections

Caesarean delivery rates, determinants and indications in Makassed Hospital, Jerusalem 1993 and 2002.

This study investigated the rising rate of caesarean section (CS) deliveries between 1993 and 2002 (9.4% to 14.4%) and associated factors, including indications for CS and sociodemographic and clinical characteristics based on the register of a major Palestinian teaching hospital. Instrumental deliveries declined from 12.6% to 4.4%. Fetal distress decreased as an indication for CS, while previous CS and breech presentations contributed to the increase. Decision-making for CS needs to frame the benefits and risks of the intervention within the context of women's entire reproductive life-cycle and existing standards of care, avoiding unnecessary and costly CS deliveries to reduce iatrogenic complications and conserve resources.

Caesarean delivery rates, determinants and indications in Makassed Hospital, Jerusalem 1993 and 2002

This study investigated the rising rate of caesarean section [CS] deliveries between 1993 and 2002 [9.4% to 14.4%] and associated factors, including indications for CS and sociodemographic and clinical characteristics based on the register of a major Palestinian teaching hospital. Instrumental deliveries declined from 12.6% to 4.4%. Fetal distress decreased as an indication for CS, while previous CS and breech presentations contributed to the increase. Decision-making for CS needs to frame the benefits and risks of the intervention within the context of women's entire reproductive life-cycle and existing standards of care, avoiding unnecessary and costly CS deliveries to reduce iatrogenic complications and conserve resources

Medicine utilisation review in selected non-governmental organisations primary healthcare clinics in the West Bank in Palestine.

BACKGROUND: Information on prescribing practices in Palestine is lacking, however, still essential for strategic planning. PURPOSE: To characterise prescribing patterns and specific medicine use indicators in selected non-governmental organisations' (NGO) primary healthcare clinics/centres (PHC) in the West Bank (WB) in Palestine. METHODOLOGY: A prospective cross-sectional survey of prescribing practices based on medical records of 6032 patients with acute symptoms frequenting 41 NGO PHCs in the WB, between July and September 2004. A systematic random sample of every 10th patient appearing on the patient registration list was selected. Direct observation of consultation and dispensing practices and times in a sub-group of patients was completed utilising special forms. RESULTS: Respiratory tract infections were the most commonly occurring conditions. On average, 1.9 drugs were prescribed per encounter and antibiotics were the most commonly prescribed medications, followed by Analgesics and NSAIDs accounting for 46 and 20% of the total medications expenditures, respectively. Injections and combined medications use per encounter was 16 and 8%, respectively. Most commonly prescribed medications were of local production. Consultation (6.4 +/- 4.6 minutes) and dispensing times (1.6 +/- 1.5 minutes) were short with inadequate labelling. Provision of reference sources and treatment guidelines implementation were also inadequate. CONCLUSION: The results suggest that prescribing practices could be improved through wider implementation of treatment guidelines, a review of antibiotic prescribing, and increased time spent with patients to promote concordance. Strategies aimed at improving prescribing and dispensing practices should be addressed through new innovative capacity building models based on problem solving and feedback mechanisms.

A trial of amniotomy in a Palestinian hospital.

This randomised controlled trial of routine amniotomy was carried out in a developing country setting to investigate the effect of this common procedure on the duration of labour, intra-partum interventions and selected newborn and maternal outcomes. In a Jerusalem teaching hospital, 533 multiparous and 157 nulliparous low-risk women were randomised to either amniotomy or intent to conserve membranes. For multiparae, the median duration from randomisation to full dilatation was 95 and 160 min, respectively in the intervention and control arms (p < 0.001); for nulliparae it was 210 and 270 min, respectively (p < 0.001). In both groups, oxytocin was used less in the intervention arms (p < 0.001), and no difference in mode of delivery and immediate outcomes was detected. However, given the risks of this intervention and these study findings indicating an overall short duration of childbirth, amniotomy should be limited to cases of abnormal progress of labour.

Obesity and selected co-morbidities in an urban Palestinian population.

OBJECTIVE: To assess the prevalence of obesity and central obesity in an urban Palestinian population and their associations with selected co-morbidities, including diabetes, hypertension and dyslipidaemia. DESIGN: A population-based cross-sectional survey in an urban Palestinian community. SUBJECTS: Men and women aged 30-65 y residing in the urban community, excluding pregnant women. MEASUREMENTS: According to WHO guidelines, obesity for men and women was defined as BMI> or =30 kg x m(-2), while pre-obesity was defined as BMI 25-29.9 kg x m(-2). Central obesity was defined as a waist-to-hip ratio (WHR) of >0.90 in men and >0.85 in women. RESULTS: The prevalence of obesity in this population was high at 41% (49% and 30% in women and men, respectively). Central obesity was more prevalent among men (59% compared to 25% in women). After adjusting for the effects of age, sex, smoking and each other, obesity and central obesity were found to be significantly associated with diabetes, low HDL-cholesterol and elevated triglycerides in separate logistic regression analyses. Central obesity was also significantly associated with hypertension (OR 2.26, 95% CI 1.30-3.91). CONCLUSION: Obesity and central obesity are prevalent in the urban Palestinian population. Their associations with diabetes, hypertension, and dyslipidaemia point to a potential rise in cardiovascular disease (CVD). An understanding of the reasons behind the high prevalence of obesity is essential for its prevention as well as for the prevention of the morbidities to which it may lead.