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.

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.

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 nurseś 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.

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.

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.

Anaplastic lymphoma kinase rearrangements in non-small cell lung cancer in Jordan

Introduction/Objective

ALK rearrangement is an important oncogenic driver in a substantial portion of non-small cell lung cancer (NSCLC) patients ranging from 2-7%. Treatment options such as ALK tyrosine kinase inhibitors (TKI) improve progression-free survival and overall survival. Candidates for such treatment are selected based on the identification of the ALK rearrangement. While fluorescence in situ hybridization (FISH) was considered the gold standard method, the availability of a robust FDA-approved companion diagnostic immunohistochemistry (IHC) assay has led to a paradigm shift in ALK testing. The purpose of this study is to determine the prevalence of ALK rearrangement in Jordanian NSCLC patients along with their clinicopathological characteristics and to compare the results of IHC and FISH methods for detecting ALK rearrangements.

Methods/Case Report

A retrospective study was conducted on 449 Jordanian King Hussein Cancer Center patients with NSCLC whose biopsy samples were tested for ALK rearrangement using FISH and or IHC (clone D5F3) in the period between 2018 and 2020.

Results (if a Case Study enter NA)

During the study period, the rate of ALK positivity by either IHC or FISH method was 4 percent (18 ALK positive cases out of 449 cases of non-small cell lung cancer). Seven cases were positive for both IHC and FISH, and nine cases were positive for IHC with no confirmation by FISH method; one case was ALK positive by IHC and negative by FISH with a significant response to ALK TKI; one case was IHC negative but FISH positive, with no ALK TKI therapy. The calculated sensitivity of ALK D5F3 immunostain compared to FISH results in the current study is 87.5% while the specificity is 96%.

ALK positive patients were significantly younger than those with negative results (p-value=0.051), and women were three times more likely than men to have the rearrangement (p-value=0.013). Rearrangement was more likely to be found in nonsmokers/light or ex-smokers (p-value= 0.013). All patients had clinical stage IV or III disease at presentation with stage IV found in tow thirds of the patients.

Conclusion

ALK rearrangement is found in 4% of all NSCLC in Jordan. Patients are more likely to be younger, females and light or nonsmokers with an advanced stage disease at presentation. IHC is an acceptable alternative to FISH for ALK testing with reasonable sensitivity and specificity in addition to its advantages in terms of robustness, turnaround time and cost savings

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.

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.

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.

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.

•

Data on high-risk groups in COVID 19 will help inform the national strategy.

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Women are more likely to develop COVID 19, but men are more likely to die from it.

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Spatial relation is also factored into COVID 19 deaths.

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There is a 52-fold higher risk of death among COVIDs aged 60 years and over.

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.

Mixed Method Study to Explore Ethical Dilemmas and Health Care Workers' Willingness to Work Amid COVID-19 Pandemic in Palestine

Background: The high potential risks involved in working in a healthcare setting during a pandemic and the associated fear that may affect health care workers' (HCWs') willingness to work are important to understand to eliminate potential barriers to working. This study aimed to assess Palestinian HCWs' willingness to work and the related factors as well as to explore their ethical dilemmas during the coronavirus disease 2019 (COVID-19) pandemic. Materials and Methods: Quantitative (survey questionnaire) and qualitative (semi-structured interviews) data were collected. Frontline HCWs (n = 550) received an online survey link via closed institutional networks. Frequencies summarized the data, and chi-square compared variables and outcomes. Odds ratios (ORs) and multivariable analysis examined predictors for willingness to work. Fifteen HCWs (physicians, nurses, and lab and radiology technicians) were purposefully sampled and agreed to interviews to explore their thoughts, motivations, and worries. Thematic analysis focused on ethical dilemmas to enhance the breadth and the depth of the study. Results: Almost 25% of surveyed HCWs were not willing to work during the pandemic. Logistic model results showed that physicians and nurses had higher willingness to work than others (p = 0.004, Adj. OR = 3.5). Lower stress levels and longer professional experience were predictors of more willing to work (p = 0.03, Adj. OR = 2.5; p = 0.03, Adj. OR = 2.6, respectively). Interviews showed that willingness to work did not preclude HCWs from fulfilling their duties despite grueling workloads and grave fears about safety and security. HCWs felt poorly prepared, unappreciated, and frustrated by unfair work distribution. The occupation presented additional safety issues. Conclusion: Physicians and nurses were more likely to comply with a commitment to their professional ethics and the duty or obligation to work. Stress levels could be mitigated in the future with better leadership, adding supports to address mental health and psychosocial challenges to enhance HCWs' well-being and improve quality of care. The realities of the occupation added additional threats and uncertainty.

Palestinian Health Care Workers' Stress and Stressors During COVID-19 Pandemic: A Cross-Sectional Study

BACKGROUND

COVID-19 is thought to be the most significant public health threat the modern world has encountered. Health care workers (HCWs) face enormous pressure due to work overload, negative emotions, exhaustion, lack of contact with their families, and risk of catching the infection and death.

AIM

This study aims to assess the level of stress perceived by HCWs and possible associated factors during the COVID-19 outbreak in Palestine.

METHODS

A cross-sectional sample of 430 frontlines HCWs was conducted using an online self-reported questionnaire. HCWs' stress from the COVID-19 outbreak, factors that increase stress, and the activities that reduced stress were assessed. Chi-square test was used to compare between a categorical variable and the study outcome; associations are presented as odds ratios (OR) and confidence intervals (95% CI) with 0.05 significance level. Al-Najah National University institutional review board granted ethics approval.

RESULTS

Most respondents (74.0%) reported high-stress levels during the outbreak. Fear of transmitting the virus to family was the most stressful factor (91.6%). HCWs who did not have training on the outbreak response were more likely to have high-stress levels (OR = 2.7 [95% CI = 1.7-4.4], P < .001). Those with high stress reported being disappointed (OR = 2.4 [95% CI = 1.5-3.6], P < .001), and strongly considered taking sick leave (OR = 3.9 [95% CI = 1.9-7.9], P < .001).

CONCLUSION

HCWs are under tremendous stress, given the ongoing COVID-19 pandemic. Understanding the psychological impact of the outbreak on HCWs and the activities that mitigate the stress is crucial to guide policies and interventions that can maintain psychological well-being.