Knowledge and attitudes of medical students toward death: a cross-sectional comparative study between an Arab and a Western University

BACKGROUND

Cultural factors influence attitudes toward death, and gender disparities are evident. Prior studies show that medical students have limited knowledge about death and are uncomfortable with it. Moreover, there is limited research that has examined factors that influence medical students' knowledge and attitudes toward death.

OBJECTIVES

The objectives of the study were to compare cultural and gender differences in relation to knowledge and attitudes toward loss and grief and to screen for complicated grief among medical students at the Arabian Gulf University and the University of Toronto.

METHODS

A cross-sectional study was disseminated to medical students at both universities in 2022. The variables in the survey included four parts: demographic characteristics of the participants, religious observance, history of encountering loss of a loved one, grief following loss, attitude toward death, and learning about how to deal with grief and death during medical school. The brief grief questionnaire and the death attitude profile-revised scales were used.

RESULTS

The study sample consisted of 168 medical students, with 74.1% being female. Complicated grief scores were higher among Arabian Gulf University students (3.87 ± 2.39) than among University of Toronto students (2.00 ± 1.93) and were higher for participants with a higher degree of religious observance in both schools (p < 0.05). Death avoidance (p = 0.003), approach acceptance (p < 0.001), and escape acceptance (p = 0.038) domains were significantly higher among Arabian Gulf University students than among University of Toronto students. Almost three-quarters of University of Toronto students reported not being taught about grief, compared to 54% of Arabian Gulf University students.

CONCLUSIONS

Arabian Gulf University medical students scored higher on complicated grief, most likely due to cultural and religious factors. Females at both institutions as well as those who indicated a higher level of religious observance reported higher scores of complicated grief. The study highlights how cultural and religious beliefs influence medical students' attitudes toward death and bereavement. It provides valuable insight into the knowledge and attitudes of medical students toward loss.

Resilience under protracted conflict and siege: a new paradigm shift

This study sought to explore the relationship between resilience as perceived within the Palestinian context, and individual, contextual, and psychosocial factors among adults living in the Gaza Strip. Secondly, this study applies the Connor-Davidson Resilience Scale to the Palestinian population within the context of the challenges they are facing while living under extended sieges, in order to examine the generalizability of the resilience scale. Gender-specific bivariate analyses and multivariate linear regression were conducted to examine links between resilience, and diverse psychosocial and contextual factors. Males scored higher in resilience than females. Consistent predictors of higher resilience included, being male, employed, income, not living in a peaceful area, higher life satisfaction, and the Palestinian idea of resilience (Sumud). For the overall sample and males, hardiness was a positive predictor of higher resilience. For the overall sample and females, post-secondary education was a positive predictor of resilience. Psychosocial factors may act synergistically to foster resilience in the face of adversity, low socioeconomic status, and fear of living in a non-peaceful area. Our findings add to a limited body of literature calling for attention to contextual and psychosocial influences on gender differences in measuring and defining the dynamic nature of resilience.

Exploring the Influence of Perceived Ingroup and Outgroup Threat on Quality of Life in a Region Impacted by Protracted Conflict

While the detrimental effects of protracted political conflict on the wellbeing of Palestinians living in the occupied Palestinian territory (oPt) are generally recognized, the impact of perceived threat on quality of life (QoL) faced from within their community (ingroup; Palestinians) and from the outgroup (Israelis) is unexplored. This cross-sectional study examined the following: (1) The status of perceptions of QoL on four domains measured by the World Health Organization Quality of Life (WHOQoL-Bref) instrument, physical health, psychological health, social relationships, and environment, among Palestinian adults (n = 709) living in the Gaza Strip; (2) The associations between perceived ingroup threat (PIT) and QoL on the four domains; (3) The associations between perceived outgroup threat (POT) and QoL on the four domains. Multivariable linear regression models revealed PIT was negatively associated with QoL in each of the four domains (p < 0.001). POT was positively associated with QoL in three of the four domains: physical health (p < 0.001), psychological health (p < 0.001), and social relationships (p < 0.001). This study contributes valuable insights into how QoL is viewed by a group experiencing collective existential threat. The findings expand the limited recognition of the reciprocal roles of perceived threat from the ingroup and outgroup on the QoL of vulnerable populations.

Interdependence between health and peace: a call for a new paradigm

Health and peace, and their relationships to disease/conflict/violence, are complex and multifaceted interrelated terms. Scholars have proposed a variety of definitions for health and peace. The conceptualizations of health and peace share many fundamental elements, including in their social, psychological (emotional and mental) and spiritual dimensions. We argue that health and peace are inter-dependent in a fundamental causal fashion. Health is always positively or negatively affected by conflict; peace can be directly or indirectly fostered through public health program and policy initiatives. Evidence shows that public health professionals and academics have frequently failed to recognize the inter-dependence of health and peace when conceptualizing, and addressing, issues related to health and peace. In contrast, the present article argues in support of a new paradigm for addressing public health issues related to health and peace; such a paradigm is based on the premise that health and peace are inextricably linked, requiring that they be addressed in an integrated, inter-dependent, fashion. Finally, we emphasize that fostering health and peace requires identifying and promoting positive socio-ecological influences on health, rather than limiting our focus to health deficits and obstacles at the individual or community levels.

Resilience among a large sample of adult Palestinians in the Gaza Strip: examining contextual sociodemographic factors and emotional response through a social-ecological lens

OBJECTIVES

Palestinians in the Gaza Strip continue to cope with persistent violations of their social, economic, political, and civil rights. This study sought to measure resilience among adult Palestinians and its relation to contextual factors (sociodemographic variables) and emotional response using a social-ecological framework.

STUDY DESIGN

Community-based, cross-sectional.

METHODS

Involving 1068 households in the Gaza Strip, individuals (aged ≥18 years) completed (a) a questionnaire on demographics and social construct, (b) 25-item Connor-Davidson Resilience Scale (Cronbach alpha = .91), and (c) Positive and Negative Affect Schedule (PANAS) (Cronbach alpha = .89). Bivariate analysis, Pearson correlations, and step-wise multiple regression were conducted.

RESULTS

Gazans scored significantly lower resilience compared to the normative mean in the general population (mean score = 75.9 vs. 80.4). Bivariate analysis revealed that being employed and highly educated were associated with higher resilience scores. Likewise, participants showed statistically lower positive affects (PA) (mean = 33.49, standard deviation [SD] = 7.5: 95% confidence interval [CI] 2.39-1.23, P < 0.00) and higher negative affects (NA) (mean = 22.3, SD = 7.0; 95% CI 3.68-4.73, P < 0.001) compared to normative means. Resilience scores were positively correlated with PA (r = .40, P < 0.001), with much weaker negative correlation with NA (r = -.10, P < 0.001). Only PA and NA were significant predictors of resilience (r² = 16%); PA recorded a positive and higher beta value (beta = .38, P < 0.001) than NA (beta = -.089, P = 0.017).

CONCLUSIONS

Sumud, the Palestinian notion of resilience, is an interactive process that depends on individual assets and contextual resources. Given the political turmoil and high levels of poverty, the employment opportunities must be addressed for this highly educated population to preserve resilience. Providing accessible mental health and social support services is critical.

Genomic epidemiology of meticillin-resistant Staphylococcus aureus ST22 widespread in communities of the Gaza Strip, 2009

Remarkably high carriage prevalence of a community-associated meticillin-resistant Staphylococcus aureus (MRSA) strain of sequence type (ST) 22 in the Gaza strip was reported in 2012. This strain is linked to the pandemic hospital-associated EMRSA-15. The origin and evolutionary history of ST22 in Gaza communities and the genomic elements contributing to its widespread predominance are unknown. Methods: We generated high-quality draft genomes of 61 ST22 isolates from Gaza communities and, along with 175 ST22 genomes from global sources, reconstructed the ST22 phylogeny and examined genotypes unique to the Gaza isolates. Results: The Gaza isolates do not exhibit a close relationship with hospital-associated ST22 isolates, but rather with a basal population from which EMRSA-15 emerged. There were two separate resistance acquisitions by the same MSSA lineage, followed by diversification of other genetic determinants. Nearly all isolates in the two distinct clades, one characterised by staphylococcal cassette chromosome mec (SCCmec) IVa and the other by SCCmec V and MSSA isolates, contain the toxic shock syndrome toxin-1 gene. Discussion: The genomic diversity of Gaza ST22 isolates is not consistent with recent emergence in the region. The results indicate that two divergent Gaza clones evolved separately from susceptible isolates. Researchers should not assume that isolates identified as ST22 in the community are examples of EMRSA-15 that have escaped their healthcare roots. Future surveillance of MRSA is essential to the understanding of ST22 evolutionary dynamics and to aid efforts to slow the further spread of this lineage.

Occupation, settlement, and the social determinants of health for West Bank Palestinians

A contentious issue in the Israel-Palestine conflict is the ongoing construction of settlements in the occupied West Bank along with its related policies, both of which have had impacts on the lives of resident Palestinians. These impacts have been documented by various UN and non-governmental agencies yet have been insufficiently studied in the academic literature. This article aims to review the literature on the social determinants of health for West Bank Palestinians and understand how settlement construction and policy influence these determinants. To accomplish these aims, the article first includes an analysis of how military infrastructure, resource allocation, land appropriation and house demolition related to the settlements influence the lives of West Bank Palestinians. The article then proceeds to review available literature on the social determinants of health in the West Bank, most notably: access to healthcare, exposure to political violence, economic conditions and water contamination, with the goal of understanding how settlement-related policies are related to these social determinants of health.

The Palestinian-Israeli conflict: a disease for which root causes must be acknowledged and treated

Fourth of June 2017 marks a half century of the Six Day War, three decades post the first Intifada, seven decades post the Palestinian Nakba (catastrophe), the 70th anniversary of Israeli Independence, and one century post the Balfour Declaration. Both Palestinians and Israelis remain occupied. Five million Palestinians remain sick with hopelessness and despair rendered by years of subjugation. Israelis are stuck, occupied by their historical narrative and transcendental fears. Over two decades have passed since the Oslo accords, which both Israelis and Palestinians hoped might be a historic turning point. This was supposed to put an end to the chronic disease of protracted conflict, allowing Palestinians to enjoy freedom in an independent state side by side to Israel and Israelis to live within peaceful, secure borders with the respect of the international community. Palestinians were ready to give up 78% of their land. Free Palestine would be in the remaining 22%, with East Jerusalem as the capital and a satisfactory solution to the Right of Return. The patient's diagnosis and seeking therapy has been delayed by greed, ignorance, ideology, violence and fear. Accurate diagnosis is needed to successfully heal the wounds and cure this chronic disease.

Second-hand smoke and indoor air quality in public places in Gaza City

Second-hand smoke is a major cause of preventable disease and death in the Eastern Mediterranean Region. To assess how second-hand smoke impacts air quality, respirable suspended particles (PM2.5) which are emitted during cigarette and waterpipe smoking, were measured inside and outside of 18 smoking and 5 nonsmoking public venues in Gaza city. Median PM2.5 level inside the smoking venues was 117 microg/m3, which exceeds the WHO guidelines for daily PM2.5 exposure (25 microg/m3) by more than 4-fold. The median level inside the smoking venues (117 microg/m3) was significantly higher than outside the venues (43 microg/m3), and significantly higher than the median level inside non-smoking venues (40 microg/m3). By contrast particulate levels outside non-smoking venues (35 microg/m3) did not differ from the corresponding levels inside (40 microg/m3). To protect employees and the public from second-hand smoke exposure, policies prohibiting sinoking in public niaces are needed in Gaza city.

CHX10 mutations cause non-syndromic microphthalmia/ anophthalmia in Arab and Jewish kindreds

Microphthalmia/anophthalmia is a clinically heterogeneous disorder of eye formation, ranging from small size of a single eye to complete bilateral absence of ocular tissues. The genetic defect underlying isolated autosomal recessive microphthalmia/anophthalmia is yet unclear. We studied four families (two of Arab origin, one of Bedouin origin, and one of Persian-Jewish origin) with autosomal recessive microphthalmia/anophthalmia and no associated eye anomalies, and one Syrian-Jewish family with associated colobomas. Assuming a founder effect in each of the families, we performed homozygosity mapping using polymorphic markers adjacent to human homologues of genes known to be associated with eye absence in various species, namely EYA1, EYA2, EYA3, SIX4, SIX6, PAX6 and CHX10. No association was found with EYA1, EYA2, EYA3, SIX6 or PAX6. In two families, linkage analysis was consistent with possible association with SIX4, but no mutations were found in the coding region of the gene or its flanking intron sequences. In three of the five families, linkage analysis followed by sequencing demonstrated that affected individuals in each family were homozygous for a different CHX10 aberration: a mutation in the CVC domain and a deletion of the homeobox domain were found in two Arab families, and a mutation in the donor-acceptor site in the first intron in the Syrian-Jewish family. There was phenotypic variation between families having different mutations, but no significant phenotypic variation within each family. It has been previously shown that mutations in a particular nucleotide in CHX10 are associated with an autosomal recessive syndrome of microphthalmia/anophthalmia with iris colobomas and cataracts in two families. We now show that different mutations in other domains of the same gene underlie isolated microphthalmia/anophthalmia.