Journal Article > ResearchFull Text
Int J Methods Psychiatr Res. 2020 September 18; Volume 30 (Issue 1); e1850.; DOI:10.1002/mpr.1850
Llosa AE, Martinez-Viciana C, Carreño C, Evangelidou S, Casas G, et al.
Int J Methods Psychiatr Res. 2020 September 18; Volume 30 (Issue 1); e1850.; DOI:10.1002/mpr.1850
OBJECTIVE
We present the results of a cross-cultural validation of the Mental Health Global State (MHGS) scale for adults and adolescents (<14 years old).
METHODS
We performed two independent studies using mixed methods among 103 patients in Hebron, Occupied Palestinian Territories and 106 in Cauca, Colombia. The MHGS was analyzed psychometrically, sensitivity and specificity, ability to detect clinically meaningful change, compared to the Clinical Global Impression-Severity scale (CGI-S). Principal component analysis was used to reduce the number of questions after data collection.
RESULTS
The scale demonstrated good internal consistency, with a Cronbach alpha score of 0.80 in both settings. Test retest reliability was high, ICC 0.70 (95% CI [0.41-0.85]) in Hebron and 0.87 (95% CI [0.76-0.93]) in Cauca; inter-rater reliability was 0.70 (95% CI [0.42-0.85]) in Hebron and 0.76 (95% CI [0.57-0.88]) in Cauca. Psychometric properties were also good, and the tool demonstrated a sensitivity of 85% in Hebron and 100% in Cauca, with corresponding specificity of 80% and 79%, when compared to CGI-S.
CONCLUSIONS
The MHGS showed promising results to assess global mental health thereby providing an additional easy to use tool in humanitarian interventions. Additional work should focus on validation in at least one more context, to adhere to best practices in transcultural validation.
We present the results of a cross-cultural validation of the Mental Health Global State (MHGS) scale for adults and adolescents (<14 years old).
METHODS
We performed two independent studies using mixed methods among 103 patients in Hebron, Occupied Palestinian Territories and 106 in Cauca, Colombia. The MHGS was analyzed psychometrically, sensitivity and specificity, ability to detect clinically meaningful change, compared to the Clinical Global Impression-Severity scale (CGI-S). Principal component analysis was used to reduce the number of questions after data collection.
RESULTS
The scale demonstrated good internal consistency, with a Cronbach alpha score of 0.80 in both settings. Test retest reliability was high, ICC 0.70 (95% CI [0.41-0.85]) in Hebron and 0.87 (95% CI [0.76-0.93]) in Cauca; inter-rater reliability was 0.70 (95% CI [0.42-0.85]) in Hebron and 0.76 (95% CI [0.57-0.88]) in Cauca. Psychometric properties were also good, and the tool demonstrated a sensitivity of 85% in Hebron and 100% in Cauca, with corresponding specificity of 80% and 79%, when compared to CGI-S.
CONCLUSIONS
The MHGS showed promising results to assess global mental health thereby providing an additional easy to use tool in humanitarian interventions. Additional work should focus on validation in at least one more context, to adhere to best practices in transcultural validation.
Conference Material > Slide Presentation
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 May 10; DOI:10.57740/74t1-zq11
Conference Material > Video (talk)
Nasser H, Jha Y, Keane G, Carreño C, Mental Health Working Group
MSF Scientific Days International 2022. 2022 June 10; DOI:10.57740/z68q-6865
Journal Article > ResearchFull Text
JCO Global Oncology. 2024 February 22; Volume 10 (Issue 10); e2300470.; DOI:10.1200/GO.23.00470
Elshami M, Albandak M, Alser M, Al-Slaibi I, Ayyad M, et al.
JCO Global Oncology. 2024 February 22; Volume 10 (Issue 10); e2300470.; DOI:10.1200/GO.23.00470
PURPOSE
To assess colorectal cancer (CRC) awareness and its influence on attitudes toward colonoscopy in Palestine.
MATERIALS AND METHODS
Convenience sampling was used to recruit Palestinian adults from hospitals, primary health care centers, and public spaces across 11 governorates. To evaluate the awareness of CRC signs/symptoms, risk factors, and mythical causes, the Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were used after translation into Arabic. For each correctly recognized item, one point was given. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered high awareness, and the other two tertiles were considered low awareness.
RESULTS
A total of 4,623 questionnaires were included. Only 1,849 participants (40.0%) exhibited high awareness of CRC signs/symptoms. High awareness of CRC symptoms was associated with higher likelihood of showing positive attitudes toward colonoscopy (odds ratio [OR], 1.21 [95% CI, 1.07 to 1.37]). A total of 1,840 participants (38.9%) demonstrated high awareness of CRC risk factors. Participants with high awareness of CRC risk factors were more likely to display positive attitudes toward colonoscopy (OR, 1.20 [95% CI, 1.07 to 1.37]). Only 219 participants (4.7%) demonstrated high awareness of CRC causation myths. There was no association between awareness of CRC causation myths and positive attitudes toward colonoscopy.
CONCLUSION
Awareness of CRC was poor with less than half of the study participants demonstrating high awareness of CRC signs/symptoms and risk factors, and a minority (<5%) displaying high awareness of CRC causation myths. High awareness of CRC signs/symptoms and risk factors was associated with greater likelihood of demonstrating positive attitudes toward colonoscopy. Educational initiatives are needed to address knowledge gaps and dispel misconceptions surrounding CRC.
To assess colorectal cancer (CRC) awareness and its influence on attitudes toward colonoscopy in Palestine.
MATERIALS AND METHODS
Convenience sampling was used to recruit Palestinian adults from hospitals, primary health care centers, and public spaces across 11 governorates. To evaluate the awareness of CRC signs/symptoms, risk factors, and mythical causes, the Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were used after translation into Arabic. For each correctly recognized item, one point was given. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered high awareness, and the other two tertiles were considered low awareness.
RESULTS
A total of 4,623 questionnaires were included. Only 1,849 participants (40.0%) exhibited high awareness of CRC signs/symptoms. High awareness of CRC symptoms was associated with higher likelihood of showing positive attitudes toward colonoscopy (odds ratio [OR], 1.21 [95% CI, 1.07 to 1.37]). A total of 1,840 participants (38.9%) demonstrated high awareness of CRC risk factors. Participants with high awareness of CRC risk factors were more likely to display positive attitudes toward colonoscopy (OR, 1.20 [95% CI, 1.07 to 1.37]). Only 219 participants (4.7%) demonstrated high awareness of CRC causation myths. There was no association between awareness of CRC causation myths and positive attitudes toward colonoscopy.
CONCLUSION
Awareness of CRC was poor with less than half of the study participants demonstrating high awareness of CRC signs/symptoms and risk factors, and a minority (<5%) displaying high awareness of CRC causation myths. High awareness of CRC signs/symptoms and risk factors was associated with greater likelihood of demonstrating positive attitudes toward colonoscopy. Educational initiatives are needed to address knowledge gaps and dispel misconceptions surrounding CRC.
Journal Article > ResearchFull Text
JCO Global Oncology. 2024 February 22; Volume 10 (Issue 10); e2300400.; DOI:10.1200/GO.23.00400
Elshami M, Albandak M, Alser M, Al-Slaibi I, Ayyad M, et al.
JCO Global Oncology. 2024 February 22; Volume 10 (Issue 10); e2300400.; DOI:10.1200/GO.23.00400
PURPOSE
To compare colorectal cancer (CRC) awareness between vegetarians and nonvegetarians in Palestine.
MATERIALS AND METHODS
The validated Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were translated into Arabic and used to assess awareness of CRC signs/symptoms, risk factors, and mythical causes. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered as good awareness. Multivariable logistic regression analysis was used to examine the association between being a vegetarian and displaying good awareness in each domain.
RESULTS
This study included 4,623 participants: 560 vegetarians (12.1%) and 4,063 nonvegetarians (87.9%). Lump in the abdomen was the most recognized CRC sign/symptom among both nonvegetarians (n = 2,969, 73.1%) and vegetarians (n = 452, 80.7%). Vegetarians were less likely than nonvegetarians to display good awareness of CRC signs/symptoms (odds ratio, 0.59 [95% CI, 0.48 to 0.72]). Lack of physical activity was the most identified modifiable CRC risk factor in both nonvegetarians (n = 3,368, 82.9%) and vegetarians (n = 478, 85.4%). Similarly, having a bowel disease was the most identified nonmodifiable risk factor among both nonvegetarians (n = 2,889, 71.1%) and vegetarians (n = 431, 77.0%). There were no associated differences between both groups in the awareness levels of CRC risk factors. The most recognized food-related CRC causation myth in nonvegetarians was drinking from plastic bottles (n = 1,023, 25.2%), whereas it was eating burnt food in vegetarians (n = 176, 31.4%). Having a physical trauma was the most recognized food-unrelated myth in both nonvegetarians (n = 2,356, 58.0%) and vegetarians (n = 396, 70.7%). There were no associated differences in the awareness of CRC causation myths between both groups.
CONCLUSION
Awareness of CRC was notably low in both Palestinian vegetarians and nonvegetarians. Particularly, vegetarians demonstrated lower awareness of CRC signs and symptoms.
To compare colorectal cancer (CRC) awareness between vegetarians and nonvegetarians in Palestine.
MATERIALS AND METHODS
The validated Bowel Cancer Awareness Measure and Cancer Awareness Measure-Mythical Causes Scale were translated into Arabic and used to assess awareness of CRC signs/symptoms, risk factors, and mythical causes. The total awareness score of each domain was calculated and categorized into tertiles; the top tertile was considered as good awareness. Multivariable logistic regression analysis was used to examine the association between being a vegetarian and displaying good awareness in each domain.
RESULTS
This study included 4,623 participants: 560 vegetarians (12.1%) and 4,063 nonvegetarians (87.9%). Lump in the abdomen was the most recognized CRC sign/symptom among both nonvegetarians (n = 2,969, 73.1%) and vegetarians (n = 452, 80.7%). Vegetarians were less likely than nonvegetarians to display good awareness of CRC signs/symptoms (odds ratio, 0.59 [95% CI, 0.48 to 0.72]). Lack of physical activity was the most identified modifiable CRC risk factor in both nonvegetarians (n = 3,368, 82.9%) and vegetarians (n = 478, 85.4%). Similarly, having a bowel disease was the most identified nonmodifiable risk factor among both nonvegetarians (n = 2,889, 71.1%) and vegetarians (n = 431, 77.0%). There were no associated differences between both groups in the awareness levels of CRC risk factors. The most recognized food-related CRC causation myth in nonvegetarians was drinking from plastic bottles (n = 1,023, 25.2%), whereas it was eating burnt food in vegetarians (n = 176, 31.4%). Having a physical trauma was the most recognized food-unrelated myth in both nonvegetarians (n = 2,356, 58.0%) and vegetarians (n = 396, 70.7%). There were no associated differences in the awareness of CRC causation myths between both groups.
CONCLUSION
Awareness of CRC was notably low in both Palestinian vegetarians and nonvegetarians. Particularly, vegetarians demonstrated lower awareness of CRC signs and symptoms.
Journal Article > ResearchFull Text
Open Forum Infect Dis. 2024 September 27; Volume 11 (Issue 10); DOI:10.1093/ofid/ofae579
Taher AQM, Aqel R, Alnajjar M, Walker C, Repetto E, et al.
Open Forum Infect Dis. 2024 September 27; Volume 11 (Issue 10); DOI:10.1093/ofid/ofae579
BACKGROUND
The history of conflicts in the Middle East has resulted in a high burden of complications from conflict-related wounds like posttraumatic osteomyelitis (PTO). This is particularly challenging to manage in settings like Mosul, Iraq and Gaza, Palestine, where healthcare systems are weakened. In nonconflict settings, PTO caused by Pseudomonas aeruginosa (PAPTO) can lead to >20% of treatment failures. We aim to describe the clinical characteristics, outcomes, and management, in PAPTO patients admitted to Médecins Sans Frontières (MSF) facilities in Mosul and Gaza between 1 April 2018 and 31 January 2022.
METHODS
We conducted a retrospective cohort study on patients with PAPTO diagnosed with culture of intraoperative bone biopsy, using routinely collected data.
RESULTS
Among 66 PAPTO episodes from 61 enrolled patients, 37.9% had a multidrug-resistant Pseudomonas aeruginosa, with higher antibiotic resistance in Gaza. Polymicrobial infections were prevalent (74.2%), mainly involving Staphylococcus aureus (74.1%), being predominantly methicillin-resistant (95.0%). Overall, 81.7% received appropriate antibiotic treatment, with monotherapy used in 60.6% of episodes and a median treatment duration of 45.5 days. Recurrence was observed in 24.6% of episodes within a median of 195 days (interquartile range, 64-440 days). No significant differences were found in recurrence rates based on the type of antibiotic treatment (mono- or dual therapy) or episode (mono- or polymicrobial).
CONCLUSIONS
Management of PAPTO in the conflict-affected, low-resource settings of Mosul and Gaza achieved a recurrence rate aligned with global reports through appropriate and targeted antibiotic use, primarily in monotherapy, provided over a mean treatment duration of 45.5 days.
Journal Article > ResearchFull Text
Ann Plast Surg. 2017 May 1; Volume 78 (Issue 6); 505-506.; DOI:10.1097/SAP.0000000000000955
Harb L, Wadi M, Godwin Y
Ann Plast Surg. 2017 May 1; Volume 78 (Issue 6); 505-506.; DOI:10.1097/SAP.0000000000000955
This article describes an economical, versatile hand board that was conceived in Gaza during a surgical mission in the absence of commercially available hand holding devices. It was initially created to allow access and immobilization of the hand when addressing volar digital burn contractures. It has been applied subsequently during 5 further missions and now forms a standard part of our surgical kit. We present it to provide others with an easy solution should they need to release complex hand contractures and not have any assistant or instrument to immobilize the hand.
Conference Material > Abstract
Aqel R
Epicentre Scientific Day Paris 2022. 2022 June 1
BACKGROUND
Post-traumatic osteomyelitis (PTO) is a serious consequence of orthopaedic trauma often complicated with multi-drug resistant (MDR) infections, a major health issue globally and particularly in conflict settings like Gaza, Palestine. In this study we aimed to provide a description of the clinical characteristics and outcomes of PTO patients treated by MSF in our reconstructive surgery centres in Gaza, Palestine.
METHODS
This is a retrospective cohort study using routinely collected clinical data on patients with PTO admitted to the reconstructive surgery centres supported by MSF in Gaza, between 01-December-2018 and 15-September-2021 and followed up till 31-January-2022.
RESULTS
202 patients with 275 PTO episodes, primarily to gunshot wounds resulting from the conflict in Gaza were included. Among all episodes, 43% (118/275) were polymicrobial, with 437 organisms isolated in total. The most common isolated pathogens were Staphylococcus aureus (157/437, 36%), Staphylococcus epidermidis (71/437, 16%) and Pseudomonas aeruginosa (45/437, 10%). 33% (146/437) of the isolates were MDR; the most prevalent being Methicillin-resistant Staphylococcus aureus [MRSA, (97/146, 66%)] and extended spectrum beta-lactamase [ESBL, (24/146, 16%]. 77 (38%) of PTO patients had >=1 recurrent infection during their follow-up. The odds of developing an MDR infection with a polymicrobial episode were almost twice higher than with a monomicrobial episode [OR 2.39 (95% CI 1.36 - 4.24), p-value=0.03]. Patients admitted within 1 year from their injury were almost 80% less likely to develop an MDR infection versus those admitted >=4 years from their injury [OR 0.17 (95% CI (0.03 - 0.73), p-value=0.031].
CONCLUSION
The study results highlighted the level of complexity of PTO cases seen in Gaza with a high risk of recurrent infections. This provides an evidence-based data to guide the existing MSF treatment guidelines.
KEY MESSAGE
Treating post-traumatic osteomyelitis cases in Gaza is complex and is presented with high MDR infections and risk of recurrent infections.
This abstract is not to be quoted for publication.
Post-traumatic osteomyelitis (PTO) is a serious consequence of orthopaedic trauma often complicated with multi-drug resistant (MDR) infections, a major health issue globally and particularly in conflict settings like Gaza, Palestine. In this study we aimed to provide a description of the clinical characteristics and outcomes of PTO patients treated by MSF in our reconstructive surgery centres in Gaza, Palestine.
METHODS
This is a retrospective cohort study using routinely collected clinical data on patients with PTO admitted to the reconstructive surgery centres supported by MSF in Gaza, between 01-December-2018 and 15-September-2021 and followed up till 31-January-2022.
RESULTS
202 patients with 275 PTO episodes, primarily to gunshot wounds resulting from the conflict in Gaza were included. Among all episodes, 43% (118/275) were polymicrobial, with 437 organisms isolated in total. The most common isolated pathogens were Staphylococcus aureus (157/437, 36%), Staphylococcus epidermidis (71/437, 16%) and Pseudomonas aeruginosa (45/437, 10%). 33% (146/437) of the isolates were MDR; the most prevalent being Methicillin-resistant Staphylococcus aureus [MRSA, (97/146, 66%)] and extended spectrum beta-lactamase [ESBL, (24/146, 16%]. 77 (38%) of PTO patients had >=1 recurrent infection during their follow-up. The odds of developing an MDR infection with a polymicrobial episode were almost twice higher than with a monomicrobial episode [OR 2.39 (95% CI 1.36 - 4.24), p-value=0.03]. Patients admitted within 1 year from their injury were almost 80% less likely to develop an MDR infection versus those admitted >=4 years from their injury [OR 0.17 (95% CI (0.03 - 0.73), p-value=0.031].
CONCLUSION
The study results highlighted the level of complexity of PTO cases seen in Gaza with a high risk of recurrent infections. This provides an evidence-based data to guide the existing MSF treatment guidelines.
KEY MESSAGE
Treating post-traumatic osteomyelitis cases in Gaza is complex and is presented with high MDR infections and risk of recurrent infections.
This abstract is not to be quoted for publication.
Journal Article > ResearchFull Text
BMC Cancer. 2023 October 13; Volume 23 (Issue 1); 975.; DOI:10.1186/s12885-023-11484-z
Elshami M, Al-Madhoun S, Alser M, Al-Slaibi I, Yaseen A, et al.
BMC Cancer. 2023 October 13; Volume 23 (Issue 1); 975.; DOI:10.1186/s12885-023-11484-z
BACKGROUND
Several factors contribute to delayed presentation with ovarian cancer (OC) symptoms including poor symptom awareness and barriers to seeking help. This study explored the anticipated time to seek medical advice for possible OC symptoms and its association with OC symptom awareness. In addition, it examined perceived barriers that may delay help-seeking among Palestinian women.
METHODS
A cross-sectional study was conducted among adult women (≥ 18 years) recruited from hospitals, primary healthcare centers, and public spaces in 11 Palestinian governorates. A modified version of the OC awareness measure was used to collect data in face-to-face interviews. The questionnaire comprised three sections: sociodemographic details, awareness of 11 OC symptoms and time to seek medical advice, and barriers to early presentation.
RESULTS
Of 6095 participants approached, 5618 completed the OCAM (response rate = 92.1%). The proportion of participants who would immediately seek medical advice for a possible OC symptom varied based on the symptom’s nature. For OC symptoms with pain, the proportion that reported immediate seeking of medical advice ranged from 7.9% for ‘persistent low back pain’ to 13.6% for ‘persistent pain in the pelvis’. For non-specific potential OC symptoms, the proportion that reported immediate seeking of medical advice ranged from 2.3% for ‘feeling full persistently’ to 15.8% for ‘increased abdominal size on most days’. Good OC symptom awareness was associated with higher likelihood of seeking medical advice within a week from recognizing 10 out of 11 OC symptoms.
Emotional barriers were the most common barriers with ‘feeling scared’ as the most reported barrier (n = 1512, 52.4%). Displaying good OC symptom awareness was associated with a lower likelihood of reporting ≥ 4 emotional barriers (OR = 0.61, 95% CI: 0.38–0.98).
CONCLUSION
Participants with good OC symptom awareness were more likely to seek medical advice earlier and to display fewer emotional barriers. Establishing educational interventions to raise OC awareness may help in promoting earlier help-seeking and, thus, facilitate earlier diagnosis and improved prognosis.
Several factors contribute to delayed presentation with ovarian cancer (OC) symptoms including poor symptom awareness and barriers to seeking help. This study explored the anticipated time to seek medical advice for possible OC symptoms and its association with OC symptom awareness. In addition, it examined perceived barriers that may delay help-seeking among Palestinian women.
METHODS
A cross-sectional study was conducted among adult women (≥ 18 years) recruited from hospitals, primary healthcare centers, and public spaces in 11 Palestinian governorates. A modified version of the OC awareness measure was used to collect data in face-to-face interviews. The questionnaire comprised three sections: sociodemographic details, awareness of 11 OC symptoms and time to seek medical advice, and barriers to early presentation.
RESULTS
Of 6095 participants approached, 5618 completed the OCAM (response rate = 92.1%). The proportion of participants who would immediately seek medical advice for a possible OC symptom varied based on the symptom’s nature. For OC symptoms with pain, the proportion that reported immediate seeking of medical advice ranged from 7.9% for ‘persistent low back pain’ to 13.6% for ‘persistent pain in the pelvis’. For non-specific potential OC symptoms, the proportion that reported immediate seeking of medical advice ranged from 2.3% for ‘feeling full persistently’ to 15.8% for ‘increased abdominal size on most days’. Good OC symptom awareness was associated with higher likelihood of seeking medical advice within a week from recognizing 10 out of 11 OC symptoms.
Emotional barriers were the most common barriers with ‘feeling scared’ as the most reported barrier (n = 1512, 52.4%). Displaying good OC symptom awareness was associated with a lower likelihood of reporting ≥ 4 emotional barriers (OR = 0.61, 95% CI: 0.38–0.98).
CONCLUSION
Participants with good OC symptom awareness were more likely to seek medical advice earlier and to display fewer emotional barriers. Establishing educational interventions to raise OC awareness may help in promoting earlier help-seeking and, thus, facilitate earlier diagnosis and improved prognosis.
Journal Article > LetterFull Text
BMJ. 2018 October 15; Volume 363; k4273 .; DOI:10.1136/bmj.k4273
Kanapathipillai R, Malou N, Baldwin K, Marty P, Rodaix C, et al.
BMJ. 2018 October 15; Volume 363; k4273 .; DOI:10.1136/bmj.k4273