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1.  Assessment of research productivity of Arab countries in the field of infectious diseases using Web of Science database 
Background
To meet the future challenges of infectious diseases and limit the spread of multidrug resistant microorganisms, a better understanding of published studies in the field of infectious diseases is needed. The objective of this study was to analyze the quantity and quality of research activity in the field of infectious diseases in Arab countries and compare it with that in non-Arab countries.
Methods
Documents published in Arab countries within the research category of “infectious diseases” were extracted and analyzed using the Web of Science database. The data analyzed represent research productivity during the time interval between 1900 – 2012.
Results
Worldwide, the total number of documents published in the field of infectious diseases up to 2012 was 227,188. A total of 2,408 documents in the field of infectious diseases were published in Arab countries, which represents 1.06% of worldwide research output. Research output from Arab countries in the field of infectious diseases was low for decades. However, approximately a five-fold increase was observed in the past decade. Arab countries ranked 56th to 218th on the standard competition ranking (SCR) in worldwide publications in the field of infectious diseases. Egypt, with a total publication of 464 (19.27%) documents ranked first among Arab countries, while Kuwait University was the most productive institution with a total of 158 (6.56%) documents. Average citation per document published in Arab countries was 13.25 and the h-index was 64. Tuberculosis (230; 9.55%), malaria (223; 9.26%), and hepatitis (189; 7.8%) were the top three infectious diseases studied as according to the retrieved documents.
Conclusion
The present data reveals that some Arab countries contribute significantly to the field of infectious diseases. However, Arab countries need to work harder to bridge the gap in this field. Compared with non-Arab countries in the Middle East, research output from Arab countries was high, but more efforts are needed to enhance the quality of this output. Future research in the field should be encouraged and correctly directed.
Electronic supplementary material
The online version of this article (doi:10.1186/2049-9957-4-2) contains supplementary material, which is available to authorized users.
doi:10.1186/2049-9957-4-2
PMCID: PMC4327970
Bibliometric; Infectious diseases; Arab world; Web of science
2.  Contribution of Arab researchers to ophthalmology: a bibliometric and comparative analysis 
SpringerPlus  2015;4:42.
Through history, Arabs and Muslims have made valuable contribution to medicine and science. The main objective of this study was to assess the contribution of Arab researchers to ophthalmology using bibliometric indicators. Published articles in “Ophthalmology” authored by Arab researchers were screened and analyzed using ISI Web of Science database. Worldwide research productivity in ophthalmology was 216,921 documents while that from Arab countries; Israel, Turkey and Iran were 2083, 2932, 3027 and 859 documents respectively. Those from Arab countries were published in 85 peer-reviewed ophthalmology related journals with 280 (13.44%) documents published in Journal Francais d Ophtalmologie. Among Arab countries, Kingdom of Saudi Arabia had the highest (828 (39.75%)) research output followed by Egypt (461 (22.13%)) and Tunisia 210 (10.08). Countries with highest collaboration with researchers in Arab world in ophthalmology research were USA; (397; 19.06%) followed by England (92; 4.42%) and Spain (91; 4.37%). The most research productive organization in Arab countries was King Khalid Eye Specialist Hospital (396; 19.01%). Ophthalmology articles authored or co-authored by an Arab researcher had a total citation f 21098 with an average citation of 10.13 per document and an h-index of 51. In conclusion, the present data show promising increase but relatively low ophthalmology research productivity from Arab countries. Wide variation in research productivity do exists. Compared with other non-Arab countries in the Middle East, Arab countries showed lesser ophthalmology research activity than Israel and Turkey but higher than that in Iran.
doi:10.1186/s40064-015-0806-0
PMCID: PMC4318829
Bibliometric; Ophthalmology; Arab world; ISI Web of Science
3.  Public, environmental, and occupational health research activity in Arab countries: bibliometric, citation, and collaboration analysis 
Background
The objective of this study was to analyze quantity, assess quality, and investigate international collaboration in research from Arab countries in the field of public, environmental and occupational health.
Methods
Original scientific articles and reviews published from the 22 Arab countries in the category "public, environmental & occupational health" during the study period (1900 – 2012) were screened using the ISI Web of Science database.
Results
The total number of original and review research articles published in the category of "public, environmental & occupational health" from Arab countries was 4673. Main area of research was tropical medicine (1862; 39.85%). Egypt with 1200 documents (25.86%) ranked first in quantity and ranked first in quality of publications (h-index = 51). The study identified 2036 (43.57%) documents with international collaboration. Arab countries actively collaborated with authors in Western Europe (22.91%) and North America (21.04%). Most of the documents (79.9%) were published in public health related journals while 21% of the documents were published in journals pertaining to prevention medicine, environmental, occupational health and epidemiology.
Conclusion
Research in public, environmental and occupational health in Arab countries is in the rise. Public health research was dominant while environmental and occupation health research was relatively low. International collaboration was a good tool for increasing research quantity and quality.
doi:10.1186/2049-3258-73-1
PMCID: PMC4322552  PMID: 25671116
Arab countries; Public health; Environmental and occupational health; Bibliometric analysis; ISI web of science
4.  Bibliometric analysis of nutrition and dietetics research activity in Arab countries using ISI Web of Science database 
SpringerPlus  2014;3:718.
Reducing nutrition-related health problems in Arab countries requires an understanding of the performance of Arab countries in the field of nutrition and dietetics research. Assessment of research activity from a particular country or region could be achieved through bibliometric analysis. This study was carried out to investigate research activity in “nutrition and dietetics” in Arab countries. Original and review articles published from Arab countries in “nutrition and dietetics” Web of Science category up until 2012 were retrieved and analyzed using the ISI Web of Science database. The total number of documents published in “nutrition and dietetics” category from Arab countries was 2062. This constitutes 1% of worldwide research activity in the field. Annual research productivity showed a significant increase after 2005. Approximately 60% of published documents originated from three Arab countries, particularly Egypt, Kingdom of Saudi Arabia, and Tunisia. However, Kuwait has the highest research productivity per million inhabitants. Main research areas of published documents were in “Food Science/Technology” and “Chemistry” which constituted 75% of published documents compared with 25% for worldwide documents in nutrition and dietetics. A total of 329 (15.96%) nutrition - related diabetes or obesity or cancer documents were published from Arab countries compared with 21% for worldwide published documents. Interest in nutrition and dietetics research is relatively recent in Arab countries. Focus of nutrition research is mainly toward food technology and chemistry with lesser activity toward nutrition-related health research. International cooperation in nutrition research will definitely help Arab researchers in implementing nutrition research that will lead to better national policies regarding nutrition.
doi:10.1186/2193-1801-3-718
PMCID: PMC4320167
Arab world; Nutrition; Dietetics; Bibliometric analysis; ISI; Web of Science
5.  Substance use disorders in Arab countries: research activity and bibliometric analysis 
Background
Substance use disorders, which include substance abuse and substance dependence, are present in all regions of the world including Middle Eastern Arab countries. Bibliometric analysis is an increasingly used tool for research assessment. The main objective of this study was to assess research productivity in the field of substance use disorders in Arab countries using bibliometric indicators.
Methodology
Original or review research articles authored or co-authored by investigators from Arab countries about substance use disorders during the period 1900 – 2013 were retrieved using the ISI Web of Science database. Research activity was assessed by analyzing the annual research productivity, contribution of each Arab country, names of journals, citations, and types of abused substances.
Results
Four hundred and thirteen documents in substance use disorders were retrieved. Annual research productivity was low but showed a significant increase in the last few years. In terms of quantity, Kingdom of Saudi Arabia (83 documents) ranked first in research about substance use disorders while Lebanon (17.4 documents per million) ranked first in terms of number of documents published per million inhabitants. Retrieved documents were found in different journal titles and categories, mostly in Drug and Alcohol Dependence Journal. Authors from USA appeared in 117 documents published by investigators from Arab countries. Citation analysis of retrieved documents showed that the average citation per document was 10.76 and the h - index was 35. The majority of retrieved documents were about tobacco and smoking (175 documents) field while alcohol consumption and abuse research was the least with 69 documents.
Conclusion
The results obtained suggest that research in this field was largely neglected in the past. However, recent research interest was observed. Research output on tobacco and smoking was relatively high compared to other substances of abuse like illicit drugs and medicinal agents. Governmental funding for academics and mental health graduate programs to do research in the field of substance use disorders is highly recommended.
doi:10.1186/1747-597X-9-33
PMCID: PMC4144697  PMID: 25148888
Bibliometric; Substance use disorders; Arab countries; ISI web of science
6.  Osteoporosis is a neglected health priority in Arab World: a comparative bibliometric analysis 
SpringerPlus  2014;3:427.
Osteoporosis is an important health problem with serious consequences. Evaluation of osteoporosis scientific output from Arab countries has not been explored and there are few internationally published reports on research activity about osteoporosis. The main objectives of this study were to analyze the research output originating from Arab countries and 3 Middle Eastern non-Arab countries, particularly Israel, Turkey and Iran in the field of osteoporosis. Original scientific articles or reviews published from the 21 Arab countries, Israel, Turkey and Iran about “osteoporosis” were screened using the ISI Web of Science database. The time frame for the result was up to year 2012. The total number of original and review research articles published globally about osteoporosis was 43,571. The leading country in osteoporosis research was United States of America (14,734; 33.82%). Worldwide, Turkey ranked 16th while Israel and Iran ranked 24th and 31st respectively. Among Arab countries, Egypt and Kingdom of Saudi Arabia came on positions 41 and 45 respectively. A total of 426 documents about “osteoporosis” were published from Arab countries which represents 0.98% of the global research output. Research about osteoporosis from Arab countries was very low until 2002 and then increased steadily. The total number of citations for osteoporosis documents from the Arab world was 5551 with an average citation of 13.03 per document and an h- index of 35. Thirty (7.04%) documents published from Arab countries about osteoporosis were published in Saudi Medical Journal. Egypt, with a total publication of 117 (27.47%) ranked first among the Arab countries in research about osteoporosis while American University in Beirut was the most productive institution with a total of 47 (11.03%) documents. Compared with other non-Arab countries in the Middle East, the research productivity from the Arab countries was lesser than that from Turkey and Israel but higher than that from Iran. The present data showed low research productivity in osteoporosis field in Arab countries. Research output can be improved by investing in more international and national collaborative research projects in the field of osteoporosis.
doi:10.1186/2193-1801-3-427
PMCID: PMC4141069  PMID: 25152852
Osteoporosis; Arab countries; Bibliometric; ISI; Web of Science
7.  Quantity and quality of obesity-related research in Arab countries: assessment and comparative analysis 
Background
Obesity is a serious worldwide medical condition, considered by some researchers as one of the most serious public health problems of the 21st century. The main objective of this study was to assess the quantity and quality of obesity-related research from Arab countries and compare it with that from non-Arab Middle Eastern countries.
Methods
Original scientific articles or reviews published by Arab countries about obesity up until 2011 were screened using the ISI Web of Science database. Research activity was assessed by analyzing the annual research productivity, journals names, citations, top 10 active institutions, and the contribution of each Arab country to obesity research.
Results
The total number of original and review research articles published globally about obesity was 110,167. The leading country in obesity research was United States of America (42.47%). Turkey, Israel, and Iran were in the top 30 countries while Kingdom of Saudi Arabia (KSA), Egypt, and Kuwait ranked 39th, 43rd, and 47th, respectively. A total of 1,121 documents about “obesity” were published by Arab countries, representing 1.0% of the global research output, with 13,343 citations (average citation of 11.9 per document) and an h-index of 44. The Arab countries’ research output was very low until the mid-1990s and then increased steadily. Of the 1,121 documents, 107 (9.55%) were published in the Saudi Medical Journal. KSA, with a total of 318 publications ranked first among Arab countries in research quantity while Kuwait ranked first after adjustment based on population size. King Saud University in KSA was the most productive institution with a total of 140 documents. Compared with other non-Arab Middle Eastern countries, the research productivity from Arab countries was lower than that from Turkey, higher than that from Iran, and close to that from Israel. However, the h-index of documents about obesity published from Arab countries was lower than that of Turkey and Israel, but slightly higher than that from Iran.
Conclusions
The present data reveals a good contribution by some Arab countries, particularly Arab gulf countries, to obesity research. More efforts are needed by other Arab countries to bridge the gap in this topic and to improve the quality of obesity-related research originating from Arab countries.
doi:10.1186/1478-4505-12-33
PMCID: PMC4094602  PMID: 25005130
Arab countries; Bibliometric; ISI Web of Science; Obesity
8.  Bronchial asthma and chronic obstructive pulmonary disease: research activity in Arab countries 
Background
Chronic respiratory diseases, like bronchial asthma and chronic obstructive pulmonary disease (COPD), are a worldwide health problem. Quantitative and qualitative assessment of asthma and COPD-related research from Arab countries has not been explored and there are few internationally published reports on such field. The main objectives of this study were to analyze research output originating from Arab countries in the field of bronchial asthma and COPD.
Methods
Original scientific articles or reviews published from the 22 Arab countries were screened using specific words pertaining to asthma and COPD using Scopus database and search engine. Research productivity was evaluated based on: (a) total and trends of contribution of each Arab country to asthma and COPD research and (b) journals in which researchers from Arab countries published their research.
Results
The total number of original research and review articles published globally about bronchial asthma and COPD was 163,964. The leading country in bronchial asthma and COPD research was United States of America (38,632; 23.56%). Worldwide, Turkey ranked 19th while Israel and Iran ranked 25th and 29th respectively. Among Arab countries, Egypt and Kingdom of Saudi Arabia came on positions 39th and 43rd, respectively. A total of 1,304 documents about bronchial asthma and COPD were published from Arab countries which represents 0.8% of the global research output. Research in bronchial asthma was almost double that in COPD. Research from Arab countries was low and showed a significant increase after 2000. Approximately 12% of research activity in asthma and COPD from Arab countries was published in Saudi Medical Journal, Annals of Saudi Medicine, Eastern Mediterranean Health Journal and Tunisie Medicale. Kingdom of Saudi Arabia, with a total publication of 353 (27.07%) ranked first among the Arab countries while University of Kuwait was the most productive institution with a total of 123 (9.43%) documents.
Conclusions
The present data showed relatively low research productivity about bronchial asthma and COPD in Arab countries. Research output can be improved by investing more in international and national collaborative research projects in the field of asthma and COPD.
doi:10.1186/2049-6958-9-38
PMCID: PMC4105064  PMID: 25050176
Arab countries; Bronchial asthma; COPD; Scopus
9.  Assessing urology and nephrology research activity in Arab countries using ISI web of science bibliometric database 
BMC Research Notes  2014;7:258.
Background
Bibliometric analysis is increasingly being used for research assessment. The main objective of this study was to assess research output in Urology and Nephrology subject from the Arab countries. Original scientific articles or reviews published from the 21 Arab countries in “Urology and Nephrology” subject were screened using the ISI Web of Science database. Research productivity was evaluated based on a methodology developed and used in other bibliometric studies by analyzing the annual productivity, names of journals, citations; top 10 active institution and authors as well as country contribution to Urology and Nephrology research.
Results
Three thousand and seventy six documents in “urology and nephrology” subject category were retrieved from 104 journals. This represents 1.4% of the global research output in “urology and nephrology”. Four hundred and two documents (12.66%) were published in Annales D Urologie Journal. The h-index of the retrieved documents was 57. The total number of citations, at the time of data analysis, was 30401 with an average citation of 9.57 per document. Egypt, with a total publication of 1284 (40.43%) ranked first among the Arab countries in “urology and nephrology” subject category. Mansoura University in Egypt was the most productive institution with a total of 561 (15.33%) documents. Arab researchers collaborated most with researchers from the United States of America (226; 7.12%) in urology and nephrology research.
Conclusion
The present data reveals a good contribution of some Arab countries to the field of “urology and nephrology”. More efforts are needed by some other Arab countries to bridge the gap in urology and nephrology research. Overall, the quality of urology/nephrology research is considered relatively high as measured by h-index. Cooperation in urology/nephrology research should be encouraged in the Arab world to bridge the gap with that from developed countries.
doi:10.1186/1756-0500-7-258
PMCID: PMC4002886  PMID: 24758477
Bibliometric; Urology and nephrology; Arab world; ISI Web of science
10.  Estimation of 10 - year probability bone fracture in a selected sample of Palestinian people using fracture risk assessment tool 
Background
The Fracture Risk Assessment (FRAX) tool has been developed by the World Health Organization (WHO) to calculate 10-year probability hip fracture (HP) or major osteoporotic fracture (MOF). The objective of this study was to assess the 10-year probability of MOF and HF among a selected sample of Palestinian people.
Methods
A sample of 100 subjects was studied. Dual energy X-ray absorpitometry was performed to measure bone mineral density (BMD) which was then inserted into FRAX Palestine online WHO tool to calculate the 10-year probability of MOF and HF.
Results
The median age of participants was 61.5 years and the majority (79%) were females. The median (interquartile range) of femoral hip BMD was 0.82 (0.76-0.92) g/cm2. The mean vertebral and hip T scores were -1.41 ± 0.13 SDs and -0.91 ± 0.10 SDs respectively. About one fifth of the sample (21%) had vertebral osteoporosis and 5% had hip osteoporosis. The median (interquartile range) 10-year probability of MOF and HF based on BMD were 3.7 (2.43-6.18)%, and 0.30 (0.10-0.68)% respectively.
Conclusion
Osteoporosis is common among Palestinian people above 50 years old. Bone fracture prevention strategies and research should be a priority in Palestine. Using FRAX might be a helpful screening tool in primary healthcare centres in Palestine.
doi:10.1186/1471-2474-14-284
PMCID: PMC3853474  PMID: 24093559
FRAX; Osteoporosis; Palestine
11.  Conformance to schizophrenia treatment guidelines in North West-Bank, Palestine: focus on antipsychotic dosing and polytherapy 
BMC Psychiatry  2013;13:179.
Background
Analysis of the prescribing patterns of antipsychotic drugs can improve therapeutic outcomes. The purpose of this study was to evaluate the prescribing pattern of antipsychotics and its conformance to international treatment guidelines.
Methods
A cross sectional study at primary psychiatric centers was carried out. Patients’ medical files were used to obtain demographic, medication and clinical information. International guidelines for schizophrenia were used to create conformance indicators. All statistical analyses were conducted using Statistical Package for Social Sciences.
Results
250 patients were included in this study. A total of 406 antipsychotic agents were used; 348 (85.7%) were first generation antipsychotics (FGA). The prevalence of antipsychotic combination was 50.4% (n=126). There was no significant difference in positive (p=0.3), negative (p=0.06) and psychopathology (p=0.5) scores of schizophrenia symptoms among patients on monotherapy versus those on antipsychotic combination. Furthermore, no significant difference was observed in the annual cost of antipsychotic monotherapy versus combination therapy. One hundred and five patients (42%) were using optimum dose of (300 – 600 mg CPZeq) while the remaining were using sub or supra therapeutic doses. Analysis showed that use of depot, use of anticholinergic agents and increasing amount of total CPZeq were significant factors associated with antipsychotic combination.
Conclusions
This study indicated that antipsychotic prescribing was not in conformance with international guidelines with respect to maintenance dose and combination therapy. Type of antipsychotic treatment regimen, combination versus monotherapy, was not associated with better clinical or economic outcome.
doi:10.1186/1471-244X-13-179
PMCID: PMC3700822  PMID: 23816223
Antipsychotics; Prescribing pattern; Palestine
12.  Beliefs and practices regarding childhood fever among parents: a cross-sectional study from Palestine 
BMC Pediatrics  2013;13:66.
Background
Fever is an extremely common occurrence in paediatric patients and the most common cause for a child to be taken to the doctor. The literature indicates that parents have too many misconceptions and conflicting information about fever management. The aim of this study was to identify parents’ beliefs and practices regarding childhood fever management.
Methods
We conducted a cross-sectional survey among parents whose children were enrolled and presented for health care at primary health care clinics in the Nablus region of Palestine. Data were collected using structured questionnaire interviews with parents. The questionnaire consisted of ‘yes/no’ responses and multiple-response questions. Descriptive statistics were used.
Results
Overall, 402 parents were interviewed. All parents believed that fever could cause at least one harmful effect if left untreated. The harmful effects most frequently reported by parents were brain damage (38.1%), dehydration (15.7%), and other organs damage such as liver and kidney damage (14.2%). The study showed that 65.4% of parents would recognise fever by only touching the child, 31.6% would measure the temperature and 3.0% would assess temperature by touching and measuring the child. Antipyretic was preferred to be used by 34.8% of parents, while 49.8% stated that they preferred cold sponges, and 3.2% stated that they preferred homeopathic methods to treat fever. The most common factors influencing frequency of medication administration included physician’s instruction (61.7%), the degree of elevated temperature (14.9%) and instructions on the medication leaflet (13.7%). Of the participant parents, 53.2% believed antipyretics used to reduce fever were harmful. Parents reported the most harmful outcomes from these antipyretics to be allergic reactions (20.9%), effects on the stomach (16.9%), kidney damage (16.2%) and overdose (11.4%).
Conclusions
Parents were anxious when dealing with a feverish child, which resulted in incorrect or inappropriate practices. Parents require reliable evidence-based information about the care of feverish children. These results indicate a need to develop and evaluate educational programs in our setting that will provide parents with education on fever and fever management.
doi:10.1186/1471-2431-13-66
PMCID: PMC3641948  PMID: 23622106
Children; Fever management; Belief; Temperature
13.  Evaluation of Defined Daily Dose, percentage of British National Formulary maximum and chlorpromazine equivalents in antipsychotic drug utilization 
Objective
The present study was carried out to investigate and compare the three methods for calculating total antipsychotic dose among outpatients with schizophrenia attending primary psychiatric health care centers. The three methods were: Defined Daily Doses (DDDs), chlorpromazine equivalents (CPZeq) and percentages of the British National Formulary (BNF) maximum.
Methodology
Antipsychotic drug dosing data for 250 patients with schizophrenia were investigated by calculating Spearman’s rank correlation coefficients. Factors associated with antipsychotic dose, expressed as DDDs, CPZeq and percentages of the BNF maximum recommended daily dose, were investigated by means of linear regression analysis.
Results
Spearman’s correlation showed that there is a significant relationship between all pairs of the three dosing methods. In all three methods, coherence was strongest when dealing with first generation antipsychotics (FGA). Linear regression analyses showed a high degree of coherence between antipsychotic doses expressed as DDDs, CPZeq and percentages of the BNF maximum recommended daily dose.
Conclusion
All three tested methods are reliable and coherent for calculating antipsychotic dosing.
doi:10.1016/j.jsps.2013.03.003
PMCID: PMC3950502  PMID: 24648824
%BNFmax, percentage of British National Formulary maximum; CPZeq, chlorpromazine equivalents; DDD, Defined Daily Dose (DDD); FGA, first generation antipsychotics; SGA, second generation antipsychotics; Antipsychotics; Chlorpromazine equivalents; Defined Daily Doses; Schizophrenia
14.  Medical and biomedical research productivity from Palestine, 2002 – 2011 
BMC Research Notes  2013;6:41.
Background
Medical research productivity reflects the level of medical education and practice in a particular country. The objective of this study was to examine the quantity and quality of medical and biomedical research published from Palestine.
Findings
Comprehensive review of the literature indexed by Scopus was conducted. Data from Jan 01, 2002 till December 31, 2011 was searched for authors affiliated with Palestine or Palestinian authority. Results were refined to limit the search to medical and biomedical subjects. The quality of publication was assessed using Journal Citation Report. The total number of publications was 2207. A total of 770 publications were in the medical and biomedical subject areas. The annual rate of publication was 0.077 articles per gross domestic product/capita. The 770 publications have an h-index of 32. One hundred and thirty eight (18%) articles were published in 46 journals that were not indexed in the web of knowledge. Twenty two (22/770; 2.9%) articles were published in journals with an IF > 10.
Conclusions
The quantity and quality of research originating from Palestinian institutions is promising given the scarce resources of Palestine. However, more effort is needed to bridge the gap in medical research productivity and to promote better health in Palestine.
doi:10.1186/1756-0500-6-41
PMCID: PMC3566958  PMID: 23375070
Research; Productivity; Scopus; Medical and biomedical research; Palestine
15.  Prevalence of metabolic syndrome among patients with Schizophrenia in Palestine 
BMC Psychiatry  2012;12:235.
Background
Metabolic syndrome (MS) is a cluster of the most dangerous cardiac risk factors and is associated with high mortality. Ethnic differences in metabolic syndrome (MS) criteria and prevalence rates have been reported. The purpose of this study was to investigate the MS prevalence among patients with schizophrenia in Palestine.
Methods
We recruited 250 patients with schizophrenia from 4 psychiatric primary healthcare centers in Northern Palestine. The MS prevalence was assessed based on National Cholesterol Education Program Adult Treatment Panel III Adapted criteria.
Results
The overall MS prevalence was 43.6%, with 39% in male and 55.9% in female patients. On average, the study patients had 2.3 ± 1.3 metabolic abnormalities. Univariate analysis showed that MS was significantly higher with older age, female gender, longer duration of the illness, smoking, abdominal obesity, high systolic and diastolic blood pressure, high triglycerides, low HDL-C, and high fasting plasma glucose. Multiple logistic regression analysis showed that only systolic blood pressure, high triglycerides, high fasting plasma glucose, and low HDL-C were significant predictors of MS in schizophrenic patients.
Conclusions
MS is common among Arab patients with schizophrenia. Patients with schizophrenia should receive regular monitoring and adequate treatment of cardio-metabolic risk factors.
doi:10.1186/1471-244X-12-235
PMCID: PMC3543707  PMID: 23270504
Schizophrenia; Metabolic syndrome; Palestine
16.  Pattern of self-medication with analgesics among Iranian University students in central Iran 
Background:
Self-medication is defined as the use of drugs for the treatment of self-diagnosed disorders. It is influenced by factors such as education, family, society, law, availability of drugs and exposure to advertisements. This study was performed to evaluate self-medication with analgesics and its pattern among different groups of Iranian University Students.
Materials and Methods:
A randomized, cross-sectional, multicenter study was conducted from December 2009 to February 2010. The target population of this study was 564 students out of 10,000 students attending four medical and non-medical science universities in Qom state. Data was analyzed using SPSS version 16, and analysis was conducted with descriptive analysis procedures.
Results:
76.6% of the students had used analgesics in self-medication in the previous 3 months. The frequency of analgesic use in the study period was once in 19.2% of the participants, twice in 22.2%, three times in 16.3% and more than three times in 35.5% of the participants, although 6.8% of them were not sure when they were used. Of all the respondents, 49.8% reported headache as the problem. This was the most common problem, after which came Dysmenorrhea,headache and stomach ache. Bone and joint pains were other problems that led to the use of analgesics. The most commonly used source of information for self-medication with analgesics was advice from friends and family (54.7%), previously prescribed medications (30.1%), their medical knowledge (13.3%) and recommendation of a pharmacist (1.9%).
Conclusion:
Self-medication with analgesics is very high among Iranian students in Qom city. This could be an index for other parts of the Iranian community. Because the source of information about analgesics is inappropriate, we would recommend education courses about analgesics and self-medication on the radio and television for the entire population.
doi:10.4103/2230-8229.98302
PMCID: PMC3410176  PMID: 22870417
Analgesics; Iran; students; self-medication
17.  Sleep habits and sleep problems among Palestinian students 
Aim
The aim of this study was to describe sleep habits and sleep problems in a population of undergraduates in Palestine. Association between self-reported sleep quality and self-reported academic achievement was also investigated.
Methods
Sleep habits and problems were investigated using a convenience sample of students from An-Najah National University, Palestine. The study was carried out during spring semester, 2009. A self-administered questionnaire developed based on The Diagnostic and Statistical Manual of Mental Disorders IV criteria and Pittsburgh Sleep Quality Index was used.
Results
400 students with a mean age of 20.2 ± 1.3 were studied. Reported mean duration of night sleep in the study sample was 6.4 ± 1.1 hours. The majority (58.3%) of students went to bed before midnight and 18% of the total sample woke up before 6 am. Sleep latency of more than one hour was present in 19.3% of the students. Two thirds (64.8%) of the students reported having at least one nocturnal awakening per night. Nightmares were the most common parasomnia reported by students. Daytime naps were common and reported in 74.5% of the study sample. Sleep quality was reported as "poor" in only 9.8% and was significantly associated with sleep latency, frequency of nocturnal awakenings, time of going to bed, nightmares but not with academic achievement.
Conclusion
Sleep habits among Palestinian undergraduates were comparable to those reported in European studies. Sleep problems were common and there was no significant association between sleep quality and academic achievement.
doi:10.1186/1753-2000-5-25
PMCID: PMC3148974  PMID: 21762479
18.  Knowledge and practices of pesticide use among farm workers in the West Bank, Palestine: safety implications 
Objectives
The objectives of this study were to assess the knowledge and practices associated with pesticide use in an agricultural community in Palestine, and to determine the prevalence of self-reported health symptoms related to pesticide exposure.
Methods
In this cross-sectional questionnaire study, agricultural farm workers in Nablus district, Palestine, were interviewed on their knowledge and practices of pesticide use. Comparisons of knowledge and practices of pesticide use between various groups were performed using the Mann–Whitney U-test or the Kruskal–Wallis rank test of variance. The program of the Statistical Package for Social Sciences (SPSS) version 15 was used for data analysis.
Results
The questionnaire was completed by 381 farm workers. The mean age ± SD of the participants was 38.8 ± 11.8 years. The majority (97.9%) of the participants were male. The mean participant scores for knowledge and safety procedures were 2.8 ± 3.2 out of 8 and 9.8 ± 2.4 out of 15, respectively. There was a significant positive correlation (r = 0.323; P < 0.001) between the knowledge and safety procedure scores. Unsafe behaviors were identified as the storage of pesticide products at home, the preparation of pesticides in the kitchen, inadequate disposal of empty pesticide containers, eating and drinking during pesticide application, and using inadequate protective clothing. The most frequent self-reported toxicity symptoms associated with pesticide use were skin rash (37.5%), headache (37%), excessive sweating (24.9%), and diarrhea (21.3%). There was a strong significant negative correlation (r = −0.83; P < 0.001) between self-reported toxicity symptoms and scores for protective measures.
Conclusion
The results of this study indicate that most farm workers in this district need more educational programs regarding the safety and use of pesticides. Legislation promoting the use of safer pesticides is also needed.
doi:10.1007/s12199-010-0136-3
PMCID: PMC2886885  PMID: 21432553
Pesticide; Knowledge; Practice; Symptom; Palestine
20.  Optimal dosing of angiotensin-converting enzyme inhibitors in patients with chronic heart failure: a cross-sectional study in Palestine 
Annals of Saudi Medicine  2009;29(2):119-122.
BACKGROUND AND OBJECTIVE:
Because high-dose angiotensin-converting enzyme (ACE) inhibitor therapy is desirable in patients with chronic heart failure (CHF), we sought to determine the usage and dosing patterns of ACE inhibitors in CHF patients at a governmental hospital in Palestine.
METHODS:
This cross-sectional study was conducted between September 2006 and August 2007. All patients admitted with a confirmed diagnosis of CHF and an ejection fraction <40% were evaluated. After excluding patients with a caution/contraindication to ACE inhibitor use or not taking an ACE inhibitor, we determined the number of patients receiving optimal (captopril 150-300 mg/day, enalapril 20-40 mg/day, ramipril 5-10 mg/day) and suboptimal doses. We then conducted statistical analyses to evaluate associations between ACE inhibitor use and dosing and various demographic and clinical factors.
RESULTS:
Of the 165 patients initially evaluated, 69 (41.8%) had a caution/contraindication (n=28, 40.6%) or were not using an ACE inhibitor (n=41, 59.4%). Of the remaining 96 patients (70.1%), 49/96 (51%) were given an optimal dose while 47/96 (49%) were given a suboptimal dose. Of all patients with CHF and no contraindication (n=137), 88 (64.2%) were either receiving no ACE inhibitor or a suboptimal dose. Only the presence of hypertension was significantly associated with the use of an ACE inhibitor (P=.009, odds ratio=2.7). The use of an optimal dose was not significantly associated with any of the tested factors (age, gender, presence of hypertension, diabetes mellitus, renal dysfunction, ischemic heart disease or number of diagnosis).
CONCLUSION:
Underutilization and suboptimal dosing of ACE inhibitors was common. Since there is an abundance of evidence in favor of using high-dose ACE inhibitor therapy in patients with CHF, physicians need to be educated about proper dosing of these agents.
doi:10.4103/0256-4947.51794
PMCID: PMC2813632  PMID: 19318756
21.  Predictors of in-Hospital Mortality after Acute Stroke: Impact of Gender 
The purpose of this study was to identify predictors of in-hospital mortality after acute stroke and investigate the impact of gender on stroke mortality. All patients admitted to Al-watani governmental hospital in Palestine from September 2006 to August 2007 and diagnosed with acute stroke were included in the study. Diagnosis of stroke was confirmed by computerized tomography scan. Demographics and clinical data pertaining to the patients were obtained from their medical files. The main outcome measure in this study was vital status at hospital discharge. Multiple logistic regression analysis was used to identify the independent predictors of in-hospital mortality. Statistical analysis was carried out using SPSS 15. A total of 186 acute stroke cases (95 females and 91 males) were included in the study. Hypertension (69.9%) and diabetes mellitus (45.2%) were the most common risk factors among the patients. Thirty nine (21%) of the stroke patients died in hospital. Multiple logistic regression analysis indicated that chronic kidney disease (P = 0.004), number of post-stroke complications (P = 0.037), and stroke subtype (P = 0.015) were independent predictors of in-hospital mortality among the total stroke patients. Knowledge of in-hospital mortality predictors is required to improve survival rate after acute stroke. The study showed that gender was not an independent predictor of mortality after acute stroke. More research is required to understand gender differences in stroke mortality.
PMCID: PMC2680055  PMID: 19436831
Predictors; hospital mortality; acute stroke; gender
22.  Evaluation of antihypertensive therapy in diabetic hypertensive patients: impact of ischemic heart disease 
Pharmacy Practice  2009;7(1):40-46.
Macrovascular complications are common in diabetic hypertensive patients. Appropriate antihypertensive therapy and tight blood pressure control are believed to prevent or delay such complication.
Objective
To evaluate utilization patterns of antihypertensive agents and blood pressure (BP) control among diabetic hypertensive patients with and without ischemic heart disease (IHD).
Methods
Retrospective cohort study of all diabetic hypertensive patients attending Al-watani medical center from August 2006 until August 2007. Proportions of use of different antihypertensive drug classes were compared for all patients receiving 1, 2, 3, or 4 or more drugs, and separately among patients with and without IHD. Blood pressure control (equal or lower 130/80 mmHg) was compared for patients receiving no therapy, monotherapy, or combination therapy and separately among patients with and without IHD.
Results
255 patients were included in the study; their mean age was 64.4 (SD=11.4) years. Sixty one (23.9%) of the included patients was on target BP. Over 60% of the total patients were receiving angiotensin-converting enzyme inhibitors (ACEI)/ angiotensin receptor blocker (ARB), followed by diuretics (40.8%), calcium channel blockers (25.1%) and beta-blockers (12.5%). The majority (> 55%) of patients were either on mono or no drug therapy. More than 55% of patients with controlled BP were using ACE-I. More than half (50.8%) of the patients with controlled BP were on combination therapy while 42.3% of patients with uncontrolled BP were on combination therapy (p=0.24). More patient in the IHD achieved target BP than those in non-IHD group (p=0.019). Comparison between IHD and non-IHD groups indicated no significant difference in the utilization of any drug class with ACE-I being the most commonly utilized in both groups.
Conclusions
Patterns of antihypertensive therapy were generally but not adequately consistent with international guidelines. Areas of improvement include increasing ACE-I drug combinations, decreasing the number of untreated patients, and increasing the proportion of patients with controlled BP in this population.
PMCID: PMC4139755  PMID: 25147591
Hypertension; Diabetes Mellitus; Drug Utilization; Palestine
23.  Prevalence of reduced renal function among diabetic hypertensive patients 
Patients with diabetes mellitus and hypertension are at high risk of vascular complications, particularly, renal deterioration. This study aimed to evaluate the prevalence and the risk factors of reduced renal function corresponding to chronic kidney disease (CKD) stages 3 – 5 among diabetic hypertensive patients. This is a retrospective cohort study of diabetic hypertensive patients attending A-Watani governmental medical center from August 2006 until August 2007. Creatinine clearance (CrCl) was estimated using the Cockcroft–Gault equation. Those with CrCl< 60 ml/ min, corresponding to CDK stages 3 – 5, were considered to have reduced renal function. The prevalence of reduced renal function was calculated, and the risk factors associated with it were evaluated using multiple logistic regression. The following were the results found in this study: (a) the prevalence of reduced renal function among the study patients was 35.5% distributed as follows: (63.5%) had stage 3 CKD, 21.7% had stage 4 and 13% had stage 5 CKD. (b) Patients with reduced renal function were elderly, had a higher number of chronic diseases and had a longer duration of diabetes and hypertension than those with CrCl≥ 60ml/ min. (c) Men had a higher prevalence of reduced renal function than women. (d) Significant predictors of reduced renal function were older age, duration of diabetes and the number of chronic diseases based on logistic regression analysis. Early and continuous screening of renal function among diabetic hypertensive patients is required to implement preventable strategies of end stage renal disease (ESRD). Better control of blood pressure and diabetes mellitus are important.
PMCID: PMC3040939  PMID: 21383877
Prevalence; reduced renal function; diabetic hypertension; diabetes mellitus

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