The quality of reports of medical and public health research from Palestinian institutions:A systematic review

Research reports are the most common way to communicate research findings for target readerships. Complete, accurate and transparent reporting of research studies facilitates dissemination, interpretation, translation and replication of research findings. Inadequate reporting has major consequences for clinicians, researchers, policy makers and ultimately patients. It impairs critical assessment of the validity, relevance and trustworthiness of research and so impedes its use in practice. It also limits the usability of study findings by other researchers conducting systematic reviews and meta-analyses and building on or replicating studies. In addition, inadequate reporting is one of the key contributors to avoidable waste in biomedical research. Researchers thus have an ethical obligation to research participants, funding organisations and society as a whole to report their findings in ways that are of use in practice and policy makin

Familial and non-familial factors associated with obesity

The work of my thesis is based on the MIDSPAN Family Study, which included a survey of the parent generation in 1972-6 and the offspring generation in 1996. The main aim was to investigate familial and non-familial factors associated with changes in body mass index (BMI) between the two generations and to identify the characteristics of susceptible subgroups. The study populations come from a highly deprived area with high mortality and cancer incidence rates. In the parent population, BMI was positively associated with cardiovascular mortality and negatively associated with respiratory mortality. Only breast cancer and lung cancer incidences were associated with BMI. Lung cancer incidence was negatively associated with high BMI. The observed association was not the result of confounding effect of smoking or sub-clinical illness. The negative association between lung cancer incidence and BMI was found in other cohort screened at the same time as the parents cohort. This finding encourages further research explaining this observation at the biological level. The first finding was that the prevalence of obesity (BMI>30kg/m2) has doubled in sons while a slight increase in the prevalence of obesity was found in daughters with almost no change in mean BMI or the prevalence of obesity and overweight combined (BMI>25kg/m2). Comparison of BMI distributions in parents and offspring showed an anchoring of the lower parts of the BMI distributions and skewing in the top parts. To a certain extent this observation was found in all social class and smoking subgroups. Parental obesity was the strongest factor associated with offspring BMI and obesity prevalence. The offspring of obese parents were more than four times as likely to be obese than the offspring of lean parents. Physical activity, smoking status and dietary intakes were the important environmental determinants of high BMI. However, the effect of these factors was not the same in men and women or in different social class groups. Further, the correlates of high BMI were different in offspring with and without family predisposition to high BMI. Familial susceptibility is an important factor associated with offspring obesity. The offspring of obese parents are at highest risk of becoming obese themselves. However, the effect of familial susceptibility depends on environmental and behavioural factors. This conclusion was based on findings from studying exceptions (obese offspring with obese parents and obese offspring with normal weight parents) and differences between groups of offspring (obese and normal weight offspring of obese parents and obese and normal weight offspring of normal weight parents) offspring groups. In the presence of family susceptibility, obese offspring were less likely to be smokers, to be in the manual social class and were less physically active than normal weight offspring. In the absence of family susceptibility, obese offspring were more likely to be former smokers, to be in the manual social class, were less physically active and reported high intakes of energy-dense foods than normal weight offspring. On the other hand, obese offspring with family susceptibility were more likely to be smokers, in the manual social class, physically active and had high food intakes compared to obese offspring without family susceptibility. Normal weight offspring with obese parents were more likely to be smokers, in the manual social and to report high food intakes. The findings of this study are consistent with gene-environment interaction in the development of obesity and stress the fact that offspring with family susceptibility are more affected by differences in environmental and lifestyle factors. Individuals with familial susceptibility to obesity are at higher risk of becoming obese if they are former smokers, in the manual social class and physically inactive. They are less likely to become obese if they are current smokers or have manual father. The findings encourage further research to investigate the genetic and patho-physiological basis of these findings. Furthermore, these findings raise the possibility of intervention programmes targeted at high risk groups

Research capacity and training needs for non-communicable diseases in the public health arena in Turkey

Background The aim of this study is to define the research capacity and training needs for professionals working on non-communicable diseases (NCDs) in the public health arena in Turkey. Methods This study was part of a comparative cross-national research capacity-building project taking place across Turkey and the Mediterranean Middle East (RESCAP-Med, funded by the EU). Identification of research capacity and training needs took place in three stages. The first stage involved mapping health institutions engaged in NCD research, based on a comprehensive literature review. The second stage entailed in-depth interviews with key informants (KIs) with an overview of research capacity in public health and the training needs of their staff. The third stage required interviewing junior researchers, identified by KIs in stage two, to evaluate their perceptions of their own training needs. The approach we have taken was based upon a method devised by Hennessy&#38;Hicks. In total, 55 junior researchers identified by 10 KIs were invited to participate, of whom 46 researchers agreed to take part (84%). The specific disciplines in public health identified in advance by RESCAP-MED for training were: advanced epidemiology, health economics, environmental health, medical sociology-anthropology, and health policy. Results The initial literature review showed considerable research on NCDs, but concentrated in a few areas of NCD research. The main problems listed by KIs were inadequate opportunities for specialization due to heavy teaching workloads, the lack of incentives to pursue research, a lack of financial resources even when interest existed, and insufficient institutional mechanisms for dialogue between policy makers and researchers over national research priorities. Among junior researchers, there was widespread competence in basic epidemiological skills, but an awareness of gaps in knowledge of more advanced epidemiological skills, and the opportunities to acquire these skills were lacking. Self-assessed competencies in each of the four other disciplines considered revealed greater training needs, especially regarding familiarity with the qualitative research skills for medical anthropology/sociology. Conclusions In Turkey there are considerable strengths to build upon. But a combination of institutional disincentives for research, and the lack of opportunities for the rising generation of researchers to acquire advanced training skills.</p

Sex distribution of offspring-parents obesity: Angel's hypothesis revisited

This study, which is based on two cross sectional surveys' data, aims to establish any effect of parental obesity sex distribution of offspring and to replicate the results that led to the hypothesis that obesity may be associated with sex-linked recessive lethal gene. A representative sample of 4,064 couples living in Renfrew/Paisley, Scotland was surveyed 1972-1976. A total of 2,338 offspring from 1,477 of the couples screened in 1972-1976, living in Paisley, were surveyed in 1996. In this study, males represented 47.7% among the total offspring of the couples screened in 1972-1976. In the first survey there was a higher male proportion of offspring (53%, p &lt; 0.05) from parents who were both obese, yet this was not significant after adjustment for age of parents. Also, there were no other significant differences in sex distribution of offspring according to body mass index, age, or social class of parents. The conditions of the original 1949 study of Angel (1949) (which proposed a sex-linked lethal recessive gene) were simulated by selecting couples with at least one obese daughter. In this subset, (n = 409), obesity in fathers and mothers was associated with 26% of offspring being male compared with 19% of offspring from a non-obese father and obese mother. Finally we conclude that families with an obese father have a higher proportion of male offspring. These results do not support the long-established hypotheses of a sex-linked recessive lethal gene in the etiology of obesity

Obesity and selected co-morbidities in an urban Palestinian population

OBJECTIVE: To assess the prevalence of obesity and central obesity in an urban Palestinian population and their associations with selected co-morbidities, including diabetes, hypertension and dyslipidaemia. DESIGN: A population-based cross-sectional survey in an urban Palestinian community. SUBJECTS: Men and women aged 30 – 65 y residing in the urban community, excluding pregnant women. MEASUREMENTS: According to WHO guidelines, obesity for men and women was defined as BMI 30 kg m72, while pre-obesity was defined as BMI 25 – 29.9 kg m72. Central obesity was defined as a waist-to-hip ratio (WHR) of > 0.90 in men and > 0.85 in women. RESULTS: The prevalence of obesity in this population was high at 41% (49% and 30% in women and men, respectively). Central obesity was more prevalent among men (59% compared to 25% in women). After adjusting for the effects of age, sex, smoking and each other, obesity and central obesity were found to be significantly associated with diabetes, low HDL- cholesterol and elevated triglycerides in separate logistic regression analyses. Central obesity was also significantly associated with hypertension (OR 2.26, 95% CI 1.30 – 3.91). CONCLUSION: Obesity and central obesity are prevalent in the urban Palestinian population. Their associations with diabetes, hypertension, and dyslipidaemia point to a potential rise in cardiovascular disease (CVD). An understanding of the reasons behind the high prevalence of obesity is essential for its prevention as well as for the prevention of the morbidities to which it may lead

Country and gender differences in the association between violence and cigarette smoking among youth

Background: Exposure to violence in youth may be associated with substance use and other adverse health effects. This study examined cigarette smoking in two middle-income areas with different levels and types of exposure to violence. Methods: Association of exposure to verbal and physical violence with cigarette smoking in the West Bank oPt (2008) and in Jujuy Argentina (2006) was examined using cross-sectional surveys of 14 to 17-year old youth in 7th to 10th grade using probabilistic sampling. Results: Violence exposure rates were more than double for Palestinian girls (99.6% vs. 41.2%) and boys (98.7% vs. 41.1%) compared with Argentinians. The rate of current cigarette smoking was significantly higher among Argentinian girls compared with Palestinian girls (33.1% vs. 7.1%, p < 0.001). Exposure to verbal violence from family and to physical violence increased the odds of current cigarette smoking, respectively, among Argentinian girls (aOR = 1.3, 95% CI = 1.0–1.7; aOR = 2.5, 95%CI = 1.7–3.8), Palestinian girls (aOR 2.2, 95%CI = 1.1–2.4; aOR = 2.0, 95%CI = 1.1–3.6) and Argentinian boys (aOR = 1.5, 95%CI = 1.1–2.0; aOR = 2.2, 95%CI = 1.6–3.0), but not among Palestinian boys. Conclusion: Findings highlight the importance of producing context and gender specific evidence from exposure to violence, to inform and increase the impact of targeted smoking prevention strategies.Fil: Abu Rmeileh, Niveen M. E.. Birzeit University; Palestina (ANP)Fil: Alderete, Ethel del Carmen. Universidad Nacional de Jujuy; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades. Universidad Nacional de Jujuy. Unidad Ejecutora en Ciencias Sociales Regionales y Humanidades; Argentina. Instituto de Ciencia y Tecnología Regional; ArgentinaFil: Husseini, Abdullatif. Birzeit University; Palestina (ANP)Fil: Livaudais Toman, Jennifer. University of California; Estados UnidosFil: Pérez Stable, Eliseo J.. National Institutes of Health; Estados Unido

Whole-genome sequencing for One Health surveillance of antimicrobial resistance in conflict zones: a case study of Salmonella spp. and Campylobacter spp. in the West Bank, Palestine

Antimicrobial resistance (AMR) is a critical global concern driven by the overuse, misuse, and/or usage of inadequate antibiotics on humans, animals' agriculture, and as a result of contaminated environments. This study is the first One Health survey in the Middle East that incorporated whole-genome sequencing (WGS) to examine the spread of AMR in Campylobacter spp. and Salmonella spp. This cross-sectional study was conducted to examine the role of AMR at the human-animal-environmental interface and was performed in Ramallah/Al-Bireh and Jerusalem governorates of the central West Bank, Palestine. In 2021 and 2022, a total of 592 samples were collected and analyzed. From a total of 65 Campylobacter jejuni and 19 Salmonella spp. isolates, DNA was extracted for WGS using Oxford Nanopore Technologies MinION platform. We found that the dominant serotypes of C. jejuni and Salmonella enterica were present in chicken manure, chicken meat sold in markets, and feces of asymptomatic farm workers, with high genetic similarities between the isolates regardless of origin. Additionally, our results showed rapid strain turnover in C. jejuni from the same sites between 2021 and 2022. Most of the positive Salmonella spp. samples were multidrug-resistant (MDR) S. enterica serovar Muenchen carrying the plasmid of emerging S. infantis (pESI) megaplasmid, conferring resistance to multiple antibiotics. Our findings highlight the spread of MDR foodborne pathogens from animals to humans through the food chain, emphasizing the importance of a One Health approach that considers the interconnections between human, animal, and environmental health. IMPORTANCE Prior to this study, there existed hardly an integrated human-animal-environmental study of Salmonellosis and Campylobacteriosis and related AMR in Middle Eastern countries. The few existing studies lack robust epidemiological study designs, adequate for a One Health approach, and did not use WGS to determine the circulating serotypes and their AMR profiles. Civil unrest and war in Middle Eastern countries drive AMR because of the breakdown of public health and food security services. This study samples simultaneously humans, animals, and the environment to comprehensively investigate foodborne pathogens in the broiler chicken production chain in Palestine using WGS. We show that identical serotypes of C. jejuni and S. enterica can be found in samples from chicken farms, chicken meat sold in markets, and asymptomatic broiler chicken production workers. The most striking feature is the rapid dynamic of change in the genetic profile of the detected species in the same sampling locations. The majority of positive Salmonella spp. samples are MDR S. enterica serovar Muenchen isolates carrying the pESI megaplasmid. The results demonstrate a close relationship between the S. enterica serovar Muenchen isolates found in our sample collection and those responsible for 40% of all clinical Salmonella spp. isolates in Israel as previously reported, with a sequence identity of over 99.9%. These findings suggest the transboundary spread of MDR S. enterica serovar Muenchen strains from animals to humans through the food chain. The study underscores the importance of combining integrated One Health studies with WGS for detecting environmental-animal-human transmission of foodborne pathogens that could not be detected otherwise. This study showcases the benefits of integrated environmental-animal-human sampling and WGS for monitoring AMR. Environmental samples, which may be more accessible in conflict-torn places where monitoring systems are limited and regulations are weak, can provide an effective AMR surveillance solution. WGS of bacterial isolates provides causal inference of the distribution and spread of bacterial serotypes and AMR in complex social-ecological systems. Consequently, our results point toward the expected benefits of operationalizing a One Health approach through closer cooperation of public and animal health and food safety authorities

Intergenerational change and familial aggregation of body mass index

The relationship between parental BMI and that of their adult offspring, when increased adiposity can become a clinical issue, is unknown. We investigated the intergenerational change in body mass index (BMI) distribution, and examined the sex-specific relationship between parental and adult offspring BMI. Intergenerational change in the distribution of adjusted BMI in 1,443 complete families (both parents and at least one offspring) with 2,286 offspring (1,263 daughters and 1,023 sons) from the west of Scotland, UK, was investigated using quantile regression. Familial correlations were estimated from linear mixed effects regression models. The distribution of BMI showed little intergenerational change in the normal range (\25 kg/m2), decreasing overweightness (25– \30 kg/m2) and increasing obesity (C30 kg/m2). Median BMI was static across generations in males and decreased in females by 0.4 (95% CI: 0.0, 0.7) kg/m2; the 95th percentileincreased by 2.2 (1.1, 3.2) kg/m2 in males and 2.7 (1.4, 3.9) kg/m2 in females. Mothers’ BMI was more strongly associated with daughters’ BMI than was fathers’ (correlation coefficient (95% CI): mothers 0.31 (0.27, 0.36), fathers 0.19 (0.14, 0.25); P = 0.001). Mothers’ and fathers’ BMI were equally correlated with sons’ BMI (correlation coefficient: mothers 0.28 (0.22, 0.33), fathers 0.27 (0.22, 0.33). The increase in BMI between generations was concentrated at the upper end of the distribution. This, alongside the strong parent-offspring correlation, suggests that the increase in BMI is disproportionally greater among offspring of heavier parents. Familial influences on BMI among middle-aged women appear significantly stronger from mothers than father