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Objective This study examined the relationship between sweet consumption and academic performance among medical university students in Palestine. A cross-sectional survey was conducted among full-time students selected via stratified sampling. Data on academic performance (self-reported GPA), sweet consumption frequency, and potential confounders (demographics, BMI, parental education, income, breakfast consumption, physical activity, and mental health via the Strengths and Difficulties Questionnaire) were collected using structured questionnaires. Multiple linear regression models were used to assess associations. Results Of 355 invited students, 220 completed the survey (response rate: 62%). Nearly half (48.2%) reported consuming sweets daily or more. Frequent sweet consumption was significantly associated with lower GPA in both crude and fully adjusted models (β = − 0.15; 95% CI: − 0.29, − 0.01; p  = 0.039). Low physical activity (β = − 0.22; p  = 0.008) and abnormal mental health scores (β = − 0.31; p  = 0.004) were also independently linked to poorer academic performance. Frequent sweet intake is independently associated with reduced academic achievement among university students, even after adjusting for lifestyle and mental health factors. Promoting healthy eating and mental well-being may support academic success in this population. Clinical trial number Not applicable.

Background Equity in access to quality healthcare is a fundamental human right. Yet studies demonstrate that some people receive preferential treatment while others are discriminated against. Wasta is a prevalent strategy whereby personal connections are used for influence and may result in gaining unfair advantages over others. This study aims to investigate wasta use in healthcare, the factors associated with its use, and the impact of wasta use on the equity and quality of healthcare services. Methods A mixed-methods study utilizing a quantitative survey and qualitative interviews was conducted in Palestine (West Bank and Gaza) between October 2021 and February 2022. Quantitative analysis was performed using Stata version 14. Bivariate and multivariate logistic regressions assessed the relationship between wasta use and individual-level variables such as gender, residence, age, employment status, and financial situation. Content analyses of qualitative transcripts were performed using Dedoose version 9. Textual quotes were grouped into major and minor themes. Results Multivariate regressions revealed that wasta use is more prevalent among refugee camp dwellers and more frequent in Gaza compared to the West Bank. Wasta was also employed to a greater degree among government employees. Qualitative interviews complemented the quantitative results and added further insights into the consequences of Wasta use in healthcare settings such as negatively impacting quality and equity in healthcare services. Conclusion Wasta use in healthcare can have an adverse effect on equity and quality. Ensuring efficient processes, reduced financial burdens, stringent accountability measures, transparency, and training programs can contribute to diminishing the need for using wasta in healthcare. By addressing both systemic and cultural factors that perpetuate wasta, societies can move closer to healthcare systems characterized by fairness, accessibility, and ethical integrity.

Background The war between Israel and Hamas on October 7, 2023, had a significant impact on the Palestinian population and mental health services. There are considerable negative psychological consequences, as well as an increase in fatality rates due to severe injuries and the destruction of infrastructure. However, there is a lack of research that investigates the impact of armed conflicts on the psychological well-being of mental health professionals who provide care to patients during armed conflict. The aim of this study was to assess the prevalence of depression and anxiety symptoms, as well as coping strategies, among Palestinian mental health professionals in the West Bank during the Gaza war on October 7, 2023. Methods This study employed a cross-sectional research design. Data were gathered through self-administered questionnaires, specifically the Hospital Anxiety and Depression Scale (HADS) and the Brief COPE scale. The prevalence of depression and anxiety and the relationships between the study’s variables the were examined using descriptive statistics (frequencies and percentages), Pearson correlation, and multivariate regression. Results We recruited a total of 514 participants, of whom 39.7% had depression and 36.6% had anxiety. The multivariate analysis revealed that participants who had work experience for 11–15 years ( p  = 0.030), those who treated patients affected by armed conflicts ( p  = 0.011), those whose psychological status was affected negatively by the current Gaza war ( p  = 0.007), and those who said that their psychological state had gotten worse during the wartime ( p  = 0.015) were more likely to develop depression. Additionally, those who used coping strategies such as venting ( p  = 0.009), self-blame ( p  = 0.010), and denial ( p  = 0.013) were more likely to develop depression. The use of active coping ( p  = 0.023), humor ( p  = 0.006), and self-distraction ( p  = 0.012) lowered depression risk. Also, participants who felt disabled or unable to deal with their patients during armed conflicts ( p  = 0.003), those who reported their need for training in crisis intervention and treatment of war victims ( p  = 0.020), and those who used self-blame ( p  < 0.001), denial ( p  < 0.001), and behavioral disengagement ( p  < 0.001) were more likely to experience anxiety symptoms. Finally, acceptance-based coping strategies reduced anxiety symptoms ( p  = 0.002). Conclusion The findings reveal significant levels of depression and anxiety in mental health workers during armed conflicts and highlight a critical gap in support. To fix this, we need to quickly put in place complete plans, such as easy access to therapy, regular support from supervisors, and ongoing training, to protect the mental health of these important professionals.

Background Since October 2023, the humanitarian crisis in Gaza has dramatically escalated and food insecurity (FI) has rapidly deteriorated. In the face of such situation, it has been recommended that accurate information on FI should be integrated in emergency reporting systems in order to better target and assess the impact of humanitarian aid. To achieve this, field practitioners, researchers and decision-makers should be equipped with user-friendly and psychometrically sound measures tailored to real-life war situations and the Palestinian context. Therefore, the present study aimed to test the psychometric properties of the Food Insecurity Experiences Scale (FIES) in a sample of Arabic-speaking community adults currently living in the Gaza Strip during the war. Methods This study used a cross-sectional design, snowball sampling as a recruiting strategy, and a self-administered online questionnaire to collect data from participants. It was performed during the period from September 1st to 30th, 2024. A total of 534 valid responses were received and were included in the final analysis. Results Approximately one out of two people in Gaza were experiencing any FI. Fit indices in confirmatory factor analysis indicated that a one-factor solution fit the data with acceptable factor loadings. Furthermore, our findings indicated that the Arabic version of the FIES presented an excellent level of reliability, with both Cronbach’s alpha and McDonald omega coefficients of 0.94. Cross-sex measurement invariance in the FIES was established at scalar and metric levels. Finaly, concurrent validity was evidenced by FIES’s positive correlations with water insecurity experiences, post-traumatic stress, depression and anxiety symptoms. Conclusion Altogether, our findings showed that the FIES fulfils requirements of validity and reliability. It may thus be considered as appropriate tool for assessing FI in Gazan war-affected populations currently suffering from acute FI emergency and requiring urgent action to meet their food needs. The FIES is simple, short, economic and time-effective. As a FI indicator, the Arabic FIES is useful in providing information that enables actions by policy makers and guides humanitarian-aid actors’ efforts aimed at decreasing, mitigating, or preventing severe FI, and saving lives or livelihoods. Clinical trial number Not applicable.

Background: The dramatic increase in TikTok use over the past few years has generated a major challenge globally. Providing researchers with a valid, reliable, yet brief measure may stimulate large-scale epidemiological research that can help to clarify the mechanisms involved in susceptibility to TikTok addiction and guide the development of prevention strategies. The objective of our study was to design and validate a brief measure that we labelled the TikTok Addiction Test (TAT) using a multi-country sample, with a specific focus on measuring the 6 core features of addiction through 1 item each. Method: A multi-country survey with a cross-sectional design was conducted in February of 2025 among general population adults (N = 3362) from five Arab countries: Egypt, Jordan, Lebanon, Oman, and Palestine. Results: A single-factor solution was obtained in the Exploratory Factor Analysis and corroborated in the Confirmatory Factor Analysis, indicating an adequate goodness-of-fit indices, with all 6 items satisfactorily loading on the same latent variable. In addition, the internal consistency reliability indicators were excellent for the entire measure, with Cronbach’s alpha and McDonald’s omega values of 0.91. We found invariance in factor structure, factor loadings, and intercepts between sexes and for country groups. A total of 207 (6.2%) participants were identified as TikTok addicts. Females exhibited significantly higher mean TAT scores than males. Palestinian and Lebanese participants reported the highest TikTok addiction scores, followed by Egyptians, Jordanians, and Omani. Finally, significant positive associations were observed between TAT scores and smartphone addiction, depression, anxiety, and loneliness, supporting the concurrent validity of the scale. Conclusion: Results suggest that the TAT is a simple and useful instrument for measuring TikTok addiction of general population adults with only 6 items and 1 factor. As a brief self-report measure, the TAT can be highly valuable in time- and resource-pressured real-life settings, and offers a foundation for future research in this area.

BackgroundThis study aimed at assessing patient experiences with hospital services and key factors associated with better experiences.MethodsThe study design is cross-sectional supported by qualitative interviews. The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was used as data collection instrument. A convenience sample of 391 volunteers aged ≥18 years participated in this study. Qualitative interviews were conducted with patients and healthcare providers to further enrich and explain the quantitative results.ResultsThe average age of the sample was 41.34, SD (16.4), range (18–87). Females represented 61.9% of the whole sample. Almost 75% were from the West Bank and 25% from the Gaza Strip. The majority of respondents reported that doctors and nurses were respectful, listened to them and explained clearly to them always or most of the time. Only 29.4% of respondents were given written information about the symptoms they may have after discharge from the hospital. Factors that were independently associated with higher scores on the HCAHPS scale were; being females (coef: 0.87, 95% CI: 0.157 to 1.587, p=0.017), being healthy (coef: −1.58, 95% CI: −2.458 to −0.706, p=0.000), being with high financial status (coef: 1.51, 95% CI: 0.437 to 2.582, p=0.006), being from Gaza (coef: 1.45, 95% CI: 0.484 to 2.408, p=0.003) and who visited hospitals outside of Palestine (coef: 3.37, 95% CI: 1.812 to 4.934, p=0.000). Overcrowding, weak organisational and management processes, and inadequate supply of goods, medicines, and equipment were reported factors impeding quality services via in-depth interviews.ConclusionsThe overall hospital experiences of Palestinian patients were moderate but varied significantly based on patients’ factors such as sex, health status, financial status and residency as well as by hospital type. Hospitals in Palestine should invest more in improving their services including communications with patients, the hospital environment and communication with patients.

Understanding of the mechanisms involved in the occurrence of psychotic experiences (PEs) in highly autistic individuals is crucial for identifying appropriate prevention and intervention strategies. This study aimed to investigate the mediating role of susceptibility to social pain and loneliness in the relationship between autistic traits (ATs) and PEs in adults from the general population of 12 Arab countries. This cross-sectional study is part of a large-scale multi-country research project. A total of 7646 young adults (age range 18–35 years, mean age of 22.55 ± 4.00 years and 75.5% females) from twelve Arab countries (i.e., Algeria, Bahrain, Egypt, Iraq, Jordan, Kingdom of Saudi Arabia, Kuwait, Lebanon, Morocco, Oman, Palestine, and Tunisia) were included. Mediation analyses showed that, after adjusting over confounding variables, both loneliness (indirect effect: Beta = 0.18; Boot SE = 0.02; Boot CI 0.14; 0.21) and social pain (indirect effect: Beta = 0.03; Boot SE = 0.01; Boot CI 0.001; 0.05) partially mediated the association between ATs and PEs. Higher ATs were significantly associated with more loneliness and susceptibility to social pain, and directly associated with more severe PEs. Finally, higher loneliness and susceptibility to social pain were significantly associated with greater PEs scores. Findings indicated that individuals with higher ATs tend to experience greater loneliness and feel more pain from rejection, which can in turn be associated with higher levels of PEs. Interventions targeting susceptibility to social pain and loneliness as a means of mitigating PEs among highly autistic adults should be considered.

Background End-stage renal disease (ESRD) is a growing cause of morbidity worldwide. Protein malnutrition is common among patients with ESRD. Peritoneal dialysis (PD) offers greater lifestyle flexibility and independence compared to the widely used treatments for ESRD. This study aimed to assess the nutritional status and the quality of life (QOL) of Palestinian patients undergoing PD, as well as the variables affecting these two outcomes. Methods A cross-sectional study was conducted on patients receiving PD at An-Najah National University Hospital, Palestine. The malnutrition-inflammation scale (MIS) was used to measure malnutrition, and the QOL score was evaluated using the Dutch WHOQOL-OLD module. Univariate and multivariate linear regressions were performed to check the association between the QOL and MIS scores. Results The study included 74 patients who were undergoing PD, with an average age of 50.5 ± 16.38. The majority of the patients were females. The study found a significant correlation between malnutrition and lower quality of life (QOL) scores, as measured by the WHOQOL-OLD questionnaire ( p  < 0.001). Furthermore, younger patients and those who had an occupation were more likely to report a good QOL ( p  = 0.01). Conversely, patients with pitting edema and diabetes were at higher risk of reporting a lower QOL ( p  < 0.001). Conclusions Given the elevated risk of malnutrition and diminished QOL among elderly patients, those with pitting edema, and individuals with diabetes, it is imperative to conduct thorough assessments for these groups. We strongly recommend that general practitioners, dietitians, and specialists collaborate to develop tailored programs and interventions to provide these patients with the focused care and attention they require.

Background and Aims This study had the main purpose of investigating the psychometric properties of the 9‐item Self‐Report Altruism scale (9‐SRA) in its translated Arabic‐language version among Palestinian HCWs in Gaza during war times. Methods This cross‐sectional study was performed between January 15 and April 15, 2025, among 615 HCWs at several hospitals and primary health care centers in the Gaza Strip. Results Our data adequately fitted this original hypothetical one‐factor model, with excellent internal consistency reliability coefficients (Cronbach's α = 0.92). The assumption of measurement invariance across sex groups of the Arabic version of the 9‐SRA was supported. Empathy scores were significantly and positively correlated with altruism scores. Finally, higher depression and anxiety were significantly associated with lower altruism. Conclusion Our research offers robust evidence in terms of reliability and validity to support the use of the 9‐SRA instrument to evaluate self‐reported altruistic behavior among Arabic‐speaking HCWs, especially in the context of war.