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The COVID-19 pandemic has triggered major changes worldwide, with repercussions on mental health and education. The present study primarily aimed to retrospectively explore undergraduate students' risk perceptions of COVID-19 and their experiences with remote learning during the pandemic, with an emphasis on their high school years. This qualitative photovoice study was conducted between 30 March and 4 May 2023. The target population of this study was first- and second-year undergraduate students who had been in high school during the pandemic. Maximum variation, snowball, and convenience sampling methods were used to recruit students. They were asked to share photos and provide comments in written or voice messages explaining their experiences during the pandemic. Voice messages were manually transcribed verbatim. A manual content analysis of these comments was performed to derive the codes and themes relevant to the study objectives. Forty-seven students initially agreed to participate and signed an informed consent form. However, the final sample included 16 students (nine men and seven women). The content analysis revealed four themes that were identified as the main factors contributing to high school students' risk perceptions of COVID-19. The first theme was psychosocial factors related to the pandemic, including emotions, isolation and stress. The second focused on the mechanisms used to cope with the pandemic. The third theme included beliefs and behaviours that either increased or decreased COVID-19 risk. The final theme addressed schools' responses to COVID-19, including factors such as maintaining connections with schools, preventive measures and the transition to remote learning. This study highlighted the extensive impact of the pandemic on Palestinian high school students, demanding instantaneous adaptation to ensure their safety and well-being while maintaining the quality of education. Remote learning has become an important strategy with opportunities and challenges for high school students.

Background Understanding health literacy and its predictors is fundamental for adolescents to have healthy lives. This study investigated the association between exposure to violence and other factors with health literacy levels among Palestinian middle school students. Methods This cross-sectional study included middle school students. We used the validated Arabic version of the Health Literacy Assessment Scale for Adolescents to measure health literacy levels, and asked adolescents 11 questions to assess whether they were exposed to various forms of violence. We used binary logistic regression to identify the factors associated with each health literacy subscale. Results Among the 816 students, 20.4%, 30.5%, and 50.5% had low functional, confusion, and communication health literacy levels, respectively. Exposure to political violence was significantly associated with lower levels of functional health literacy (OR: 2.65, 95%CI: 1.71–4.08) and low confusion health literacy (OR: 1.96, 95%CI: 1.31–2.94). Domestic and school violence were associated with low levels of confusion health literacy (OR: 1.82, 95%CI: 1.30–2.55). Conclusion Exposure to different forms of violence predicted low levels of health literacy among Palestinian middle school students. This study identified the need for middle school students to acquire the skills required to analyse and integrate the health information they receive. Therefore, there is a need for regular interventions that target an increase in their critical health literacy.

Background Oral health diseases pose a major global and public health problem. Access to trusted sources of information might be pivotal for improving health knowledge levels. Health knowledge can be considered a consequence of having or lacking the appropriate health literacy skills. This study identified the association between the number of health information sources and oral health knowledge (OHK) mediated by health literacy. Methods This cross-sectional household survey targeted Palestinian adolescent refugees in Ramallah and Al-Bireh District of the West Bank, Palestine. We measured OHK using seven questions about basic oral and dental health information. We used the Arabic Health Literacy Assessment Scale for Adolescents to measure health literacy levels. We also asked the adolescents to report their sources of health information. We conducted a mediation analysis using Process Macro for SPSS. Results This study included 300 adolescents who live in Ramallah and Al Bireh refugee camps. Among family members, adolescents mainly consulted their parents for health information, with 86.3% seeking health information from their mothers and 66.3% from their fathers. Out of seven questions, the mean number of correct answers for the OHK scale was 5.7 (Standard Deviation [SD]1.0). The association between the number of health information sources and OHK was fully mediated by communication health literacy (significant indirect effect: 0.0203, 95% Confidence Interval [CI]: 0.007 to 0.037, and insignificant direct effect β = 0.0267, p  = 0.15). This association was partially mediated by functional health literacy (significant indirect effect: -0.008, 95%CI: -0.0173 to -0.0018, and significant direct effect β = 0.0536, p  = 0.003). Conclusion Different types of health literacy can mediate the association between the number of health information sources and OHK. Functional health literacy is necessary to gain knowledge from multiple sources, but it is insufficient. High communication health literacy fully mediated this association. Strengthening communication skills in the context of health would be highly required to effectively transform accessed information into gained knowledge. Clinical trial number Not applicable.

Background Premenstrual syndrome (PMS) is a common menstruation-related condition among adolescent girls. Vulnerability to environmental and social factors such as living under war, exposure to political violence (EPV), and human insecurity significantly influence the health and well-being of adolescents more generally. However, research on the association between PMS and social determinants in conflict settings remains limited. This study aimed to identify the severity of PMS and its association with EPV, human insecurity, and well-being among adolescent girls in Palestine refugee camps in the West Bank. Methods This cross-sectional study included 1,399 girls aged 15–18 years residing in 19 Palestinian refugee camps in the West Bank, occupied Palestinian territory. PMS severity was measured using a scale developed based on the literature, expert input, and the girls’ experiences, comprising two categories: “none to mild” and “moderate to severe.” EPV was assessed based on past experiences at individual, familial, collective, and cumulative levels. Multivariate analyses were conducted using five regression models with a primary focus on the relationship between PMS severity and EPV. Results The prevalence of PMS with at least one symptom was 92.1%. PMS severity was positively associated with collective EPV (adjusted odds ratio [AOR], 1.5; 95% confidence interval [CI], 1.1–2.1), whereas individual and familial EPV were only significant when included separately in the model. Girls who experienced two or three types of cumulative EPV (AOR, 2.5; 95% CI, 1.6–3.7) were more likely to experience severe PMS. High levels of human insecurity (AOR, 1.3; 95% CI, 1.0–1.6) and depression-like symptoms (AOR, 1.9; 95% CI, 1.3–2.7) were significantly associated with PMS severity. Conclusions The results demonstrate a significant association between PMS severity and EPV, human insecurity, and low levels of well-being. These findings suggest that prolonged occupation and unresolved conflict may adversely impact adolescent health and exacerbate PMS symptoms, highlighting the need to recognize PMS as a public health concern. In protracted conflict settings, integrating psychosocial support and menstrual health education into schools and community-based programs such as primary healthcare facilities may help adolescent girls manage PMS, menstruation-related symptoms, and associated stressors more effectively. Plain English summary Premenstrual syndrome (PMS) is a common symptom among adolescent girls occurring before menstruation, causing physical and mental symptoms such as headaches and low mood. PMS is not only related to lifestyle but also to trauma and the surrounding environmental and social conditions. People in Palestine have been exposed to political violence caused by long-term occupation and war for several decades, including restrictions on movement, economic instability, and daily insecurity. Political violence includes violence against individuals, such as home invasions and humiliation by soldiers; against families, such as imprisonment, injury, and the loss of family members; and against collectives, such as witnessing or hearing about political violence. Herein, we investigated the relationship between PMS severity and exposure to political violence (EPV), sense of insecurity, and well-being. We conducted home visits with adolescent girls aged 15–18 years living in refugee camps in the West Bank of Palestine. The results showed that 92.1% of girls experienced PMS symptoms, with PMS severity associated with EPV, high levels of insecurity, and low level of well-being. Furthermore, the presence of more types of EPV was strongly associated with PMS severity. These findings demonstrate the potential impact of long-term occupation and conflict on adolescent health, highlighting the need to address PMS as an important adolescent health issue, beyond simply causing discomfort. Integrated psychosocial support and menstrual health education in community- and school-based settings may enable adolescent girls to enhance their coping skills and manage menstruation-related symptoms, including PMS.

Background/Objectives: Postpartum women frequently experience nonspecific low back pain (NSLBP), yet the impact of delivery mode on the function of local core muscles, particularly the transversus abdominis (TrA) and lumbar multifidus (LM), is not well understood, limiting the development of targeted rehabilitation strategies. To compare NSLBP intensity and TrA and LM strength in women who underwent cesarean delivery (CD) or vaginal delivery (VD), and to examine the associations between pain intensity and muscle strength. Methods: An analytical cross-sectional study was conducted on 36 women divided into two groups: 18 who underwent CD (Group A) and 18 who underwent VD (Group B). NSLBP intensity was assessed using the visual analogue scale, while TrA and LM strength were measured via a pressure biofeedback unit. Results: The two groups showed non-significant differences in age (p = 0.342), BMI (p = 0.429), or parity (p = 0.894), confirming comparable baseline characteristics. NSLBP intensity was significantly higher in the CD group (p = 0.000), and they exhibited weaker TrA (p = 0.009) strength than the VD group; however, there was a non-significant difference in LM strength (p = 0.602). The Spearman correlation analysis revealed non-significant associations between NSLBP intensity and TrA and LM strength in the CD group (p = 0.702, 0.129, respectively) and in the VD group (p = 0.149, 0.877, respectively). Conclusions: Women undergoing CD experienced higher NSLBP intensities and weaker TrA strength than those undergoing VD, while LM strength remained similar between groups. However, NSLBP intensity showed non-significant associations with TrA or LM strength in either group, suggesting that other biomechanical or neuromuscular factors may contribute to the increased post-CD NSLBP. These findings highlight the need for targeted rehabilitation strategies beyond core muscle strengthening alone.

ObjectivesFor adolescents and young adults, most health literacy research has been conducted in Western countries, but few studies have been conducted in the Eastern Mediterranean region (EMR). This review aimed to explore the existing health literacy research in the EMR in addition to the levels of health literacy and its associated factors among adolescents and young adults.MethodsThe search, conducted using the PubMed/MEDLINE, EBSCOhost/CINAHL plus, Web of Science and J-STAGE databases, was initially performed on 16 June 2022 and later updated on 1 October 2022. Studies that targeted 10–25 years old persons, conducted in any of the EMR countries and that used the health literacy concept and/or described its levels or predictors were included in the review. Content analysis was used for data extraction and analysis. Data related to the study methods, participants, outcome variables and health literacy were extracted.ResultsThe review included 82 studies, most of which were conducted in Iran and Turkey and adopted a cross-sectional design. Half of the studies showed that more than half of adolescents and young adults had low or moderate health literacy. Nine studies applied university-based or school-based health education interventions to improve health literacy, which was also predicted by demographic and socioeconomic factors and internet usage. Little attention was paid to assessing the health literacy of vulnerable people, such as refugees and those with a disability and exposed to violence. Finally, various health literacy topics were investigated, including nutrition, non-communicable diseases, media and depression.ConclusionHealth literacy levels were low-to-moderate in adolescents and young adults in the EMR. To promote health literacy, it is recommended to use school-based health education and attempt to reach adolescents and young adults through social media platforms. More attention should be paid to refugees, people with disabilities and those exposed to violence.

Complying with the technical specifications of compost production is of high importance not only for environmental protection but also for increasing the productivity and promotion of compost use by farmers in agriculture. This study focuses on the compost quality of the Palestinian market and farmers’ attitudes toward agricultural use of compost. The quality is assessed through selection of 20 compost samples of different suppliers and producers and lab testing for quality parameters, while the farmers’ attitudes to compost use for agriculture are evaluated through survey questionnaire of 321 farmers in the Hebron area. The results showed that the compost in the Palestinian markets is of medium quality due to partial or non-compliance with the quality standards and guidelines. The Palestinian farmers showed a positive attitude since 91.2% of them have the desire to use compost in agriculture. The results also showed that knowledge of difference between compost and chemical fertilizers, perception of compost benefits, and previously experiencing problems in compost use are significant factors affecting the farmers’ attitude toward the use of compost as an organic fertilizer.

ObjectiveTo examine the moderating role of health literacy in the association between direct exposure to violence and weight status among Palestinian adolescents.DesignA household cross-sectional study conducted in 2017.SettingA Palestinian district of the West Bank.ParticipantsPalestinian adolescents aged 11–16 years.ResultsAfter excluding underweight adolescents from the 1200 who were initially recruited, the data of 1173 adolescents were analysed. A high proportion (62%) of adolescents were directly exposed to violence. The prevalence of obesity and overweight was 6.5% and 17.1%, respectively. The odds of obesity and overweight were 2.8 and 1.8 times higher among adolescents who were not exposed to domestic and school violence when they had low health literacy in the communication subscale. The odds of obesity were 62% and 57% lower among adolescents with high functional health literacy when exposed to domestic and school violence and to any form of violence, respectively. Among adolescents who were not exposed to any form of violence, those who had high health literacy in the communication subscale were 72% less likely to be obese compared with those who had low health literacy.ConclusionsHealth literacy moderated the association between direct exposure to violence and weight status. When health literacy levels were higher, lower obesity rates were observed among adolescents who were directly exposed to any form of violence or exposed either to political violence only or domestic and school violence only. The results warrant further investigation of the role of health literacy in adolescent health. It is recommended that policy-makers integrate the health literacy concept into both education and health systems.

In recent years, the term “postbiotics” has become increasingly popular in food microbiology, food science, and commercial products. This importance has been raised due to the safety issues associated with live bacterial cells. Postbiotics are defined as bioactive substances of probiotics. It confers unique health-promoting functions with its chemical structure, safe profile, and long shelf life. Meanwhile, postbiotics nanoparticles (postbiotics-NPs) can be considered novel postbiotic delivery systems to deliver bioactive components with health benefits and therapeutic aims, promote the shelf-life of food products, and develop novel functional foods. The present scientific literature shows that nanotechnology approaches are not yet mature enough to be used in postbiotic delivery systems. For all of that, the potential applications of postbiotics-NPs in the food industry and biomedical fields will be a new trend in the future.