Due to the majority of currently available genome data deriving from individuals of European ancestry, the clinical interpretation of genomic variants in individuals from diverse ethnic backgrounds remains a major diagnostic challenge. Here, we investigated the genetic cause of a complex neurodevelopmental phenotype in two Palestinian siblings. Whole exome sequencing identified a homozygous missense TECPR2 variant (Chr14(GRCh38):g.102425085G>A; NM_014844.5:c.745G>A, p.(Gly249Arg)) absent in gnomAD, segregating appropriately with the inheritance pattern in the family. Variant assessment with in silico pathogenicity prediction and protein modeling tools alongside population database frequencies led to classification as a variant of uncertain significance. As pathogenic TECPR2 variants are associated with hereditary sensory and autonomic neuropathy with intellectual disability, we reviewed previously published candidate TECPR2 missense variants to clarify clinical outcomes and variant classification using current approved guidelines, classifying a number of published variants as of uncertain significance. This work highlights genomic healthcare inequalities and the challenges in interpreting rare genetic variants in populations underrepresented in genomic databases. It also improves understanding of the clinical and genetic spectrum of TECPR2-related neuropathy and contributes to addressing genomic data disparity and inequalities of the genomic architecture in Palestinian populations.

This article explores the intersectional fields of displacement and architecture by examining the interrelationship between youth development and spatial configurations in Palestinian refugee camps in Lebanon, more specifically in Ein El Hilweh Camp, South of the country. It aims at understanding how spatial configurations can alter human behavior, and the ways in which societal reform can take place in an urban context. Through taking Ein El Hilweh Camp as a case study and field interviews with experts working and residing in the Ein El-Hilweh Camp, this article asserts that youth development in Palestinian Camps in Lebanon is hindered by the dire conditions of spatial configurations in the camps and their geopolitics. It also asserts that in the presence of fostered youth protection and capacity and skills building, youth engagement and participation in the modification of their spaces act as essential drivers of change which contribute to the reduction of urban poverty and to the development of urban strategies that can sustain their development and provide an incubating environment for them to grow during the stages of their youth and beyond. Moreover, this article suggests that the primary factor contributing to the hindered situation of Palestinian refugees in Lebanon is the condition of permanent temporariness imposed by the state. The reduction of socio-spatial inequalities is temporary unless the integration of Palestinian refugees is fostered and their accessibility to social, economic, and civil rights, as well as the right to the city is granted.

UNASSIGNED: Familial Mediterranean fever is a hereditary autoinflammatory disease affecting mainly Arabs, Turks, Armenians, and Jews with genotype-phenotype heterogeneity, presenting as recurrent episodes of fever along with polyserositis and rash. To date, more than 370 mutations in the MEFV gene have been recognized to cause the disease.
UNASSIGNED: We conducted a retrospective cohort study involving 124 patients in Hebron, Palestine, diagnosed with FMF at the Al-Ahli, and Palestinian Red Crescent Society (PRCS) Hospitals.
UNASSIGNED: The median age of diagnosis was five years, presenting as abdominal pain (76.6%), fever (67.7%), joint pain and arthritis. Regarding MEFV gene mutations, we had 62 patients (50%) with heterozygous genotypes, 40 patients (32.3%) with homozygous phenotypes, 21 patients (16.9%) with compound heterozygous genotypes, and one was a missing state. Regarding variant frequencies, M694V was the most common one (43.4%), followed by E148Q (15.6%), V726A (5.7%), A744S (4.1%), and R202Q (4.1%). Positive family history was detected in 59 patients (54.6%), and there was no significant difference in zygosity regarding characteristics, consanguinity, and family history.
UNASSIGNED: We affirm in this study of 124 children with FMF, abdominal pain, followed by fever, joint pain and arthritis were the main manifestations. Further, M694V, E148Q, V726A, A744S, and R202Q were the most frequent mutations, and carrying the M649V mutations is associated with a predisposition to other comorbidities. We believe that this study gives a pervasive overview of FMF in Palestinian patients. Looking forward, future studies on a larger number of patients could precisely highlight the genotype-phenotype association among FMF patients.

Cancer is the second leading cause of mortality in the occupied Palestinian territory (oPt), and a more than 65 % rise in all cancer mortality is expected by 2030, with potentially devastating consequences which could overwhelm an already strained Palestinian health system. Advanced stage at diagnosis and the pervasive shortages in basic treatment options are to blame These factors are accompanied by a lack of infrastructure and trained human resources, the absence of reliable and timely data, and poorly coordinated healthcare systems. At present, resources for cancer control in the country are not only inadequate, but some of them are misallocated because of decisions that have been made that have not been based on evidence. This could lead to a waste of badly needed resources in a system that is already gravely short of funding. This paper highlights the challenges facing national primary cancer prevention measures in the oPt that will be needed to reduce exposure to cancer-related risk factors. The paper aims to provide evidence-based recommendations on how the oPt can detect in good time and thus treat the three most common cancers in the country - lung, breast, and colorectal cancer.

(1) Background: Nursing students should be well-prepared and educated in order to provide high-quality palliative care (PC) to patients with chronic diseases, which will have an impact on the quality of care for dying patients in the future; this study aimed to investigate the level of knowledge about PC and attitudes towards the care of dying patients among Palestinian nursing undergraduate students; (2) Methods: The study was a descriptive quantitative cross-sectional study design of 410 nursing students who participated and completed the questionnaire. The PC Quiz for Nurses (PCQN) and the Short Version of the Frommelt Attitudes Towards Care of the Dying (FATCOD) Form B Scales were used to assess students\' PC knowledge and attitudes toward PC and caring for dying patients. Generalized linear regression analysis was applied to identify the influencing variables on knowledge and attitudes; (3) Results: The overall knowledge mean score was 7.42 ± 2.93, ranging from 0 to 20, which indicates that nursing students lacked knowledge about PC; however, they have a positive attitude (25.94 ± 4.72; ranging from 9 to 45) toward care for a dying person. Receiving lectures or training about PC, caring for relatives in their last days of life, gender, and year of study were independently associated with students\' knowledge and attitudes about PC and care of dying patients; and (4) Conclusion: This study generated evidence showing insufficient knowledge about PC among nursing students at the Al-Quds University, Palestine, albeit a favorable attitude towards EoLC was shown. Integrating PC education into the nursing curriculum at Palestinian Universities need to increase their awareness of PC.

Total testosterone (TT) is known to influence health and virility in men. Among men from United States and Europe, numerous sociodemographic and lifestyle factors were reported to be associated with TT. However, associations with TT and Leydig cell function in the Middle East are poorly described. A cross-sectional, population-based sample had a structured interview, physical examinations, and blood tests in two hospitals in Jerusalem, Israel. A subsample (25- to 44-year-old men, n = 286: 124 Israelis, 162 Palestinians) had sex hormone measurements. The primary outcomes were TT and free testosterone/luteinizing hormone (FT/LH) ratio, representing Leydig cell function. Associations with sociodemographic and lifestyle factors, body mass index (BMI), and physical activity (PA) were evaluated using multivariable linear regression. Compared with Palestinians, Israelis had similar TT (4.81 vs. 5.09 ng/mL, p = .405) and higher FT/LH (31.2 vs. 25.8 ng/IU, p = .002). In ln-transformed values, marital status had a stronger association in Palestinians (P for interaction = 0.03). Age, BMI, and PA had a stronger association with TT in Israelis with significant interactions with ethnicity. BMI <25 and a higher PA quartile were associated with a higher TT (p < .001). Among Israelis, age (p = .007), married marital status (p = .007), and BMI <25 were significantly associated with FT/LH. No associations of any factors were identified among Palestinians. Associations with several modifiable factors identified in Western samples were replicated in Israelis and to a lesser degree in Palestinians. Different relationships of several factors with TT and FT/LH could result from ethnically diverse genetic, sociodemographic, and behavioral characteristics that warrant further research.

Obesity can be a major problem due to its potential to cause a number of health issues, including high blood pressure and diabetes. Many reports have come out of Palestine on overweight and obesity and their direct link to non-communicable diseases, although there is only limited evidence available on the connection between obesity and hypertension in Palestinian adults. We aimed to look at the associations between anthropometric and body composition variables and blood pressure in a large population of Palestinian adults (1337 subjects) and determine which anthropometric indices most strongly correlate with high blood pressure. Anthropometric measurements including height, waist circumference (WC), hip circumference (HC), body mass index (BMI), and total body fat (TBF) were assessed. A body composition analyzer was used to measure body weight, fat mass and fat-free mass. Systolic (SBP) and diastolic (DBP) blood pressure were measured using a Dinamap vital signs monitor. In both males and females, all the anthropometric measurements showed significant strong positive correlations with mean SBP and mean DBP (p < 0.01). SBP correlated the most strongly with waist circumference in all subjects (r = 0.444 in females, r = 0.422 in males), while DBP correlated the most strongly with WC in males (r = 0.386), but with TBF in females (r = 0.256). By controlling fat percentage, WC, HC, and BMI, which are affected by extra weight and lack of exercise, blood pressure levels can be regulated.

OBJECTIVE: To assess the impact of organisational communication satisfaction (OCS) on the work engagement of health care professionals (HCPs).
BACKGROUND: Organisational communication can influence employees\' work engagement, which is an essential component of an organisation\'s effectiveness. However, these concepts have not been broadly investigated in health care organisations.
METHODS: A cross-sectional survey was administered to 235 HCPs in the Gaza Strip, Palestine. The SPSS statistical software (version 25) and partial least squares structural equation modelling (PLS-SEM) were used to analyse the collected data.
RESULTS: The HCPs reported a moderate level of OCS (M = 4.96, SD = 0.94) and work engagement (M = 5.56, SD = 0.96). The impact of OCS on work engagement was found to be positive and statistically significant (β = .524, p < .05). No significant difference was revealed in level of OCS or work engagement among the HCPs according to their job categories. Only years of experience significantly influenced their OCS.
CONCLUSIONS: Improving HCPs\' satisfaction with organisational communication is vital in enhancing their work engagement and, ultimately, sustaining health care manpower.
CONCLUSIONS: Strategies for improving the quantity and quality of organisational communication must be prioritized to strengthen work engagement among HCPs. These strategies include management\'s role in and ways of communicating essential information about their organisations to HCPs.

Little is known about the prevalence and risk factors of diabetes among Gaza Palestinians, 64% of whom are refugees with exceeded sugar intake. We aimed to estimate the prevalence of type 2 diabetes (T2D) and its association with added sugar intake among residents, with regular visits to primary healthcare centers (PHCs) across Gaza.
From October to December of 2019, a cross-sectional survey was conducted among 1000 citizens and refugees in nine PHCs selected from the five governorates of the Gaza Strip. Information on dietary intake, medical history, and other risk factors was collected by trained health workers, using structured questionnaires. Anthropometry and biochemical data were extracted from the PHC medical record system.
Overall, the prevalence of diagnosed T2D and undiagnosed T2D were 45.2% and 16.8%, respectively, in adults aged 42 to 74 years, with the differences among citizens and refugees (diagnosed: 46.2% vs. 43.8%; undiagnosed: 15.7% vs. 18.2%). The uncontrolled glycaemic rate was 41.9% and 36.8% for diagnosed patients in citizens and refugees, respectively. Among those without a clinical diagnosis of T2D, after multivariable adjustment, daily added sugar intake was positively associated with fasting glucose and the risk of undiagnosed T2D (odds ratio, 95% CI, highest vs. lowest intake, was 2.71 (1.12-6.54) (pfor trend < 0.001). In stratified analysis, the associations between added sugar intake and the risk of undiagnosed T2D tend to be stronger among refugees or those with higher body mass index.
Among Palestinian adults, both citizens and refugees are affected by T2D. Added sugar intake is associated with the risk of undiagnosed T2D.

BACKGROUND:   The impact of political violence on the psychosocial functioning of adolescents and their families was compared for surveyed populations from two regions of Palestine.
METHODS:   A randomly-selected sample of 971 adolescents (521 from the West Bank and 450 from the Gaza Strip regions, 42% male/57% female) completed scales measuring traumatic event, post-traumatic stress disorder (PTSD), peer relations, mental health, aggression, and family functioning.
RESULTS:   (1) West Bank participants reported a significantly higher level of exposure to political violence and significantly more aggression, mental health symptoms, problems in family and social functioning; (2) Participants exposed to greater political violence reported higher levels of depression, hostility, paranoid ideation, and PTSD; (3) Economic status and level of parental education were related to reduced levels of mental health symptoms and greater family functioning; (4) There were gendered differences.
CONCLUSIONS:   The study provides a starting point to begin to compare the experiences and outcomes between Palestinian adolescents in the West Bank and Gaza Strip and a basis for considering implications for service delivery and policy makers concerned with the well being of Palestinian communities.