Overview of health in the Palestinian populationa pilot study

Resumen

This doctoral thesis provides a health overview for the Palestinian population in regard to factors relating to quality of life and the prevalence of depression in patients undergoing a coronary artery bypass graft (CABG), in addition to the prevalence of overweight/obesity and high blood pressure/hypertension in children and adults. The findings of this work are contained in five main sections (two systematic reviews and meta-analyses and three original research papers). The first systematic review and meta-analysis study demonstrates that the prevalence of depression pre-CABG ranges from 19–37%, while post-CABG this is 15–33%. Although this study reports an overall improvement in depressive symptoms after a CABG, depression persists postoperatively in the majority of patients. The depression levels present prior to the operation may affect a patient’s postoperative recovery. Thus, given the prevalence of depression and its impact, early detection is crucial, since this enables the identification of at-risk patients, through a clinical interview employing validated measurement tools. Health professionals can then implement preventive strategies and monitor the development of the depression. In the second systematic-review and meta-analysis study, we observed that CABG surgery improves people’s quality of life both physically and mentally, although this improvement is more extensive in physical terms. This favours the normalisation of the day-to-day life of these people in both their personal and work environments, and a decrease in impact prevalence was observed in different aspects of their lives that varied between 18% and 6%. This surgery therefore seems to be a good choice for improving the quality of life of people with coronary disease, once the possible existing risks have been assessed. In the original research investigating the associations between health-related quality of life (HRQoL) and sociodemographic and clinical characteristics in 119 Palestinian patients who underwent CABG surgery, our findings indicate that HRQoL decreases as age increases, whereas HRQoL increases with a higher educational level, greater job security, and a higher salary. Additionally, patients who had undergone a prior percutaneous coronary intervention (PCI) reported worse HRQoL, with all domains having a significantly lower score. The results of this study are relevant for health professionals, particularly nursing professionals, since they reveal that comprehensive assessments of individuals undergoing a CABG are necessary to prepare high-quality patient care that allows them a greater HRQoL and better post-operative rehabilitation. This study also shows that other factors, such as emotional components and certain sociodemographic variables, have an important influence on patients undergoing CABG surgery and these should be considered by the nursing staff when developing nursing care plans. In the original study of a 971 cohort of children, we found that the prevalence of overweight/obesity was 25.3% in girls and 23.1% in boys. Additionally, 26.3% of Palestinian children have elevated systolic blood pressure/hypertension, whereas 23.4% have elevated diastolic blood pressure/hypertension. Palestinian children with elevated blood pressure or hypertension have a significantly higher weight, body mass index, waist circumference, hip circumference, fat mass, and fat-free mass than the participants with normotension, supporting a direct association between high values of obesity-related parameters and high blood pressure. Similar results were found in the research conducted on a cohort of 1337 Palestinian adults. In that case, the prevalence of hypertension in adults was 61.7% in males and 38.3% in females. Our results therefore highlight the need for a serious focus on obesity and hypertension in the Palestinian population as well as community-based programmes to manage this health problem. Weight reduction interventions are essential for reducing the prevalence of related disorders, including hypertension in both childhood and adulthood; as well as halting the development of cardiovascular diseases that involve surgery, increased health costs, and decreased HRQoL. For this reason, obesity prevention should be a national public health priority in Palestine.