Reliability and validity of the Sit-To-Stand Test to assess Global Foot Mobility
Published on: 23rd June, 2017
OCLC Number/Unique Identifier: 7286355564
The Sit-to-Stand test (STST) involves comparing the change in a person’s non-weight-bearing and weight-bearing foot posture to quickly classify a person’s overall foot mobility. Despite the simplicity of the test, its reliability and validity has not been established. The purpose of this study is to determine the intra-rater and inter-rater reliability of the STST as well as its validity. Ninety-seven subjects with a mean age of 25 years (±3.7) participated in the study. Each subject’s foot posture from non-weight-bearing to weight-bearing was evaluated by two different raters. Each rater classified each subject’s change in foot posture as “Hypomobile”, “Normal” or “Hypermobile”. This same procedure was repeated approximately one week later without the raters being able to review what their original classification for that subject had been. The subjects also had their foot mobility quantified by measuring the height and width of their dorsal arch in both non-weight-bearing and weight-bearing. These quantitative measures of foot mobility were then classified as “Hypomobile”, “Normal”, or “Hypermobile” using quartiles. A series of Cohen’s Kappa coefficients were used to assess the amount of agreement between the visual classifications by each rater as well as the classification between the observational and objective classifications. The between-day Kappa coefficients ranged from 0.613 to 0.719 and the inter-rater Kappa coefficients ranged from 0.473 to 0.531. The Kappa coefficients between the visual and quantitative classifications ranged from 0.281 to 0.436. The STST should therefore be used with caution because of its moderate between-rater reliability and validity.
The body composition analysis: Differences between students and the trend of their change
Published on: 22nd March, 2018
OCLC Number/Unique Identifier: 7493653979
Anthropometric characteristics, represent one of the most important subsystems within the “system” of man, and which can be in affected by physical exercises in the direction of the desired transformation. Very often the anthropometric parameters (height and weight) are used in the assessment of the morphological status of an individual, and on the basis of the results of Body Mass Index (BMI) bring certain estimates and conclusions. BMI as a statistical measures, is used in many public health campaigns as an approximate measure of the ideal body mass and the degree of nutrition of a population. The main goal of the research was to determine and analyze differences in BMI parameters between male and female students, aged 18±0.5 years, and determine the trend of changes. Using the T-test module, the obtained results confirmed that there are statistically significant differences in body height (t=8,17; p<0.001) and body weight (t=5,29; p<0.001), while in BMI values there are not statistically significant differences (t=-0.68, p>0.001). Based on BMI values, a positive trend of somatic changes of both poles is evident.
Parents Take-On Concussion: Advances in Sideline Research and Culture in Youth Sports
Published on: 16th March, 2017
OCLC Number/Unique Identifier: 7286354252
Identifying concussion and initiating removal from play is challenging for even the most diligent youth sports organizations. Empowering parents to implement removal from play protocols and sideline testing may be the most practical plan at community levels to protect young athletes. We developed paradigms for community-based youth sports teams that incorporated both standard concussion protocols and research investigations. The research studies were designed to determine how sideline tests of vision, cognition and balance augment the capacity for parents and other responsible adults to identify youth athletes with concussion in ice hockey, football, lacrosse and cheerleading. Research-based sideline tests were performed at pre-season baseline sessions and during the season at the time of injury or as soon as symptoms were recognized by trained volunteer parent team testers. The combination of standard concussion protocols and research studies were performed for 510 athletes, aged 5-17 years, over 2.5 years through 5 athletic seasons. To implement the protocols and studies, approximately 80 student volunteers and parents were educated and trained on early concussion recognition and on baseline and sideline test administration. Over 80% of parent-identified head injuries were physician-confirmed concussions. Of the sideline tests performed, over two-thirds were administered within 24 hours of injury; the rest were performed within an average of 2.6 days post-injury since some athletes had delayed development of symptoms. Removal from play guidelines and standard concussion evaluation protocols were maintained in the context of the sideline testing research investigations. Based on this observational study, parents of youth athletes can be successfully empowered to perform rapid sideline tests in the context of existing concussion protocols. Implementation of objective testing may improve concussion identification and shift the culture of advocacy and responsibility towards parent groups to promote safety of young athletes. Ongoing investigations will further examine the impact of these programs on concussion management in youth sports.
Electrocardiographic criteria in founder mutations related to Arrhythmogenic cardiomyopathy
Published on: 2nd February, 2018
OCLC Number/Unique Identifier: 7347065911
Founder mutations are rare causes in arrhythmogenic cardiomyopathy including TMEM43 und phospholamban mutations. The incidence is approximately 1%. P.S358L TMEM43 mutations cause aggressive, in most cases biventricular arrhythmogenic cardiomyopathy [1], with the necessity of primary prophylactic ICD implantation in men and in women>30 years for sudden cardiac death prevention.
The epidemiology, evaluation, and assessment of lateral ankle sprains in athletes
Published on: 26th May, 2021
OCLC Number/Unique Identifier: 9155134376
Approximately 30,000 ankle injuries occur every day in the United States. With the incidence estimated at more than 3 million a year and at a rate of 2.15/1,000 in the U.S. alone, medical specialists and other healthcare providers caring for the foot and ankle must take notice. Despite the millions of ankle injuries sustained annually, the true incidence may be underestimated, as fewer than half of individuals with ankle sprains seek medical attention from healthcare professionals. The economic burden associated with the evaluation, diagnosis, and treatment is close to $4 billion annually. Ankle sprains account for half of all sports injuries and remains a difficult diagnostic and therapeutic challenge in the athlete. Accurate diagnosis is critical as 40% of ankle sprains are misdiagnosed or poorly treated leading to chronic ankle pain and disability. Implementing evidence supported diagnostic and treatment strategies is the goal for ensuring safe and rapid return to play.
The Lateral Ankle Sprain (LAS) is among the most common type of ankle sprains suffered during athletic activities. Up to 80% of LAS are of the inversion type, and 75% lead to recurrence and instability. Although most individuals experiencing a LAS return to activity within six weeks, many report continued pain, diminished function, and instability.
The purpose of this review is to highlight the epidemiology, pathoetiology, pathoanatomy, and biomechanics of the LAS, enabling sports physicians to implement the best practice guidelines and protocols to manage this common enigma.
Review of Stereotactic and Neuronavigation Brain Biopsy Methods in the Dog
Published on: 1st November, 2018
OCLC Number/Unique Identifier: 7912354081
Objective: To perform a review of brain biopsies in the canine species and determine if it is possible to compare the stereotactic and neuronavigation results.
Method: A search was performed in NCBI’s PubMed database for stereotactic or neuronavigational canine brain biopsy publications and articles which met at least one of the inclusion criteria and not any of the exclusion criteria were selected. The inclusion criteria were: 1) assessment of the specificity of the biopsy, 2) assessment of system accuracy, 3) assessment of the biopsy results, and 4) duration of the procedure.
Results: Only one article met all the inclusion criteria. Eleven articles that partially met the criteria were used for comparison. Authors used different stereotaxic methods and two used neuronavigation equipment. The authors of the stereotactic studies either adapted devices from human medicine or developed their own devices; the level of accuracy was variable (errors of 0.0 mm to 5.1 mm), and the two articles that used animals with spontaneous lesions had a diagnostic specificity rate higher than 90 percent. The accuracy of the neuronavigation studies was approximately 3.3 mm; however, no live animals were used.
Conclusions: It was not possible to properly compare stereotactic and neuronavigation techniques. To do so, the methodologies and the assessed parameters need to be standardized.
Pulsed Shortwave Diathermy and Joint Mobilizations Restore a Twice Fractured Elbow with Metal Implants to Full Range of Motion
Published on: 27th January, 2017
OCLC Number/Unique Identifier: 7286359001
A 21-y-old recreationally active male lacking the last 30° of elbow extension from a fractured and dislocated elbow sustained while wakeboarding came to our clinic November of 2015. A regimen was applied of 20-minutes of pulsed shortwave diathermy (PSWD) treatments delivered at 100 watts to heat the affected tissue prior to approximately 40°C followed by 10 minutes of joint mobilizations. This was followed by application of an ice pack to the area for 30 minutes. Measurements and treatments were given on Nov 3,5 and 10. The changes in AROM extension were as follows: Nov 3, from 30° to 20°; Nov 5, from 24° to 10°; Nov 10, from 10° to 0°. Over the course of the treatment the PSWD/ joint mobilizations improved extension AROM of the elbow 30° (full AROM) in just 3 treatments. There was also no post-treatment pain.
MicroRNA Therapeutics in Triple Negative Breast Cancer
Published on: 27th June, 2017
OCLC Number/Unique Identifier: 7317597564
Breast cancer is a complex disease and one of the main causes of cancer-related mortality in women worldwide. In case of approximately 15% of all breast cancers, three markers i.e. estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptors-2 (HER2) are not expressed, and is commonly termed as triple-negative breast cancer (TNBC). Particularly, TNBC is associated with a higher percentage of breast cancer related mortality, which is often aggressive and most frequently found with a BRCA1 mutation or increased basal marker expression. However, due to the limitations of chemotherapy and radiation based treatment; the current challenge is to establish a new strategy of diagnosis and treatment of TNBC. The deregulation of a number of microRNAs (miRNAs) in breast cancer has been widely reported. Therefore, this review is directed towards enhancing our understanding of the involvement of various miRNAs in the pathology of TNBC, their upregulations and downregulations and the effects on various factors. From recent studies a number of miRNAs are found to be related with TNBC, which have great potential to be used as a biomarker to determine the disease prognosis and predict the fate of disease. Again miRNA can be targeted to be applied as a therapeutic to provide a great benefit to the patients of TNBC by finding a new, safe, and effective treatment strategy.
Promising Future in the Detection of Oral Cancer by Using Advance Screening Technology
Published on: 30th December, 2016
OCLC Number/Unique Identifier: 7286354686
Oral cancer has a tendency to be detected at late stage which is detrimental to the patients because of its high mortality and morbidity rates (survival rate 15-50% [1]). The incidence of oral cancer worldwide is approximately 3% of all malignancies, thus creating a significant worldwide health problem [2].
Determinants of neonatal near miss among neonates admitted to Ambo University Referral Hospital and Ambo General Hospital, Ethiopia, 2019
Published on: 24th June, 2020
OCLC Number/Unique Identifier: 8625640828
Background: Neonatal Near-miss is defined as complications of neonates so severe as to be imminently life-threatening but survived due to chance or treatment. The number of neonates who survived morbidities were approximately 3 to 6 times greater than those who died. There was little evidence about neonatal near miss in Ethiopia. This study attempted to identify the determinants of neonatal near miss among neonates admitted to the Ambo University Referral Hospital and Ambo General Hospital.
Methods: Hospital-based quantitative unmatched case-control study was conducted at the Ambo University Referral Hospital and Ambo General Hospital from March 1 to 28, 2019. The respondents, 134 cases and 268 controls were recruited by simple random technique. Data were coded, entered and cleaned in EpiInfo version 7 and exported to SPSS. Both Bivariable and multivariable logistic regression was computed at 95% CI and the final model was checked by Hosmer and Lemeshow goodness -of-fit test. Multi collinearity and cofounders were not detected.
Result: Multivariate analysis showed that distance more than 15km away from health facilities [AOR=2.11, 95% CI: (1.09, 4.095)], Unwanted, and unplanned current pregnancy [AOR=3.71, 95% CI: (1.28, 10.79)], less than four Antenatal care visit [AOR=6.55, 95% CI: (3.07, 13.98)], Instrumental delivery [AOR=4.62, 95% CI: (1.78, 11.98)] were positively associated with Neonatal Near Miss. Whereas Term Neonates [AOR= 87%, 95% CI: (0.05, 0.32)], and Normal birth weight [AOR=91%, 95% CI: (0.03, 0.28)] were negatively associated with Neonatal Near Miss.
Conclusion: Distance from health facilities, Antenatal care visit, current pregnancy type, birth weight, gestational age and mode of delivery were determinants of Neonatal Near Miss. Therefore, providing adequate Antenatal services, health education and training is needed to improve neonatal health.
The Risk Factors for Ankle Sprain in Cadets at a Male Military School in Iran: A Retrospective Case-control Study
Published on: 23rd March, 2017
OCLC Number/Unique Identifier: 7286429204
Introduction: Ankle sprain is a widespread impairment in sport groups; this impairment leads to an absence from the workplace. The ankle sprains incidence rates are induced by height, weight, BMI, physical fitness, level of match, classification of sport, and personal exposure to sport.
Methods: A longitudinal case-control study was executed to verify the outcome of risk factors for ankle sprain at a Military Male School between 2012 and 2013 of 4987 people at risk for ankle sprain, a total of 234 cadets sustained new ankle sprains during the study, 432 non-injured cadets randomly selected as the control group.
Results: Regarding to the total people at risk in our study the incidence rate was approximately 5/1000 ankle sprain-years. Cadets with ankle sprains had higher weight, BMI and higher scores in Army Physical Fitness test than the control group. Ankle sprain occurred most commonly during athletics (51.4%). Ankle sprain incidence rate did not significantly vary from different athletic competitions after controlling for athlete-exposure. Soccer and Ball Games had the highest ankle sprain incidence rate.
Conclusion: Higher weight, increased BMI, greater physical conditioning and athlete exposure to selected sports were all risk factors for ankle sprain.
Effect of storage period on the quality characteristics of two varieties of African Mango Seed Flour at ambient temperature
Published on: 10th August, 2017
OCLC Number/Unique Identifier: 7286354684
The effects of storage of Ogbona seed flour (Irivingia gabonensis and Irivingia excelsa), at ambient condition (30±20C, 65-74% RH) for 0-4 months on some physical characteristics were investigated. The samples were subjected to storage in air tight polyethylene bags for up to four months. Samples were removed at intervals of 0, 1, 2, 3 and 4 months for analysis. The chemical: proximate constituents, free-fatty acids and peroxide values; selected functional properties: water/oil absorption capacity, foam capacity and viscosity and sensory attributes of the samples were investigated. The result shows that there was no observable change in the chemical composition, selected functional and sensory properties of the two varieties of Ogbona seed flours when stored up to two months but decreased from third to fourth month during storage at ambient temperature. Therefore, storage at ambient temperature (30±20C, 65-74% RH) could extend the shelf life of the samples for up to two months in air-tight polyethylene bags of 0.7mm thickness without losing its quality characteristics.
Effect of Pre-Treatments and Drying Methods on the Chemical Quality and Microbial Density of Wild Edible Oyster Mushroom
Published on: 31st August, 2017
OCLC Number/Unique Identifier: 7286430436
This study was carried out to evaluate the effect of pretreatments and drying methods on the chemical quality and microbial density of wild edible oyster mushroom. The mushroom samples were pretreated by steeping in 0.5% citric and sodium metabisulphite at room temperature for 10 minutes before being subjected to sun and cabinet drying until a constant weight was reached. The dried samples including the control samples (Samples not pretreated with chemicals) were evaluated for proximate, mineral composition and microbial density. The proximate analysis (protein, ash, fat, moisture and fibre) showed that untreated mushroom samples (both sun and cabinet dried) had the overall best results followed by samples pretreated with 0.5% sodium metabisulphite while samples pretreated with 0.5% citric acid had the lowest values. The mineral analysis (calcium, sodium, magnesium and potassium) of the mushroom samples followed the same trend as the proximate analysis. The microbial density of the samples showed that samples pretreated with 0.5% citric acid had the lowest count followed by samples pretreated with 0.5% sodium metabisulphite while the untreated samples had the highest microbial density. This implies that pretreatment with citric acid and sodium metabisulphite reduced the microbial density which may invariably extend the storage life of the edible oyster mushroom.
Evaluation of Clupeids and Danish fish meal based diets on the growth of African catfish, Clarias gariepinus fingerlings
Published on: 4th December, 2018
OCLC Number/Unique Identifier: 8255863994
Two experimental feeding trials were conducted concurrently to study the growth response of African catfish Clarias gariepinus fingerlings to graded levels (0, 5, 10, 15 or 20%) of clupeids in Danish fish meal (DFM) based diets. Chemical analysis of the DFM and clupeids fish meal (CFM) was carried out. Completely randomized design with triplicated groups of fingerlings were used for both trials in an indoor and out-door concrete tanks for six and twelve weeks respectively. The study aimed at achieving a cost effective fish meal from local aquatic resources (clupeids fish) highly prolific and abundant in Nigeria water bodies to replace foreign fish meal in West Africa Region. A project supported by West African Agricultural Productivity Project (WAAPP) in NIFFR, Nigeria.
The results of proximate, amino acid profile, mineral and fatty acid composition analysis of CFM indicated values which are very close to those of the DFM. The proximate analysis revealed CFM to contain 70.6% crude protein while DFM contains 72%. There were no significant difference between the treatments with respect to final weight, feed consumed, feed conversion ratio, digestibility and survival (P>0.05) although there was significant difference in specific growth rate (P<0.05) with the highest value obtained in the diets with both fish meal at ratio 1:1. There were no significant difference in haematological parameters (P>0.05). However the lymphocytes were high in all the groups which might not be particularly due to the treatments. The high proliferation of the body defence cells by the fish could be a mechanism of survival in the aqua-medium which is likely to be high in microbial load due to waste materials. Feed Cost/Kg for DFM was N260.16 while for CFM was N227.16. The results of chemical analysis and feeding trials indicated positive replacement of the DFM with CFM in fish feeds without negative effect on growth performance
Nutritional analysis of Sphenostylis Stenocarpa seeds partially included with soya bean meal in Heterobranchus Bidorsalis fingerling diet
Published on: 27th December, 2019
OCLC Number/Unique Identifier: 8506033891
Five experimental feeding trials were conducted to investigate the performance of Heterobranchus Bidorsalis fingerlings to graded levels (0%, 25%, 50%, 75% and 100%) of Sphenostylis Stenocarpa seed meal diets. Complete randomized design with triplicate groups of fingerlings was used for the study for ten weeks. The proximate, anti-nutritional factor and amino acid profile of the S. stenocarpa was analysed. The study showed that treatment C with 50% inclusion of Sphenostylis Stenocarpa meal was significantly different (p < 0.05) and performed best among other treatments in terms of the net weight gain, standard growth rate, and survival. The feed conversion ratio was best in treatment C but not significantly different (p > 0.05) to other treatments.
Quality Evaluation of Sorghum bicolor Stem Sheath Enriched with Spondias mombin Extract
Published on: 3rd June, 2020
OCLC Number/Unique Identifier: 8628641937
The nutritional compositions of sorghum stem sheath-Spondias mombin extract were evaluated. The enriched stem sheath extract were obtained by mixing sorghum stem sheath and Spondias mombin (iyeye) extract in varied proportions at 100:0; 0:100; 95:5; 90:10 and 85:15. The five samples were subjected to analysis: proximate, mineral, vitamin C, antinutrient composition. Data obtained were analysed using descriptive and inferential statistics. The result showed that observable increases were noticed in proximate, vitamin C and mineral composition from 5% inclusion of Spondias mombin extract in sorghum stem sheath drinks. The anti-nutrient compositions: tannin, oxalate and saponin, ranged from (0.144 to 0.442, 0.303 to 0.385, 0.070 to 0.198) mg/100 ml, respectively for sorghum stem sheath- Spondias mombin extract which were within consumable safe limits. The study concluded that nutritious enriched drinks could be produced from sorghum stem sheath and Spondias mombin extract at ambient temperature.
Eating habits and lifestyle changes during the COVID-19 lockdown: A comparative study (before and during isolation) on the 9 de Julio city (Buenos Aires, Argentina) population
Published on: 16th November, 2020
OCLC Number/Unique Identifier: 8872698108
Following the COVID-19 proliferation beyond China’s borders at the beginning of 2020, containment measures have been taken by different countries around the globe. Citizens were forced to stay at home. Specifically, on March 19th, the Argentine Government decided to implement the “Social, preventive and mandatory isolation”, strategy that unfortunately impacts on the lifestyle, the practise of physical activity and on the nutritional aspect of the population. The aim of this study was analize eating habits and lifestyle changes during the COVID-19 lockdown on the 9 de Julio city, Bs. As., Argentina. The survey was conducted using Google Form. The questionnaire was divided into different sections: sociodemographic data, eating habits, physical activity and concepts and emotions associated with isolation. The research reached 287 responses with a medium socioeconomic level. During isolation, the frequency of purchases decreased. It was observed an increase in the consumption of pasta, bread and cakes. Concerning the physical activity, approximately 70% declared to train before the COVID-19 lockdown, decreased by 13% during the lockdown. Other activities conducted during the COVID-19 lockdown; the most mentioned were cleaning the house, cooking, watching television, series and movies. A percentage greater than 50% of the surveyed population associated the situation of lockdown with positive emotions (share with my family, stay at home); while only 24% associate it with negative emotions (anxiety, anguish, fear). It is expected that most habits will return to normal, however, it would be interesting to know which of those developed, adopted and implemented during lockdown will remain in the new normality.
Neutrophil to Lymphocyte Ratio (NLR) in Peripheral Blood: A Novel and Simple Prognostic Predictor of Non-small Cell Lung Cancer (NSCLC)
Published on: 30th March, 2017
OCLC Number/Unique Identifier: 7355938332
Lung cancer is the leading cause of cancer-related deaths worldwide, and almost accounts for 20% of these deaths, however, the cure rate is less than 10% [1]. Non-small cell lung cancer (NSCLC) accounts for approximately 85% of all cases of lung cancer [1], but fewer than 15% of individuals diagnosed with NSCLC can survive for more than 5 years, which poses a great threat to the patient’s life and health [2]. Recently, the incidence of lung cancer keeps dynamically growing, but more than 75% of patients at diagnosis has appeared local development or metastasis, missing the best period of surgery. Moreover, despite surgical treatment is the optimal choice for early-stage NSCLC patients, 30%-40% of patients with NSCLC develop tumor recurrence in a short time. Therefore, improving the prognosis of patients with lung cancer and predicting the long-term survival of patients is of particular importance [3]. At present, tumor and node metastasis (TNM) staging system, clinicopathological characteristics, visceral pleural invasion and marginal status are used to predict the disease progression and overall survival of NSCLC patients. There is no index which is stable, effective, reliable and less harmful to assess prognosis, predict recurrence risk and overall survival.
Reversal of pure red cell aplasia by varicella zoster virus infection
Published on: 3rd May, 2019
OCLC Number/Unique Identifier: 8163589934
Background: Pure red cell aplasia is characterized by anemia, reticulocytopenia and diminished bone marrow erythroid precursors. It has multifactorial etiology and consequently several therapeutic interventions.
Case: In August 2017, a young patient was diagnosed to have pure red cell aplasia. She was given immunosuppressive therapy for approximately two months but this treatment was stopped due to intolerance. Later on she developed herpes zoster infection that was treated with valacyclovir. Subsequently, it was noted that the patient became blood transfusion independent due to normalization of her hemoglobin and regeneration of the erythroid precursors in the bone marrow.
Discussion: Varicella zoster virus behaves differently from other members of the herpes group of viruses such as cytomegalovirus and Epstein-Barr virus. Two retrospective studies, performed in patients with malignant hematological disorders and bone marrow failure, have shown that infection with the virus may cause stimulation of the three cell lines in the bone marrow and superior overall survival.
Conclusion: The outcome of the patient presented confirms the findings of the two studies showing long-term beneficial effects of varicella zoster virus infections in immunocompromised individuals.
Assessment of physicians’ knowledge, attitudes, and practices regarding smoking cessation management in the Gaza Strip
Published on: 11th February, 2020
OCLC Number/Unique Identifier: 8549664436
Background: Despite its negative effects, approximately 23% of Palestinians (≥ 18 years) smoke cigarettes. Studies have shown physicians to be an important channel for smoking cessation intervention. This investigation examines physicians’ smoking-related knowledge, attitudes, and behaviors in the Gaza strip (Palestinian Territories).
Methods and findings: A convenience sample of 154 physicians in medical and surgical units took part in this investigation (87.7% response rate). The data show that 37.8% of physicians in Gaza smoke, and most of them about 72% smoke in the hospital’s public spaces, thereby implicitly giving public approval for smoking. While 82.4% reported that they advise patients who smoke to stop, the majority (59%) also believe that their own smoking habits negatively influence the impact of that advice.
Unfortunately, our survey showed that physicians’ knowledge levels towards smoking addiction and management were lower than expected (e.g. only 34% knew that nicotine dependence is a psychiatric disorder that necessitates treatment). The physicians in this study believed that the primary barriers to failure of their patients’ smoking cessation were the perceived lack of will (81.3%), and the strength of patients’ addiction (67.9%). Moreover, (61%) of physicians did not spend enough time to convince their patients to quit smoking.
Conclusion: Smoking is common among Gaza-strip physicians, and unfortunately, most of them smoke in the hospital’s public spaces. Many obstacles face the smoking cessation program that some physicians linked it to patients, and others linked it to the health-care system. Furthermore, smokers in Gaza receive poor care regarding assessment, referral, and management of their smoking habit.
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