BMC Public Health 2006, 6:268 http://www.biomedcentral.com/1471-2458/6/268 Table 2: Characteristics of the diabetes patients (%) Characteristics Type of diabetes Type 1 Type 2 Duration of diabetes (since first diagnosis) < 1 year 2–5 years 6–10 years > 10 years Complications None Major one Retinopathy Nephropathy Neuropathy Diabetic foot Two or more Treatment for diabetes Pills Insulin Pills + Insulin Diet only these factors also severely impact HRQOL among con- trols. Interestingly, in the analysed set of variables, educa- tion played no independent role with respect to HRQOL. Another important finding is the high impact of the eco- nomic situation on the HRQOL (which did not interact with the disease status), especially in the younger age group. This is a big concern, because more than one half of the sample had an income in the lowest category. This study also contributed to the literature by translating the WHOQOL-BREF into Arabic and by administering the assessment tool for the first time to an Arabic speaking sample. The psychometric properties of the Arabic transla- tion of the WHOQOL-BREF were somewhat better than in a Norwegian general population sample [22] or Danish sample consisting of five different groups of patients [23], but this may be due to the fact that our sample was more homogenous. Table 3: Crude domain scores of WHOQOL-BREF for diabetic patients and controls (mean scores and 95% confidence intervals) Domain Physical health Psychological Social relationships Environment Diabetes patients controls 36.7 (33.7; 39.6) 34.8 (31.8; 37.8) 52.4 (49.7; 55.1) 23.4 (21.0; 25.9) 75.9 (73.0; 78.8) 70.0 (66.7; 72.7) 71.4 (68.7; 74.1) 36.2 (33.7; 38.6) Male N = 104 Female N = 93 p-value Chi-square 7.2 92.8 8.2 34.1 33.7 24.0 58.7 10.6 3.8 4.3 4.8 17.8 54.8 15.9 16.8 12.5 8.1 91.9 3.8 31.7 39.8 24.7 30.1 17.7 9.7 9.7 12.9 19.9 51.1 18.8 25.3 4.8 0.75 0.23 <0.001 0.014 The strengths of this study are the relatively large sample size and inclusion of a control group. Further, the sample was designed to represent the refugee population in the Gaza strip camps, a population which is not only unders- erved but also understudied. There are however several weaknesses of this study. Diabetic patients recruited for this study are a random sub-sample of patients treated in the UNRWA clinics but may not represent all diabetic patients living in the camps. Whereas this restriction does not threaten the internal validity of the analysis, findings may be not generalisable. The Palestinian Health care sys- tem comprises three sectors: the governmental, UNRWA, and the private sector. Most of the refugees in the camps receive care fromthe UNRWA, but some of the refugees are able to pay for the health insurance and they prefer to seek health care from the governmental institutions because of their comprehensiveness. Other refugees receive health care from the private sector outside of the camps. Patients treated at the UNRWA clinics may have a worse health condition than patients receiving care from other provid- ers. In some cases the medical records regarding complica- tions of diabetes may have been incomplete. This information was not verified by an examination by the physician for the purpose of this study. This may have resulted in underreporting of complications, but this does not affect the comparison between diabetic patients and controls. We do not know whether the controls proposed by the patients had any characteristics which were related to either higher or lower HRQOL than in the general popu- Page 5 of 7 (page number not for citation purposes)