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Background
Prophylactic antibiotic regimens for women undergoing caesarean section are useful for prevention of maternal morbidity, and antibiotic misuse can give rise to antimicrobial resistance. The aim of this study was to compare a single preoperative dose of cefazolin with the current standard practice of cefazolin, gentamicin, and metronidazole three times daily after the caesarean section until patient discharge.Methods
In this randomised, unmasked, parallel-group controlled trial, we enrolled women (aged 18–45 years) who were undergoing a caesarean section at the Al-Helal Al-Emirati Hospital in Rafah, Gaza Strip, occupied Palestinian territory. Using manual-blocks formation based on the rolling of a die, recruited women were randomly assigned to either 1000 mg intravenous cefazolin 30–60 min before the caesarean section (cefazolin group) or 1000 mg cefazolin, 80 mg gentamicin, and 500 mg metronidazole three times daily after the caesarean section until hospital discharge (triple antibiotic group). Outcome measures included readmission to the hospital because of wound infection, registered post-caesarean complications, duration of the caesarean section procedure, and length of hospital stay. Data were analysed with SPSS. Groups were compared using student's t test or χ2 test. The study was approved by the Ministry of Health of the Gaza Strip and done in accordance with the Declaration of Helsinki. Women provided verbal informed consent before participation in the trial and before undergoing the caesarean section.Findings
Between Jan 1, 2013, and July 31, 2013, we screened 329 women and enrolled 313 (mean age 31·2 years [SD 6·5]). We excluded 26 women because of previous infections (n=12), history of drug allergy (n=5), and missing data (n=9). 158 women were assigned to the cefazolin group, and 155 women assigned to the triple antibiotic group. Four women were readmitted to the hospital because of wound infections (three [2%] women from the cefazolin group, one [1%] from the triple antibiotic group; p=0·375). Mean duration of the caesarean section procedure was 35·86 min (SD 7·77) in the cefazolin group and 36·70 min (7·40) in the triple antibiotic group (p=0·511). Mean length of hospital stay after the caesarean section was 39·62 h (SD 11·19) in the cefazolin group and 40·48 h (13·07) in the triple antibiotic group (p=0·672). No cases of endometritis, urinary tract infections, or febrile morbidities were reported.Interpretation
Pre-caesarean, single-dose cefazolin was as effective as the combination of cefazolin, gentamicin, and metronidazole in preventing post-caesarean infections. We therefore recommend that cefazolin is used pre-operatively to prevent post-caesarean infection.Funding
None. 相似文献3.
Background
Cancer is a serious health problem and the third leading cause of death in the occupied Palestinian territory, both in adults and children. For most children younger than 18 years who have cancer, there is no obvious cause. The aim of this study was to identify the main risk factors for paediatric cancer in the Gaza Strip.Methods
This case-control study was done in five Gaza Strip governorates. We enrolled children diagnosed with paediatric cancer and receiving treatment at oncology departments at Ranteesy Specialised Paediatric Hospital, Al Shifa Hospital, and at the European Gaza Hospital in 2012 and 2013. Controls were children who visited primary health-care centres and matched for locality, age, and sex. We used face-to-face questionnaires to interview the children's parents and χ2 tests for analyses.Findings
292 children were enrolled in this study. 146 children had been diagnosed with paediatric cancer (70 [48%] children had a solid tumour, 50 [35%] had haematological cancer, and 25 [17%] had a lymphoma tumour). 146 children were enrolled as controls. The main risk factors associated cancer were exposure to ultrasound during gestational period (p<0·0001) and family cancer history (p=0·001). For environmental factors, we found associations of paediatric cancer with family history of smoking (p=0·016), exposure in pregnancy to passive smoking (p=0·018), and white phosphorus (p<0·0001). Agriculture pesticides and herbicides were not associated with paediatric cancer. Furthermore, the parents' educational level and occupation and the mother's exposure to x-rays were not associated with paediatric cancer.Interpretation
The study presents data on several potentially avoidable environmental risk factors for paediatric cancer in the Gaza Strip.Funding
None. 相似文献4.
Background
Chronic diseases are the greatest public health concern worldwide, contribute to a large burden of disease in the developed world, and are increasing rapidly in prevalence in developing countries. The aim of this study was to quantify the burden of reported chronic diseases in the occupied Palestinian territory.Methods
We used the global burden of disease (GBD) approach and its templates to quantify disability-adjusted life years (DALYs). To estimate years of life lost, we used mortality data from Ministry of Health materials, and we used local morbidity data from the Palestinian Central Bureau of Statistics (heath survey 2010) to estimate years lived with disability. The study was approved by the Palestinian Health Research Council.Findings
In 2010, DALYS lost due to selected chronic diseases were estimated as 60 per 1000 DALYs in the West Bank and 57 per 1000 DALYs in Gaza Strip, with each DALY defined as 1 year of optimum healthy life lost. Ischaemic heart disease and hypertension contributed the highest proportion of DALYs in men and women in 2010, followed by lung cancer in men and breast cancer in women. Respiratory disease also contributed a high proportion of DALYs, with a small difference in rank between the Gaza Strip and West Bank. Cancer was ranked the third largest contributor and respiratory disease the fourth largest contributor to DALYs in the Gaza Strip, whereas respiratory disease was the third and cancer the fourth largest contributors to DALYs in the West Bank. We also found differences by sex and region. Heart disease and cancer continued to rank highly as causes of years of life lost in the West Bank and Gaza Strip for both sexes in 2010, indicating the major causes of chronic disease burden in the occupied Palestinian territory in 2010.Interpretation
The burden of chronic disease is increasing substantially in the occupied Palestinian territory, and interventions are needed to tackle these burdens. Further studies using recent data and increasing attention to chronic non-communicable diseases are needed in the occupied Palestinian territories.Funding
None. 相似文献5.
Background
Antenatal care is an effective means of reducing risk for the mothers and fetuses during pregnancy. It is intended to prevent obstetric complications by improving the quality of antenatal care, hygiene, and knowledge about signs and symptoms of common medical problems during pregnancy. Low birthweight (<2·5 kg at birth) is an important factor affecting neonatal mortality and a predictor of health of the newborn child. The aim of this study was to assess the association between antenatal care provision and birthweight.Methods
This case-control study was done in two main hospitals with obstetric services in the Gaza Strip. Women were eligible if they had lived in the Gaza Strip for at least 1 year before delivery, delivered a live singleton infant, and were admitted for labour at the Al-Tahrier Hospital between May and June, 2007, or at the Al-Shifa Medical Centre between July and August, 2007. Women were assigned as cases and controls in a 1:1 ratio; cases were women who delivered live singleton infants with a weight of less than 2·5 kg. Matched controls were mothers who delivered single live infants weighing 2·5 kg or more during the first 24 h after their respective cases were identified. We estimated univariately unadjusted matched odds ratios (mOR) and 95% CIs with conditional logistic regression. Multivariate analysis of the data was completed in two integrated steps. Model 1 included the antenatal predictors that resulted after the stepwise backward selection for variables, with univariate p value less than 0·20, as recommended by Hosmer and Lemeshow. Model 2 included the significant antenatal variables of model 1 and other principal confounding factors, namely parents' education, occupation, residency, income, and maternal body-mass index. Maternal antenatal care was assessed (1) objectively, from conditions recorded in the mothers' hospital file (anaemia and pregnancy-induced hypertension) and (2) subjectively, by asking mothers about the number of antenatal visits, perception of the quality of given care, consanguinity, and symptoms of vaginal bleeding and periodontal disease.Findings
446 women were enrolled in this study. The results of multivariate analysis show that six prenatal factors were associated with an increased likelihood of low birthweight after adjustment for principal confounding variables, namely lower perception of the quality of given antenatal care (mOR 4·30, 95% CI 1·49–12·4), consanguinity (first-cousin marriage; 2·34, 1–25–4·41), medical complaints of anaemia (4·16, 2·12–8–13), pregnancy-induced hypertension (3–29, 1·23–8·75), maternal reporting of vaginal bleeding (5·18, 1·57–17·0), and periodontal diseases (3·69, 1·48–9·19).Interpretation
The findings suggest that several maternal antenatal factors are associated with low birthweight in the Gaza Strip. Such associations might have implications for clinical antenatal work, especially since the identified exposures mostly are modifiable. Emphasis should be given to educational health strategies combined with governmental actions in monitoring, controlling, and improving the quality of antenatal care provision at different health-care sectors in the Gaza Strip.Funding
None. 相似文献6.
7.
Background
Acute meningococcal septicaemia is a fulminant disease, and mortality and long-term morbidity can be very high if not treated appropriately. We aimed to evaluate case fatality rate of all children admitted with acute meningococcal septicaemia.Methods
We did a retrospective cohort study of all paediatric cases of acute meningococcal septicaemia admitted to Al-Nasser Paediatric Hospital, the largest paediatric hospital in the Gaza Strip. Acute meningococcal septicaemia was diagnosed clinically and confirmed on the basis of results from skin smears and blood cultures, and meningitis was diagnosed clinically and confirmed by bacteriological examination of cerebrospinal fluid. Sociodemographic and clinical data and outcome information were obtained from hospital records. Outcome measures were predicted mortality using Paediatric Risk of Mortality score III (PRISM-III), actual mortality, and standardised mortality ratio (SMR).Findings
Between Jan 1, 2009, and Sept 31, 2015, 240 children were admitted with acute meningococcal septicaemia. 113 (47%) children were boys, and the average age was 3·15 years (SD 2·6). The number of admitted children with acute meningococcal septicaemia decreased from 47–59 cases per year in 2009–11, to 21–22 cases per year in 2012–15. Similarly, there were fewer deaths in 2012–15 (n=14) than in 2009–11 (n=35). The total mortality predicted by PRISM-III was 25·6%, whereas the actual overall mortality was 21% (standardised mortality ratio 0·814; n=49). 41 (82%) children died within 24 h of admission, 69 (29%) children received corticosteroid, 85 (35%) children received inotropic medications, and 46 (19%) children required mechanical ventilation for a median of 24 h (IQR 6–48]. Acute meningococcal septicaemia was associated with meningitis in 75 (31%) children. The most common complications were multiorgan failure (22 [9%] children), skin necrosis or scarring (13 [5%]), convulsions or seizures (13 [5%]), and disseminated intravascular coagulopathy (ten [4%]). Mortality was independently associated with age (odds ratio per 1-year decreased age 1·06, 95% CI 1·03–1·10; p=0·0006), shock (3·83, 1·32–11·70; p=0·015), absence of meningitis on presentation (9·55, 3·25–28·07; p=0·0013), and mechanical ventilation (9·85; 4·31–22·54; p<0·0001).Interpretation
The mortality and morbidity associated with meningococcemia are improving but remain high. Timely identification of acute meningococcal septicaemia in primary care as well as in emergency departments is crucial.Funding
None. 相似文献8.
Background
Labour induction is a commonly used obstetric procedure that has specific indications and may result in complications. This audit evaluated the adherence to the Palestinian Ministry of Health guidelines for labour induction at Al-Helal Al-Emarati Maternity Hospital in the Gaza Strip, and considered the implications.Methods
Data were collected retrospectively from patients' medical records at Al-Helal-Al-Emirati Maternity Hospital from Aug 25 to Oct 7, 2017, including all patients who underwent induction of labour. Local practice was compared to the Palestinian Ministry of Health guidelines. Patient confidentiality was maintained and ethics approval was obtained from the Palestinian Ministry of Health.Findings
In total, 101 patients were identified, with a mean age of 26·6 years (SD 5·3 years). The modified Bishop score was documented in 86% of women (87 of 101). The most frequent indication for induction was prolonged pregnancy (for 28% of women; 28 of 101). Of these women, 82% (23 out of 28) were induced at 41 or 42 weeks. Pre-labour rupture of membranes was the indication for induction in 25% of the cases (25 of 101). The prostaglandin misoprostol was used for induction in 99% of women (100 of 101), given orally as a 50 μg tablet in accordance with the Palestinian Ministry of Health guidelines. Cardiotocography was performed before and 1 h after misoprostol (in accordance with guidelines) in 43% of cases (43 out of 101), whereas 49% of women (49 out of 101) had cardiotocography only after misoprostol. Four women had cardiotocography only before misoprostol, three women had no cardiotocography, and documentation was missing for two women. Cervical evaluation was carried out before each dose of misoprostol (in accordance with guidelines) in 42% of women (42 out of 101). The mean duration between initiation of induction and delivery was 20·9 h (SD 21·94 h). Informed written consent for induction was obtained from three women, but none of the women were informed about the risks and benefits of induction.Interpretation
Adherence to local guidelines was poor, particularly with respect to the care that women received prior to and during induction, including cervical assessment and performance of cardiotocography. Further weaknesses were insufficient patient education combined with a lack of formal consent and poor documentation. These findings highlight deficiencies in involving patients in their care and decision making processes, which are widespread in the Gaza Strip. These results were shared with the team. Performance improvements are being implemented and a re-audit is planned to assess progress.Funding
None. 相似文献9.
Background
Inadequacy of breastfeeding was considered the only factor leading to excessive weight loss, which might lead to unnecessary initiation of formula. However, other factors might contribute and should be considered. The aim of this study was to observe the effect of fluids given antenatally to mothers on the weight of their newborn children.Methods
This prospective observational study was done in the newborn nursery and labour room of the Al-Makassed Hospital. We included all women who had an uncomplicated pregnancy, were admitted between May 1 and Aug 31, 2015, and gave birth to a single healthy full-term baby weighing 2500–3999 g. We documented amount of intravenous fluids, weight of the newborn baby, and weight of diapers every 8 h until the mother and child were discharged from hospital. This study was approved by the ethical committee at Al-Makassed Hospital. Parental consent was taken verbally for participation.Findings
375 pregnant women participated in this study, of whom 266 (71%) were multiparous and 247 (66%) had a normal spontaneous vaginal delivery. 255 (68%) mothers received intravenous fluids. The administration of intravenous fluids 24 h before delivery was associated with a statistically significant but not clinically significant increase in weight loss in the newborn child at 48 h compared with those who did not receive any fluids (190 g vs 156 g; p<0·05). Other predictors of weight loss were feeding and delivery method. The use of formula in addition to breastfeeding was associated with more weight loss compared with exclusively breastfed infants (215 g [6·5%] vs 168 g [5·2%]; p=0·03). Both delivery by caesarean section and induced labour were associated with a marginally significant increase in weight loss (p<0·05) compared with spontaneous normal vaginal delivery.Interpretation
Weight loss in the newborn child is a multifactorial process. Intravenous fluid infused before delivery is a contributory factor. We recommend an intravenous fluid-restrictive policy to avoid false positive weight loss.Funding
None. 相似文献10.
Yancy Jensen Meghan A Cupp Roeann Osman Monica Lakhanpau Meradin Peachey Alexander Light Logan Manikam 《Lancet》2018
Background
Childhood obesity is a rapidly-growing global concern, with huge impacts on health in childhood and later life. Within the London Borough of Newham, about 25% of children aged 4–5 years and 40% of those aged 10–11 years are overweight. Early intervention strategies are key to targeting childhood obesity. As part of their Childhood Obesity Action Plan, Newham Council, London, introduced an early years nutrition programme in May, 2017. We aimed to assess the implementation of this programme through an audit of Newham's children's centres.Methods
Newham's 11 children's centres were invited to participate in this audit. Our objectives were to determine whether centres are displaying the UNICEF breastfeeding logo, to audit what information about healthy eating is displayed in early years settings, to determine what sessions the centres offer in their timetable for parents, and to conduct a face-to-face interviews on early years nutrition with staff members at each children's centre. Interaction with parents or children was out of scope for this research. Data collection, from Jan 1, to March 31, 2018, was conducted through photographs and field notes. We assessed whether nutrition activities of each centre complied with guidelines from the National Institute for Health and Care Excellence (NICE).Findings
Eight (72·7%) centres participated. All centres displayed the UNICEF breastfeeding logo. The most frequent display board topics related to generic health and wellbeing (four centres, 50·0%), and breastfeeding (three, 37·5%). The most frequent sessions offered were oral health (four, 50·0%) and nutrition (three, 37·5%) workshops. Staff regarded health visitors and parental engagement as the most important factors for delivering effective early years nutrition.Interpretation
This audit indicates that Newham's early years nutrition programme is consistent with NICE guidelines, meeting all 18 relevant recommendations. Future acquisition of data on obesity, tooth decay, and breastfeeding will help determine the programme's effectiveness. Additional research on the importance of health visitors in delivery of early years nutrition will further characterise their role in such programmes and inform the implementation of similar programmes in Newham and elsewhere.Funding
Newham Council. 相似文献11.
Background
The annual number of newly licensed doctors is an important indicator of medical workforce supply, which can accurately reflect an inflow into the health-care market during a time period. Since the implementation of the Law on Practicing Doctors in 1999, the Chinese Government has established its medical licensure system to both regulate medical professions and improve the quality of health-care services. We aimed to analyse the trend and structure of newly licensed doctors since the establishment of its medical licensure system.Methods
We analysed a unique census dataset that provides the headcount of newly licensed doctors in China between 2005 and 2015. We also review a short history of medical licensing system reform in China since the 1990s.Findings
The annual number of first-time licensed doctors in China increased from 159?489 in 2005 to 221?639 in 2015. Until 2015, more than 50% of newly licensed doctors had not received equivalent medical education of a bachelor degree or higher. In 2005, about 51% of China's newly licensed doctors were women, whereas in 2015, 56% newly licensed doctors were women.Interpretation
Our findings could inform policy making in human resources for health in at least two aspects. First, the heterogeneity of medical education of entering doctors needs to draw more attention of policy makers. The second policy implication is, however, that the feminisation of physician in China is becoming more apparent, and the consequences still require more rigorous examinations.Funding
None. 相似文献12.
Majdi Ashour 《Lancet》2018
Background
Catastrophic health expenditure (CHE) is measured to assess the financial protection from the risk of health-related conditions, which is considered a principle performance goal of any health system. The incidence and intensity of CHE in the occupied Palestinian territory between 1998 and 2007 was assessed in previous research; however, no research has assessed the occurrence of CHE in different population groups in the occupied Palestinian territory. The objective of this study was to examine the changes in the occurrence of CHE in different groups of Palestinians from 1996 to 2011, which was a period of increasing political turmoil, transformation of the national health system, and economic hardship faced by the population.Methods
The repeated cross-sectional series of the Palestinian Expenditure and Consumption Survey was conducted by the Palestinian Central Bureau of Statistics ten times between 1996 and 2011. Each survey asks detailed questions about a household's expenditure, including spending on health, using a diary approach. CHE was measured using a threshold of spending of 10% or more of the household's resources on health care. Total household expenditure was used as a proxy of a household's resources. The occurrence of CHE was traced from 1996 to 2011 and compared across different expenditure quantiles, dwellers of urban areas, rural areas, or refugee camps, and the characteristics of head of households within the West Bank and the Gaza Strip were compared.Findings
CHE in the occupied Palestinian territory increased from 7·3% of households in 1996 to 8·2% of households in 2011. This increase was observed in the West Bank and Gaza Strip. However, the occurrence of CHE in the Gaza Strip was consistently and significantly lower than in the West Bank. CHE was consistently higher in the worse-off expenditure quantiles in the occupied Palestinian territory and in the West Bank compared with affluent households. The change in the occurrence of CHE in different expenditure quantiles in the Gaza Strip was statistically insignificant from 1997 to 2004. From 2005 onward, the economically vulnerable groups of the households have become less exposed to CHE than affluent households. The occurrence of CHE in households in rural areas of the West Bank was consistently higher than elsewhere. Households in the West Bank with illiterate heads of family were consistently more exposed to CHE than other households, whereas the opposite was observed in the Gaza Strip.Interpretation
The findings should be interpreted within the context of the unique Palestinian situation. For example, the overburdened rural populations in the West Bank could have greater difficulty in accessing health services. The lower occurrence of CHE in the Gaza Strip and the trend towards reducing inequalities between the more vulnerable households, especially in a period of socioeconomic adversity, points to an emerging paradox of resilience in the Gaza Strip, which should be investigated carefully from the perspectives of both the health system and social lives.Funding
None. 相似文献13.
Background
Emergency departments see uniquely large numbers of patients across all demographic groups who are more likely to smoke and who attend with acute health concerns that can provide an impetus for behaviour change. Despite this potential opportunity, no smoking cessation programme in any UK emergency department yet exists. This study sought to identify perceived barriers and facilitators for emergency department smoking cessation activity, as well as potential modes of intervention, by exploring staff attitudes.Methods
16 members of staff from the Emergency Department, Derby NHS Teaching Hospital were purposively sampled to include a spectrum of clinical and non-clinical roles, grades, and employment duration. Semi-structured interviews were conducted within the department, and thematically analysed with dual-coding for validity under an interpretivist paradigm.Findings
Three themes were identified: roles of emergency departments, effects of smoking, and scope for intervention. Effects were described in individual-health and department-management contexts, with belief that reducing patient smoking would benefit both. Health promotion was seen as theoretically part of, and practically achievable within, the emergency department role. Lack of organisational support was a key barrier. Staff practice included occasional ad-hoc smoking cessation activity, but nothing routine. Those who did not incorporate smoking cessation into their practice felt that lack of training and support, rather than time, stopped them from doing so.Interpretation
Support for emergency department smoking cessation was found in the face of major barriers. Options to address these barriers were suggested, highlighting a willingness to engage. Complex interventions appeared impractical, and no single approach seemed universally applicable to emergency department environments. This study addresses the paucity of evidence around emergency department attitudes towards smoking cessation by providing a unique and in-depth picture of staff in the study department. It also balances clinical and population health viewpoints and has potential to inform promising prevention strategies in the emerging population-focused health-care structures. However, the study might not be generalisable to other emergency departments. Further research exploring patient attitudes would be a valuable next step.Funding
Health Education East Midlands. 相似文献14.
Background
The contribution of income inequality to health inequality has been widely examined in developed countries. However, little evidence exists on the effect of health on income inequality in resource-constrained settings. Findings from previous studies have indicated several mechanisms through which health affects income inequality, with the labour market being an important channel. Given the different levels of development, there are reasons to believe that health might represent a greater constraint on earnings in low-income settings. The aim of this study was to examine the relation between income and health in the West Bank and Gaza Strip.Methods
Data were extracted from the 2004 Household Health Expenditure Survey, which covered 4014 households. We applied a Shapley value approach to assess the contribution of health to income inequality. The analysis involved estimating and decomposing the relative Gini index. The contribution of each variable to income inequality was then computed as the average marginal effect, holding all other covariates at the mean.Findings
Results indicated clear age-specific health-income gradients. This is particularly apparent in the working-age population. Results also indicated that chronically ill people live in households witht low income. The regression analyses showed a negative effect of the proportion of adults in the household with chronic illness on income. The lack of education and employment appear to have the highest negative effect on income. The decomposition analyses revealed that ill health contributes to income inequality, whereas such an effect is reduced when we controlled for employment status.Interpretation
Our results suggested the presence of a ubiquitous relation between health and income. The contribution of health to income inequality depends on how it is distributed. Evidence supports a significant effect of ill health on income, which mainly operates through employment. Additionally, variation in exposure to health risks is a potentially important mechanism through which health might generate income inequality.Funding
None. 相似文献15.
Background
Excessive gestational weight gain appears to be a risk factor for low and high birthweight, preterm delivery, gestational diabetes, pre-eclampsia, caesarean section, and post-partum haemorrhage). The objective of this study was to determine the association between gestational weight gain and pregnancy outcomes.Methods
This retrospective cohort study was done at a primary health-care centre supported by the Palestinian Ministry of Health in Tulkarem (one of the main cities in northern occupied Palestinian territory) and in two United Nations Relief and Works Agency (UNRWA) primary health-care centres (in the Tulkarem and Nourshams Camps) in 2016. Patient files of women who had given birth were reviewed, and sociodemographic data, medical history, body-mass index (BMI), and gestational weight gain were recorded. We used SPSS version 20 for statistical analysis. Significance was set at a p value of less than 0·05. This study was approved by the Institutional Review Board committee at An-Najah National University, and permission was obtained from the Ministry of Health and the UNRWA.Findings
771 patient files were reviewed (326 from Tulkarem City, 274 from Tulkarem Camp, and 171 from Nourshams Camp). The mean age of mothers at first visit was 26·5 years (SD 5·81), and 328 (43%) women had attended tertiary education. 341 (44%) women had a normal BMI at first visit, 254 (33%) women were overweight, and 147 (19%) women were obese. 283 (37%) women gained weight within recommended levels, and 213 (28%) women gained more than the recommended weight. 210 (27%) women had a caesarean section. The incidences of preterm delivery, gestational diabetes, pre-eclampsia, and post-partum haemorrhage were 9%, 6%, 2%, and 10%, respectively. 405 (53%) newborn babies were boys and 366 (48%) were girls, with an overall mean birthweight of 3313 g (SD 511·83). 37 (5%) neonates had low birthweight, and 60 (8%) neonates had high birthweight. Bivariate analysis showed a significant association between gestational weight gain and BMI at first visit, high birthweight, and post-partum haemorrhage (p<0·001). Multivariate logistic regression showed that women who gained weight above recommendations had a higher risk of giving birth to a baby with high birthweight (odds ratio 3·4, 95% CI 1·65–7·00), whereas women who gained less than recommended had a lower risk of developing post-partum haemorrhage (odds ratio 0·44, 95% CI 0·199–0.996).Interpretation
Gaining more than the recommended weight during pregnancy is consistently associated with negative maternal and infant outcomes. These effects could be avoided if improved individualised care were systematically implemented in both ministry of health and UNRWA clinics to support women preconceptionally, prenatally, and post partum.Funding
None. 相似文献16.
17.
Background
There are limited studies about optimal duration and benefits of breastfeeding—and in particular, exclusive breastfeeding—on infant health and growth in the occupied Palestinian territory. This study aimed to evaluate the effect of exclusive breastfeeding on the health of infants in the Gaza Strip (at age 9 months), in terms of anthropometric measurements, growth, and morbidity.Methods
This study targeted mothers with infants attending primary health centres for vaccination at 9 months of age. Eight primary health centres were randomly selected from United Nation for Relief and Work Agency and Ministry of Health primary health centres in four regions of the Gaza Strip. Of 343 mother–infant pairs, in the first 6 months of life 251 infants received mixed feeding and 92 were exclusively breastfed.Findings
There were significant differences between the head circumferences of infants who were exclusively breastfed and those who received mixed feeding (44·1 cm [SD 1·39] and 43·7 cm [SD 1·15], respectively; p=0·007). There were no significant differences in the length and weight of infants between the two groups. Infants who were exclusively breastfed had a significantly lower frequency of gastrointestinal infections than infants who received mixed feeding (48% and 80%, respectively; p=0·001), as well as greater protection against respiratory tract infection (47% and 83%, respectively; p=0·001), lower incidence of otitis media (18% and 38%, respectively), and a significantly lower risk of urinary tract infection (5% and 65% respectively; p=0·001).Interpretation
Human milk is unique, and breastfeeding is the healthiest practice for healthy term infants for approximately the first 6 months after birth, providing ideal nutrition and supporting optimal growth and development. It also provides reasonable protection against infectious diseases. Thus, breastfeeding is the reference model against which all alternative feeding methods must be measured, with respect to growth, and short-term and long-term health outcomes. Infants should be introduced to nutrient-rich, solid foods (with particular attention to iron) at 6 months, with continued breastfeeding for up to 2 years. Every effort should be made to maintain breastfeeding rather than using formula or other milk substitute.Funding
None. 相似文献18.
Background
Prostaglandins are commonly used for labour induction in obstetric practice. Given the harsh effects of occupation and siege on provision of health care and on economic conditions, this study was conducted to compare the efficacy and safety of oral misoprostol and vaginal dinoprostone, to find the more appropriate and economic drug for labour induction in the Gaza Strip, occupied Palestinian territory.Methods
In this case-control study, we screened medical files of 155 women undergoing labour induction at Al-Helal Al-Emirati Hospital, Rafah, in the Gaza Strip. Inclusion criteria were singleton, cephalic presentation, and full-term pregnancies (40 weeks) needing labour induction. Patient files were divided into two groups according to the drug regimen. 76 women received 50 μg oral misoprostol for parity 0–4 or 25 μg for parity 4 or greater, every 6 hours. 79 women received dinoprostone vaginal tablets, with a dose of 3 mg then 1·5 mg for nulliparous women and 1·5 mg for parity 1 or greater, every 8 hours. There were no significant differences between the misoprostol and dinoprostone groups in terms of mean age (25·07 [SD 5·66] vs 27·86 [6·56] years, p=0·34), mean gestational age (279·43 [SD 11·41] vs 285·57 [SD 15·50] days, p=0·81), and mean parity (2·10 [SD 1·97] vs 2·73 [SD 2·64], p=0·05). Outcome measures were induction success, induction–delivery interval, number of used drugs and doses, caesarean section rate, and maternal complications. Data were analysed with SPSS software. We compared outcomes using the Mann–Whitney U-test, student's t-test, or chi squared test. A p value of less than 0·05 was considered significant. The study was approved by the Helsinki Committee, Gaza Strip.Findings
Induction of labour succeeded in 80% (61 of 76) and 78% (62 of 79) cases (p=0·492) in the misoprostol and dinoprostone groups, respectively. There was no significant difference between the misoprostol and dinoprostone groups in the induction–delivery interval (15·2 h vs 16·4 h, p=0·625). The number of doses required was 2·2 and 1·8 in the misoprostol and dinoprostone groups, respectively (p=0·070). The caesarean section rate did not differ significantly between the misoprostol and dinoprostone groups (7·9% [six of 76] vs 10·1% [eight of 79], p=0·369). In addition, complications (mild vaginal bleeding, post-partum haemorrhage, and puerperal fever) also did not differ significantly between the misoprostol and dinoprostone groups (37·7% [23 of 76] vs 33·9% [21 of 79], p=0·430), and all were mild.Interpretation
Oral misoprostol and dinoprostone vaginal tablets have the same safety and efficacy. Misoprostol is a good alternative for induction of labour.Funding
None. 相似文献19.
Hanne Heszlein-Lossius Yahya Al-Borno Yasmeen Keita Nashwa Skaik Hazim Shawwa Mads Gilbert 《Lancet》2018
Background
During four separate Israeli military attacks on the Gaza Strip (in 2006, 2009, 2012, and 2014), about 4000 Palestinians were killed and more than 17?000 Palestinians were injured (412 killed and 1264 injured in 2006; 1383 killed and more than 5300 injured in 2009; 130 killed and 1399 injured in 2012; and 2251 killed and 11?231 injured in 2014). An unknown number of people had traumatic amputation of one or more extremities. In addition to loss of body parts, loss of work and income further complicated patients' lives after trauma. In 2015, we reported preliminary data on the somatic consequences, showing that eight of ten amputees had unilateral or bilateral lower limb amputations, most often because of attacks by drone-carried weapons. A third of cases had amputations during ceasefire periods. A high number of debilitating extremity injuries were in the young civilian population, where needs of rehabilitation were difficult to meet because of limited local resources during the long-lasting siege of the Gaza Strip. Here we report long-term functional and psychosocial consequences of traumatic amputations in Gaza War casualties.Methods
This cross-sectional study was done at The Artificial Limb and Polio Center, a local rehabilitation centre in Gaza City. We studied Palestinians living in the Gaza Strip who had sustained traumatic amputations during Israeli military attacks between 2006 and 2014. We explored the amputees' self-assessed health, socioeconomic status, anatomical location and level of amputation, comorbidity, and date and mechanism of injury. We used two validated and self-administered screening questionnaires (36-Item Short Form Survey and General Health Questionnaire 12 [GHQ12]) combined with a detailed clinical examination of each amputee. We used standardised records and questionnaires in Arabic. Data were analysed with SPSS. The study was approved by the Palestinian Ministry of Health in the Gaza Strip, Al-Shifa Hospital's board, and the director of the Artificial Limb and Polio Center in the Gaza Strip. All participants included in the study completed a written consent form.Findings
We included 165 Palestinians in this study. Pain was reported by more patients who were unable to continue work because of the traumatic amputation than by patients who were unemployed for other reasons, even when adjusting for time passed since amputation (p=0·039). We found a correlation between reported pain and poverty (income <800 shekels per month; χ2=0·034) but no correlation between GHQ12 scores indicating psychological distress and the extent of the initial trauma. Use of prosthetics decreased GHQ12 scores, suggesting a lower level of psychological distress in users of artificial limbs.Interpretation
Self-reported pain after loss of one or more limbs correlated with deteriorated occupational and financial life situation after the amputation. Use of prosthesis seemed to ease the psychological distress. Poverty and unemployment caused by amputations and disability might be a more important trauma than the physical amputation itself.Funding
None. 相似文献20.