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1.
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2.
Background
A public health research system is the bedrock of health systems to improve population health, system responsiveness, and equity. An international concern, referred to as the 10/90 gap, is that less than 10% of global funds are devoted to diseases or conditions that account for 90% of the global disease burden, particularly in developing countries. Palestinian health research is progressing, but it is not sufficiently investigated, with a remarkable knowledge gap on its conceptualisation, stewardship, stakeholders, and capacity and resources. The aim of this study was to understand the Palestinian public health research system by investigating challenges related to the system components that need to be strengthened.Methods
The study was done in the Gaza Strip and West Bank in the occupied Palestinian territory between January and July, 2016. We targeted relevant government institutions, academic schools, and large local and international health agencies. Data were collected through 52 in-depth interviews and six focus group discussions with policy makers, academics, and experts. Participants and institutions were selected purposively on the basis of stated criteria and peer review. Data were translated, transcribed, checked, and imported into MAXQDA 12 for thematic and content analysis. Approvals were obtained from The Research Commission of Swiss TPH, “Ethikkommission Nordwest- und Zentralschweiz” (EKNZ) in Switzerland, the Palestinian Ministry of Health, Helsinki Committee, and An-Najah National University in Palestine.Findings
The health research system is not well structured, whereas public health research is promising but probably without regulated national policies. Most experts emphasised that governance is not clearly framed in managing research functions, whereas public health research activities are most likely scattered and individually driven. There is a consensus that the concept of the health research system is misunderstood and that the system is underperforming because of various problems such as resource insufficiency. Research is also not fundamentally at the heart of the political agenda or itemised in central budgets. Besides workforce scarcity with poor incentives and infrastructure, priorities in public health research are inconsistent and efforts are uncoordinated with poor multidisciplinary research. Dissemination and application of the public health research agenda among stakeholders are lacking. The research culture seems to be insufficiently cultivated. The international support to the public health research system is inconspicuous although some initiatives have been successful. The overall environment in the occupied Palestinian territory formed one of obstacles of the public health research system. Precious opportunities are proposed to strengthen public health research system synergistically through best strategies.Interpretation
The occupied Palestinian territory is a fertile place for growth of public health research system activity. Development actions should therefore be taken to get the system materialised by reactivating a unified governance body that cooperatively manages the national policies, capacities, priorities, research utilisation, and application of the public health research system.Funding
The Swiss Federation and Swiss Tropical and Public Health Institute. 相似文献3.
Background
Social media has become popular and changed social interaction between people. The Middle East is an important and expanding market, particularly the occupied Palestinian territory, where restrictions related to cultural and geopolitical realities create an environment of isolation for young adults. Dependence on social media is suggested to diminish motivation to participate in naturally occurring activities and life interests, leading to physical and mental health risks. The aim of this study was to assess the potential association between excessive Facebook use and physical health complaints, unhealthy habits, and emotional discomfort in university students.Methods
In this cross-sectional study, we recruited students at the An-Najah National University of Palestine. We used a pretested, self-administered questionnaire to collect demographic data and information about Facebook use, unhealthy habits related to Facebook use, and physical health complaints. The Facebook Intensity Scale (FIS) and the Depression Anxiety Stress Scales (DASS21) were used as study instruments. The study was approved by the Institutional Review Board of An-Najah National University. Participation was voluntary, and written consent was obtained from each participant.Findings
The sample included 1003 students of both sexes and from a range of study areas. 938 participants returned valid questionnaires. 922 (98%) students had Facebook accounts, with 240 (26%) students spending more than 3 h per day on Facebook, and 258 (28%) students reporting having more than 300 Facebook friends. A positive relationship was found between time spent on social network sites, number of Facebook friends, and Facebook Intensity Scales scores and an increase in unhealthy habits including skipping meals, delaying urination, and late night and interrupted sleep. Negative health consequences related to excessive use included eye strain, reduction in energy levels, reduction in frequency and duration of exercise, and back and wrist pain. Excessive Facebook use and having a high number of Facebook friends were associated with emotional discomfort (depressive, anxiety, and stress symptoms).Interpretation
These findings present evidence that excessive social networking online is associated with unhealthy habits and negative health effects in Palestinian students. Excessive Facebook use might also lead to increased risk of mental health symptoms and interfere with actual developmental tasks. Public awareness and alternative opportunities for socialisation and recreation are needed to combat this high-risk health trend.Funding
None. 相似文献4.
Background
Young people in the occupied Palestinian territory are facing considerable challenges that affect their wellbeing. As limited research on youth wellbeing in this region exists, this study aims to assess the prevalence of wellbeing and its determinants among youths in the occupied Palestinian territory.Methods
We carried out a secondary data analysis of the Power2Youth cross-sectional survey, conducted between Oct 13, 2015 and Dec 31, 2015 in the occupied Palestinian territory. The sample consisted of 1353 youths aged 18–29 years (53.8% were female) living in the West Bank and the Gaza Strip. Bivariate and multivariate analyses were conducted with the WHO-5 Well-Being Index as the dependent variable and seven independent variables: demographic (age, sex, locality, and region), socioeconomic status (education and subjective economic situation scale), trust in people, personal freedom, political confidence, satisfaction with the quality of governance, and future outlook. Informed verbal consent was obtained from the participants.Findings
The mean wellbeing score was 58·73 (SD 22·7). Age (β=–0·60, p=0·01) and being male were negatively associated with wellbeing, with male scores approximately three points lower than for females on the wellbeing scale (β=–2·80, p<0·05). By contrast, living in camp areas compared to urban areas (β=4·45, p<0·01), trust in people (β=1·92, p<0·001), personal freedom (β=2·02, p<0·001), satisfaction with the quality of governance (β=2·36, p<0·001), satisfaction with economic conditions (β=1·61, p<0·001) and positive future outlook (β=0·67, p<0·01) were all significantly positively associated with wellbeing.Interpretation
The results underscore the impact of demographic, social, economic, and political circumstances on youth wellbeing in the occupied Palestinian territory, with trust in people, personal freedom, and satisfaction with economic conditions having the greatest impact. These variables and satisfaction with the quality of governance were found to have a significant positive association with youth wellbeing, highlighting the importance of the political domain. Finally, the positive association between outlook and wellbeing indicates that youths' future outlook can impact wellbeing in the present.Funding
The research that produced the Power2Youth dataset received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement number 612782. Analysis and production of the Abstract was supported by Oxfam Quebec. 相似文献5.
Background
The eRegistry for maternal and child health is an electronic registry system developed for the collection, analysis, retrieval, storage, and dissemination of information on health determinants and outcomes for women and children. The purpose of the eRegistry is to improve health-care provision and public health surveillance in the occupied Palestinian territory. Given the highly sensitive nature of reproductive health information, however, careful attention to ethical and legal considerations is essential. The aim of this study was to map the legal, regulatory, and ethical landscape using a situation analysis tool tailored for the Palestinian context and to identify gaps, opportunities, and actions necessary to ensure an ethical and lawful framework for an eRegistry.Methods
We used an exploratory situation analysis tool (SAT) to map the current legislative, regulatory, and governance environment in the occupied Palestinian territory. The primary objective was to assess, document, and analyse the legal and ethical landscape. Specific focal topics addressed by the SAT included identifying relevant legislation (eg, civil registration, data privacy, health registries, public health law), existing governance structures, accountability, and oversight bodies (ie, ethical review committees, data protection authorities), and data quality and security policies. The Palestinian National Institute of Public Health (PNIPH) completed the SAT and held workshops for relevant stakeholders, including staff from the ministry of health's legal affairs department, PNIPH staff, and other legal experts. No ethical approval was required because data were collected from public documents.Findings
The findings from the SAT reflect the current situation in the occupied Palestinian territory with respect to existing laws, accountability and oversight bodies, and data collection protocols and policies concerning data privacy and security. Existing Palestinian legislation relevant to health registries includes Article 4 of the General Statistics Law (2000), which honours data confidentiality and the privacy of individuals. The Penal Law number 16 of 1960 addresses the disclosure of confidential information, whereas Article 355 specifically states that disclosure of official confidential information to unauthorised persons is unlawful and could result in imprisonment. Furthermore, the Public Health Law (2004) addresses general maternal and child health issues in Articles 4 and 5. We investigated relevant oversight and accountability bodies (eg, ethical review board) that might be relevant to an electronic maternal and child health registry. Finally, in a review of existing data privacy protocols and policies, we noted that few formal protocols (ie, privacy manual) or policies regulate data collection and access practices.Interpretation
Specific areas within the legal and regulatory framework of the occupied Palestinian territory could be strengthened. The eRegistry Governance Guidance Toolkit, predicated on the SAT content, outlines responsible data stewardship practices and provides assistance in developing protocols and policies in lieu of specific laws by providing a framework to ensure the protection of women and children's privacy. Effective governance that protects women and children's privacy and confidentiality is essential for maintaining public trust and ensuring the long-term success of an eRegistry.Funding
European Research Council and the Norwegian Agency for Development Cooperation (Norad). 相似文献6.
Background
Electronics waste is solid waste that accumulates because of the short lifespan of many types of electronic equipment. Most electronics waste ends up in landfills, whereas some is recycled. In the occupied Palestinian territory, the village of Idhna in the Hebron District is a large site for recycling electronics waste (much of this waste originates from Israel). The aim of this study was to evaluate the effects of electronics waste on human DNA damage and chromosome breaks.Methods
In this cross-sectional study, we recruited non-smoker individuals with direct exposure to electronics waste either because they were employed in the workshops or resident in Idhna. Control participants were selected to match the test sample in age and sex distribution, were recruited from Bethlehem and Al-Aizariya (Bethany). Blood samples in sodium heparin were evaluated for DNA damage using the COMET assay, whereas chromosome aberrations were tested by using conventional cytogenetic techniques.Findings
46 participants were included in the test sample, and 16 participants were included in the control sample. Participants in the test sample had an average of 3·77 chromosomes with aberrations (SD 2·5), whereas participants in the control group had an average of 0·75 chromosomes with aberrations (SD 0·61). The frequency of chromatid and chromosome breaks, formation of rings, and total chromosome aberrations was statistically different between exposed and control samples, but no difference was observed between exposed and controls for the incidence of dicenterics and tetraploidy. Results of the Comet assay showed a significant difference in DNA damage between exposed and control participants (p<0·05). No difference between the workers and the residents living in the area was noted (p<0·05).Interpretation
Exposure to recycled electronics waste in Idhna has potentially adverse health consequences. This is the second study of this kind in the occupied Palestinian territories. Hammad and Qumsiyeh (2013) have previously shown substantial genotoxic effects of Israeli industrial settlement discharge on human populations in Salfit (northern West Bank). Considering increased incidence of cancer and congenital birth defects in the southern part of the West Bank, these findings were important in promoting the case for mitigation measures, which are now under way.Funding
None. 相似文献7.
Asad Ramlawi Alaa Abu Rub Enrico Materia Laura Rossi Nisreen Shuabi Marco Barone Vincenzo Racalbuto 《Lancet》2018
Background
The increasing prevalence of non-communicable diseases in the occupied Palestinan territory accounts for a large part of general mortality. WHO recommends a 30% reduction in mean population intake of salt or sodium as a cost-effective option to decrease the burden of cardiovascular disease. Results of surveys show that salt consumption is 7 g per day in Palestine, almost 50% higher than the recommended daily amount per person. Bread is consumed in large amounts and is an important contributor to salt intake. The aim of this study was to assess the content of salt in the bread sold in the West Bank with the aim of setting a reliable salt reduction target.Methods
In this cross-sectional study, ad-hoc trained inspectors from the ministry of mealth visited 135 bakeries in all West Bank's Governorates in August, 2015. Data were collected through a structured questionnaire administered to bakers with questions about the amount of salt added to flour during the preparation of 281 bread products. The sample size was calculated for a level of accuracy of 7%. Data were analysed using SPSS 17.0.Findings
The average amount of salt added to flour during bread preparation was 1·33 g per 100 g of flour (SD 0·62; range 0·00–4·00), corresponding to 1?11 g salt per 100 g bread.Interpretation
Salt content in bread sold in the West Bank was highly variable. The salt reduction target for 2016 was set by the Palestine Standard Institute at 1·3 g of salt per 100 gram of flour, with a gradual reduction of 0·1 g of salt per year in the next 3 years to adjust consumers' palates to less salty products. The compliance to the regulation is monitored by the ministry of health and the Palestine food producers association assures full support. According to the available literature, the occupied Palestinian territory is the first Arab country to establish a mandatory programme for salt reduction in foods.Funding
The Italian Cooperation. 相似文献8.
9.
Background
Policy development, one of the core functions of public health, is often achieved through professional associations leveraging disciplinary expertise and values via their official policy statements. The 140-year-old American Public Health Association (APHA) has adopted hundreds of policy statements, including several focused on the health implications of war and armed conflict, both in general, and in Iran, Iraq, the Persian Gulf, Nicaragua, El Salvador, and Vietnam. Yet, despite four attempts, the APHA has failed to pass a resolution addressing the health consequences of the Israeli occupation of Palestine. Here, we document the need for solidarity between health professionals in the USA and occupied Palestinian territory, and identify mechanisms predicting success of professional advocacy based on a commitment to international health justice.Methods
We conducted a case study, drawing on extensive literature review, historical analysis, examination of APHA procedures and documents, and interviews with organisations that have been successful in professional advocacy in addressing US policy as it relates to occupied Palestinian territory.Findings
Findings point to four factors within US academic institutions that underlie the advancement of policies relating to occupied Palestinian territory: (1) the moment in history and the political environment; (2) the organisation's history of taking controversial policy stands; (3) the rhetorical strategies deployed; (4) the organisation's structure and process of decision making. We applied these factors to our case study.Interpretation
Findings reveal profound differences in understanding among US public health professionals regarding the effects of the occupation of Palestinian territory on public health in the region. Results suggest that fear of controversy interferes with what should otherwise be an obvious response for US public health professionals. For public health resolutions that are deemed politically controversial, advocates need to adjust the language to respond to the historical moment, and history and culture of the organisation, to effectively counter deflective rhetorical strategies, and to acknowledge the formal and informal power of stakeholders within governing structures.Funding
None. 相似文献10.
11.
Background
Dental caries is still the most prevalent chronic disease worldwide. In the occupied Palestinian territory, data about oral health status and its determinants are scarce. This study aimed to assess the prevalence of dental caries and associated factors among schoolchildren in a random sample of marginalised schools in the West Bank.Methods
Marginalised schools (according to the School Support Program [SPP] criteria) were stratified by district, gender, and grade level to select a random sample of 20 schools. Students in the sixth and ninth grades were interviewed by senior dental students about their oral hygiene and diet habits. Students' weight, height, gingival health, and dental caries experience were assessed. Senior dental students were trained and calibrated to carry out the interviews and the examinations. Parental informed consents were collected by school administrative staff. Ethics approval for the study was obtained from the Al-Quds University Scientific Research Ethics Committee.Findings
In total, 1282 students completed the interviews and the clinical screening. The mean decayed, missing and filled teeth (DMFT) index was 6·4 (SD 4·4). According to the WHO dental caries experience classification, 49% (309 of 623) of the sixth grade students and 74% (484 of 658) of the ninth grade students fell in the high and very high categories. The mother's level of education and recent visit to the dentist correlated negatively with DMFT score (ρ=–0·06, p=0·029; ρ=–0·063, p=0·024). BMI was correlated positively with DMFT (r=0·092, p=0·001). Drinking milk and fresh juices was related to lower DMFT scores (r=–0·077, p=0·006 and r=–0·072, p=0·010). In the final model, grade (β=0·314, p<0·0001), gender (β=0·058, p=0·034), recent visit to the dentist (β=–0·059, p=0·029) and drinking fresh juices (β=–0·054, p=0·047) were significant factors in explaining the high level of dental caries in this sample.Interpretation
Students in the marginalised schools of the West Bank have high DMFT scores that indicate high prevalence of dental caries. Access to dental care and bad oral health habits are associated with high disease prevalence. Interventions to improve access to care and increase awareness about healthy diet and hygiene habits are crucial to alleviate the burden of oral disease in this population.Funding
AMIDEAST School Support Program (SSP). 相似文献12.
Background
The increasing incidence of hospital-acquired infections caused by antibiotic-resistant pathogens has led to an increase in morbidity and mortality worldwide. The aim of this study was to assess the frequency and antibiotic susceptibility of bacterial pathogens isolated at An-Najah National University Hospital (NNUH) in Nablus city in the occupied Palestinian territory during 2015.Methods
A retrospective study was conducted of all positive bacterial cultures obtained from the microbiology laboratory of NNUH. Results of culture and sensitivity of patients' specimens were analysed. Approval was obtained from the institutional review board of An-Najah National University.Findings
Of the 4421 cultures processed, 1335 (30·2%) were positive. 621 (46·4%) bacterial isolates were Gram-positive, 565 (42·3%) were Gram-negative organisms and 151 (11·3%) were Candida species. The most frequent Gram-positive organisms were coagulase-negative Staphylococci (CoNS) and Enterococcus species, followed by Staphylococcus aureus (50·2%, 25·0%, and 14·8%, respectively). Enterococcus coli was the most frequent Gram-negative organism followed by Klebsiella pneumonia, Acinetobacter baumannii, and Pseudomonas aeroginosa (28·3%, 21·0%, 18·4%, and 18·4%, respectively). CoNS showed high resistance to oxacillin (89%) and erythromycin (74·6%). Enterococcus spp had the highest resistance to clindamycin (93·5%), followed by tetracycline (85·7%), and erythromycin (74·6%). S aureus isolates were resistant to oxacillin (56·0%) and erythromycin (52·0%). E coli showed high resistance to ampicillin (90·1%), ceftriaxone (77·0%), fluoroquinolones (eg, ciprofloxacin; 75·0%), and erythromycin (70·2%). K pneumoniae was mostly resistant to ampicillin (100·0%), aztreonam (83·3%), and third generation cephalosporins (ceftriaxone, 80·9%; ceftazidime, 78·2%; and cefotaxime, 77·2%). Pseudomonas aeruginosa showed high resistance to tigecycline (95·4%), ceftriaxone (94·1%), and cefotaxime (95·4%). A baumannii was resistant to all tested antibiotics—including amikacin, cephalosporins, fluoroquinolones, and carbapenems—except tetracycline.Interpretation
The high rates of antibiotic resistance are a cause for concern. Similar studies should be carried out at all hospitals in Palestine in an effort to control the development of antibiotic resistance and the spread of these multidrug-resistant organisms.Funding
An-Najah National University. 相似文献13.
Background
Iodination of table salt (salt for table use) is one of the best methods to eliminate iodine deficiency disorders (IDDs) and associated thyroid diseases. Iodate and iodide levels in table salt may vary for many reasons. There are no studies of the concentration of iodine in salt packs on the shelf and in use (open packs). This study aimed to quantify iodine in salt from twelve brands on the Palestinian market, either produced locally or imported, and both on the shelf and in use (opened).Methods
Samples of table salt (99) were collected from randomly selected market places and households in eleven governorates of the occupied Palestinian territory. From each household, three samples were collected; the first when the consumer started to use the salt package, the second when the package was half consumed, and the third when the package was almost empty. In addition, 12 salt packages were purchased from a local market, one package for each studied brand. The samples were treated and the absorbance of iodate in the sample was measured using a spectrophotometer at 665·6 nm, based on a previous method. In brief, a specific mass of salt was dissolved, then potassium iodide, hydrochloric acid, methylene blue, and acetate buffer (pH 4) were added. The solution was mixed and diluted. A reference solution using 99% sodium chloride was also created with this method. Finally, the absorbance of iodate was measured, and the iodate concentration obtained by subtracting the absorbance of the sample solution from that of the reference solution. The iodate content was then compared to the content printed on the salt package. Iodine content was also quantified for a number of samples after exposure to oven heat or being boiled or heated in water, as well as after exposure to light or dark.Findings
Of the 99 samples, 23 had lost 61% of their iodine content, 28 had lost 80%, and nine had lost all of their iodine. A little less than half (43 of 93) of the samples followed the Palestinian Standard regarding iodine content (3·5–5·5 mg per 100 g), and 70% (69 of 99) complied with the UNICEF recommendation (1·5 mg per 100 g). Iodine content in a newly opened pack (measured immediately after opening) was different from samples taken when the pack was half full, and when the pack was almost empty (0·023 mg/g, 0·0206 mg/g, and 0·0195 mg/g, respectively). The study also showed that up to 68% of iodine was lost during heating in a water solution, whereas dry heat led to a loss of 26%. Iodine loss was higher in light than in dark storage conditions (its concentration dropped from 48·2 mg/kg to 23·6 mg/kg in the dark, and decreased to 22·2 mg/kg in light).Interpretation
A significant proportion of iodine is lost from salt after production and during consumption. There should be more awareness regarding the importance of using iodised salt, and education for consumers about salt storage. The iodine content in salt packages should be monitored by regulatory authorities.Funding
None. 相似文献14.
Tamara Awwad Mahima Venkateswaran Marie Hella Lindberg Khadija Abu Khader Taghreed Hijaz Buthaina Ghanem Kjersti Mørkrid Asad Ramlawi Rand Salman J Frederik Frøen 《Lancet》2019
Background
In primary care maternal and child health clinics in occupied Palestinian territory, documentation and reporting consume considerable time for care providers. An electronic maternal and child health registry (MCH eRegistry), with point-of-care clinical decision support, is being implemented nationally in governmental clinics. We conducted a pilot study of time spent by care providers on important tasks, in preparation for a trial to compare eRegistry and non-eRegistry clinics.Methods
We conducted semi-structured interviews of ten nurse-midwives from six governmental clinics in the West Bank to map clinical workflows, and developed a data collection tool for time-motion observations. In May, 2017, observers recorded one workday in three eRegistry and three non-eRegistry clinics. For each consultation, we calculated the median time spent (in minutes) on each task, and then compared time spent in eRegistry and non-eRegistry clinics using Wilcoxon rank-sum tests. Ethics approvals were obtained from the Palestinian Health Research Council and Regional Ethics Committee, Norway. Informed consent was obtained from all pregnant women.Findings
Twelve antenatal consultations (four first booking visits, eight follow-up visits) were observed in eRegistry clinics and 39 (four first visits, 35 follow-up visits) in non-eRegistry clinics. The median duration of booking visits was 19·9 min (IQR 12·9) in eRegistry clinics and 22·1 min (24·9) in non-eRegistry clinics. In eRegistry clinics, the median duration of follow-up visits was 14·6 min (17·3), of which the median clinical examination time was 1·7 min (0·6) and median health information management time was 5·3 min (5·8). In non-eRegistry clinics, the median duration of follow-up visits was 8·8 min (8·7), of which the median clinical examination time was 2·5 min (2·9) and health information management time was 4·6 min (2·0). This pilot study was not sized for comparisons; health information management time was not statistically different between groups (p=0·1).Interpretation
Health information management constituted large parts of limited antenatal consultation time. The pilot provided data to estimate that the upcoming trial must include a sample of 24 clinics and 210 observations, with similar proportions of booking and follow-up consultations in both arms, to observe meaningful differences in time consumption with sufficient statistical power.Funding
European Research Council and Research Council of Norway. 相似文献15.
16.
Maha Alfaqawi Yousef Abuowda Abdalrahman Alqedra Ahmad Alborno Hisham Abuamro Bettina Böttcher 《Lancet》2019
Background
The WHO trauma checklist reduces morbidity and mortality. This study evaluates adherence of three hospitals in Gaza to the basic WHO checklist standards in order to promote set standards of care.Methods
A multi-centre clinical audit was conducted at the three major hospitals in Gaza (Nasser Hospital, European Gaza Hospital, and Alshifa Hospital), which we refer to as hospitals A, B, and C. A prospective observational study was carried out to assess current trauma care practice and to compare this with the WHO trauma care checklist, which was used as a data collection sheet. A team member selected the sample prospectively and randomly from patients with trauma in the emergency department of each of the hospitals over a 3-month period (June to September 2017), and data were analysed using SPSS.Findings
In each hospital, 50 patients were included, with mean ages of 9·5 years (SD 4·1 years), 21·3 years (7 years), and 13 years (9 years) in hospitals A, B, and C, respectively. The majority of these patients were male; 38 out of 50 patients (76%) in hospital A, 44 of 50 patients (88%) in hospital B, and 37 of 50 patients (74%) in hospital C. Road traffic accidents were the most common cause of trauma in hospitals A and C, whereas falling from a height of 2 m or greater was the most common in hospital B. All patients reached the emergency room within 30 min, mainly by ambulance in hospital A (28 of 50 patients; 56%), whereas private cars were the most frequent type of transportation to hospital B (28 of 50 patients; 56%) and hospital C (30 of 50 patients; 60%). Pre-hospital care was provided by non-trained first responders in all cases. In the emergency room, airway devices and chest drains were provided in all cases when indicated, but intravenous fluids and oximeters were not always used. Intravenous fluids were used in 32%, 34%, and 60% of indicated cases in hospitals A, B, and C, respectively. Oximeters were used in 72%, 74%, and 76% of indicated cases in hospitals A, B, and C, respectively. All patients were checked for internal and external bleeding and pelvic fractures, with immobilisation when indicated. In hospitals A and B, urinary catheters were used in some cases despite no appropriate indication (for 8% and 16% of patients with no indication in hospitals A and B, respectively). In hospital C, urinary catheters were only used when indicated. The broader treatment plan was discussed with patients' families, with good communication with units to which the patients were referred after the emergency room. In the majority of cases (126 of 150 patients), the treatment plan was not documented on the patient's trauma chart.Interpretation
The findings show that adherence to trauma care standards and emergency room care provision vary by hospital. Areas requiring improvement include pre-hospital care and documentation on the patient's trauma chart. Universal use of the WHO checklist, a simple adaptable tool, should facilitate the necessary improvements, and a re-audit should be carried out after this improvement are made.Funding
None. 相似文献17.
18.
Background
China's system of social health insurance is fragmented into three separated insurance plans and is not transferrable across regions, which can leave some migrants without insurance or with multiple insurance. This study aimed to investigate the health insurance status among internal migrants, and its relationship with migration characteristics.Methods
We used data from a national cross-sectional database from the 2014 and 2015 Migrant Dynamics Monitoring Survey in China for respondents aged 15 years or older. We applied multinomial logistic regressions to estimate the association between migration characteristics and health insurance status, adjusting for sociodemographic characteristics. Insurance status included being uninsured, having one insurance plan, and having multiple insurance.Findings
The 2014 sample included 200?937 respondents and the 2015 sample included 201?294 respondents. In 2014, 163?906 (81·6%) migrants were covered by one insurance plan, and 7098 (3·5%) had multiple insurance, while 29?933 (14·9%) were uninsured. In 2015, the uninsured rate and the multiple insurance rate decreased to 7·3% (n=14 783) and 2·9% (n=5780), respectively. Using the 2014 sample, cross-city migration within a province significantly increased the probability of being uninsured by 53% (relative risk ratio 1·53, 95% CI 1·46–1·61) and having multiple insurance by 35% (95% CI 1·22–1·46) compared with intra-city migration, whereas cross-province migration increased the probability of being uninsured by 105% (95% CI 1·93–2·13) and having multiple insurances by 14% (95% CI 1·03–1·23). Living in the destination city for 5 years or longer significantly increased the likelihood of being uninsured by 4% (95% CI 1·01–1·08) and having multiple insurance by 30% (95% CI 1·21–1·37), compared to those staying for less than 1 year. The same patterns held in the 2015 sample except that no statistically significant relationship was detected between years lived in the destination city and having multiple insurance.Interpretation
Cross-province migration and living in the destination city for longer times were positively associated with no insurance and multiple insurance, causing inequality and inefficiency in the insurance system. Policies that integrate the three insurance plans across the country should be urgently promoted to achieve universal coverage.Funding
National Nature Science Foundation of China (grant no 71403007 and 71503059). 相似文献19.
20.