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Background
Women face gender inequality and marginalisation in many aspects of their lives that affect their wellbeing and role in life as important members of society. This study aimed to investigate attitudes towards gender equality in Palestinian youth, and the associated factors.Methods
We used the Power2Youth 2015 dataset, which consists of a sample of 1353 young people aged 18–29 years (46% males and 54% females) living in the West Bank and Gaza. Households with youths were randomly selected. In the households with more than one youth, a kish grid was used to select the youth participant. Our Prowomen scale was developed to measure participants' attitudes towards gender equality by scoring their responses to 15 questions related to gender equality issues such as the ability and right to work, divorce laws, inheritance rights, leadership, and the right to education. Positive responses to statements favourable to gender equality or biased towards women were given a score of 1, and disagreement was given a score of 0. For statements that were unfavourable to gender equality, disagreement was given a score of 1, and agreement a score of 0. Scores were then summed into one composite score, ranging from 0 to 15. Multivariate linear regression was used to examine the association between individuals' scores on the Prowomen scale (the outcome variable) and gender, age, wealth index, place of residence, education, mother's education and employment, and their score on a scale measuring the perceived influence of women in society (developed using questions relating to women's influence in choosing their spouse, education, and work). Ethics approval for the project was attained from Birzeit University and informed verbal consent was obtained from all participants.Findings
Of the factors assessed, the main predictors of attitudes towards gender equality were gender, age, place of residence, education, mother's education and employment, and the perceived influence of women in society. The scores ranged between 0 and 15 on the Prowomen scale. On average, men agreed with 2.3 fewer items than women (β=–2·334, p<0·0001). Residents in the West Bank had significantly higher scores than residents in the Gaza Strip (β=0·843, p<0·0001). Residents of camps had significantly higher scores than residents of urban areas (β=0·783, p<0.0001). Respondents educated to beyond secondary level supported approximately one additional item (β=0·979, p<0·0001) compared with those educated to below secondary level. Mother's education and employment were also significantly and positively associated with scores on the Prowomen scale. Youths whose mothers had completed secondary education or higher supported approximately one additional item on the scale compared with youths whose mothers were educated to below secondary level (β=0·837, p<0·01). Respondents whose mothers were employed also supported approximately one additional item (β=0·923, p<0·01). Each time respondents reported that they believed women had influence, they supported approximately 0·3 items on the Prowomen scale (β=0·269, p<0·001).Interpretation
Our results highlight the need to target men with awareness programmes relating to gender equality. Women's education, and that greater involvement and inclusion of women in society and in the labour market can potentially foster more favourable attitudes towards equality.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. Data analysis and production of the Abstract was supported by the Arab Fund for Economic and Social Development. 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
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5.
Mervett Isbeih Mahima Venkateswaran Tamara Awwad Buthaina Ghanem Khadija Abu-Khader Taghreed Hijaz Mohammad Baniode Eatimad Abbas Rand Salman Asad Ramlawi Binyam Bogale J Frederik Frøen 《Lancet》2019
Background
Good quality data from health systems can benefit several stakeholders, including policy makers, care providers, clients, and researchers. Conventional data collection methods for maternal and child health, such as household surveys, may not be suitable to assess processes of service delivery. The electronic maternal and child health registry (MCH eRegistry) has been implemented in 182 governmental primary care clinics in Palestine. Here we present the data in the MCH eRegistry.Methods
We processed the raw data in the MCH eRegistry from the West Bank, and documented validation rules for crude data points (time of entry, values allowed). Definitions and appropriate categorisations were created for core process indicators. Data from the MCH eRegistry and the electronic health information system in governmental hospitals were linked using statistical software.Findings
As per the second quarter of 2018, the MCH eRegistry contained raw data on 69?793 antenatal care visits, 27?304 postpartum care visits and 40?264 newborn care visits. From antenatal care, data on core process indicators were available for screening of anaemia (n=48?542), hypertension (n=66?814), diabetes (n=18?013), asymptomatic bacteriuria (n=31?757), as well as antenatal ultrasound (n=55?453). Distributions of raw data on haemoglobin and blood pressures had no extreme outliers. Links had been established between antenatal care and delivery data in governmental hospitals for 51% of births.Interpretation
The MCH eRegistry contains data from antenatal to postpartum and newborn care. These data have been successfully linked with delivery data, resulting in a large data set on continuity of care and birth outcomes. Furthermore, the data are accessible, of good quality, and can be used for studies of quality of care and maternal and newborn epidemiology, among others. Researchers are invited to use this resource in working towards improving the health system and the health of Palestinians.Funding
European Research Council and Research Council of Norway. 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.
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8.
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9.
Background
Metabolic syndrome is characterised by the presence of several metabolic abnormalities, including hyperglycaemia, central obesity (also known as abdominal obesity), elevated blood pressure, and an abnormal blood lipid profile. The prevalence of metabolic syndrome is rising rapidly around the world as childhood obesity is increasing. The aim of this study is to determine the prevalence of metabolic syndrome in school children aged 6–18 years residing in Ein Alhelwe Refugee camp in Saida, Lebanon.Methods
School children aged 6–18 years from the first to twelfth grades from two United Nations Relief and Works Agency (UNRWA) schools were randomly chosen. We used a school-based cross-sectional study design with two stages. The first stage included measurements of weight, height, body mass index (BMI), waist circumference, and blood pressure. In the second stage, blood tests were carried out for fasting blood sugar, triglycerides, and high-density lipoprotein (HDL). Approval was obtained from the ethics committee at Al Hamshari Hospital in Saida, Lebanon. Written permission was obtained from the UNRWA and the principals of the two schools for the first stage, and informed written consent was obtained from parents on behalf of the children involved in the second stage of the study.Findings
The first stage of the research included 487 participants (258 female, 229 male) and the second stage included 73 participants (36 overweight participants [12 male, 24 female] and 37 obese participants [19 male, 18 female]). The prevalence of overweight and obesity were 15·2% (74 of 487) and 14·4% (70 of 487) among all age groups, respectively. Among Palestinian refugee school children in Saida aged 10–18 years, the prevalence of metabolic syndrome was more pronounced when the modified National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP-III) definition was used (30·9%; 21 of 68) compared to the International Diabetes Federation (IDF) definition (11·8%; eight of 68), with no statistical differences between male and female participants. Note that the IDF definition can be applied to children aged 10–18 years, of whom there were 68 participants, and for comparison between IDF and NCEP ATP-III, prevalence of metabolic syndrome was calculated for participants in this age range. Low HDL cholesterol (52·1%; 38 of 73), central obesity (46·6%; 34 of 73), and raised blood pressure (42·5%; 31 of 73) were the leading three common metabolic abnormalities among children who were overweight or obese.Interpretation
This study has shown that metabolic syndrome is common among children who are obese or overweight, who are aged 10–18 years, living in Ein Al-Helwa Refugee Camp in Saida, Lebanon. These data raise the importance of early prevention and treatment of metabolic syndrome and its components (abdominal obesity, elevated triglycerides, reduced HDL cholesterol, elevated blood pressure, and elevated blood glucose) to reduce the risk of diabetes and cardiovascular complications in susceptible individuals. A potential limitation of this study is that the small sample size may not accurately reflect the prevalence of metabolic syndrome.Funding
Palestinian Civil Society Organizations Commission, Life Hope Center, and Palestinian Red Crescent Society Al Hamshari Hospital. 相似文献10.
Background
Socioeconomic factors have been found to be related to adolescents' dietary habits, physical activity, and body mass index (BMI). 50 schools in the West Bank that face socioeconomic and political challenges in terms of infrastructure, academic achievement, dropout rate, limited access, geography, and economic status were labelled as marginalised by the AMIDEAST School Support Program (SPP). This study aimed to describe and assess factors relating to dietary habits, energy drink consumption, BMI index, and physical activity in Palestinian adolescents attending marginalised schools.Methods
Marginalised schools (n=50) were stratified by district and gender to select a random sample of 20 schools. All students in sixth or ninth grades in the targeted schools were interviewed one-to-one by one of 14 senior dental students who were trained and calibrated by a public health specialist. The schoolchildren were asked about their dietary habits, such as daily consumption of added sugar, carbonated drinks, sweetened juices, and energy drinks. Daily intake of milk, fruits, vegetables, nuts, and non-vegetarian food were also assessed. In addition, schoolchildren's physical activity, father's employment and mother's education were recorded. Weight and height were measured, and BMI percentile was calculated. Parental informed consents were collected by the school administration. Ethics approval for the study was obtained from Al-Quds University Scientific Research Ethics Committee.Findings
A total of 1282 students out of 1308 completed the questionnaire; a response rate of 98%. Of our sample, 6% (77 of 1282) were underweight (5th percentile or under) and 34% (436 of 1282) were overweight or obese (85th percentile or over). Among sixth graders, 43% (155 of 360) of the boys and 24% (59 of 247) of the girls were overweight or obese. The opposite was true for ninth graders; 20% (54 of 268) of the boys and 42% (158 of 377) of the girls were overweight or obese. Ninth graders had more added sugar in their diet than sixth graders (p=0·002), less milk consumption (p<0·0001), more energy drink consumption (p=0·001), and less physical activity (p<0·0001). Consumption of carbonated and sweetened drinks was associated with being overweight or obese (p=0·016, p=0·001). Consumption of carbonated drinks was higher among children of mothers with a high-school education than among children of mothers with college degrees (p<0·0001). In addition, children of mothers educated to high school level or below were associated with being underweight (p=0·05)Interpretation
The results of this study suggest that dietary habits worsen between the ages of 12 years and 15 years. The mother's level of education is an important factor in being overweight or underweight. Interventions to increase awareness of the importance of healthy diets and physical activity among adolescents and their mothers should start before the age of 12 years.Funding
AMIDEAST School Support Program (SSP). 相似文献11.
Background
Breast cancer is the leading cause of cancer deaths among females in Palestine. The aims of this study were to assess the histological types of breast cancer, the stage at diagnosis, and oestrogen receptor status of women with breast cancer in the West Bank.Methods
This retrospective study was conducted in the two major outpatient oncology clinics of the West Bank (Al-Watani Governmental Hospital in Nablus and Beit Jala Governmental Hospital). The data collection form was completed by reviewing patients' medical records. SPSS was used for data analysis. The study was approved by the Institutional Review Board of An-Najah National University and the Palestinian Ministry of Health.Findings
The study included 400 women with an average age of 52·16 years (SD 11·56); as the number of patients with breast cancer in the country was not known, a sample size calculator was input with an estimate of breast cancer cases, as given by six oncologists. Ductal carcinoma was the most common histological type (79%; 317 of 400), followed by lobular carcinoma (15%; 60). Patients were most commonly diagnosed at stage three (27%; 106), followed by stage two (25%; 100), stage four (24%; 95), and stage one (20%; 81). Most patients (88%; 353) were not tested for BRCA1 and BRCA2 gene mutations. Among the tested patients, 5% (21) had BRCA1 or BRCA2 gene mutation. Regarding oestrogen receptor status, 249 out of 386 women (65%) for whom data were available had a positive test, and the progesterone receptor test was positive for 225 out of 385 women (58%) for whom data were available. In terms of HER2 receptor overexpression, 306 out of 381 women (80%) for whom data were available had negative test results.Interpretation
The most common type of breast cancer among Palestinian women is invasive ductal carcinoma. Approximately half of the patients were diagnosed at stage three or four, indicating that better awareness and earlier diagnosis are needed. A high percentage of patients had positive oestrogen receptor and progesterone receptor status, which makes hormone therapy an important part of treatment.Funding
None. 相似文献12.
Background
Metabolic syndrome is one of the main reasons for elevated mortality worldwide. The aim of this study was to characterise and establish sex-adjusted prevalence of metabolic syndrome in young Palestinian adults.Methods
This cross-sectional study was done at An-Najah National University in 2014 using International Diabetes Federation (IDF) and modified National Cholesterol Education Program-Third Adult Treatment Panel (NCEP) definitions. Approval was obtained from the Institutional Review Board, and written informed consent was obtained from all participants.Findings
Of 850 students (352 men, 498 women) aged 18–24 years, 178 (21%) were overweight, and 45 (5%) were obese. 154 students were enrolled in this study (89 [58%] men, 65 [42%] women). 114 [74%] participants were overweight, and 40 [26%] participants were obese. Metabolic syndrome was more prevalent when the IDF definition was used (44 [29%] participants) than when the modified NCEP definition was used (37 [24%] participants; p<0·001), with no differences between men and women (p>0·05). Metabolic syndrome was more prevalent in participants with obesity than in students with overweight according to the IDF definition (16 [40%] vs 29 [25%]) and the modified NCEP definition (14 [35%] vs 23 [20%]). The prevalence of individual metabolic syndrome components was: 111 (72%) for central obesity (48 [43%] men, 63 [57%] women) according to the IDF definition, and 66 (43%) participants (18 [27%] men, 48 [73%] women) according to the modified NCEP definition; 46 [30%] for increased blood pressure (33 [72%] men, 13 [28%] women); 28 [18%] for high triglycerides (24 [86%] men, four [14%] women); 115 [75%] for low HDL-cholesterol (72 [63%] men, 43 [37%] women); and 37 (24%) for impaired fasting glucose (22 [59%] men, 15 [41%] women). Low HDL-cholesterol, central obesity, and raised blood pressure were the leading three common metabolic abnormalities in participants.Interpretation
Irrespective of the definition used, metabolic syndrome is highly prevalent in Palestinian young adults. With the increase of obesity, the clustering of metabolic syndrome components was remarkably increased. More attention should therefore be given to the adult population at risk to reduce adulthood obesity and subsequent cardiovascular disease.Funding
None. 相似文献13.
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14.
Yara Hadweh 《Lancet》2019
Background
Reproductive health rights were declared as fundamental human rights at the International Conference on Population and Development in Cairo in 1994, and at the Fourth World Conference on Women in Beijing in 1995. Acknowledgment of the importance of these rights was a momentous event for reproductive health. In the Palestinian context, reproductive health rights are severely affected by the political system and cultural context. There has been growing interest in efforts to strengthen women's knowledge and opportunities to promote their reproductive health rights in Palestine. This study aimed to identify the multiple political, demographic, and cultural factors that influence Palestinian women's reproductive health rights as well as their knowledge, awareness, opportunities, and challenges regarding these rights.Methods
The study was designed with two parts. First, a thorough review of previous literature was carried out using key terms and definitions to search for papers, to gain an overview of reproductive health rights in Palestine, focusing on the long-standing conflict, the Palestinian cultural context, and Palestinian law. Second, an empirical qualitative study was carried out using semi-structured interviews that were carried out via Skype. A purposive sample of ten Palestinian women aged 18–55 years, and living in the Bethlehem Area of the West Bank, were chosen. The sample was selected to include Islamic and Christian women, refugee and non-refugee women, and housewives and working wives. Interviews formed the basis of the analysis. The theory of intersectionality was used to guide the various discussions and debates within the interviews. All interviews were conducted in Arabic, recorded on a portable device, and translated into English. They were then analysed using the Six-Phase Thematic Analysis. Ethics approval was obtained from the Queen Margaret University Ethics Committee. Informed written consent was obtained from participants.Findings
The literature from approximately the past 20 years confirms that women's health has had a place in Palestinian health regulations and policies. Many Palestinian organisations and institutions have launched procedures to promote reproductive health for women and their families, through maternal and child health services. Despite the focus on women's health and reproduction, access to knowledge or education regarding reproductive health rights in Palestine is limited. Access has been hampered by the combination of the political situation and traditional cultural norms existing in Palestinian society. Interviews were considered in the context of several themes and sub-themes: knowledge, information, and education (knowledge levels and access to information and knowledge); services and resources (accessibility and distribution of services); Palestinian context and norms (patriarchal society and loss of privacy and decision making); conflict and occupation (restriction of movement, and discrimination and humiliation); and violence against women. These themes shaped women's knowledge of reproductive health rights, highlighting factors that influence the existing opportunities and challenges for women to access reproductive health care and services, health-seeking behaviours, and overall wellbeing. Reproductive health rights in Palestinian society are perceived and acknowledged differently by different group of individuals (eg, between those living in cities and those in villages), but such differences are rarely mentioned in laws, policies, or programmes relating to reproductive health. Moreover, there is often a gap between laws and policies that are set, and what is implemented.Interpretation
This research emphasises the great importance of women's reproductive health rights in Palestine. Two significant limitations were the unavailability and scarcity of literature on Palestinian women's reproductive health rights, and the sensitive nature of the political conflict. It is recommended that governments demonstrate commitment to prioritising initiatives to promote reproductive health rights. Further research regarding reproductive health rights should be conducted in other areas of Palestine.Funding
None. 相似文献15.
Liana Al-Labadi Reem Shahin Frank Eperjesi Yousef Al-Shanty Yasmine Abdel Rahman Mohammad Shehadeh Ithar Beshtawi Abdulsalam Al-Khayatt 《Lancet》2018
Background
Vision screening programmes for preschool children (aged 3–5 years) have been implemented for early detection and intervention of blinding visual disorders. In the occupied Palestinian territory, scientific data on visual disorders among preschool children are lacking. The aim of this study was to determine the prevalence of visual disorders in Palestinian preschool children living in urban areas.Methods
In this cross-sectional study, preschools in Nablus city were selected using a cluster sampling randomised technique. All attending children aged 3–5 years were included in a vision screening after parental consent was obtained and a self-administered parental questionnaire was completed. The screening assessment included visual acuity, ocular alignment, depth perception, colour vision, non-cycloplegic retinoscopy, and ocular health. Children who failed the screening were referred for cycloplegic comprehensive eye examination. We used percentage and 95% CI to describe the prevalence, and the Pearson χ2 test was applied to determine any associations. A p value less than 0·05 was considered significant. An Institutional Review Board's ethical approval was obtained.Findings
764 children from eight preschools were included in the vision screening. 127 children failed the screening test and proceeded to the comprehensive eye examination referral. The most prevalent visual disorders were refractive error (176 [29%] children), amblyopia (15 [4%]), colour vision deficiency (seven [1%]), strabismus (seven [1%]), and ocular health abnormalities (four [1%]). We found no variation in the prevalence of refractive errors by age (p=0·35) or sex (p=0·32). The leading causes for amblyopia were anisometropia (seven [1%] children), significant refractive error (six [1%]), and strabismus (two [<1%]).Interpretation
Refractive error was the most prevalent visual disorder in Palestinian preschool children in Nablus. Both anisometropia and significant refractive errors were found to be the major causes of amblyopia. Although this study presented valuable information with respect to visual disorders among children at preschool age, the small sample size is a major limitation and the results cannot be extrapolated to the entire country.Funding
None. 相似文献16.
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17.
18.
Background
Gram-negative bacteria are a common cause of human infections and can be transmitted through food handling and food consumption. Infection with carbapenemase-producing Gram-negative bacteria is becoming a worldwide threat, and is hard to cure because the broad-spectrum carbapenem antibiotics are considered a last resort for treatment. This research aimed to determine carbapenem resistance among Gram-negative bacteria from poultry samples.Methods
Samples from chicken litter, water, chicken feed, and intestinal content (220 samples in total) were collected during 2017 from representative slaughter houses, farms, and homes from four different randomly selected locations in the Gaza Strip. Samples were cultured and all isolates were identified using conventional techniques. The Clinical and Laboratory Standards Institute disk diffusion method was used to determine antimicrobial susceptibility to 15 antimicrobial agents. Carbapenemase was detected by the modified Hodge test. The multiple antibiotic resistance (MAR) index for each isolate was also calculated. Permission was obtained from the Ministry of Agriculture, and verbal consent was obtained from owners of the establishments.Findings
Escherichia species were the most frequently isolated bacteria (48 of 122; 39%), followed by non-lactose fermenting Enterobacteriacae (36 of 122; 30%) and other lactose fermenting Enterobacteriacae (32 of 122; 26%). The lowest frequency was for non-fermenting Gram-negative bacilli (six of 122; 5%). Most isolates were resistant to most antimicrobial agents tested except for meropenem and amikacin (3% were resistant to meropenem and amikacin), and 41 isolates (34%) were resistant to imipenem. From 122 tested isolates, 42 carbapenem-resistant isolates (36%) were detected. There was no significant difference in resistance to carbapenem or other drugs among isolates from the four locations. None of the three meropenem-resistant isolates and only five of the 41 imipenem-resistant isolates (12%) were positive for carbapenemase production. Most of the tested isolates (115 of 122 isolates; 94%) were resistant to five or more of the tested antimicrobials, and were regarded as multi-drug resistant according to MAR index results.Interpretation
Resistance to carbapenems as well as to other antimicrobials was high, as indicated by the MAR index. This might be due to the lack of regulation of the use of antimicrobials in poultry. The responsible authorities should take note of these findings and implement an immediate antimicrobial resistance monitoring programme for poultry. Cross-contamination prevention measures should also be promoted and implemented.Funding
None. 相似文献19.
20.
Abdelrahman Alshaikh Ahmad Mohammed Al.Qudairi Abdulah Abo Jalambo Mohammed Elser Khalid Alnahhal Khamis Elessi Mohammed Kalloub 《Lancet》2019