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1.
Majed Hababeh Amjad Matooq Abdalla Odattalla Asa&#x;ad Na&#x;jeh Hanan diab Imad Burbara Amjad khoury Zaki Saleh Ayoub Ayoub Mohammad Salameh Mohammad Hadi Saleh Ali Khader Akihiro Seita Patricia Di Caccamo Lilia Biscaglia Mari Antonietta Arrica Cristiana Zerosi Guglielmo Campus 《Lancet》2019
Background
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) School Health Programme provides preventive oral health services to school students through regular dental screening of new entrants and fourth and seventh grade students, in addition to the health education activities and treatment of decayed teeth provided by dental surgeons in health centres and by mobile dental teams. The main focus of UNRWA oral health services continues to be prevention rather than treatment. The objective of this follow-up survey was to calculate decayed, missing, and filled teeth (DMFT), and decayed, missing, and filled surfaces (DMFS) indices among seventh grade UNRWA schoolchildren in all five areas in which UNRWA operates (Gaza, Jordan, Lebanon, Syria, and West Bank), and to compare the results of this survey globally, locally and with a previous survey conducted in 2010 and 2011.Methods
A cross-sectional survey was conducted by calibrated examiners between March, 2016, and May, 2016. Two-stage sampling was used, with schools selected during the first stage and classes selected in the second stage. The sample size was calculated based on the number of students registered in each area. The confidence level was 95%, power 80%, and precision 5%. A total of 1550 children participated (100% response rate), 383 in Jordan, 390 in Lebanon, 340 in West Bank, and 437 in Gaza. All participants provided verbal informed consent. Data were analysed using Epi Info 7. Multiple logistic regression was used to analyse caries experience, prevalence of caries, and the most relevant behavioural and sociodemographic indicators. A p value of less than 0·05 was considered statistically significant.Findings
The prevalence of dental caries among examined children was 72·8% (1129 of 1550; 95% CI 70·5–75·0); the highest prevalence was in the West Bank (79·7%; 271 of 340) and lowest was in Jordan (68·4%; 262 of 383). The prevalence of untreated decayed surfaces was 69·4% (1076 of 1550; 95% CI 67·0–71·7); the highest prevalence was in the West Bank (76·8%; 261 of 340) and lowest was in Jordan (64·0%; 245 of 383). The percentage of children with one or more sealed permanent teeth was 9·8% (8·4–11·4), compared with 6·8% in 2011, and with wide variation between areas; the highest prevalence was in Lebanon (31.5%), while in Gaza and the West Bank the prevalence was less than 2·0%. The percentage of children who did not use a toothbrush and toothpaste was 19·1%, compared with 22·0% in 2011. The percentage of children who cleaned their teeth after every meal was 59·3% (919 of 1550), compared with 31·6% in 2011. Overall, 18·3% (284 of 1550) of children had never attended a dentist, and 83·1% (1289 of 1550) had experienced toothache in the past. In the total sample, 66·0% (1022 of 1550) of children were used to drinking soft drinks during meals. This habit was less frequent in Gaza (37·5%; 164 of 437) than in Jordan (71·1%; 272 of 383), the West Bank (75·0%; 255 of 340), and Lebanon (75·0%; 292 of 390).Interpretation
The prevalence of dental caries remains very high in Palestinian refugee school children, of whom only 27·2% are free of caries. The high percentage of untreated dental caries and the low percentage of sealed teeth call for increased efforts, refinement, and completion of the preventive strategies of the UNRWA. The main behavioural factors relating to the prevalence and severity of caries were frequency of sugar intake between meals and soft drink consumption.Funding
None. 相似文献2.
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3.
Background
The Cause of Death Registry data are derived from death notification forms (DNFs). These data are used to formulate mortality statistics that are used in the development of health systems and in public health planning. This study assessed the quality of registered data in DNFs in Gaza to form a basic understanding of the current situation, and with a view to providing evidence-based recommendations to improve data quality.Methods
In 2016, the Ministry of Health issued 4861 DNFs in the Gaza governorate. A representative sample of 509 DNFs was selected using proportional systematic random sampling. A set of indicators was identified using the WHO guidelines for DNF data quality assessment. 13 data items were identified to represent administrative data plus nine items to represent medical data, and a total score for completeness was calculated. The quality of medical data was examined by a doctor trained to analyse the quality of mortality data. Administrative approval was obtained from the Ministry of Health. The assessment did not include any personal data (and all data were anonymous).Findings
The completeness of administrative and medical data was 89·0% (5500 of 6180) and 47·3% (2168 of 4581), respectively. For the underlying cause of death, completeness was 36·5% (186 of 509). The completeness of ICD-10 coding was 46·8% (238 of 509) for the direct cause of death and 12·6% (64 of 509) for the underlying cause. Only 23·0% (three of 13) of DNFs for women of reproductive age indicated whether the woman was pregnant or not and whether her death was related to maternal health problems. The ICD-10 codes with the written cause of death were checked and the ICD-10 documentation was correct in 58·0% (138 out of 238) of DNFs for the direct cause of death and 67·2% (43 out of 64) of DNFs for the underlying cause of death.Interpretation
The completeness and accuracy of medical data in DNFs is low. There is an urgent need to train physicians and medical interns to give the correct death sequence and ICD-10 codes, particularly for the underlying cause of death.Funding
None. 相似文献4.
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5.
6.
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7.
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.
10.
Background
Work engagement is a positive, fulfilling affective and motivational state of work-related wellbeing and a protective factor for workers' mental health. The aim of the present study was to examine the association between psychological distress (conceptualised as the target variable), job satisfaction, and work engagement in contexts of low-intensity warfare and political violence. According to the salutogenic perspective, the relationship between job satisfaction and psychological distress is influenced by the level of work engagement.Methods
We selected a convenience sample of 380 Palestinian teachers from Gaza (40%, 152 out of 380) and the West Bank (60%, 228 out of 380). The participants were recruited on-site during morning breaks from the classroom teaching activity. The selection criteria were being in a teaching position, and working in a primary or lower secondary school. The participants completed the Arabic versions of the Teacher Job satisfaction Scale (TJSS-9), the General Health Questionnaire (GHQ-12) and the Utrecht Work Engagement Scale (UWE-SF). The statistical strategy was based on structural equation modelling. The study was approved by the Ethical Board of the University of Milano Bicocca. Informed written consent was obtained from all participants.Findings
The General Health Questionnaire cumulative score revealed a medium to high level of psychological distress (mean 18·68 [SD 4·03]) among teachers, but high job satisfaction (mean 27·18 [SD 5·65]). The structural model showed an excellent fit (χ2 (23)=69·6, p<0·0001, NC=3·021, NFI=0·939, NNFI=0·959, CFI=0·958, RMSEA=0·073). Job satisfaction and psychological distress had a moderate and inverse relationship that was, statistically speaking, fully mediated by the level of work engagement (F=17·05, p<0·001, R2=0·16). The direct effect of job satisfaction on work engagement was positive and medium (according to Cohen, 1988) in strength.Interpretation
The main finding of the study is that work engagement may mediate the impact of job satisfaction on teachers' psychological distress by lessening the effect of difficult working conditions. It further suggests that in order to mediate the effect of low job satisfaction on psychological distress of teachers, organisational policies and practices should focus on improving employees' work engagement. This means that, in developing job programmes for teachers in contexts characterised by difficult working conditions, the main focus must be to increase the level of subjective resources (eg, inner states, emotional activation, personal motivational processes) and workers' engagement rather than focusing primarily on job satisfaction.Funding
None. 相似文献11.
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12.
Mohammad Qadi Lubna Kharraz Amira Shaheen Athar Amleh Fatima Ibrahim Doaa Abu Saleh Hanin Rabee Ro&#x;ya Hamed Ghassan Shakhshir Rasha Khayyat 《Lancet》2019
Background
The health and safety of children at schools in Palestine are not paid the attention they require. Our objective was to assess the major risks and patterns associated with hygiene and sanitation at selected schools in Nablus in the West Bank.Methods
A two-layer cross-sectional survey was implemented to collect data on hygiene, sanitation, and bacterial contamination from pupils and staff at ten urban schools in Nablus. We took swab samples from 199 children's and eight food handlers' dominant hands and from 82 school bathrooms and classrooms. We observed and recorded variables related to school hygiene on a pre-prepared form. Bacterial identification for each sample was done at An-Najah National University. Using univariate and multivariate analysis, risk factors related to hygiene and sanitation were tested for individual and combined association with the presence of bacterial species transmitted primarily through fecal-oral contamination. Approval was obtained from the institutional review board committee at An-Najah University and consent forms were signed by children's parents and by food handlers.Findings
Our findings showed non-statistically significant associations between the presence of bacterial species that indicate a substantial risk of fecal-oral contamination (Listeria, Streptococcus, Microccocus, Bacillus subtilis, and Gram-negative bacilli) and the following factors: school address (univariate analysis, p=0·384), absence of soap in the school, absence of hand washing after use of bathroom, increased number of children per classroom, and decreased numbers of teachers, toilets, and sinks per number of students at school (ordinal logistic regression, p=0·084).Interpretation
This pilot study highlights the presence of several risk factors for bacterial contamination, including child behaviour and aspects of the school environment, favouring the possible spread of fecal-oral transmitted diseases. Policy makers' efforts should be turned towards new policies rendering schools a safer place for Palestinian children. This study has to be validated on a larger scale and in other cities in the occupied Palestinian territories.Funding
This research was funded by An-Najah University as a support for research projects of medical students. 相似文献13.
Samah W Al-Jabi Sa&#x;ed H Zyoud Waleed M Sweileh Aysha H Wildali Hanan M Saleem Hayat A Aysa Mohammad A Badwan Rahmat Awang 《Lancet》2019
Background
The ability to identify indicators of poor health-related quality of life (HRQoL) is crucial for both improving clinical care and determining targets of intervention for the prevention and treatment of disease. The main objectives of this study were to assess the HRQoL profile of individuals with hypertension in Palestine, and to determine the sociodemographic and clinical characteristics associated with poor HRQoL.Methods
A cross-sectional study was conducted, adopting the EuroQoL-5 Dimensions scale (EQ-5D-5 L) for the assessment of HRQoL. Patients with hypertension attending the outpatients' clinic at Al-Makhfyah primary health care clinic and from the outpatients' clinic at Alwatani Hospital, Nablus, Palestine, were approached for the study. The study was approved by the Institutional Review Board at An-Najah National University. Informed verbal consent was obtained from the participants before the start of the study.Findings
A total of 410 patients with hypertension were enrolled from the two centres (205 patients from each centre). Of these patients, 51·95% (213 of 410) were females. The average age of the study population was 58·37 (SD 10·65) years. The mean EQ-5D-5 L index value and EQ visual analogue scale (EQ-VAS) scores were 0·80?(SD 0·16) and 74·13?(15·62), respectively. There was a significant positive correlation (r?=?0·56; p<0·001) between the EQ-5D-5L index values and the reported EQ-VAS scores. Higher EQ-5D-5L index values were significantly associated with patients who were younger than 50 years, employed, married, with income higher than US$500, who were university graduates, with a disease duration of less than 1 year, with or without one comorbid disease, and those taking 1–3 medications (Kruskal–Wallis test, p<0·05), as well as with male gender and monotherapy (Mann–Whitney test, p<0·05).Interpretation
The results highlight that specific sociodemographic and disease-related characteristics of patients with hypertension, as well as treatment factors, are strongly associated with HRQoL. The study findings may be helpful in clinical practice, particularly in the early treatment of such patients, at a point at which improvement of HRQoL is still possible.Funding
None. 相似文献14.
Background
Palestinian refugees living in Lebanon continue to face social and economic exclusion that hinders their ability to improve their living conditions and livelihoods. This study aimed to investigate the effect of a two-pronged intervention that employed women through social enterprises to deliver a subsidised healthy daily school meal to elementary schoolchildren in Palestinian camps.Methods
We established two healthy kitchens in community-based organisations in Palestinian camps; these kitchens employed 32 women to provide daily meals to children attending primary schools. We used mixed methods to assess the effect of participating in the intervention on the women's economic, social, and food security outcomes. We also assessed the impact of the subsidised meal programme on children's dietary diversity, nutritional status, school absenteeism, and achievement in two intervention schools, compared to two control schools. Difference-in-difference and regression analyses were conducted to examine the associations between participation and outcomes, controlling for potential confounders. Quantitative and qualitative data analyses were conducted using Stata 13·0 and NVivo 10, respectively. Written informed consent was obtained from women and parents, followed by assent from children prior to participation. All study protocols were approved by the Institutional Review Boards of the American University of Beirut and the University of Maryland.Findings
At baseline, women's median household expenditure was US$169 per capita per month. Additional income due to the intervention was equivalent to US$110 per month, which translated into increases in total household and food expenditures (p=0·040), as well as a reduction in food insecurity (p=0·006). Qualitative data found improvements in morale, social support, and decision making. There were 648 children in the control group, and in the meal programme group there were 260 children with low participation (LP; participated less than 50% of total school days) and 454 with high participation (HP; participated more than 50% of total school days). There was a significantly greater increase in overall diet diversity score (Δ0·32, p=0·0060) and dairy consumption (odds ratio 1·2, 95% CI 1·1–1·3) in the HP group compared to controls. Both LP and HP groups were more likely to consume proteins, and less likely to consume sweetened beverages and desserts than controls. Furthermore, the HP group had a significant increase in haemoglobin (p=0·05) and both LP and HP groups had a significant decrease in school absenteeism (p=0·04) compared with controls.Interpretation
This study provides evidence of the positive effect of the Healthy Kitchens, Healthy Children model on economic, food security, and social outcomes of marginalised women, as well as diet diversity, haemoglobin, and school outcomes of children. This intervention contributed to human capital gains in two generations of protracted refugees.Funding
The Nestle Foundation for the Study of Problems of Nutrition in the World. 相似文献15.
16.
Enas Alaloul Mohamedraed Elshami Esraa Khader Huda Abu Nemer Alaa Alhelu Israa Awad Heba Baraka Bettina Böttcher Khamis Elessi 《Lancet》2019
Background
For patients with breast cancer, the quality of care following mastectomy should be designed with long-term goals to ensure the physical and psychosocial wellbeing of survivors. This study explores the impact of mastectomy on the quality of life of breast cancer survivors in the Gaza Strip.Methods
This cross-sectional study involved the only two oncology centres of the Gaza Strip. In total, 173 patients who had undergone mastectomy were chosen using convenience sampling. Upon their arrival at the oncology centres (a minimum of 3 months after mastectomy), the patients completed face-to-face questionnaires made up of five sections: sociodemographic data, physical, psychological, and social wellbeing, and family dynamics. Data were collected from August, 2015, to September, 2016. SPSS software (version 21) was used for data analysis. Ethics approval was obtained from the Palestinian Ministry of Health.Findings
The mean age at data collection was 51·0 (SD 10·0) years. In total, 73·0% (126 of 173) had low educational achievements (below secondary level), 91·0% (157) were unemployed, and 20·8% (36) had a first-degree relative with breast cancer. Two-thirds (133) had undergone radical mastectomy, and 17·0% (29) had breast-conserving surgery. Evaluation of the negative impacts of mastectomy showed that psychological wellbeing was the most affected domain (66·4%; 115), followed by physical wellbeing (52·2%; 90), social wellbeing (44·2%; 77), and family dynamics (49·2%; 85). Following mastectomy, 57·2% (99), 48·6% (84), and 42·8% (74) of patients experienced fatigue, early menopausal symptoms, and sleep disturbances, respectively. Feeling worried was the most common psychological complaint (52·6%; 91). Furthermore, 55·5% of patients (96) experienced financial impacts (eg, some mentioned that treatment expenses were drawn from very basic living and household funds), and 59·0% (102) had decreased day-to-day activity (physical activity for the household that would usually be carried out on a regular basis, such as chores). Interestingly, 95·4% (165) were worried about divorce owing to their surgery.Interpretation
The fear of divorce found in this study demonstrates the insecurity of women in society in Gaza. However, this study could not validate the reality of such fears (for example, determine the proportion of women who get divorced following mastectomy). Involving the patient's family in the treatment process is important to promote social wellbeing. Improving holistic medical care for survivors of breast cancer in the Gaza Strip is essential.Funding
None. 相似文献17.
Background
Access to unsafe water is a concern in the Gaza Strip, where water supplies continue to degrade owing to regional sanctions, bombardment, and mismanagement. Our previous study found that decreased access to public water networks was associated with increased diarrhoea prevalence in children younger than 5 years in the Gaza Strip. This study examined the role of socioeconomic status as an effect modifier in this association.Methods
We used data from five consecutive demographic health surveys and multiple indicator cluster surveys conducted by the Palestinian Central Bureau of Statistics in 2000, 2004, 2006/2007 (December, 2006, to March, 2007), 2010, and 2014. Multivariable logistic regression models were applied to pooled data with prevalence of diarrhoea as the outcome and access to water as the main exposure of interest, with adjustment for age, sex, governorate, and survey year (to adjust for the seasons or other administrative conditions, for each survey). Access to water was characterised by the type of source, namely piped, other improved (eg, public standpipe, borehole, protected dug well, protected spring, and rainwater collection), or unimproved, as defined by the WHO. We defined socioeconomic status in the analysis using maternal education, refugee status, and locality type (urban, rural, or camp).Findings
The odds ratio (OR) of diarrhoea for children with access to unimproved water sources was higher than for those with access to piped water sources when mothers had only primary education (OR 1·35; 95% CI 1·07–1·71) than when mothers also had secondary or higher education (1·09; 0·93–1·27). The OR for children in camps was 1·32 (1·10–1·57) compared with 1·19 in urban areas (1·05–1·36). Point estimates of ORs suggested strong effect modification by refugee status, although with wider CIs for non-registered refugee children (4·95; 1·58–15·55) than for registered refugees (1·35; 1·18–1·53) or non-refugees (1·18; 1·07–1·43).Interpretation
Our results suggest that, in the Gaza strip, children with lower socioeconomic status experience a greater burden of diarrhoea morbidity risk than children with higher socioeconomic status, even when using the same type of water source. Changes to policy are required to address such disproportionate burden of diarrhoea risk in the occupied Palestinian territory.Funding
None. 相似文献18.
Osaid Alser Haya Tahboub Ibrahim Al-Slaibi Yousef Abuowda Mohamedraed Elshami Loai Albarqouni 《Lancet》2019
Background
Surgical site infection (SSI) is defined as operation-related infections that occur at or near surgical incisions within 30 days after surgery. SSI is the most common postoperative complication and leads to increased morbidity and mortality among surgical patients. In Palestine, prospective multicentre studies on the epidemiology of SSI are lacking. We aimed to describe SSI epidemiology following gastrointestinal surgery in Palestine.Methods
We used data from an international study (GlobalSurg 2), which is a prospective, multicentre cohort study. The 11 participating hospitals (four in the Gaza Strip and seven in the West Bank) provided a 30-day follow-up for consecutive gastrointestinal surgical operations performed during a 2-week period between Jan 1 and July 31, 2016, with the follow-up for the last period ending on Aug 30, 2016. 30-day follow-up data collection included incidence of SSI or other hospital acquired infection, any unexpected re-intervention and 30-day mortality. The primary outcome was the occurrence of SSI within 30 days of surgery, and secondary outcomes were 30-day postoperative mortality rate and administration of perioperative antibiotics. We used RedCap for data management, and SPSS for data analysis. Ethics approval was obtained from the Palestinian Ministry of Health.Findings
Data were included for 249 patients; 133 (53·4%) were male and the mean age was 29 years (SD 17). Of these individuals, 43 patients (17%) were current smokers, 13 (5%) had diabetes, and 197 (79%) were rated as healthy according to the American Society of Anaesthesiology classification. Of the operations, 142 (57%) were emergencies, 224 (90%) were clean-contaminated, 186 (75%) were open surgeries, and 144 (58%) involved appendectomy. Antibiotics were given preoperatively to 79 patients (32%) and at the point of incision to 128 (51%). In total, 24 patients (10%) developed SSI and 3 (1%) had an intra-abdominal or pelvic abscess. The average length of in-hospital postoperative stay was 3 days (SD 2·5). One patient (0·4%) died within 30 days of surgery (30-day mortality rate).Interpretation
We observed a low rate of SSI (10%) and 30-day postoperative mortality rate (0·4%) compared with other low-income and middle-income countries (SSI rate of 23·2% to 14·0%, 30-day postoperative mortality rate of 4·8% to 1·6%, for low-income to middle-income countries, respectively). This may be attributable to the fact that most of our cases were healthy and had clean-contaminated wounds. The results should be interpreted cautiously because of limited sample size and event rates.Funding
None. 相似文献19.
Background
Cancer is the second leading cause of death in Palestine, accounting for 13·8% of all deaths. The adolescent and young adult (AYA) population is considered to include individuals aged 15–39 years. Diagnosing cancer at any age is an inevitable stressor. In the case of AYAs who have been diagnosed with cancer, fears relating to future and developmental consequences grow as they negotiate developmental normative tasks during this period of their lives. This study aimed to identify the strategies used by patients aged 15–39 years to cope with cancer.Methods
A triangulation approach was used, involving two hospitals—Beit-Jala governmental hospital and Augusta Victoria non-governmental hospital—offering oncology services in the West Bank between August, 2017, and April, 2018. These were chosen based on their capacity to treat cancer patients from all regions in West Bank and Jerusalem. The brief COPE scale (the abbreviated version of the COPE inventory) and the Arabic version of the SpREUK-P self-administered questionnaire were completed by a convenience sample of 165 patients aged 15–39 years from the hospitals. Qualitative in-depth interviews were also conducted with 12 individuals to obtain a more in-depth understanding of their coping strategies with cancer, based on content analysis. Statistical tests (Student's t-test, ANOVA, Tukey's honest significant difference, Pearson's correlation) were performed using IBM-SPSS (version 20). Written informed consent was obtained from patients, and parents or guardians of patients under 18 years old. The study was approved by the School of Public Health of Al-Quds University.Findings
Out of 196 respondents, 165 completed the questionnaire of the quantitative survey; a response rate of 84%. Individuals indicated the degree to which they use each coping strategy on a four-point Likert scale, ranging from 1 (not at all) to 4 (a lot). Different coping strategies were used by patients. Religion and acceptance of cancer were the most commonly used (mean 3·77, SD 0·5), followed by emotional support (3·65, 0·67), active coping (3·55, 0·64), and planning (3·43, 0·85). The lowest scores were for behavioural disengagement (1·46, 0·76), self-blame (1·56, 0·76), and substance use (1·69, 0·98). Respondents used problem-focused coping strategies (3·34, 0·53) more than emotion-focused coping strategies (2·67, 0·30). The major themes of coping identified in the interviewswere: coping mechanisms associated with religion, social support and affiliation, acceptance, positive reinterpretation and growth, self-distraction, planning, and spirituality coping.Interpretation
Our findings underline the range of methods by which young people cope with cancer, and the importance of helping individuals to find and use the coping strategies thatare best suited tothem.Funding
None. 相似文献20.