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1.
Background
In their quest for universal health coverage (UHC), many developing countries explore alternative financing strategies to address the potential budgetary impact of health coverage expansion (for example, deferred debt versus current finance through taxation or premiums). Given the limited fiscal space, these policies may have different implications for fiscal sustainability and may worsen intergenerational inequality.Methods
We assessed the impact of UHC on fiscal sustainability and intergenerational inequality using an overlapping generations model within a general equilibrium framework, which we calibrate using data from the Palestinian Expenditures and Consumption Survey (PECS-2011) and the Social Accounting Matrix (SAM-2011). Fiscal sustainability is assessed using a prudent debt–GDP level of 39%. Intergenerational inequality induced by different policies is assessed by comparing the relative incremental burden (RIB) borne by each generation following the policy adjustment.Findings
In the absence of any policy adjustment, an ad hoc expansion of health coverage would increase the debt–GDP level to 15% above the prudent level. This indicates that the UHC fiscal stance may be financially unsustainable in the long run, therefore calling for a policy adjustment. Among the policies we examined, UHC finance through the increase of premiums (whether current or deferred) seems to be unsustainable and may further widen intergenerational inequality (RIB∈[3,6]). By contrast, current finance through indirect taxes helps to restore a prudent debt–GDP level and seems to be associated with a lower level of intergenerational inequality than deferred-debt finance through direct taxation (RIB of 1·25 and 5, respectively).Interpretation
Among the policy options assessed, the current indirect taxation emerged as the best policy option in terms of its impact on both fiscal sustainability and intergenerational inequalities. However, from a policy perspective, the capacity of governments to raise additional revenues might be constrained in the short-term. Under such circumstances, deferred-debt finance may be preferred—a situation in which policy makers may have to trade fiscal sustainability against intergenerational inequality.Funding
The A*MIDEX project (number ANR-11-IDEX-0001-02) funded by the French Government programme Investissements d'avenir, managed by the French National Research Agency (ANR). 相似文献2.
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
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5.
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6.
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7.
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8.
9.
Background
About 2·1 million Palestinians live in Jordan, and 370?000 Palestinians live in Jordanian refugee camps. Conflict in their country of origin, poverty, unemployment, and squalid camp conditions are some of the environmental factors that render Palestine refugees susceptible to mental health problems. The aim of this study was to identify the barriers that contribute to the treatment gap in mental health-care services for Palestinian refugees in the Baqa'a refugee camp north of Amman, Jordan.Methods
In this cross-sectional study, qualitative, semi-structured interviews of health-care professionals working at health centres for Palestine refugees in Jordan were done by a British researcher in the English language in the presence of an interpreter. All interviews were recorded, transcribed, and thematically analysed. Ethical approval was granted by the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and the University of Leeds. Written consent was obtained from all participants.Findings
16 health-care professionals were interviewed during a 3 week period in May, 2015. 14 participants were based in health-care centres at the Baqa'a refugee camp, and two participants were based at the Field Office of the UNRWA in Amman, Jordan. All (100%) participants reported that underfunding was the most common barrier to accessing treatment. Other major barriers were sex (reported by 15 [94%] participants), stigma and religion (12 [75%]), and culture (ten [63%]).Interpretation
We suggest the following policy recommendations to overcome the barriers to accessing and using mental health-care services in Palestinian refugee camps in Jordan: (1) allocation of more resources for the provision of mental health-care services; (2) establishing a health and social care model that adopts a holistic approach to treating mental health problems in Palestinian refugees, incorporating a framework that facilitates enhanced communication and cooperation between faith leaders and health-care providers; and (3) launching anti-stigma campaigns that are culturally and religiously sensitive and specific.Funding
None. 相似文献10.
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11.
Background
In mid-2014, 1?350?800 Palestinians were living in Israel (excluding residents of occupied East Jerusalem and the Golan Heights). Palestinians comprise 17% of the total population in Israel. The Palestinian community in Israel is very young, with 36% of Palestinians aged 14 years and younger, whereas in the Naqab, 49% of the Palestinian community is aged 14 years and younger. According to Ministry of Health reports, there is a gap between Arabs and Jews in most health indicators (life expectancy, infant mortality, chronic morbidity, and health behaviours). Most official surveys on the health of Palestinians living in Israel are based on small samples and do not consider specific characteristics of the Arab population (eg, composition, geographic distribution). The aim of this study was to obtain broader data on the health status of Palestinians in Israel as part of a socioeconomic survey.Methods
We surveyed Palestinian households in the north of Israel, the Haifa region, the Naqab, and central Israel. We used a structured questionnaire to gather data on demographic and socioeconomic status, housing conditions, standards of living, education, culture, health, and environment. Data were collected by trained interviewers in face-to-face interviews. Verbal and written informed consent was obtained from participants.Findings
Fieldwork was completed between March 1 and June 30, 2014. 97% of questionnaires were completed, providing data from 1698 Palestinian households (896 households from the north of Israel, 271 from the Haifa region, 293 from the Naqab, and 238 from central of Israel; 7115 participants in total). 15% of all study participants (14% of women and 15% of men) and 2% of participants aged 0–14 years reported chronic diseases. The highest prevalence of chronic diseases was found in mixed cities (22%) and in large communities with more than 15?000 residents (16%), whereas the prevalence of chronic diseases was lowest (4%) in villages that are not officially recognised by Israel. 6% of the participants had diabetes (5% of women and 6% of men). 9% of participants in general and 2% of participants aged 0–14 years had moderate or severe difficulties in their activities of daily living, and the prevalence of people with such difficulties increased with age, reaching 24% in participants aged 50–59 years and 51% in participants aged 60 years and older. 20% of the participants were smokers (4% of women and 36% of men), whereas 7% of participants aged 10 years and older were smokers. About 38% of participants exercised and played sports, and 16% took regular exercise. 42% of marriages were consanguineous, and this percentage increased to 70% of marriages in the Naqab.Interpretation
Compared with the Jewish population in Israel, Palestinians with Israeli citizenship have more chronic diseases and more unhealthy behaviours. These findings should be used to inform national health strategic planning and interventions to improve and promote the health status of the Palestinian population in Israel.Funding
None. 相似文献12.
Hanne Heszlein-Lossius Yahya Al-Borno Yasmeen Keita Nashwa Skaik Hazim Shawwa Mads Gilbert 《Lancet》2018
Background
During four separate Israeli military attacks on the Gaza Strip (in 2006, 2009, 2012, and 2014), about 4000 Palestinians were killed and more than 17?000 Palestinians were injured (412 killed and 1264 injured in 2006; 1383 killed and more than 5300 injured in 2009; 130 killed and 1399 injured in 2012; and 2251 killed and 11?231 injured in 2014). An unknown number of people had traumatic amputation of one or more extremities. In addition to loss of body parts, loss of work and income further complicated patients' lives after trauma. In 2015, we reported preliminary data on the somatic consequences, showing that eight of ten amputees had unilateral or bilateral lower limb amputations, most often because of attacks by drone-carried weapons. A third of cases had amputations during ceasefire periods. A high number of debilitating extremity injuries were in the young civilian population, where needs of rehabilitation were difficult to meet because of limited local resources during the long-lasting siege of the Gaza Strip. Here we report long-term functional and psychosocial consequences of traumatic amputations in Gaza War casualties.Methods
This cross-sectional study was done at The Artificial Limb and Polio Center, a local rehabilitation centre in Gaza City. We studied Palestinians living in the Gaza Strip who had sustained traumatic amputations during Israeli military attacks between 2006 and 2014. We explored the amputees' self-assessed health, socioeconomic status, anatomical location and level of amputation, comorbidity, and date and mechanism of injury. We used two validated and self-administered screening questionnaires (36-Item Short Form Survey and General Health Questionnaire 12 [GHQ12]) combined with a detailed clinical examination of each amputee. We used standardised records and questionnaires in Arabic. Data were analysed with SPSS. The study was approved by the Palestinian Ministry of Health in the Gaza Strip, Al-Shifa Hospital's board, and the director of the Artificial Limb and Polio Center in the Gaza Strip. All participants included in the study completed a written consent form.Findings
We included 165 Palestinians in this study. Pain was reported by more patients who were unable to continue work because of the traumatic amputation than by patients who were unemployed for other reasons, even when adjusting for time passed since amputation (p=0·039). We found a correlation between reported pain and poverty (income <800 shekels per month; χ2=0·034) but no correlation between GHQ12 scores indicating psychological distress and the extent of the initial trauma. Use of prosthetics decreased GHQ12 scores, suggesting a lower level of psychological distress in users of artificial limbs.Interpretation
Self-reported pain after loss of one or more limbs correlated with deteriorated occupational and financial life situation after the amputation. Use of prosthesis seemed to ease the psychological distress. Poverty and unemployment caused by amputations and disability might be a more important trauma than the physical amputation itself.Funding
None. 相似文献13.
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.
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16.
17.
18.
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19.
Nisreen Salti Jad Chaaban Hala Ghattas Alexandra Irani Karin Seyfert Tala Ismail Salma Khedr 《Lancet》2019
Background
Palestinians in Lebanon have been protracted refugees for 70 years, but the Syrian crisis has caused shocks that threaten to destabilise their already fragile livelihoods. Over a million Syrian refugees and 42?000 Palestinian refugees from Syria have fled to Lebanon, adding pressure to an already weak infrastructure and labour market. The United Nations Relief and Works Agency (UNRWA), the main provider of health, education and relief services to Palestinian refugees, is exceptionally strained. This study examines changes in education, health, employment, food security, and poverty indicators for Palestinian refugees in Lebanon (excluding Palestinian refugees from Syria) using two nationally representative household surveys conducted in April, 2010, and July, 2015.Methods
The surveys were conducted using multi-stage cluster random sampling. Both surveys included households residing in camps and gatherings. Health conditions were reported for all household members by a proxy survey respondent from among the household members. Food insecurity was assessed using the Arab Family Food Security Scale. The poverty lines (thresholds) were set at US$6·84 per person per day (upper poverty line) and US$2·47 per person per day (extreme poverty line) in 2015, and US$6 per person per day (upper poverty line) and US$2·17 per person per day (extreme poverty line) in 2010. The difference across the 2 years reflects adjustment for inflation rates within the 5-year period. Data were analysed using STATA13. The study was approved by the Institutional Review Board of the American University of Beirut. Informed verbal consent was obtained from the survey respondents.Findings
Of the eligible sampled households of Palestinian refugees in Lebanon, 88% (2974 of 3382) in 2015 and 99% (2593 of 2626) in 2010 gave informed consent and completed the questionnaire. Net enrolment rates for elementary education remained high (98% in 2015 and 95% in 2010), but failed to lead to better labour market outcomes. The unemployment rate increased from 8% in 2010 to 23% in 2015, and the fraction working in elementary occupations increased from 23% to 36%. Overall poverty remained unchanged but with considerable regional shifts: poverty increased by 9% and 11% in central Lebanon and north Lebanon, respectively, whereas it dropped by 8% and 9% in Saida and Tyre. Extreme poverty was halved from 7% to 3%. There was a high prevalence of chronic diseases in both years (37% in 2015 and 31% in 2010); and in 2015, out-of-pocket health expenditure was six times higher when the household reported at least one chronic condition (US$50·9 per capita per month compared with US$8·3 per capita per month). Despite the reduction in extreme poverty, 4% of households shifted from moderate to severe food insecurity.Interpretation
Pressures on UNRWA services come at a time when the organisation is operating with a large shortfall in funding. Recent US funding cuts may have dire repercussions for a population burdened by a high prevalence of chronic conditions and facing high healthcare costs. With additional budgetary strains and worsening labour market conditions, Palestinian refugees in Lebanon risk losing some of the ground that they have gained in net enrolment rates in education, access to health-care services and the reduction in extreme poverty that the UNRWA has worked towards for decades.Funding
UNRWA funded the data collection for both surveys. 相似文献20.