Notes

Stability, quality and receptiveness of the Step-up as well as Lower (True stud) examination for individuals together with characteristic leg arthritis.
indicate an urgent need to make mental health interventions routinely available through general hospital liaison units in Gaza. The risk factors that were identified indicate that psychosocial interventions and access to developmental support are key components of such clinical services, and will be required to reduce the very large, and mostly unmet, population burden of mental health problems in Gaza.

WHO, occupied Palestinian territory, as part of the EU project "Building Palestinian resilience improving psychosocial and mental health responses in emergency".
WHO, occupied Palestinian territory, as part of the EU project "Building Palestinian resilience improving psychosocial and mental health responses in emergency".
Integration of mental health and psychosocial support (MHPSS) into primary health care in the Gaza Strip involves the delivery of mental health services within the essential service package provided by UNRWA, as recommended by WHO to fill the treatment gap. In early 2016, a successful pilot demonstrated that the integration is achievable in limited resource settings, and resulted in the adoption of a stepped care model to screen, identify, support, and treat patients. This study aimed to evaluate the MHPSS integration process and outcomes at UNRWA health centres in the Gaza Strip.

We used a descriptive analytical study design, with quantitative and qualitative data collected from records, and individual feedback from patients and health care providers (HCPs). The study was performed in the 22 UNRWA health centres of the Gaza Strip and all participants agreed to participate either verbally or by written consent. Approval was also obtained from the UNRWA Health Program Gaza Field Office.

The integration plt of the collective effort of all participants. However, there are challenges to overcome, and observation, further evaluation, and refinement of the process are needed to stabilise and sustain the integration of MHPSS services into primary health care for maximum benefit.

WHO, and UNRWA resources.
WHO, and UNRWA resources.
The incidence of non-communicable diseases (NCDs) increases annually by approximately 5% among older (age 50 years and older) Palestinian refugees in Lebanon, of whom around 10% are housebound. Care for housebound patients does not exist in the over-medicalised and highly privatised Lebanese health system or within the health system for Palestinian refugees in Lebanon. This has led to a neglected population. In 2016, Médecins Sans Frontières (MSF) started to provide home-based care (HBC) for housebound patients in two Palestinian camps Bourj-el-Barajneh and Ain-al-Hilweh. HBC is carried out by a team comprising a doctor, nurse, and social worker, and includes basic medical monitoring, health literacy educational sessions, support for treatment adherence, as well as networking with relevant social service providers.

A qualitative study was carried out between January and October, 2018, nine patients, ten caregivers, and personnel from two main international non-governmental organisations providing health cof HBC by the MSF staff. To a lesser extent, patients and caregivers sensed improved self management as their disease literacy and treatment adherence increased, and as caregivers became more efficient in handling toilet care, bathing, and wound dressing. Missing components of HBC were perceived to be "outdoor" activities and mental health services.

HBC had an effect in reducing patients' social isolation, decreasing caregivers' burden and anxiety, and enhancing self management of disease for both. HBC should be considered for replication by all refugee health care providers as well as by the Lebanese Ministry of Public Health. This model of care needs to adopt a more holistic approach by including provision of mental health care and by increasing the focus on social isolation.

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Cut wounds and lacerations are common, but effective treatment is essential to achieve good cosmetic outcomes and maintain function. We assessed the use of local anaesthetic, infection control procedures, and antibiotics in the management of cut wounds and lacerations.

Eligible patients were those attending the emergency departments of Nasser and Dar Al Shifa Hospitals in the Gaza Strip with cut wounds or lacerations, from Aug 25 to Sept 2, 2018. The management of cut injuries and lacerations was observed directly in emergency departments. Approval for the study was obtained from the Human Development Department for both and hospital administrations of each. Due to the lack of local guidelines, we compared management with the international guidelines from The Royal Children's Hospital, Melbourne, NSW, Australia.

84 patients attended Nasser Hospital and 100 Dar Al Shifa Hospital during the study period and all 184 were included. At Nasser hospital, the mean age was 12·0 years (SD 11·5; median 8 years) anlities, or lack of awareness of infection control polices, or a combination of these factors. Clear and consistent leadership with staff education and feedback needs to be implemented to achieve sustainable culture change and improve infection control management in Gaza hospitals.
Poor adherence to hand washing policies, environmental cleaning, and use of antibiotics was seen. Relevant reasons might be workload, lack of facilities, or lack of awareness of infection control polices, or a combination of these factors. Clear and consistent leadership with staff education and feedback needs to be implemented to achieve sustainable culture change and improve infection control management in Gaza hospitals.
Public health research suggests that multiple factors contribute to the mental health sequalae of political violence, but the daily experiences and ongoing strategies of psychological survival during active warfare are not clearly understood. We analysed retrospective chronological diaries from Palestinian women in Gaza, occupied Palestinian territory, to explore their lives during Operation Protective Edge in 2014, when a series of aerial bombardments killed over 2000 Palestinians and left around 500 000 displaced from their homes.

20 Palestinian female teachers in Gaza were recruited via an intervention for trauma recovery 1 month after the end of Operation Protective Edge, in September, 2014. Following the experience sampling method, women were asked to chronicle specific memories and affective responses associated with their experiences. Data were imported into qualitative data analysis software, coded line by line, and analysed using content analysis, with special attention to the causes of mental di larger populations. Limitations notwithstanding, in drawing out the unique contribution of reflective narratives of women survivors of war, our study highlights the need to solicit and analyse reflective and chronologically grounded narratives within global mental health epidemiology.

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Disease activity is suggested to be an important indicator for quality of life (QoL) in patients with inflammatory bowel disease (IBD). Few studies of the association between adherence to medication and QoL in patients with IBD are available, and their findings are conflicting. We examined associations between disease activity, medication adherence, and QoL in patients with IBD in occupied Palestinian territory.

This correlation cross-sectional study was done from July 1, 2017, to Feb 30, 2018. We used convenience sampling to recruit patients from three major hospitals in southern and northern regions of occupied Palestinian territory. The disease-specific inflammatory bowel disease questionnaire (IBDQ) was used to examine QoL. Medication adherence was measured with the modified Morisky adherence scale. Associations were assessed by regression analysis. Results were analysed with SPSS version 20. The study was approved by the Al-Quds University Research Ethics Committee. Informed verbal consent was obtains. Attention should be given by health-care providers and strategists to increasing knowledge about IBD. The importance of treatment adherence should be explored further. Some limitations were encountered during the study period; it was conducted in only three hospitals and the results might not be generalisable. The cross-sectional type of this study might prevent the identification of any cause-and-effect relationships, especially between medication and post-treatment improvements in QoL.

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Increasing refugee populations worldwide highlight the need for development indicators that cover refugees, especially as they tend to be excluded from national statistics. read more Refugee youth face double exclusion, as most wellbeing indices are not youth-specific. We developed a youth wellbeing index (YWI) for Palestinian refugees in Lebanon (PRL) and Palestinian refugees from Syria (PRS) living in Lebanon, with the aim of providing a snapshot of youth wellbeing to inform evidence-based youth-specific development strategies.

The YWI was developed and its data generated using information from the 2015 survey of PRL and PRS, which was approved by the American University of Beirut Institutional Review Board. The wellbeing of PRL (n=3940) and PRS (n=1581) aged 15-29 was measured using the YWI, which examines five wellbeing dimensions educational attainment, health, housing, active education or employment, and access to information. Scores for each of the five dimensions are scaled to [0, 1], and YWI is their arithn for both PRL and PRS. The reversal of the educational edge of PRS over PRL in the 15-19 years age group is another concerning indicator of the cost of conflict for PRS that persists even four years after their displacement.

UNRWA funded the 2015 survey data collection and the Economic Research Forum funded the development of the YWI.
UNRWA funded the 2015 survey data collection and the Economic Research Forum funded the development of the YWI.
Overweight and obesity are multifactorial conditions that are spreading fast in both developing and developed countries. They are emerging as a major public health threat among children and adolescents, and present a serious morbidity and mortality burden. Adolescence is a critical period in which lifestyle and dietary behaviours are shaped that persist into adulthood. Therefore, adolescents are an ideal study target in terms of estimating the magnitude of the problem, understanding its risk factors and investigating potential effective intervention programmes. This study assesses the prevalence of overweight, obesity, and associated factors among adolescents in Palestinian schools.

Weighted analysis was conducted on data from the Palestinian Micronutrient Survey, a national cross-sectional study carried out in 2013 by the Palestinian Ministry of Health in collaboration with UNICEF. For sample selection, stratified cluster random sampling was used. This school-based survey involved 2400 male and female ad observed a diet for weight loss.

The data suggest that one in every four adolescents is overweight or obese, which is an alarming statistic and calls for attention. The high prevalence can be attributed to different lifestyles, eating behaviours, and dietary intake, which affect energy balance. These factors should be investigated within social, political, and economic contexts, and addressed comprehensively, first at the level of individuals and family, and then at the level of schools and the community. It should be noted that the original study included students in the 10th grade and 11th grade only, whereas adolescence covers a wider age group (10-19 years).

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