Journal of Public Health Research (PAGEPress Publications)
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Post-traumatic stress disorder in adolescents in Lebanon as wars gained in ferocity: a systematic review
Get PDFFor decades, Lebanon was war-torn by civil strife, and occupation and invasion by neighboring countries. In time, these wars have escalated in intensity from sniping, barricading streets and random shelling of residential quarters to the use of rockets, aerial bombing, and heavy artillery. Adverse mental health effects are noted in times of war with post traumatic stress disorder (PTSD) as a main outcome. The aim of this study was to carry out a systematic review of published studies documenting the prevalence of PTSD in the adolescent population of Lebanon, to investigate the increase in these rates with the escalation of war intensity, and to examine PTSD determinants. A search strategy was developed for online databases (PubMed and Google Scholar) between inception to the first week of January 2013. Search terms used were PTSD, adolescents and Lebanon. Eleven studies reporting PTSD in adolescents met the inclusion criteria for a total number of 5965 adolescents. Prevalence rates of PTSD ranged from 8.5% to 14.7% for the civil war, 3.7% for adolescents with sensory disabilities, 21.6% for the Grapes of Wrath War, and 15.4% to 35.0% for the 2006 July War. Some increase in PTSD rates in time is noted. Type of trauma such as bereavement, injury, house destruction, and economic problems, low self efficacy and scholastic impairment were related to PTSD. These findings may help in the development of public health policies for PTSD prevention and treatment for the protection of adolescents from war atrocities and their consequences
Evaluation of knowledge and practice behaviors of a group of Iranian obstetricians, general practitioners, and midwives, regarding periodontal disease and its effect on the pregnancy outcome
Get PDFBackground. Periodontal disease is considered as a risk factor for poor pregnancy outcomes, including preterm birth and low birth weight. Only few studies have assessed the knowledge and practice behaviours of healthcare providers, concerning oral health during pregnancy, periodontal diseases and their role in adverse pregnancy outcomes. The present study aimed to compare the knowledge and practice behaviours of a group of Iranian obstetricians, general practitioners, and midwives about periodontal disease.Design and methods. A cross-sectional study was conducted using a self-administered, structured questionnaire that was previously used in North Carolina. The questionnaire was translated into Persian language and was randomly distributed among 200 obstetricians, general practitioners, and midwives participating in an international congress. Data were analysed by Chi-square and spearman correlation tests using SPSS statistical software (version PASW 18).Results. A total of 150 completed the questionnaires, achieving a response rate of 75%. Totally, the knowledge of the obstetricians was more accurate compared to the two other groups and the midwives were the worst. More experienced general practitioners (P=0.002) and obstetricians (P=0.049) did less dental examinations for their patients during their first visit or periodically. More experienced obstetricians also referred their patients for dental examinations during pregnancy less than their less experienced colleagues (P<0.001).Conclusions. Although the participants had some knowledge about periodontal disease and its association with adverse pregnancy outcomes, there is much space for improvements. The participants’ attitude and knowledge were consistent
The role of issue familiarity and social norms: findings on new college students’ alcohol use intentions
Get PDFBackground. Scholars in a variety of disciplines are interested in understanding the conditions under which social norms affect human behavior. Following the distinction made between descriptive and injunctive norms by the focus theory of normative conduct, the theory of normative social behavior predicts that the influence of descriptive norms on behavior is moderated by injunctive norms, outcome expectations, and group identity. We extended the theory by testing the proposition that the influence of descriptive norms on behavior would be greater under conditions of greater issue familiarity, defined as the ease with which one can cognitively access the behavior or behavioral issue. Design and Methods. The model was tested in the domain of alcohol consumption intentions by conducting a survey among incoming students (n=719) to a large university in the United States. Data indicated that students in the sample were well representative of the university population. Results. The influence of descriptive norms on behavioral intentions was moderated by issue familiarity, as predicted. Familiarity was a facilitator of behavior: the influence of descriptive norms on behavioral intentions was greater under conditions of high, rather than low, familiarity. The overall model explained 53% of the variance in alcohol consumption intentions. Conclusions. Public health interventions promoting health behaviors need to take into account the extent to which the behaviors are familiar to the target audience. The influence of norms appears to be weaker when the behavior is unfamiliar or novel. Implications for theory and interventions for reducing alcohol consumption are discussed
Disclosure of adverse events in the United States and Canada: an update, and a proposed framework for improvement
Get PDFThere is consensus that physicians, health professionals and health care organizations should discuss harm that results from health care delivery (adverse events), including the reasons for harm, with patients and their families. Thought leaders and policy makers in the USA and Canada support this goal. However, there are gaps in both countries between patients and physicians in their attitudes about how errors should be handled, and between disclosure policies and their implementation in practice. This paper reviews the state of disclosure policy and practice in the two countries, and the barriers to full disclosure. Important barriers include fear of consequences, attitudes about disclosure, lack of skill and role models, and lack of peer and institutional support. The paper also describes the problem of the second victim, a corollary of disclosure whereby health care workers are also traumatized by the same events that harm patients. The presence of multiple practical and personal barriers to disclosure suggests the need for a comprehensive solution directed at multiple levels of the health care system, including health departments, institutions, local managers, professional staff, patients and families, and including legal, health system and local institutional support. At the local level, implementation could be based on a translating-evidence-into-practice framework. Applying this framework would involve the formation of teams, training, measurement and identification of local barriers to achieving universal disclosure of adverse events
Prevalence of gastrointestinal pathogens in developed and developing countries: systematic review and meta-analysis
Get PDFDiarrhoeal illness is a leading cause of child mortality and morbidity worldwide. There are no precise or current estimates of the types and prevalence of pathogens associated with diarrheal illnesses in developed and developing settings. This systematic review assessed data from 60 studies published in the English language from five developing regions and developed countries worldwide to provide regional estimates of enteric pathogens affecting children. The random-effect method was used to establish the weighted average prevalence of pathogens in adults and children for each region. Significantly more pathogens were reported by studies from developing regions compared with Organisation for Economic Co-operation and Development countries (P<0.016). The identification rates of pathogens from community based and hospital based studies were similar (58.5% and 58.1% respectively, P<0.619). The overall detection of enteric pathogens in developing countries was higher in adults (74.8%; 95% CI 63.1-83.8%) compared with children (56.7%; 95% CI 53.0-60.4%) (P<0.001). Rotavirus was the most frequently detected pathogen in all regions with the highest rate, 24.8% (95% CI 18.0-33.1%), detected in the developed countries. This systematic review is the first to provide an estimate of the prevalence of enteric pathogens associated with diarrhoeal illnesses in adults and children in developed and developing settings. While pathogen detection rate is greater in developing regions the consistently high prevalence of rotavirus in both developed and developing settings underscores the urgent need for access to rotavirus vaccines. Increased travel between developing and developed countries increases disease risk, and hence developed countries have a vested interest in supporting vaccine accessibility in developing settings
Heuristic thinking: interdisciplinary perspectives on medical error
Get PDFApproximately 43 million adverse events occur across the globe each year at a cost of at least 23 million disability-adjusted life years and $132 billion in excess health care spending, ranking this safety burden among the top 10 medical causes of disability in the world.1 These findings are likely to be an understatement of the actual severity of the problem, given that the numbers merely reflect seven types of adverse events and completely neglect ambulatory care, and of course they only cover reported incidents. Furthermore, they do not include statistics on children and incidents from India and China, which host more than a third of the world’s population. Best estimates imply that about two thirds of these incidents are preventable. Thus, from a public health perspective, medical errors are a seri- ous global health burden, in fact ahead of high-profile health problems like AIDS and cancer. Interventions to date have not reduced medical errors to satisfactory rates. Even today, far too often, hand hygiene is not practiced properly (even in developed countries), surgical procedures take place in underequipped operating theaters, and checklists are missing or remain uncompleted. The healthcare system seems to be failing in managing its errors − it is costing too much, and the complexity of care causes severe safety hazards that too often harm rather than help patients. In response to this evolving discussion, the International Society for Quality in Healthcare recently nominated an Innovations Team that is now developing new strategies. One of the emerging themes is that the medical field cannot resolve this problem on its own. Instead, interdisciplinary collaborations are needed to advance effective, evidence-based interventions that will eventually result in competent changes. In March 2013, the Institute of Communication and Health at the University of Lugano organized a conference on Communicating Medical Error (COME 2013) in Switzerland to stimulate such interdisciplinary dialogue. International scholars from eight disciplines and 17 countries attended the congress to discuss interdisciplinary ideas and perspectives for advancing safer care. The team of invited COME experts collaborated in compiling this issue of the Journal of Public Health Research entitled Interdisciplinary perspectives on medical error. This particular issue introduces relevant North American and European theorizing and research on preventable adverse events. The caliber of scientists who have contributed to this issue is humbling. But rather than naming their affiliations and summarizing their individual manuscripts here, it is more important to reflect on the contribution of this special issue as a whole. Particularly, I would like to raise two important take-home messages that the articles yield: i) What new insights can be derived from the papers collected in this issue? ii) What are the central challenges implied for future research on medical error
Fragmentation of patient safety research: a critical reflection of current human factors approaches to patient handover
Get PDFThe integration of human factors science in research and interventions aimed at increased patient safety has led to considerable improvements. However, some challenges to patient safety persist and may require human factors experts to critically reflect upon their predominant approaches to research and improvement. This paper is a call to start a discussion of these issues in the area of patient handover. Briefly reviewing recent handover research shows that while these studies have provided valuable insights into the communication practices for a range of handover situations, the predominant research strategy of studying isolated handover episodes replicates the very problem of fragmentation of care that the studies aim to overcome. Thus, there seems to be a need for a patient-centred approach to handover research that aims to investigate the interdependencies of handover episodes during a series of transitions occurring along the care path. Such an approach may contribute to novel insights and help to increase the effectiveness and sustainability of interventions to improve handover
Technology and the future of healthcare
Get PDFHealthcare changes dramatically because of technological developments, from anesthetics and antibiotics to magnetic resonance imaging scanners and radiotherapy. Future technological innovation is going to keep transforming healthcare, yet while technologies (new drugs and treatments, new devices, new social media support for healthcare, etc) will drive innovation, human factors will remain one of the stable limitations of breakthroughs. No predictions can satisfy everybody; instead, this article explores fragments of the future to see how to think more clearly about how to get where we want to go
Prevalence of vitamin D insufficiency in Qatar: a systematic review
Get PDFQatar has a high burden of chronic diseases including obesity, cardiovascular disease and type 2 diabetes mellitus. Low serum vitamin D levels have been implicated in the development and progression of a range of these chronic conditions. The prevalence of vitamin D insufficiency or deficiency in the general population of Qatar has still not been investigated. The aim of this study was to carry out a systematic review of published studies documenting the prevalence of vitamin D insufficiency or deficiency in the Qatari population. A search strategy was developed for online databases (PubMed, Ovid MEDLINE, Embase and Embase Classic) between 1980 to the last week of August 2012, and bibliographies of the included studies were further searched for additional reports. Search terms used were QATAR and VITAMIN D. Studies reporting the serum levels of vitamin D in several Qatari sub-populations were identified. Weighted-average vitamin D serum levels and prevalence of low vitamin D status (<75 nmol/L) were calculated. Subgroup analysis was carried out by age. The quality of each study was evaluated according to four criteria: national representativeness, representation of males and females, the sample size, and the sampling protocol. A total of 16 relevant publications were identified, and 8 of these (reporting from 7 unique studies) met our inclusion and exclusion criteria with a total number of 1,699 Qatari subjects. The pooled sample size weighted-average vitamin D concentration (±SD) was 45.3±14.3 nmol/L (95% CI: 44.6-46.0; range 29.2-66.9 nmol/L). The weighted-average prevalence of low vitamin D status was 90.4% (95% CI: 90.1-91.0; range 83%-91%). Age was inversely correlated with vitamin D levels and directly with its insufficiency/deficiency prevalence. There have only been a few studies on the prevalence of low vitamin D in Qatar a very high prevalence of vitamin D insufficiency/deficiency in Qatar that increases with age has been suggested. The present report underlines the need to develop a nationally representative study to further evaluate vitamin D status in Qatar. Given the growing evidence of the role of vitamin D in chronic disease, this study could help develop public health strategies for disease prevention in Qatar
Accountable Care Organizations and Clinical Commissioning Groups face an uncertain challenge for improving public health
Get PDFAccountable Care Organizations (ACO) in the United States of America (USA) and Clinical Commissioning Groups (CCG) in the United Kingdom (UK) are new proposed organizations in health services both tasked with a role which includes improving public health. Although there are very significant differences between the UK and USA health systems there appears to be a similar confusion as to how ACO and CCG will regard and address public or population health. The role of ACO in improving population health and evaluating the health needs of their registered and insured patients remains ill-defined and poorly explored. Likewise, in the current UK National Health Service (NHS) reorganisation, control and commissioning of appropriate local health services are passing from Primary Care Trusts (PCT) to new cross-organizational structures (CCG). CCG groups aim to be, like ACO, physician led. They will also assume a role for public or population health, but this role, like that of the newly-forming ACO, is currently unclear. Lessons learned from the USA and UK experience of new organizations tasked with a role in improving public health may inform mechanisms for physician led organizations in the UK and the USA to assess health needs, monitor population health information and improve population health outcomes