TY - JOUR T1 - Human insecurity, chronic economic constraints and health in the occupied Palestinian territory JF - Global Public Health: An International Journal for Research, Policy and Practice Y1 - 2014 A1 - McNeely, Clea. A1 - Barber, Brian K. A1 - Spellings, Carolyn. A1 - Giacaman, R. A1 - Arafat, Cairo. A1 - Daher, Mahmoud. A1 - El Sarraj and Abu Mallouh, Mm. U1 -

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Together with Hanna Kienzler from the Department of Social Science, Health and Medicine at King’s College London, the Mental...

The Institute of Community and Public Health participated as facilitators in the protocol development workshop (IRP) as part of...

The ICPH director participated in the fourth seminar on " Health Diplomacy" that was Cairo, Egypt, 2-4 MAY 2015.

 
ER - TY - JOUR T1 - Sick or sad? Supporting Palestinian children living in conditions of chronic political violence JF - Children and Society Y1 - 2014 A1 - Rabaia, Y. A1 - Saleh, M.F. A1 - Giacaman, R. U1 -

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ER - TY - JOUR T1 - Dignity and its components in Palestinian adolescents and young people: a pilot study JF - the Lancet online Y1 - 2012 A1 - Amro, Z. A1 - Giacaman, R. ER - TY - JOUR T1 - The Gaza Diamond drawings and wishes of Palestinian teenagers JF - Intervention Y1 - 2011 A1 - Rabaia, Y. A1 - MNguyen-Gilham, V. A1 - Giacaman, R. ER - TY - JOUR T1 - Health-related Quality of life of Gaza Palestinians in the aftermath of the winter 2008-09 Israeli attach on the Strip JF - The European Journal of Public Health Y1 - 2011 A1 - Abu Rmeileh, N. A1 - Hammoudeh, W. A1 - Mataria, A. A1 - Husseini, A. A1 - Khawaja, M. A1 - Shannon, H. A1 - Hogan, D. A1 - Watt, G. A1 - Zurayk, H. A1 - Giacaman, R. ER - TY - JOUR T1 - Human insecurity and associated factors in the Gaza Strip Six months after the winter 2008-09 Israeli attack: a cross –sectional survey JF - the Lancet online Y1 - 2011 A1 - Ziadni, M. A1 - Hammoudeh, W. A1 - Abu-Rmeileh, N. A1 - Hogan, D. A1 - Shannon, H. A1 - Giacaman, R. ER - TY - JOUR T1 - Mental health, social distress and political oppression: The case of the occupied Palestinian territory JF - Global Public Health Y1 - 2011 A1 - Giacaman, R. A1 - Rabaia, Y. A1 - Nguyen-Gillham, V. A1 - Batniji, R. A1 - Punamaki, R. L. A1 - Summerfield, D. AB -

This paper presents a brief history of Palestinian mental health care, a discussion of the current status of mental health and health services in the occupied Palestinian territory, and a critique of the biomedical Western-led discourse as it relates to the mental health needs of Palestinians. Medicalising distress and providing psychological therapies for Palestinians offer little in the way of alleviating the underlying causes of ongoing collective trauma. This paper emphasises the importance of separating clinical responses to mental illness from the public health response to mass political violation and distress. Palestinian academic research reframes the mental health paradigm utilising an approach based on the broader framework of social justice, quality of life, human rights and human security. Recognising social suffering as a public mental health issue requires a shift in the emphasis from narrow medical indicators, injury and illness to the lack of human security and human rights violations experienced by ordinary Palestinians. Such a change in perspective requires a parallel change in mental health policies from short-term emergency humanitarian aid to the development of a sustainable system of public mental health services, in combination with advocacy for human rights and the restoration of political, historical and moral justice.

SN - 1744-1706 (Electronic)
1744-1692 (Linking) N1 - Journal article
Global public health
Glob Public Health. 2010 Nov 23:1-13. ER - TY - JOUR T1 - Do victims of violence need psychodynamic treatment? Invited commentary JF - Intervention Y1 - 2010 A1 - Rabaia, Y. A1 - Giacaman, R. A1 - Nguyen-Gillham, V. VL - 8 IS - 2 ER - TY - JOUR T1 - Domestic and political violence: the Palestinian predicament JF - Lancet Y1 - 2010 A1 - Giacaman, R. A1 - Rabaia, Y. A1 - Nguyen-Gillham, V. KW - *Politics KW - *Spouse Abuse/psychology/statistics & numerical data KW - *Violence/psychology/statistics & numerical data KW - Crime Victims KW - Culture KW - Female KW - Humans KW - Male KW - Middle East/epidemiology KW - Socioeconomic Factors VL - 375 SN - 1474-547X (Electronic)
0140-6736 (Linking) N1 - Giacaman, Rita
Rabaia, Yoke
Nguyen-Gillham, Viet
Comment
England
Lancet
Lancet. 2010 Jan 23;375(9711):259-60. ER - TY - JOUR T1 - Humanitarian crisis and social suffering in Gaza Strip: an analysis of aftermath of latest Israeli war JF - the Lancet online Y1 - 2010 A1 - Abu Rmeileh, N. A1 - Hammoudeh, W. A1 - Giacaman, R. ER - TY - JOUR T1 - Mental health, social distress and political oppression: The case of the occupied Palestinian territory JF - Glob Public Health Y1 - 2010 A1 - Giacaman, R. A1 - Rabaia, Y. A1 - Nguyen-Gillham, V. A1 - Batniji, R. A1 - Punamaki, R. L. A1 - Summerfield, D. AB -

This paper presents a brief history of Palestinian mental health care, a discussion of the current status of mental health and health services in the occupied Palestinian territory, and a critique of the biomedical Western-led discourse as it relates to the mental health needs of Palestinians. Medicalising distress and providing psychological therapies for Palestinians offer little in the way of alleviating the underlying causes of ongoing collective trauma. This paper emphasises the importance of separating clinical responses to mental illness from the public health response to mass political violation and distress. Palestinian academic research reframes the mental health paradigm utilising an approach based on the broader framework of social justice, quality of life, human rights and human security. Recognising social suffering as a public mental health issue requires a shift in the emphasis from narrow medical indicators, injury and illness to the lack of human security and human rights violations experienced by ordinary Palestinians. Such a change in perspective requires a parallel change in mental health policies from short-term emergency humanitarian aid to the development of a sustainable system of public mental health services, in combination with advocacy for human rights and the restoration of political, historical and moral justice.

SN - 1744-1706 (Electronic)
1744-1692 (Linking) N1 - Journal article
Global public health
Glob Public Health. 2010 Nov 23:1-13. ER - TY - JOUR T1 - Palestinian domestic violence: unwarranted political conclusions JF - Lancet Y1 - 2010 A1 - Giacaman, R. A1 - Nguyen-Gillham, V. KW - *Politics KW - *Women's Rights KW - Domestic Violence/*statistics & numerical data KW - Humans KW - Middle East/epidemiology VL - 375 SN - 1474-547X (Electronic)
0140-6736 (Linking) N1 - Jacobs, Daniel H
Comment
Letter
England
Lancet
Lancet. 2010 Apr 10;375(9722):1253; author reply 1253-4. ER - TY - JOUR T1 - The remaining facts on the ground invited commentary JF - the Lancet Y1 - 2010 A1 - Giacaman, R. A1 - Khatib, R. ER - TY - JOUR T1 - Violence and adolescent mental health in the occupied Palestinian territory: a contextual approach JF - Asia Pac J Public Health Y1 - 2010 A1 - Rabaia, Y. A1 - Giacaman, R. A1 - Nguyen-Gillham, V. KW - *Adaptation, Psychological KW - *Adolescent Psychology KW - Adolescent KW - Arabs/*psychology KW - Community Mental Health Services/*methods KW - Community-Institutional Relations KW - Cooperative Behavior KW - Female KW - Focus Groups KW - Humans KW - Israel KW - Male KW - Psychology, Social KW - Resilience, Psychological KW - Social Justice KW - Violence/*psychology AB -

During the past decade, the Institute of Community and Public Health at Birzeit University has focused on youth psychosocial mental health research with special attention given to protective factors and forms of resilience adopted by people coping with extraordinary and violent times. The authors take a critical view of the predominantly biomedical interventions adopted by humanitarian aid agencies and question the utility of therapeutic forms of interventions introduced by Western medicine. In a context of collective exposure to violence, individual healing methods based on one-to-one counselling generally have little effect. An alternative approach is proposed that views Palestinian mental health within the historical and political context of loss and injustice, while acknowledging the lack of human security and social justice as a determining factor. In building an argument for the development of psychosocial mental health interventions that are contextually appropriate to the Palestinian situation and collective in nature, the authors present an example of an intervention designed and developed in joint cooperation between a Palestinian academic institution and a Palestinian partner in the field.

VL - 22 SN - 1941-2479 (Electronic)
1010-5395 (Linking) N1 - Rabaia, Yoke
Giacaman, Rita
Nguyen-Gillham, Viet
Research Support, Non-U.S. Gov't
China
Asia-Pacific journal of public health / Asia-Pacific Academic Consortium for Public Health
Asia Pac J Public Health. 2010 Jul;22(3 Suppl):216S-221S. ER - TY - JOUR T1 - Health as human security in the occupied Palestinian territory JF - Lancet Y1 - 2009 A1 - Batniji, R. A1 - Rabaia, Y. A1 - Nguyen-Gillham, V. A1 - Giacaman, R. A1 - Sarraj, E. A1 - Punamaki, R. L. A1 - Saab, H. A1 - Boyce, W. KW - *Arabs KW - *Human Rights KW - Civil Disorders KW - Health KW - Middle East KW - Safety KW - Sanitation KW - Social Conditions KW - War AB -

We describe the threats to survival, development, and wellbeing in the occupied Palestinian territory using human security as a framework. Palestinian security has deteriorated rapidly since 2000. More than 6000 Palestinians have been killed by the Israeli military, with more than 1300 killed in the Gaza Strip during 22 days of aerial and ground attacks ending in January, 2009. Israeli destruction and control of infrastructure has severely restricted fuel supplies and access to water and sanitation. Palestinians are tortured in prisons and humiliated at Israeli checkpoints. The separation wall and the checkpoints prevent access to work, family, sites of worship, and health-care facilities. Poverty rates have risen sharply, and almost half of Palestinians are dependent on food aid. Social cohesion, which has kept Palestinian society intact, including the health-care system, is now strained. More than US$9 billion in international aid have not promoted development because Palestinians do not have basic security. International efforts focused on prevention of modifiable causes of insecurity, reinvigoration of international norms, support of Palestinian social resilience and institutions that protect them from threats, and a political solution are needed to improve human security in the occupied Palestinian territory.

VL - 373 SN - 1474-547X (Electronic)
0140-6736 (Linking) N1 - Batniji, Rajaie
Rabaia, Yoke
Nguyen-Gillham, Viet
Giacaman, Rita
Sarraj, Eyad
Punamaki, Raija-Leena
Saab, Hana
Boyce, Will
England
Lancet
Lancet. 2009 Mar 28;373(9669):1133-43. Epub 2009 Mar 4. ER - TY - JOUR T1 - Health status and health services in the occupied Palestinian territory JF - Lancet Y1 - 2009 A1 - Giacaman, R. A1 - Khatib, R. A1 - Shabaneh, L. A1 - Ramlawi, A. A1 - Sabri, B. A1 - Sabatinelli, G. A1 - Khawaja, M. A1 - Laurance, T. AB -

We describe the demographic characteristics, health status, and health services of the Palestinian population living in Israeli-occupied Palestinian territory, and the way they have been modified by 60 years of continuing war conditions and 40 years of Israeli military occupation. Although health, literacy, and education currently have a higher standard in the Israeli-occupied Palestinian territory than they have in several Arab countries, 52% of families (40% in the West Bank and 74% in the Gaza Strip) were living below the poverty line of US$3.15 per person per day in 2007. To describe health status, we use not only conventional indicators, such as infant mortality and stunting in children, but also subjective measures, which are based on people's experiences and perceptions of their health status and life quality. We review the disjointed and inadequate public-health and health-service response to health problems. Finally, we consider the implications of our findings for the protection and promotion of health of the Palestinian population, and the relevance of our indicators and analytical framework for the assessment of health in other populations living in continuous war conditions.

SN - 1474-547X (Electronic)
0140-6736 (Linking) N1 - Journal article
Lancet
Lancet. 2009 Mar 4. ER - TY - JOUR T1 - In search of health: quality of life among postpartum Palestinian women JF - Expert Rev Pharmacoecon Outcomes Res Y1 - 2009 A1 - Hammoudeh, W. A1 - Mataria, A. A1 - Wick, L. A1 - Giacaman, R. KW - *Arabs KW - *Women KW - Adolescent KW - Adult KW - Data Interpretation, Statistical KW - Family Planning Services KW - Family Relations KW - Female KW - Health Status KW - Humans KW - Infant KW - Infant, Newborn KW - Israel KW - Middle Aged KW - Postpartum Period/*psychology KW - Quality of Life/*psychology KW - Refugees KW - Socioeconomic Factors KW - Violence KW - Young Adult AB -

OBJECTIVES: The postpartum period is a very important period for the health of the mother and the newborn. Despite its importance, research on this period is limited and tends to be more focused on biomedical aspects of the postpartum period. In the Occupied Palestinian Territory, little is known regarding women's postpartum wellbeing. This study utilizes the Maternal Postpartum Quality-of-Life instrument to assess Palestinian women's postpartum quality of life and the factors associated with variations in their quality-of-life scores. METHODS: A cross-sectional survey utilizing the adapted Maternal Postpartum Quality-of-Life Questionnaire was completed in the Occupied Palestinian Territory with a final sample size of 1020 women. RESULTS: The mean overall quality-of-life score for the sample was 21.53 (maximum = 30), suggesting that women are slightly satisfied with their lives in the postpartum period. Main variations in quality-of-life scores were associated with regional district, refugee status, the loss of a relative due to Israeli occupation violence, standard of living and pregnancy wantedness. CONCLUSION: The results of this study highlight the diversity and complexity of the social context, in particular the region where women live, and the issue of pregnancy wantedness in postpartum quality of life. They also call into question the services currently offered to postpartum women.

VL - 9 SN - 1744-8379 (Electronic)
1473-7167 (Linking) N1 - Hammoudeh, Weeam
Mataria, Awad
Wick, Laura
Giacaman, Rita
Wellcome Trust/United Kingdom
Research Support, Non-U.S. Gov't
England
Expert review of pharmacoeconomics & outcomes research
Expert Rev Pharmacoecon Outcomes Res. 2009 Apr;9(2):123-32. ER - TY - JOUR T1 - Making a difference: an interview with Rita Giacaman. Working for health in the occupied palestinian territory. Interviewed by Jane Westberg JF - Educ Health (Abingdon) Y1 - 2009 A1 - Giacaman, R. KW - *Academies and Institutes KW - *Arabs KW - *Community Networks KW - *Public Health KW - Community Health Aides/education KW - Health Services Needs and Demand KW - Humans KW - Israel KW - Middle East KW - Politics VL - 22 SN - 1469-5804 (Electronic)
1357-6283 (Linking) N1 - Giacaman, Rita
Interview
England
Education for health (Abingdon, England)
Educ Health (Abingdon). 2009 Dec;22(3):412. Epub 2009 Nov 6. ER - TY - JOUR T1 - Mortality patterns in the West Bank, Palestinian Territories, 1999-2003 JF - Prev Chronic Dis Y1 - 2008 A1 - Abu-Rmeileh, N. M. A1 - Husseini, A. A1 - Abu-Arqoub, O. A1 - Hamad, M. A1 - Giacaman, R. KW - Adolescent KW - Adult KW - Age Distribution KW - Aged KW - Aged, 80 and over KW - Cardiovascular Diseases/mortality KW - Child KW - Child, Preschool KW - Chronic Disease/mortality KW - Communicable Diseases/mortality KW - Diabetes Mellitus/mortality KW - Female KW - Humans KW - Infant KW - Infant, Newborn KW - Male KW - Middle Aged KW - Middle East/epidemiology KW - Mortality/*trends KW - Neoplasms/mortality KW - Poverty AB -

INTRODUCTION: The West Bank in the Palestinian Territories is undergoing an epidemiologic transition. We provide a general description of mortality from all causes, focusing on chronic disease mortality in adults. METHODS: Mortality data analyzed for our study were obtained from the Palestinian Ministry of Health in the West Bank for 1999 through 2003. Individual information was obtained from death notification forms. RESULTS: A total of 27,065 deaths were reported for 1999 through 2003 in the West Bank, Palestinian Territories. Circulatory diseases were the main cause of death (45%), followed by cancer (10%) and unintentional injuries (7%). Among men, the highest age-standardized mortality rates (ASMRs) were due to diseases of the circulatory system, cancer, and unintentional injuries. Among women, the highest ASMRs were due to circulatory disease, cancer, and diabetes mellitus. Of the circulatory diseases, the highest ASMRs for men were due to acute myocardial infarction and cerebrovascular disease. ASMRs attributable to circulatory system diseases were similar for women. Lung cancer was the largest cause of cancer mortality for men; breast cancer was the largest cause for women. CONCLUSION: Because of the high mortality rates, the risk factors associated with chronic diseases in the Palestinian Territories must be ascertained. Medical and public health policies and interventions need to be reassessed, giving due attention to this rise in modern-day diseases in this area.

VL - 5 SN - 1545-1151 (Electronic) N1 - Abu-Rmeileh, Niveen M E
Husseini, Abdullatif
Abu-Arqoub, Omar
Hamad, Mutasem
Giacaman, Rita
United States
Preventing chronic disease
Prev Chronic Dis. 2008 Oct;5(4):A112. Epub 2008 Sep 15. U2 - 2578778 ER - TY - JOUR T1 - Palestinian women's pregnancy intentions: analysis and critique of the Demographic and Health Survey 2004 JF - Health Policy Y1 - 2008 A1 - Giacaman, R. A1 - Abu-Rmeileh, N. M. A1 - Mataria, A. A1 - Wick, L. KW - *Family Planning Services KW - *Intention KW - Adolescent KW - Adult KW - Age Factors KW - Arabs/*psychology KW - Cross-Sectional Studies KW - Family Characteristics/ethnology KW - Female KW - Health Surveys KW - Humans KW - Israel KW - Middle Aged KW - Pregnancy in Adolescence KW - Pregnancy/*ethnology KW - Women/*psychology AB -

OBJECTIVES: The Palestinian DHS2004 reports on pregnancy intentions and their determinants are analyzed for the first time. Through this analysis, the survey instrument limitations are also highlighted. METHODS: Data on 15-49 years old ever married, non-pregnant women reporting on their last pregnancy were selected from a nationally representative cross sectional survey dataset. RESULTS: Older women were more likely not to desire the pregnancy at all, and younger women more likely to have desired to wait; with higher reports of not desiring the pregnancy at all or desiring to wait among those with a higher number of children; with higher reports of not desiring the pregnancy at all, or desiring to wait, among women who reported ever using family planning methods. Women who experienced prenatal and postnatal complications reported higher levels of having desired to wait or not having wanted the pregnancy at all, calling for the inclusion of process measures in pregnancy intention studies. CONCLUSIONS: While some of our findings are comparable to those cited in the international literature, the analysis was limited to the type of questions asked in the Palestinian DHS survey. There is a need to further develop the survey instrument in order to address women's needs from a public health policy perspective. We call for the inclusion of additional social measures to identify some of the contextual factors that influence pregnancy intentions.

VL - 85 SN - 0168-8510 (Print)
0168-8510 (Linking) N1 - Giacaman, Rita
Abu-Rmeileh, Niveen M E
Mataria, Awad
Wick, Laura
Research Support, Non-U.S. Gov't
Ireland
Health policy (Amsterdam, Netherlands)
Health Policy. 2008 Jan;85(1):83-93. Epub 2007 Aug 14. ER - TY - JOUR T1 - Disturbing distortions JF - British Medical Journal Y1 - 2007 A1 - Giacaman, R. ER - TY - JOUR T1 - Humiliation: the invisible trauma of war for Palestinian youth JF - Public Health Y1 - 2007 A1 - Giacaman, R. A1 - Abu-Rmeileh, N. M. A1 - Husseini, A. A1 - Saab, H. A1 - Boyce, W. KW - *Emotions KW - *Health Status KW - *War KW - Adolescent KW - Adolescent Psychology KW - Arabs/*psychology KW - Demography KW - Female KW - Humans KW - Male KW - Sex Factors KW - Stress Disorders, Post-Traumatic/*psychology KW - Violence/psychology AB -

OBJECTIVES: To investigate the influence of exposure to humiliation in war-like conditions on health status in 10th- and 11th-grade students living in the Ramallah District, West Bank, Occupied Palestinian Territory. STUDY DESIGN: A stratified single-stage cluster sample of 3415 students from cities, towns, villages and refugee camps of the Ramallah District. METHODS: Survey questions were derived from the World Health Organization's Health Behaviour in School-aged Children Survey, the Gaza Community Mental Health Programme Traumatic Event Checklist, and focus group discussions with young people. The survey questionnaire was completed by students in their classrooms, under the supervision of a trained field worker. RESULTS: There was a significant association between a high number of subjective health complaints and demographic variables, particularly for females compared with males, and refugee camp dwellers compared with village dwellers. In addition, exposure to humiliation was significantly associated with an increased number of subjective health complaints. Students experiencing three forms of humiliation were found to be 2.5 times more likely to report a high number of subjective health complaints compared with those who had never been exposed to humiliation (52% vs 21%), while those experiencing four forms of humiliation were three times more likely to report a high number of subjective health complaints (62% vs 21%). A multiple logistic regression model revealed that humiliation was significantly associated with a high number of subjective health complaints, even after adjusting for sex, residence and other measures of exposure to violent events. The odds ratio of reporting a high number of subjective health complaints increased as the number of forms of humiliation increased, with values of 1.69, 2.67, 4.43 and 7.49 for reporting a high number of subjective health complaints when exposed to one, two, three or four forms of humiliation, respectively, compared with those who had never been exposed to humiliation. CONCLUSIONS: The results of this study demonstrate that humiliation induced by conflict and war-like conditions constitutes an independent traumatic event that is associated with negative health outcomes in its own right, regardless of exposure to other violent/traumatic events. Based on these findings, it is proposed that humiliation should be included as an indicator of mental health status in research that investigates the consequences of war and conflict on the health of populations.

VL - 121 SN - 0033-3506 (Print)
0033-3506 (Linking) N1 - Giacaman, Rita
Abu-Rmeileh, Niveen M E
Husseini, Abdullatif
Saab, Hana
Boyce, William
Research Support, Non-U.S. Gov't
England
Public health
Public Health. 2007 Aug;121(8):563-71; discussion 572-7. Epub 2007 Jun 12. ER - TY - JOUR T1 - Individual and collective exposure to political violence: Palestinian adolescents coping with conflict JF - Eur J Public Health Y1 - 2007 A1 - Giacaman, R. A1 - Shannon, H. S. A1 - Saab, H. A1 - Arya, N. A1 - Boyce, W. KW - *Adaptation, Psychological KW - *Conflict (Psychology) KW - *Politics KW - *Violence KW - Adolescent KW - Adolescent Psychology KW - Arabs KW - Female KW - Health Surveys KW - Humans KW - Israel KW - Male AB -

BACKGROUND: We conducted a survey of Palestinian adolescents in school. We hypothesized that collective and individual exposures to violence would both negatively affect adolescents' mental health. We also anticipated that the negative effect of collective exposures on mental health would be less than that of individual exposures. Our analysis was designed to test these hypotheses. METHODS: A representative sample of 3415 students of 10th and 11th grades from the Ramallah District of the West Bank participated in the survey. The primary independent variables were scales of individual and collective exposures to trauma/violence (ETV) by the Israeli military and settlers. Factor analysis revealed several sub-scales. Outcome measures were constructed and included: a binary measure of depressive-like states, and emotional, depressive-like state, and somatic scales. Several variables were identified as possible covariates: gender, age, school-type, residence, employment status of father, and identity documents held. RESULTS: Logistic and multiple regression analyses revealed a strong relationship between ETV and adolescents' mental health, with both individual and collective exposures having independent effects. There was a higher prevalence of depressive-like symptoms among girls compared with boys, and in adolescents living in Palestinian refugee camps compared with those living in cities, towns and villages. CONCLUSION: The findings confirmed our hypothesis that both individual and collective ETV independently affect the mental health of adolescents. Contrary to expectations, individual exposures did not consistently have a greater negative effect on health outcomes than collective exposures, although the sub-scale of direct personal exposures to violence consistently showed the strongest effect among sub-scales. The results emphasize the importance of going beyond individual experiences and including the health outcomes of collective violation when analyzing violent and traumatic contexts.

VL - 17 SN - 1101-1262 (Print)
1101-1262 (Linking) N1 - Giacaman, Rita
Shannon, Harry S
Saab, Hana
Arya, Neil
Boyce, Will
Research Support, Non-U.S. Gov't
England
European journal of public health
Eur J Public Health. 2007 Aug;17(4):361-8. Epub 2006 Nov 30. ER - TY - JOUR T1 - The influence of economic factors on the location of birth among Palestinian women in Bethlehem during the second Palestinian uprising JF - Trop Doct. Y1 - 2007 A1 - Fujiya, R. A1 - Jimba, M. A1 - Giacaman, R. A1 - Nakahara, S. A1 - Ichikawa, M. A1 - Wakai, S. VL - 37 ER - TY - JOUR T1 - The limitations on choice: Palestinian women's childbirth location, dissatisfaction with the place of birth and determinants JF - Eur J Public Health Y1 - 2007 A1 - Giacaman, R. A1 - Abu-Rmeileh, N. M. A1 - Wick, L. KW - *Parturition/psychology KW - Adolescent KW - Adult KW - Arabs/psychology/*statistics & numerical data KW - Delivery, Obstetric/statistics & numerical data KW - Female KW - Health Services Accessibility/*statistics & numerical data KW - Home Childbirth/psychology/statistics & numerical data KW - Hospitals, Private/statistics & numerical data KW - Hospitals/*statistics & numerical data KW - Humans KW - Maternal Health Services/methods/statistics & numerical data KW - Middle Aged KW - Middle East KW - Patient Satisfaction/*statistics & numerical data AB -

BACKGROUND: Analysing the Palestinian Central Bureau of Statistics (PCBS) Demographic and Health Survey 2004 (DHS-2004) data, this article focuses on the question of where women living in the Occupied Palestinian Territory give birth, and whether it was the preferred/place of choice for delivery. We further identify some of the determinants of women's dissatisfaction with childbirth location. METHODS: A total of 2158 women residing in the West Bank and Gaza Strip were included in this study. Regression analysis established the association between dissatisfaction with the place of birth and selected determinants. RESULTS: A total of 3.5% of women delivered at home, with the rest in assisted facilities. Overall, 20.5% of women reported that their childbirth location was not the preferred place of delivery. Women who delivered at home; in governmental facilities; in regions other than the central West Bank; who had sudden delivery or did not reach their preferred childbirth location because of closures and siege; because of costs/the availability of insurance; or because there were no other locations available, were significantly more likely to be dissatisfied with their childbirth location compared to those who birthed in private facilities, the central West Bank, and in locations with better and more available services. CONCLUSION: The findings demonstrate that Palestinian women's choice of a place of birth is constrained and modified by the availability, affordability, and limited access to services induced by continuing closures and siege. These findings need to be taken into consideration when planning for maternity services in the Occupied Palestinian Territory.

VL - 17 SN - 1101-1262 (Print)
1101-1262 (Linking) N1 - Giacaman, Rita
Abu-Rmeileh, Niveen M E
Wick, Laura
074986/Wellcome Trust/United Kingdom
Wellcome Trust/United Kingdom
Research Support, Non-U.S. Gov't
England
European journal of public health
Eur J Public Health. 2007 Feb;17(1):86-91. Epub 2006 Jun 23. U2 - 1913630 ER - TY - JOUR T1 - Quality of life in the Palestinian context: an inquiry in war-like conditions JF - Health Policy Y1 - 2007 A1 - Giacaman, R. A1 - Mataria, A. A1 - Nguyen-Gillham, V. A1 - Safieh, R. A. A1 - Stefanini, A. A1 - Chatterji, S. KW - *Quality of Life KW - *War KW - Adolescent KW - Adult KW - Aged KW - Arabs KW - Female KW - Focus Groups KW - Humans KW - Israel KW - Male KW - Middle Aged AB -

This study aims to elucidate the concept of quality of life (QOL) in a unique environment characterized by protracted and ongoing conflict, beginning with the utilization of the WHOQOL-Bref as a starting point for discussion. It works to determine important health-related quality of life domains and items within each domain, and evaluate issues pertinent to the Palestinian population's understanding of life quality in the Occupied Palestinian Territory. Focus group discussions (FGD) were conducted with individuals living in the Gaza Strip and Ramallah District of the West Bank. Participants were asked if they understood the term QOL; and about the determinants of their own QOL, using open-ended questions. Participants were then presented with the WHOQOL-Bref questions and requested to assess their relevance and importance in determining their own QOL, and encouraged to suggest additional ones. A total of 150 men and women of various ages and socioeconomic classes participated in 13 FGD. A major finding is the all-encompassing impact of the political context on Palestinians' QOL assessment. The study demonstrates that political freedom, self-determination, participation in democratic processes and feeling involved in political decision-making are considered important contributors to people's QOL. The study raises the option of adding a new domain to the WHOQOL-Bref, allowing the study of its psychometric properties and its relationship to the rest of the instrument. This contribution should be particularly relevant to societies and cultures in conflict-affected zones and locales where violence and insecurity constitute an important part of life. The documentation of QOL, beyond fatal and non-fatal health outcomes, must remain an important objective of all evaluations in order to guide policy and resource allocation decisions directed towards improving peoples' lives in general and their health in particular.

VL - 81 SN - 0168-8510 (Print)
0168-8510 (Linking) N1 - Giacaman, Rita
Mataria, Awad
Nguyen-Gillham, Viet
Safieh, Rula Abu
Stefanini, Angelo
Chatterji, Somnath
Ireland
Health policy (Amsterdam, Netherlands)
Health Policy. 2007 Apr;81(1):68-84. Epub 2006 Jun 22. ER - TY - JOUR T1 - Response to commentary JF - Public Health Y1 - 2007 A1 - Giacaman, R. A1 - Abu-Rmeileh, N. A1 - Husseini, A. A1 - Saab, H. A1 - Boyce, W. ER - TY - JOUR T1 - Treatment of infection: a cross-sectional survey of antibiotic drug utilisation in the Ramallah district of Palestine JF - International Journal of Pharmacy Practice Y1 - 2006 A1 - Khatib, R. A1 - Dr McCaig, D. A1 - Giacaman, R. VL - 14 ER - TY - JOUR T1 - The limitations on choice: Palestinian women's childbirth location, dissatisfaction with the place of birth and determinants. JF - Eur J Public Health Y1 - 2006 A1 - Giacaman, R. A1 - Abu-Rmeileh, NM. A1 - Wick, L. VL - 17 ER - TY - JOUR T1 - Skin injuries caused by new riot control agent used against civilians on the West Bank JF - Med Confl Surviv Y1 - 2006 A1 - Hay, A. A1 - Giacaman, R. A1 - Sansur, R. A1 - Rose, S. VL - 22 ER - TY - JOUR T1 - Childbirth in Palestine JF - Int J Gynaecol Obstet Y1 - 2005 A1 - Wick, L. A1 - Mikki, N. A1 - Giacaman, R. A1 - Abdul-Rahim, H. KW - Analgesics, Opioid/therapeutic use KW - Attitude of Health Personnel KW - Clinical Competence KW - Crowding KW - data KW - Delivery, Obstetric/economics/*statistics & numerical data KW - Drug Utilization/statistics & numerical data KW - Evidence-Based Medicine KW - Female KW - Guideline Adherence KW - Hospitals, Maternity/*organization & administration/statistics & numerical KW - Hospitals, Public/*organization & administration/statistics & numerical KW - Humans KW - Male KW - Meperidine/therapeutic use KW - Middle East KW - Midwifery/statistics & numerical data KW - Oxytocics/therapeutic use KW - Oxytocin/therapeutic use KW - Personnel Staffing and Scheduling KW - Physicians/supply & distribution KW - Pregnancy KW - Private Sector/statistics & numerical data KW - Questionnaires KW - Workload AB -

OBJECTIVE: This study describes staffing, caseloads and reported routine practices for normal childbirth in Palestinian West Bank (WB) governmental maternity facilities and compares these practices with evidence-based care. METHODS: Data on routine childbirth practices in all eight governmental hospitals were obtained through interviews with head obstetricians and midwives. Data on staffing and monthly number of births were collected by phone or personal interview from all 37 WB hospitals. RESULTS: Forty-eight percent of WB deliveries took place in crowded and understaffed governmental hospitals. Reported practices were not consistently in line with evidence-based care. Lack of knowledge and structural barriers were reasons for this gap. CONCLUSION: The implications of limiting unnecessary interventions in the normal birth process are particularly important in a context of limited access and scarce resources. More skilled birth attendants and a universal commitment to effective care are needed.

VL - 89 SN - 0020-7292 (Print)
0020-7292 (Linking) N1 - Wick, L
Mikki, N
Giacaman, R
Abdul-Rahim, H
074986/Wellcome Trust/United Kingdom
Research Support, Non-U.S. Gov't
Ireland
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics
Int J Gynaecol Obstet. 2005 May;89(2):174-8. U2 - 1457108 ER - TY - JOUR T1 - Coping with conflict JF - Educ Health (Abingdon) Y1 - 2005 A1 - Giacaman, R. KW - *Adaptation, Psychological KW - *Conflict (Psychology) KW - *Health Education KW - *War KW - Adult KW - Arabs KW - Child KW - Humans KW - Life Change Events KW - Middle East KW - Stress, Psychological VL - 18 SN - 1357-6283 (Print)
1357-6283 (Linking) N1 - Giacaman, Rita
Editorial
England
Education for health (Abingdon, England)
Educ Health (Abingdon). 2005 Mar;18(1):2-4. ER - TY - JOUR T1 - The politics of childbirth in the context of conflict: policies or de facto practices? JF - Health Policy Y1 - 2005 A1 - Giacaman, R. A1 - Wick, L. A1 - Abdul-Rahim, H. KW - *Maternal Health Services KW - *Parturition KW - *War KW - Arabs/ethnology KW - Developing Countries KW - Female KW - Health Services Accessibility KW - Humans KW - Politics KW - Pregnancy AB -

The impact of warlike conditions on the lives of Palestinian women and children is far reaching. Beginning in September 2000, curfews, closures, siege and the parceling up of the country into small isolated entities have all led to a lack of access to basic maternity services, rendering pregnant women and their newborns a highly vulnerable group. Because any discussion of childbirth in the Occupied Palestinian Territories (OPT) cannot be separated from the larger historical context of international health politics, we begin with a brief review of international historical trends in childbirth policies, focusing on the relationship between discourse in the developed and developing world contexts to show how these models have intersected and diverged. We point to the similarities between the OPT and other developing countries, but also highlight the specificities that characterize the Palestinian experience today that include local political systems, medical dominance, professional group interests and the politics of gender, as well as the legacy of colonialism intertwined with an ongoing national conflict. We then provide a review of the history of childbirth in the OPT and analyze the various forces that led to the emergence of today's chaotic and contradictory de facto policies and practices. By assessing the health policy environment, we demonstrate the seeming impossibility of developing national level childbirth policies, given the current political conditions and a mix of other determinants that are not all within Palestinian control. Finally, we emphasize the importance of establishing a process as opposed to a blueprint of health policy-making based on people's immediate and long-term needs in all areas of the country. We also propose interim measures that rest on the notion of developing decentralized sub-strategies relevant to different zones of political reality and stages of system and human resource development, aiming at combining survival imperatives with those of improving women's birth experiences and women's health.

VL - 72 SN - 0168-8510 (Print)
0168-8510 (Linking) N1 - Giacaman, Rita
Wick, Laura
Abdul-Rahim, Hanan
Wick, Livia
074986/Wellcome Trust/United Kingdom
Ireland
Health policy (Amsterdam, Netherlands)
Health Policy. 2005 May;72(2):129-39. ER - TY - JOUR T1 - Imprints on the consciousness: the impact on Palestinian civilians of the Israeli Army invasion of West Bank towns JF - Eur J Public Health Y1 - 2004 A1 - Giacaman, R. A1 - Husseini, A. A1 - Gordon, N. H. A1 - Awartani, F. KW - *Arabs KW - *Health Services Accessibility KW - *Human Rights KW - *Quality of Life KW - *War KW - Adult KW - Child KW - Child, Preschool KW - Data Collection KW - Data Interpretation, Statistical KW - Family KW - Female KW - Food KW - Housing KW - Humans KW - Infant, Newborn KW - Interviews as Topic KW - Israel KW - Male KW - Models, Statistical KW - Multivariate Analysis KW - Questionnaires KW - Sampling Studies KW - Stress, Psychological KW - Time Factors AB -

BACKGROUND: The dehumanizing aspects of conflict and war are increasingly recognized as serious health and human rights concerns. This paper examines the impact on civilians of the 29 March 2002 Israeli Army invasion and subsequent curfews lasting up to 45 consecutive days, of five West Bank towns. METHODS: Using focus groups, a 10-item scale was devised to measure the effects of the invasion's impact on the social and health-related quality of life. The scale is an aggregate of three constructs measuring housing, financial, and health-related issues. A survey composed of demographic questions and the 10-item social/health scale was administered to a stratified random sample of inhabitants of the five towns. RESULTS: the invasion caused extensive destruction, food and cash shortages, internal displacement of civilians, psychological distress, and serious interruptions of basic services, including crucial health services. Overall, Jenin experienced the most deleterious effects. Using the subscales, Jenin experienced the highest overall housing damage, Bethlehem the most financial difficulties, and Ramallah the most health-related hardships. CONCLUSIONS: civilians inevitably suffer during conflict and war from destruction of the community infrastructure and from personal stress due to disruption of services and the non-fulfilment of basic human needs. In contradistinction to standard damage assessments that focus on collective physical damage, this scale provides richer information on the needs of civilians in conflict-torn areas, and can assist aid workers in the efficient deployment of resources.

VL - 14 SN - 1101-1262 (Print)
1101-1262 (Linking) N1 - Giacaman, Rita
Husseini, Abdullatif
Gordon, Nahida H
Awartani, Faisal
Comparative Study
England
European journal of public health
Eur J Public Health. 2004 Sep;14(3):286-90. ER - TY - JOUR T1 - Microbiological quality of food samples from restaurants and sweet shops in developing countries: a case study from the Occupied Palestinian Territory JF - Int J Environ Health Res Y1 - 2004 A1 - Al-Khatib, I. A1 - Giacaman, R. A1 - Husseini, A. A1 - Ramlawi, A. A1 - Atiyya, I. A1 - Salem, I. KW - *Developing Countries KW - *Food Contamination KW - *Food Microbiology KW - *Restaurants KW - Data Collection KW - Humans KW - Middle East KW - Quality Control KW - Reproducibility of Results KW - Seasons AB -

The aim of this paper is to review the microbiological quality of food samples taken from a wide range of cooked and raw foods obtained from restaurants and sweet shops in the Ramallah and al-Bireh district, and to identify the gaps in food inspection and handling that can be realistically improved. Utilizing food sample test results of the Palestinian Ministry of Health, records pertaining to the years 1995, 1996, 2000, 2002, and the first 2 months of the year 2003 reveal that only 60.9%, 44.0%, 63.8%, 93.6%, 51.8%, 83.8%, and 50.4% of the food samples tested for total aerobic count, total Coliform, faecal Coliform, Staphylococcus aureus, faecal Streptococci, moulds, and yeasts respectively are within the limits of the Palestinian and International standards. None of the tested samples for Salmonellae or Clostridium perfringes were positive. Analysis of the data indicates an irregular rather than systematic process to testing. For example, 60.4% of the tested food samples in 2000 came from sweet shops, while the relative percentage of sweet shops is 21.4% out of the total restaurants and sweet shop figures in the area at the time. In contrast to what would be expected, most of the samples were collected during the cold season, raising questions as to the suitability of testing procedures and guidelines. Systemic and procedural gaps were identified by the analysis that can be addressed to at least contain, if not completely eliminate the presence of foods in the market that are unacceptable for consumption.

VL - 14 SN - 0960-3123 (Print)
0960-3123 (Linking) N1 - Al-Khatib, Issam
Giacaman, Rita
Husseini, Abdullatif
Ramlawi, Asa'd
Atiyya, Ibrahim
Salem, Ibrahim
England
International journal of environmental health research
Int J Environ Health Res. 2004 Dec;14(6):443-52. ER - TY - JOUR T1 - Health sector reform in the Occupied Palestinian Territories (OPT): targeting the forest or the trees? JF - Health Policy Plan Y1 - 2003 A1 - Giacaman, R. A1 - Abdul-Rahim, H. F. A1 - Wick, L. KW - *International Agencies KW - *Politics KW - administration KW - Arabs KW - Colonialism KW - Financing, Organized KW - Health Care Reform/economics/*history KW - Health Care Sector/*history/legislation & jurisprudence/organization & KW - History, 20th Century KW - History, 21st Century KW - Humans KW - Israel KW - Private Sector KW - Public Sector KW - United Nations KW - War AB -

Since the signing of the Oslo Peace Accords and the establishment of the Palestinian Authority in 1994, reform activities have targeted various spheres, including the health sector. Several international aid and UN organizations have been involved, as well as local and international non-governmental organizations, with considerable financial and technical investments. Although important achievements have been made, it is not evident that the quality of care has improved or that the most pressing health needs have been addressed, even before the second Palestinian Uprising that began in September 2000. The crisis of the Israeli re-invasion of Palestinian-controlled towns and villages since April 2002 and the attendant collapse of state structures and services have raised the problems to critical levels. This paper attempts to analyze some of the obstacles that have faced reform efforts. In our assessment, those include: ongoing conflict, frail Palestinian quasi-state structures and institutions, multiple and at times inappropriate donor policies and practices in the health sector, and a policy vacuum characterized by the absence of internal Palestinian debate on the type and direction of reform the country needs to take. In the face of all these considerations, it is important that reform efforts be flexible and consider realistically the political and economic contexts of the health system, rather than focus on mere narrow technical, managerial and financial solutions imported from the outside.

VL - 18 SN - 0268-1080 (Print)
0268-1080 (Linking) N1 - Giacaman, Rita
Abdul-Rahim, Hanan F
Wick, Laura
074986/Wellcome Trust/United Kingdom
Historical Article
England
Health policy and planning
Health Policy Plan. 2003 Mar;18(1):59-67. U2 - 1457109 ER - TY - JOUR T1 - Maintaining public health education in the West Bank JF - Lancet Y1 - 2003 A1 - Giacaman, R. A1 - Halileh, S. KW - *War KW - Humans KW - Israel KW - Middle East KW - Public Health/*education KW - Universities/*organization & administration VL - 361 SN - 0140-6736 (Print)
0140-6736 (Linking) N1 - Giacaman, Rita
Halileh, Samia
England
Lancet
Lancet. 2003 Apr 5;361(9364):1220-1. ER - TY - JOUR T1 - Obesity in a rural and an urban Palestinian West Bank population JF - Int J Obes Relat Metab Disord Y1 - 2003 A1 - Abdul-Rahim, H. F. A1 - Holmboe-Ottesen, G. A1 - Stene, L. C. A1 - Husseini, A. A1 - Giacaman, R. A1 - Jervell, J. A1 - Bjertness, E. KW - Adipose Tissue KW - Adult KW - Arabs/statistics & numerical data KW - Body Mass Index KW - Cross-Sectional Studies KW - Energy Metabolism KW - Exercise KW - Female KW - Humans KW - Male KW - Middle Aged KW - Middle East/epidemiology KW - Obesity/*epidemiology/metabolism KW - Prevalence KW - Regression Analysis KW - Rural Health KW - Urban Health AB -

OBJECTIVE: To compare the prevalence of obesity, household food consumption patterns, physical activity patterns and smoking between a rural and an urban community in the Palestinian West Bank and to describe the associations of the latter factors with body mass index (BMI). DESIGN: A population-based cross-sectional survey in a rural and an urban Palestinian West Bank community. SUBJECTS: A total of 549 women and 387 men aged 30-65 y, excluding pregnant women. MEASUREMENTS: Obesity was defined as BMI >/=30 kg/m(2). RESULTS: The prevalence of obesity was 36.8 and 18.1% in rural women and men, respectively, compared with 49.1 and 30.6% in urban women and men, respectively. The mean difference (s.e) in BMI levels was 1.6 (0.52) kg/m(2) between urban and rural women and 0.9 (0.46) kg/m(2) in men. At the household level, the mean energy consumption from 25 selected food items was 13.8 MJ (3310 kcal)/consumption unit/day in the rural community compared to 14.5 MJ (3474 kcal)/consumption unit/day in the urban community (P=0.021). BMI was positively associated with age in both men and women and with urban residence in women. BMI was negatively associated with smoking and physical activity in men and with educational level in women. CONCLUSION: BMI was associated with urban residence in women after adjusting for age, smoking, education, physical activity and nutrition-related variables, suggesting that the differences in the conventional determinants of obesity could not fully explain the difference in the prevalence of obesity between the two communities. Among men, the measured determinants explained the rural-urban differences in BMI.

VL - 27 SN - 0307-0565 (Print)
0307-0565 (Linking) N1 - Abdul-Rahim, H F
Holmboe-Ottesen, G
Stene, L C M
Husseini, A
Giacaman, R
Jervell, J
Bjertness, E
Research Support, Non-U.S. Gov't
England
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity
Int J Obes Relat Metab Disord. 2003 Jan;27(1):140-6. ER - TY - JOUR T1 - Selected factors associated with diabetes mellitus in a rural Palestinian community JF - Med Sci Monit Y1 - 2003 A1 - Husseini, A. A1 - Abdul-Rahim, H. A1 - Giacaman, R. A1 - Jervell, J. A1 - Bjertness, E. KW - Adult KW - Arabs KW - Cross-Sectional Studies KW - Diabetes Mellitus/blood/*epidemiology/physiopathology KW - Female KW - Humans KW - Male KW - Middle Aged KW - Middle East/epidemiology KW - Risk Factors KW - Rural Population AB -

BACKGROUND: The purpose of this study was to investigate the distribution and association of selected risk factors for diabetes mellitus in a semi-rural Palestinian village. MATERIAL/METHODS: We performed a cross-sectional, population-based study of 500 adults aged 30 to 65 in a semi-rural Palestinian village. The study included two phases: a household survey and an individual assessment utilizing the oral glucose tolerance test OGTT to determine the diabetes status of the participants, anthropometric measurements for body mass index (BMI) and waist-hip ratio (WHR), blood biochemistry measurements for lipids, blood pressure measurement, and a standard questionnaire to assess demographic and other factors. RESULTS: The association between various risk factors and diabetes status was explored by comparing statistical means and proportions and crude and adjusted odds ratios (OR). A multivariate logistic regression using sex and seven factors initially found to be significantly associated with diabetes identified four factors that remained significantly associated with diabetes after adjustment for age and sex. The four main factors are age (OR = 1.08, 95%CI = 1.05-1.12), positive family history of diabetes (OR = 3.09, 95%CI = 1.53-6.24), triglycerides (OR = 1.006, 95%CI = 1.002-1.009), and WHR (OR = 2.13, 95%CI =1.31-3.45). CONCLUSIONS: Two factors associated with diabetes are potentially modifiable in this Palestinian population: WHR and triglyceride levels. These should be addressed by preventive health activities, including health promotion. The association between diabetes and age supports the conclusion that the prevalence of diabetes is expected to increase with the aging of the population.

VL - 9 SN - 1234-1010 (Print)
1234-1010 (Linking) N1 - Husseini, Abdullatif
Abdul-Rahim, Hanan
Giacaman, Rita
Jervell, Jak
Bjertness, Espen
Research Support, Non-U.S. Gov't
Poland
Medical science monitor : international medical journal of experimental and clinical research
Med Sci Monit. 2003 May;9(5):CR181-5. ER - TY - JOUR T1 - Scientific links support an unjust peace process JF - Nature Y1 - 2002 A1 - Giacaman, R. KW - *International Cooperation KW - Arab World KW - Israel KW - Research/economics/*organization & administration KW - Science/economics/*organization & administration KW - Social Justice/*standards KW - War VL - 417 SN - 0028-0836 (Print)
0028-0836 (Linking) N1 - Giacaman, Rita
Comment
Letter
England
Nature
Nature. 2002 Jun 13;417(6890):689-90. ER - TY - JOUR T1 - A community of citizens: disability rehabilitation in the Palestinian transition to statehood JF - Disabil Rehabil Y1 - 2001 A1 - Giacaman, R. KW - *Caregivers KW - *Civil Rights/trends KW - *Voluntary Workers KW - Arabs KW - Attitude to Health/*ethnology KW - Community Health Services/manpower/*organization & administration KW - Consumer Organizations KW - Consumer Participation KW - Cost of Illness KW - Disabled Persons/*rehabilitation KW - Female KW - Gender Identity KW - Health Care Reform KW - Humans KW - Israel KW - Male KW - Outcome Assessment (Health Care) KW - Social Class KW - Social Justice/trends KW - Women, Working/classification AB -

PURPOSE: It has been widely argued that community based programmes offer considerable advantages to the classical institutional forms of health and rehabilitation services delivery. With about 10 years of experience in operating community based rehabilitation projects (CBR) for the disabled, the Palestinian experience points to potentially serious problems relating to the conception and operationalization of such programmes in real life situations. ISSUES: Of importance is the issue of the impact of communal care on the already burdened lives of women, especially when such care is expected to be voluntary in nature. Caretaking in the Palestinian context, especially of the disabled, elderly and the sick, is a pre-defined sex linked role dictated by a patriarchal society and system of policy making that excludes women from economic and social life. The voluntary care aspect entailed in the CBR conception and practice, can and does contribute further to the exclusion of women not only from the labour force, but from most other aspects of life as well. This represents an apparent contradiction between the needs of two excluded groups, the disabled and women. The other problematic entailed in the communal model of caring for the disabled is the strategic and operational bias focusing on community, to the exclusion of the notion of social rights of all citizens, and the role and duty of state structures in the fulfilment of the disabled basic needs. Such an approach can only relegate the disabled rights back to their original place as charity. On the other hand, when CBR projects are operated holistically, in the context of social movements existing within power relation and with a broader democratic agenda engaging different groups-including a disability movement-as is currently taking place in Palestine, CBR projects can also turn into a mobilizing force for the social rights of all excluded groups. CONCLUSION: Thus the question is not merely one of governmental involvement as opposed to the involvement of non-governmental organizations and charitable societies in community based projects. Rather, it is a question of the right to a decent life for all, in dignity and security, that citizenship and statehood promise, but have yet to deliver in many developing countries, especially in Palestine.

VL - 23 SN - 0963-8288 (Print)
0963-8288 (Linking) N1 - Giacaman, R
Review
England
Disability and rehabilitation
Disabil Rehabil. 2001 Sep 20;23(14):639-44. ER - TY - JOUR T1 - Diabetes mellitus in an urban Palestinian population: prevalence and associated factors JF - East Mediterr Health J Y1 - 2001 A1 - Abdul-Rahim, H. F. A1 - Husseini, A. A1 - Giacaman, R. A1 - Jervell, J. A1 - Bjertness, E. KW - Adult KW - Age Distribution KW - Aged KW - Body Constitution KW - Body Mass Index KW - Cross-Sectional Studies KW - Diabetes Complications KW - Diabetes Mellitus/blood/diagnosis/*epidemiology/etiology KW - Female KW - Glucose Intolerance/blood/diagnosis/*epidemiology/etiology KW - Glucose Tolerance Test KW - Health Surveys KW - Humans KW - Hypercholesterolemia/complications/epidemiology KW - Hypertension/complications/epidemiology KW - Logistic Models KW - Male KW - Middle Aged KW - Middle East/epidemiology KW - Obesity KW - Population Surveillance KW - Prevalence KW - Risk Factors KW - Sex Distribution KW - Urban Population/*statistics & numerical data AB -

We investigated the prevalence of diabetes and associated factors in a cross-sectional survey of an urban Palestinian population of 492 men and women aged 30-65 years. The oral glucose tolerance test was used to diagnose diabetes and impaired glucose tolerance. World Health Organization-recommended survey protocols were followed. Diabetes was found in 12.0% of the survey population (including 9.4% previously diagnosed), and impaired glucose tolerance in 5.9%. Logistic regression analysis controlling for age and sex revealed body mass index, waist-to-hip ratio and family history of diabetes to be significantly independently associated with diabetes.

VL - 7 SN - 1020-3397 (Print)
1020-3397 (Linking) N1 - Abdul-Rahim, H F
Husseini, A
Giacaman, R
Jervell, J
Bjertness, E
Egypt
Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit
East Mediterr Health J. 2001 Jan-Mar;7(1-2):67-78. ER - TY - JOUR T1 - The metabolic syndrome in the West Bank population: an urban-rural comparison JF - Diabetes Care Y1 - 2001 A1 - Abdul-Rahim, H. F. A1 - Husseini, A. A1 - Bjertness, E. A1 - Giacaman, R. A1 - Gordon, N. H. A1 - Jervell, J. KW - *Insulin Resistance KW - Adult KW - Aged KW - Blood Pressure KW - Body Constitution KW - Body Mass Index KW - Cholesterol, HDL/blood KW - Cross-Sectional Studies KW - Diabetes Complications KW - Diabetes Mellitus/diagnosis KW - Female KW - Glucose Intolerance/complications/epidemiology KW - Glucose Tolerance Test KW - Humans KW - Hyperlipidemias/complications/epidemiology KW - Hypertension/complications/epidemiology KW - Hypertriglyceridemia/complications/epidemiology KW - Male KW - Metabolic Diseases/*epidemiology KW - Middle Aged KW - Middle East/epidemiology KW - Obesity/complications/epidemiology KW - Rural Population KW - Sex Characteristics KW - Smoking KW - Syndrome KW - Urban Population AB -

OBJECTIVE: To compare the prevalence of components of the metabolic syndrome, including hypertension, abnormal glucose metabolism, dyslipidemia, central obesity, and overall obesity, between a rural and an urban Palestinian West Bank community. RESEARCH DESIGN AND METHODS: A total of 500 rural and 492 urban men and women aged 30-65 years participated in a community-based cross-sectional survey Diabetes and impaired glucose tolerance were diagnosed using the oral glucose tolerance test. BMI, waist-to-hip ratio, and blood pressure were measured, and blood samples were taken from each subject. Sociodemographic characteristics were investigated using a questionnaire. RESULTS: Hypertriglyceridemia, low HDL cholesterol, overall obesity, and smoking were significantly more prevalent in the urban population, whereas central obesity was more prevalent in the rural population. Prevalence of hypertension was not significantly different between the rural and urban populations (25.4 and 21.5%, respectively; P = 0.15). The age-adjusted prevalences of diabetes were high: 11.3% (8.5-14.1 95% CI) and 13.9% (10.8-17.0) in the rural and urban populations, respectively, but not significantly different. In each community, the age-adjusted prevalence of the metabolic syndrome as defined by the World Health Organization was 17%. CONCLUSIONS: Although no significant differences were found in the prevalences of hypertension and diabetes between the two populations, other components of the metabolic syndrome, namely elevated triglycerides, low HDL cholesterol, and overall obesity, were more prevalent in the urban population. Given the rapid urbanization of the Palestinian population, the implications for a rise in noncommunicable diseases should be a major public health concern.

VL - 24 SN - 0149-5992 (Print)
0149-5992 (Linking) N1 - Abdul-Rahim, H F
Husseini, A
Bjertness, E
Giacaman, R
Gordon, N H
Jervell, J
United States
Diabetes care
Diabetes Care. 2001 Feb;24(2):275-9. ER - TY - JOUR T1 - Obesity and associated factors in a Palestinian West Bank village population JF - Eur J Clin Nutr Y1 - 2001 A1 - Stene, L. C. A1 - Giacaman, R. A1 - Abdul-Rahim, H. A1 - Husseini, A. A1 - Norum, K. R. A1 - Holmboe-Ottesen, G. KW - Adipose Tissue/*anatomy & histology KW - Adult KW - Aged KW - Blood Pressure KW - Body Constitution KW - Body Mass Index KW - Cross-Sectional Studies KW - Female KW - Humans KW - Israel/epidemiology KW - Male KW - Middle Aged KW - Obesity/*epidemiology/physiopathology KW - Prevalence KW - Triglycerides/*blood AB -

OBJECTIVE: To describe body mass index (BMI), waist circumference and waist-hip ratio in a Palestinian West Bank village population, and to assess the associations of these variables to blood pressure and serum lipids. DESIGN: Cross-sectional study. SETTING: Community-based study in a prototypic semi-rural Palestinian village in the central West Bank. SUBJECTS: All individuals aged 30-65 y in the study village were invited for the study and 500 (85%) participated. MAIN OUTCOME MEASURES: BMI > or = 30 was used as the measure of obesity. RESULTS: The prevalence of obesity was 37.5% among women and 18.8% among men. The prevalence of abdominal obesity was 62.5% among women and 14.8% among men. BMI seemed to be the more important correlate of blood pressure whereas waist-hip ratio seemed to be the more important correlate of serum triglycerides, compared to the other obesity measures. CONCLUSIONS: The prevalence of obesity in the study population was very high compared to most other countries in the world, particularly among women. SPONSORSHIP: The study was funded by the Norwegian Universities' Committee for Development Research (NUFU). LCM Stene was supported by a grant from the Throne Holst Foundation.

VL - 55 SN - 0954-3007 (Print)
0954-3007 (Linking) N1 - Stene, L C
Giacaman, R
Abdul-Rahim, H
Husseini, A
Norum, K R
Holmboe-Ottesen, G
Research Support, Non-U.S. Gov't
England
European journal of clinical nutrition
Eur J Clin Nutr. 2001 Sep;55(9):805-11. ER - TY - JOUR T1 - The utility of a single glucometer measurement of fasting capillary blood glucose in the prevalence determination of diabetes mellitus in an urban adult Palestinian population JF - Scand J Clin Lab Invest Y1 - 2000 A1 - Husseini, A. A1 - Abdul-Rahim, H. A1 - Awartani, F. A1 - Giacaman, R. A1 - Jervell, J. A1 - Bjertness, E. KW - Adult KW - Aged KW - Blood Glucose/*analysis KW - Diabetes Mellitus/blood/*epidemiology KW - Female KW - Glucose Tolerance Test KW - Humans KW - Israel/epidemiology KW - Male KW - Middle Aged KW - Population Surveillance KW - Predictive Value of Tests KW - Prevalence KW - Sensitivity and Specificity AB -

This paper aims to evaluate the utility of a single glucometer fasting capillary blood glucose (FCBG) measurement in determining the prevalence of diabetes mellitus in a homogeneous adult population. FCBG measurements were compared with results of the oral glucose tolerance test (OGTT) in 445 subjects aged 30-65 years in an urban cross-sectional study in Old Ramallah. Prevalence of diabetes, sensitivity, specificity and predictive values were calculated at different cut-off levels of FCBG, using OGTT as the reference. The prevalence of OGTT-diagnosed diabetes was 2.7%, while it varied considerably using different cut-off levels of FCBG. The sensitivity of a single glucometer (Exac Tech II) measurement of FCBG at the cut-off level of 6.7 mmol 1(-1) was 33.3%, with a specificity of 98.8%. Using the cut-off level of 6.1 mmol 1(-1) as suggested by the 1998 provisional report of a WHO consultation, the sensitivity increased to 41.7%. At a cut-off level of 5.6 mmol 1(-1), a sensitivity of 66.6% was reached, but the specificity decreased slightly. It can be concluded that a single glucometer measurement of FCBG in an adult population is not useful in determining the prevalence of diabetes mellitus.

VL - 60 SN - 0036-5513 (Print)
0036-5513 (Linking) N1 - Husseini, A
Abdul-Rahim, H
Awartani, F
Giacaman, R
Jervell, J
Bjertness, E
Comparative Study
Norway
Scandinavian journal of clinical and laboratory investigation
Scand J Clin Lab Invest. 2000 Oct;60(6):457-62. ER -