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Stapleton F, Abad JC, Barabino S, Burnett A, Iyer G, Lekhanont K, Li T, Liu Y, Navas A, Obinwanne CJ, Qureshi R, Roshandel D, Sahin A, Shih K, Tichenor A, Jones L. TFOS lifestyle: Impact of societal challenges on the ocular surface. Ocul Surf 2023; 28:165-199. [PMID: 37062429 PMCID: PMC10102706 DOI: 10.1016/j.jtos.2023.04.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
Societal factors associated with ocular surface diseases were mapped using a framework to characterize the relationship between the individual, their health and environment. The impact of the COVID-19 pandemic and mitigating factors on ocular surface diseases were considered in a systematic review. Age and sex effects were generally well-characterized for inflammatory, infectious, autoimmune and trauma-related conditions. Sex and gender, through biological, socio-economic, and cultural factors impact the prevalence and severity of disease, access to, and use of, care. Genetic factors, race, smoking and co-morbidities are generally well characterized, with interdependencies with geographical, employment and socioeconomic factors. Living and working conditions include employment, education, water and sanitation, poverty and socioeconomic class. Employment type and hobbies are associated with eye trauma and burns. Regional, global socio-economic, cultural and environmental conditions, include remoteness, geography, seasonality, availability of and access to services. Violence associated with war, acid attacks and domestic violence are associated with traumatic injuries. The impacts of conflict, pandemic and climate are exacerbated by decreased food security, access to health services and workers. Digital technology can impact diseases through physical and mental health effects and access to health information and services. The COVID-19 pandemic and related mitigating strategies are mostly associated with an increased risk of developing new or worsening existing ocular surface diseases. Societal factors impact the type and severity of ocular surface diseases, although there is considerable interdependence between factors. The overlay of the digital environment, natural disasters, conflict and the pandemic have modified access to services in some regions.
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Affiliation(s)
- Fiona Stapleton
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia.
| | - Juan Carlos Abad
- Department of Ophthalmology, Antioquia Ophthalmology Clinic-Clofan, Medellin, Antioquia, Colombia
| | - Stefano Barabino
- ASST Fatebenefratelli-Sacco, Ospedale L. Sacco-University of Milan, Milan, Italy
| | - Anthea Burnett
- School of Optometry and Vision Science, UNSW, Sydney, NSW, Australia
| | - Geetha Iyer
- C. J. Shah Cornea Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Kaevalin Lekhanont
- Department of Ophthalmology, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tianjing Li
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Yang Liu
- Ophthalmology Department, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Alejandro Navas
- Conde de Valenciana, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | | | - Riaz Qureshi
- Department of Ophthalmology, School of Medicine, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - Danial Roshandel
- Centre for Ophthalmology and Visual Science (incorporating Lions Eye Institute), The University of Western Australia, Nedlands, WA, Australia
| | - Afsun Sahin
- Department of Ophthalmology, Koc University Medical School, İstanbul, Turkey
| | - Kendrick Shih
- Department of Ophthalmology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Tichenor
- School of Optometry, Indiana University, Bloomington, IN, USA
| | - Lyndon Jones
- Centre for Ocular Research & Education (CORE), School of Optometry and Vision Science, University of Waterloo, Waterloo, ON, Canada
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Attwood JE, Naseer S, Michael S, Riley J. Clinical diagnosis of LGI1 antibody encephalitis in an 83-year-old woman. BMJ Case Rep 2021; 14:14/1/e237398. [PMID: 33431450 PMCID: PMC7802655 DOI: 10.1136/bcr-2020-237398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
An 83-year-old woman was referred to hospital with a 2-week history of short-lived episodic unpleasant sensations in her head and running down her body. This was accompanied by new short-term memory impairment and arm spasms. Initial investigations including blood tests and brain imaging did not reveal the diagnosis. The patient developed an increasing frequency of abnormal movements of her face and arm. These were clinically recognised as faciobrachial dystonic seizures (FBDS). FBDS are pathognomonic of an autoimmune encephalitis caused by an antibody directed against leucine-rich glioma-inactivated 1 (LGI1). The clinical diagnosis resulted in treatment with immunotherapy, leading to cessation of seizures and rapid cognitive recovery. Later, the predicted serology was confirmed. This reversible and under-recognised cause of cognitive impairment, typically affecting elderly patients, can be diagnosed clinically to enable early and effective treatment.
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Affiliation(s)
- Jonathan E Attwood
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK,Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Saniya Naseer
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
| | - Sophia Michael
- Department of Neurology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK,Nuffield Department of Clinical Neurosciences, Oxford Autoimmune Neurology Group, University of Oxford, Oxford, Oxfordshire, UK
| | - Josie Riley
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, Oxfordshire, UK
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Bou-Karroum L, El-Harakeh A, Kassamany I, Ismail H, El Arnaout N, Charide R, Madi F, Jamali S, Martineau T, El-Jardali F, Akl EA. Health care workers in conflict and post-conflict settings: Systematic mapping of the evidence. PLoS One 2020; 15:e0233757. [PMID: 32470071 PMCID: PMC7259645 DOI: 10.1371/journal.pone.0233757] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/13/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Health care workers (HCWs) are essential for the delivery of health care services in conflict areas and in rebuilding health systems post-conflict. OBJECTIVE The aim of this study was to systematically identify and map the published evidence on HCWs in conflict and post-conflict settings. Our ultimate aim is to inform researchers and funders on research gap on this subject and support relevant stakeholders by providing them with a comprehensive resource of evidence about HCWs in conflict and post-conflict settings on a global scale. METHODS We conducted a systematic mapping of the literature. We included a wide range of study designs, addressing any type of personnel providing health services in either conflict or post-conflict settings. We conducted a descriptive analysis of the general characteristics of the included papers and built two interactive systematic maps organized by country, study design and theme. RESULTS Out of 13,863 identified citations, we included a total of 474 studies: 304 on conflict settings, 149 on post-conflict settings, and 21 on both conflict and post-conflict settings. For conflict settings, the most studied counties were Iraq (15%), Syria (15%), Israel (10%), and the State of Palestine (9%). The most common types of publication were opinion pieces in conflict settings (39%), and primary studies (33%) in post-conflict settings. In addition, most of the first and corresponding authors were affiliated with countries different from the country focus of the paper. Violence against health workers was the most tackled theme of papers reporting on conflict settings, while workforce performance was the most addressed theme by papers reporting on post-conflict settings. The majority of papers in both conflict and post-conflict settings did not report funding sources (81% and 53%) or conflicts of interest of authors (73% and 62%), and around half of primary studies did not report on ethical approvals (45% and 41%). CONCLUSIONS This systematic mapping provides a comprehensive database of evidence about HCWs in conflict and post-conflict settings on a global scale that is often needed to inform policies and strategies on effective workforce planning and management and in reducing emigration. It can also be used to identify evidence for policy-relevant questions, knowledge gaps to direct future primary research, and knowledge clusters.
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Affiliation(s)
- Lama Bou-Karroum
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Amena El-Harakeh
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
| | - Inas Kassamany
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussein Ismail
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Rana Charide
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Farah Madi
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sarah Jamali
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Tim Martineau
- Department of International Public Health, Liverpool School of Tropical Medicine, United Kingdom
| | - Fadi El-Jardali
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
| | - Elie A. Akl
- Center for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of Beirut, Beirut, Lebanon
- Clinical Research Institute (CRI), American University of Beirut Medical Center, Beirut, Lebanon
- Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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Fozouni L, Weber C, Lindner AK, Rutherford GW. Immunization coverage among refugee children in Berlin. J Glob Health 2019; 9:010432. [PMID: 31217960 PMCID: PMC6571106 DOI: 10.7189/jogh.09.010432] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background The Tempelhof refugee camp offers in-camp immunizations. Other camps, like Neukölln, rely on a centralized immunization system. We aimed to determine the impact of conflict on immunization rates of Syrian children and to measure the efficacy of in-camp immunization services. Methods Families with children aged 1-5 in Tempelhof and Neukölln camps were surveyed. Surveys included siblings under the age of 18. Differences were compared using χ2 test. Results Data on 179 children at Tempelhof and 40 children at Neukölln were collected. At Tempelhof, amongst Syrian children, 27.8% under the age of 5 were “fully immunized-memory,” in contrast to 73.7% over the age of 5 (P = 0.005). This difference in immunization rates by memory between the age groups was not observed in Afghani children (P = 0.34) or in Iraqi children (P = 0.10). Furthermore, compared to the 27.8% of Syrian children, 75% of Afghani children under the age of 5 were “fully vaccinated-memory” (P = 0.0009). Compared to Tempelhof, more children at Neukölln were partially immunized (93%) or had no immunizations (5%) (P < 0.001).
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Affiliation(s)
- Laila Fozouni
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Christoph Weber
- Department of Infectious Diseases, Vivantes Auguste - Viktoria Klinikum, Berlin and Airport Tempelhof Refugee Camp, Berlin, Germany
| | - Andreas K Lindner
- Department of Infectious Diseases, Vivantes Auguste - Viktoria Klinikum, Berlin and Airport Tempelhof Refugee Camp, Berlin, Germany
| | - George W Rutherford
- School of Medicine, University of California, San Francisco, San Francisco, California, USA
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Sen K, Hussain H, Al-Faisal W. Ethics in times of conflict: some reflections on Syria, in the backdrop of Iraq. BMJ Glob Health 2016; 1:e000149. [PMID: 28588972 PMCID: PMC5321374 DOI: 10.1136/bmjgh-2016-000149] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 11/01/2016] [Indexed: 12/04/2022] Open
Abstract
Ethical challenges facing research and reporting from conflict-affected zones are well known; among them is the difficulty of finding reliable information; the tendency to take sides and define actors as either good or evil; the precarious security situation of residents and the ever-changing scenarios on the ground. We observed, however, that these challenges go unacknowledged in research and reporting on health state and on the health system from the conflict in Iraq and Syria, with the lines between science and journalistic reporting routinely blurred in the literature. What should be the restraining factor of academic research against prejudiced reporting on injury, death and the healthcare system has mostly failed in the Syrian conflict. Even social media, with its promise of 'independent' and 'citizens' voice', can be skewed, with much of the output in the Syria crisis coming from one side only, largely due to access issues. While researchers in conflict-affected zones, such as Syria, may need to take a position on one side or another when reporting, death, destruction and disease, it is important that they admit to the challenges of accessing unbiased data, the near impossibility of obtaining representative samples and the risk of the contamination of evidence, clinical or otherwise. The example of the Syrian and Iraqi conflicts (as context) indicates a need to reassess research ethics in conflict zones and their implications for policy.
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Affiliation(s)
| | - Hamid Hussain
- Faculty of Medicine, University of Baghdad, Baghdad, Iraq
| | - Waleed Al-Faisal
- Faculty of Medicine, University of Damascus, Damascus, Syrian Arab Republic
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Alshehri SA, Rezgui Y, Li H. Public perceptions and attitudes to biological risks: Saudi Arabia and regional perspectives. DISASTERS 2016; 40:799-815. [PMID: 26748769 DOI: 10.1111/disa.12179] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Saudi Arabia has experienced frequent occurrences of biological disasters due to a wide range of generator factors, including natural disasters and epidemics. A national survey (n=1,164) was conducted across 13 regions of Saudi Arabia to examine public perceptions to the risk of a biological disaster. The primary results reveal: (a) a degree of knowledge about biological threats such as SARS and H5N1 flu, despite the lack of individual experience with disasters; (b) age, gender, education and faith are positively related to the perception of biological risk; and (c) a number of important community resilience factors exist, including faith, education and willingness. This study concludes that the development of adapted resilience strategies in disaster management can be achieved through public education and training involving cooperation with official organisations and religious authorities in the country to increase public awareness, knowledge and skills in mitigating biological threats.
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Affiliation(s)
- Saud Ali Alshehri
- PhD Candidate, School of Engineering, Cardiff University, United Kingdom.
| | - Yacine Rezgui
- Professor, School of Engineering, Cardiff University, United Kingdom
| | - Haijiang Li
- Senior Lecturer, School of Engineering, Cardiff University, United Kingdom
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Wells R, Steel Z, Abo-Hilal M, Hassan AH, Lawsin C. Psychosocial concerns reported by Syrian refugees living in Jordan: systematic review of unpublished needs assessments. Br J Psychiatry 2016; 209:99-106. [PMID: 27103679 DOI: 10.1192/bjp.bp.115.165084] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 10/27/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Humanitarian organisations supporting Syrian refugees in Jordan have conducted needs assessments to direct resources appropriately. AIMS To present a model of psychosocial concerns reported by Syrian refugees and a peer review of research practices. METHOD Academic and grey literature databases, the United Nations Syria Regional Response website, key humanitarian organisation websites and Google were searched for needs assessments with Syrian refugees in Jordan between February 2011 and June 2015. Information directly reporting the views of Syrian refugees regarding psychosocial needs was extracted and a qualitative synthesis was conducted. RESULTS Respondents reported that psychological distress was exacerbated by both environmental (financial, housing, employment) and psychosocial outcomes (loss of role and social support, inactivity), which are themselves stressors. Need for improvement in research methodology, participatory engagement and ethical reporting was evident. CONCLUSIONS Participatory engagement strategies might help to address identified psychosocial outcomes. More rigorous qualitative methods are required to ensure accuracy of findings.
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Affiliation(s)
- Ruth Wells
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
| | - Zachary Steel
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
| | - Mohammad Abo-Hilal
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
| | - Abdul Halim Hassan
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
| | - Catalina Lawsin
- Ruth Wells, BSc, University of Sydney, Australia; Zachary Steel, PhD, MClinPsych, School of Psychiatry, University New South Wales, The Black Dog Institute, Hospital Road, Prince of Wales Hospital, New South Wales, Australia; Mohammad Abo Hilal, MD, Syria Bright Future; Abdulhalim Hasan, MD, American Medical Center, Erbil, Iraq; Catalina Lawsin, PhD, Department of Behavioral Sciences, RUSH Medical Center, Chicago, USA
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Gurler B, Coskun E, Oner V, Comez A, Erbagci I. Syrian Civil-War-Related Intraocular Foreign Body Injuries: A Four-Year Retrospective Analysis. Semin Ophthalmol 2016; 32:625-630. [DOI: 10.3109/08820538.2016.1142578] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bulent Gurler
- Fatih University Medicine School, Department of Ophthalmology, Istanbul, Turkey
| | - Erol Coskun
- Gaziantep University Medicine School, Department of Ophthalmology, Gaziantep, Turkey
| | - Veysi Oner
- Recep Tayyip Erdogan University Medicine School, Department of Ophthalmology, Rize, Turkey
| | - Aysegul Comez
- Sutcu Imam University Medicine School, Department of Ophthalmology, Kahramanmaras, Turkey
| | - Ibrahim Erbagci
- Gaziantep University Medicine School, Department of Ophthalmology, Gaziantep, Turkey
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Building Evidence-Based Tobacco Treatment in the Eastern Mediterranean Region: Lessons Learned by the Syrian Center for Tobacco Studies. J Smok Cessat 2016; 11:116-123. [PMID: 27563356 DOI: 10.1017/jsc.2016.5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The tobacco epidemic in Syria is characterized by high rates of cigarettes smoking in men and dramatic reemergence of waterpipe smoking, especially among youths and women. The Syrian Center for Tobacco Studies (SCTS), an NIH-funded pioneer research and capacity building institution, has developed a research infrastructure and conducted three randomized clinical trials to develop and rigorously test culturally-appropriate tobacco treatment programs integrated into primary healthcare (PHC) centers. This review aimed to discuss challenges and lessons learned from the Syrian experience. Addressing these challenges may inform future cessation research activities in Syria and other developing countries. To develop a research infrastructure, the SCTS has established Syria's first IRB and trained physicians/medical students in both tobacco treatment and research methods. Main challenges to conduct the cessation trials were difficulties of coordination between the local and international collaborators; high Smoking Rates among PHC providers; lack of pharmacological agents used in tobacco treatment; and difficulties of conducting research in a politically volatile region. Strategies to overcome these challenges were ensuring an active and regular involvement of all investigator; and advocating for a national smoking-cessation plan that involves training health care providers in smoking cessation treatment and make pharmacological agents used in smoking cessation available.
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War Wounded and Victims of Traffic Accidents in a Surgical Hospital in Africa: An Observation on Injuries. Prehosp Disaster Med 2015; 30:618-20. [PMID: 26487476 DOI: 10.1017/s1049023x15005269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Weapon injuries in armed conflict are likely to receive medical attention. Other types of injuries, like traffic accidents, continue to occur during armed conflict. PROBLEM Injuries caused by weapons and by traffic accidents require treatment, but reports and figures to help in prioritizing care are scarce. METHODS In a prospective observational study, all emergency patients admitted to the surgical ward in a public hospital of the Central African Republic were evaluated for the cause of their main injury. The proportion of patients injured by weapons and by traffic accidents was analyzed with respect to the level of violence. RESULTS Seventy-eight patients were included in this study. Weapon injuries accounted for 50 (64%) admissions and traffic accidents for 28 (36%). These proportions varied significantly according to the weekly level of violence (χ(2)=46.8; P<.001). CONCLUSION People injured in traffic accidents are an important, but overlooked, drain on surgical resources in low-income countries with armed conflict. Their proportion in relation to weapon wounded fluctuates with the level of violence. Humanitarian medical organizations might prepare themselves not only for weapon injuries, but also for wounds caused by traffic accidents.
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Affiliation(s)
- Sima L. Sharara
- Curriculum in Global Studies, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Souha S. Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
- * E-mail:
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