Physicians' perceptions, attitudes and expectations regarding the role of hospital-based pharmacists in the West Bank, Palestine

Objective - To evaluate the perceptions, expectations and experiences of physicians with regard to hospital-based pharmacists in the West Bank, Palestine. Methods - A self-administered questionnaire was distributed to 250 physicians practising in four general hospitals in the West Bank, Palestine. The main sections of the questionnaire comprised a series of statements pertaining to physicians' perceptions, expectations and experiences with pharmacists. Key findings - One hundred and fifty seven questionnaires were completed and returned (response rate, 62.8%). The majority of respondents were most comfortable with pharmacists detecting and preventing prescription errors (76.4%; 95% confidence interval (CI) 69.5–81.2%) and patient education (57.9%; CI 51.2–63.4%) but they were not comfortable with pharmacists suggesting the use of prescription medications to patients (56.7%; CI 49.8–62.4%). Most physicians (62.4%; CI 56.8–69.1%) expected the pharmacist to educate their patients about the safe and appropriate use of their medication. However, approximately one-third (31.7%; CI 26.0–39.6%) did not expect pharmacists to be available for consultation during rounds. Physicians' experiences with pharmacists were less favourable; whereas 77% (CI 70.2–81.5%) of the physicians agreed that pharmacists were always a reliable source of information, only 11.5% (CI 6.2–16.4%) agreed that pharmacists appeared to be willing to take responsibility for solving any drug-related problems. Conclusion -The present study showed that hospital physicians are more likely to accept traditional pharmacy services than newer clinical services for hospital-based pharmacists in the West Bank, Palestine. Pharmacists should therefore interact more positively and more frequently with physicians. This will close the gap between the physicians' commonly held perceptions of what they expect pharmacists to do and what pharmacists can actually do, and gain support for an extended role of hospital-based pharmacists in future patient therapy management.

Extent and nature of unlicensed and off-label medicine use in hospitalised children in Palestine

Objective of the study To determine the extent and nature of unlicensed/off-label prescribing patterns in hospitalised children in Palestine. Setting Four paediatric wards in two public health system hospitals in Palestine [Caritas children’s hospital (Medical and neonatal intensive care units) and Rafidia general hospital (Medical and surgical units)]. Method A prospective survey of drugs administered to infants and children <18 years old was carried out over a five-week period in the four paediatric wards. Main outcome measure Drug-licensing status of all prescriptions was determined according to the Palestinian Registered Product List and the Physician’s Desk Reference. Results Overall, 917 drug prescriptions were administered to 387children. Of all drug prescriptions, 528 (57.5%) were licensed for use in children; 65 (7.1%) were unlicensed; and 324 (35.3%) were used off-label. Of all children, 49.6% received off-label prescriptions, 10.1% received unlicensed medications and 8.2% received both. Seventy-two percent of off-label drugs and 66% of unlicensed drugs were prescribed for children <2 years. Multivariate analysis showed that patients who were admitted to the neonatal intensive care unit and infants aged 0–1 years were most likely to receive a greater number of off-label or unlicensed medications (OR 1.80; 95% CI 1.03–3.59 and OR 1.99; 95% CI 0.88–3.73, respectively). Conclusion The present findings confirmed the elevated prevalence of unlicensed and off-label paediatric drugs use in Palestine and strongly support the need to perform well designed clinical studies in children.

Political leadership and the politics of performance:France, Syria and the chemical weapons crisis of 2013

This article draws upon developments in UK research on political rhetoric and political performance in order to examine the incident in 2013 when French President François Hollande committed French forces to a US-led punitive strike against Syria, after the use of chemical weapons in a Damascus suburb on 21 August. The US-led retaliation did not take place. This article analyses Hollande's declaration on 27 July and his TV appearance on 15 September. His rhetoric and style are best understood as generic to the nature of the presidential office of the Fifth Republic. The article concludes by appraising how analysis of the French case contributes to the developing literature on rhetoric, celebrity and performance.

Islamist movements at crossroads: the choice between ideology and context-driven approach to politics. Case study on the Hashemite Kingdom of Jordan

The aim of the paper is to analyse the ongoing transformation process within the Islamist movements using the example of the moderate Islamic Action Front party in Jordan. The dilemma of participation in the 2010 general elections raised tensions between the Muslim Brotherhood in Jordan and its political wing, the Islamic Action Front, and between doves and hawks of the same organizations. Internal debate on the future has started recently among different groups within the Islamist movement in Jordan. The research is based on the author‘s recent field experience in Jordan (April–July 2010, Andrew W. Mellon Fellowship at the American Centre of Oriental Research, Amman, Jordan). The author also conducted research in Syria, Lebanon, Palestine and Egypt, where several interviews were carried out with leading and lower level Islamist politicians. The dynamic changes within Islamic Action Front Party in Jordan and its relation with the regime has been used as reference point. The main question of the research was aa how the changing political and regional context shapes decisions of the Islamist with special attention to the acceptance of democratic values and human rights, political participation, and the meanings of Islamic values in the 21st century, possible cooperation with secular parties/movements/the regime.

The influence of neighbourhood formality status and socio-economic position on self-rated health among adult men and women: a multilevel, cross sectional, population study from Aleppo, Syria

Background There is substantial evidence from high income countries that neighbourhoods have an influence on health independent of individual characteristics. However, neighbourhood characteristics are rarely taken into account in the analysis of urban health studies from developing countries. Informal urban neighbourhoods are home to about half of the population in Aleppo, the second largest city in Syria (population>2.5 million). This study aimed to examine the influence of neighbourhood socioeconomic status (SES) and formality status on self-rated health (SRH) of adult men and women residing in formal and informal urban neighbourhoods in Aleppo. Methods The study used data from 2038 survey respondents to the Aleppo Household Survey, 2004 (age 18–65 years, 54.8% women, response rate 86%). Respondents were nested in 45 neighbourhoods. Five individual-level SES measures, namely education, employment, car ownership, item ownership and household density, were aggregated to the level of neighbourhood. Multilevel regression models were used to investigate associations. Results We did not find evidence of important SRH variation between neighbourhoods. Neighbourhood average of household item ownership was associated with a greater likelihood of reporting excellent SRH in women; odds ratio (OR) for an increase of one item on average was 2.3 (95% CI 1.3-4.4 (versus poor SRH)) and 1.7 (95% CI 1.1-2.5 (versus normal SRH)), adjusted for individual characteristics and neighbourhood formality. After controlling for individual and neighbourhood SES measures, women living in informal neighbourhoods were less likely to report poor SRH than women living in formal neighbourhoods (OR= 0.4; 95% CI (0.2- 0.8) (versus poor SRH) and OR=0.5; 95%; CI (0.3-0.9) (versus normal SRH). Conclusions Findings support evidence from high income countries that certain characteristic of neighbourhoods affect men and women in different ways. Further research from similar urban settings in developing countries is needed to understand the mechanisms by which informal neighbourhoods influence women’s health.

Forecasting future prevalence of type 2 diabetes mellitus in Syria

Background Type 2 diabetes mellitus (T2DM) is increasingly becoming a major public health problem worldwide. Estimating the future burden of diabetes is instrumental to guide the public health response to the epidemic. This study aims to project the prevalence of T2DM among adults in Syria over the period 2003–2022 by applying a modelling approach to the country’s own data. Methods Future prevalence of T2DM in Syria was estimated among adults aged 25 years and older for the period 2003–2022 using the IMPACT Diabetes Model (a discrete-state Markov model). Results According to our model, the prevalence of T2DM in Syria is projected to double in the period between 2003 and 2022 (from 10% to 21%). The projected increase in T2DM prevalence is higher in men (148%) than in women (93%). The increase in prevalence of T2DM is expected to be most marked in people younger than 55 years especially the 25–34 years age group. Conclusions The future projections of T2DM in Syria put it amongst countries with the highest levels of T2DM worldwide. It is estimated that by 2022 approximately a fifth of the Syrian population aged 25 years and older will have T2DM.

Explaining the increase in coronary heart disease mortality in Syria between 1996 and 2006

Background Despite advances made in treating coronary heart disease (CHD), mortality due to CHD in Syria has been increasing for the past two decades. This study aims to assess CHD mortality trends in Syria between 1996 and 2006 and to investigate the main factors associated with them. Methods The IMPACT model was used to analyze CHD mortality trends in Syria based on numbers of CHD patients, utilization of specific treatments, trends in major cardiovascular risk factors in apparently healthy persons and CHD patients. Data sources for the IMPACT model included official statistics, published and unpublished surveys, data from neighboring countries, expert opinions, and randomized trials and meta-analyses. Results Between 1996 and 2006, CHD mortality rate in Syria increased by 64%, which translates into 6370 excess CHD deaths in 2006 as compared to the number expected had the 1996 baseline rate held constant. Using the IMPACT model, it was estimated that increases in cardiovascular risk factors could explain approximately 5140 (81%) of the CHD deaths, while some 2145 deaths were prevented or postponed by medical and surgical treatments for CHD. Conclusion Most of the recent increase in CHD mortality in Syria is attributable to increases in major cardiovascular risk factors. Treatments for CHD were able to prevent about a quarter of excess CHD deaths, despite suboptimal implementation. These findings stress the importance of population-based primary prevention strategies targeting major risk factors for CHD, as well as policies aimed at improving access and adherence to modern treatments of CHD.

Transactions, space and otherness : borders and boundaries in Palestine-Israel

Peer reviewed

Material mnemonics and competing narratives in Palestine-Israel

Acknowledgements This work was supported by a grant from the Netherlands Institute for Advanced Study in the Humanities and Social Sciences (NIAS) and The Carnegie Trust for the Universities of Scotland [31860].

An Arab woman supports Palestine

General note: Title and date provided by Bettye Lane.

Syria and Israel in the Middle East : an anatomy of the conflict

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

Syria and Israel in the Middle East : an anatomy of the conflict

Mémoire numérisé par la Direction des bibliothèques de l'Université de Montréal.

¿Qué hay en un nombre? –Akko-Ptolemais–´Akka-Acre

La actual ciudad de Akko in Israel, ha tenido muchos nombres a lo largo de los siglos de su prolongado asentamiento. El nombre de Acre, con el que se le conoce en el mundo Occidental, es el residuo del nombre de San Juan de Acre que le dieron sus habitantes cruzados en el s. XII de la era Cristiana. Sin embargo, el nombre de ‘Akko y sus derivados, tienen una larga historia. Bajo tal nombre, aparece ya en las fuentes escritas de comienzos el II Milenio a.C., cuando e produjo la primera urbanización del lugar. Se mantuvo como ‘Akko, ‘Ake, etc…a lo largo de los siglos posteriors, a pesar de los inentos de varios dirigentes de cambiarelo. El asentamiento se trasladó, a causa de los cambios en la línea de costa y del río Na’aman o Belos, desde el antiguo Tel Akko a la bahía, en la que se estableció un puerto artificial,reconstruido y renovado reiteradamente durante más de 2000 años. El primer nombre conocido del sitio original del asentamiento, el tell, data de época de los cruzados. Este sufrió una alteración de su nombre, reflejo de la transformación de la historia de Akko, en la que la intervención occidental (europea9, jugó un papel decisivo.

"Sub Tiberio quies"? Judaea’s Political Situation under the Prefects (6-41 c.e.), between Reality and Ideology

Deeply conflicting views on the political situation of Judaea under the Roman prefects (6-41 c.e.) have been offered. According to some scholars, this was a period of persistent political unrest and agitation, whilst according to a widespread view it was a quiescent period of political calm (reflected in Tacitus’ phrase sub Tiberio quies). The present article critically examines again the main available sources –particularly Josephus, the canonical Gospels and Tacitus– in order to offer a more reliable historical reconstruction. The conclusions drawn by this survey calls into question some widespread and insufficiently nuanced views on the period. This, in turn, allows a reflection on the non-epistemic factors which might contribute to explain the origin of such views.

Revisiting Politicide: State Annihilation in Israel/Palestine

State annihilation is a persistent concern in Israel/Palestine. While the specter of Israel’s destruction increasingly haunts Israeli public political debates, the actual materialization of Palestinian statehood seems to be permanently suspended, caught in an ever-protracted process of state-building. The current paper claims that to understand the unfolding of the discursive formations, as well as the spatial dimensions of conflict and control in Israel/Palestine, we should explicate the workings of the processes of politicide. Politicide, in this regard, denotes the eradication of the political existence of a group and sabotaging the turning of a community of people into a polity. This analysis suggests that the insistence that the State of Israel is under threat of extinction should be understood as a speech act, a performative reiteration, which allows for the securitization of Israeli rule in the occupied Palestinian territory, a securitization which then serves to rationalize the ongoing concrete politicide of the Palestinians. Elaborating on the concept of politicide, and diverging from defining it solely through the use of brute violence, this examination suggests that what is often overlooked in discussions of politicide are the seemingly more benign means of its implementation, the micro-power mechanisms of spatial control, prohibitions and regulations.