The impact of health system governance and policy processes on health services in Iraqi Kurdistan

BACKGROUND: Relative to the amount of global attention and media coverage since the first and second Gulf Wars, very little has been published in the health services research literature regarding the state of health services in Iraq, and particularly on the semi-autonomous region of Kurdistan. Building on findings from a field visit, this paper describes the state of health services in Kurdistan, analyzes their underlying governance structures and policy processes, and their overall impact on the quality, accessibility and cost of the health system, while stressing the importance of reinvesting in public health and community-based primary care. DISCUSSION: Very little validated, research-based data exists relating to the state of population health and health services in Kurdistan. What little evidence exists, points to a region experiencing an epidemiological polarization, with different segments of the population experiencing rapidly-diverging rates of morbidity and mortality related to different etiological patterns of communicable, non-communicable, acute and chronic illness and disease. Simply put, the rural poor suffer from malnutrition and cholera, while the urban middle and upper classes deal with issues of obesity and Type 2 diabetes. The inequity is exacerbated by a poorly governed, fragmented, unregulated, specialized and heavily privatized system, that not only leads to poor quality of care and catastrophic health expenditures, but also threatens the economic and political stability of the region. There is an urgent need to revisit and clearly define the core values and goals of a future health system, and to develop an inclusive governance and policy framework for change, towards a more equitable and effective primary care-based health system, with attention to broader social determinants of health and salutogenesis. SUMMARY: This paper not only frames the situation in Kurdistan in terms of a human rights or special political issue of a minority population, but provides important generalizable lessons for other constituencies, highlighting the need for political action before effective public health policies can be implemented - as embodied by Rudolf Virchow, the father of European public health and pathology, in his famous quote "politics is nothing but medicine at a larger scale"

Socio-Demographic Characteristics and Patterns of Substance Use Disorder in Oman : A retrospective study of the National Surveillance Programme between 2004 and 2018

Objectives: Substance use disorder is a global challenge. Therefore, this study aimed to provide an updated view of socio-demographic characteristics and patterns of substance use in Oman. Methods: This retrospective descriptive study was conducted between 2004 and 2018. Data were retrieved from Oman’s National Drug Addict Registry. The data collected included the socio-demographic characteristics of registered cases, the proportion of various psychoactive substances’ consumption and their routes of administration, the associated sociodemographic determinants as well as comorbid conditions. Results: A total of 6,453 cases were registered during the study’s timeframe. The majority of which were Omani (97.9%), male (98.7%), single (57.9%), unemployed (50.2%), had an education level below university (81.0%) and were adolescents and young adults (77.0%). Opiates were the most common substance used (66.6%) and more than half of the sample were polydrug users (51.0%). Injecting-drug users constituted 53.4% of the total registered cases. The proportion of people with hepatitis virus C, hepatits virus B and HIV among the registered cases were 46.9%, 5.1% and 3.7%, respectively. Conclusion: The findings are in favour of rapidly escalating the introduction of a substance use preventive programme at all school levels as well as making opioid substitution therapy and other harm reduction programmes available in Oman. Keywords: Substance Use Disorders; Intravenous Drug Abuse; Opioid-Related Disorders; Comorbidity; Oman

Noise in ICUs: Review and Detailed Analysis of Long-Term SPL Monitoring in ICUs in Northern Spain

Intensive care units (ICUs) are busy and noisy areas where patients and professional staff can be exposed to acoustic noise for long periods of time. In many cases, noise levels significantly exceed the levels recommended by the official health organisations. This situation can affect not only patient recovery but also professional staff, making ICUs unhealthy work and treatment environments. To introduce the measures and reduce the acoustic noise in the ICU, acoustic noise levels should first be measured and then appropriately analysed. However, in most studies dealing with this problem, measurements have been performed manually over short periods, leading to limited data being collected. They are usually followed by insufficient analysis, which in turn results in inadequate measures and noise reduction. This paper reviews recent works dealing with the problem of excessively high noise levels in ICUs and proposes a more thorough analysis of measured data both in the time and frequency domains. Applied frequency domain analysis identifies the cyclic behaviour of the measured sound pressure levels (SPLs) and detects the dominant frequency components in the SPL time series. Moreover, statistical analyses are produced to depict the patterns and SPLs to which patients in ICUs are typically exposed during their stay in the ICU. It has been shown that the acoustic environment is very similar every night, while it can vary significantly during the day or evening periods. However, during most of the observed time, recorded SPLs were significantly above the prescribed values, indicating an urgent need for their control and reduction. To effectively tackle this problem, more detailed information about the nature of noise during each of the analysed periods of the day is needed. This issue will be addressed in the continuation of this project