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Global directions for reforming health systems and expanding insurance. What is suitable for the Arab Gulf countries?

Most countries are exploring and implementing reforms of their health care systems. The Arab countries in the Gulf are no exception after establishing modern governmental health care systems accessible to all and free of charge. Current problems of the Arab systems include financial, managerial and quality issues. The private sector in these countries has no defined national role and is gowing abruptly and unplanned. The paper presents the major global health reform directions, analyzing the current activities in the Arab Gulf countries and proposing certain practical relevant approaches for health reform, and expansion of insurance in these activites.

Developing Countries↗

Violence against women in Arab and Islamic countries.

In Arab and Islamic countries, domestic violence is not yet considered a major concern despite its increasing frequency and serious consequences. Surveys in Egypt, Palestine, Israel and Tunisia show that at least one out of three women is beaten by her husband. The indifference to this type of violence stems from attitudes that domestic violence is a private matter and, usually, a justifiable response to misbehaviour on the part of the wife. Selective excerpts from the Koran are used to prove that men who beat their wives are following God's commandments. These religious justifications, plus the importance of preserving the honour of the family, lead abusers, victims, police and health care professionals to join in a conspiracy of silence rather than disclosing these offences. However, a fair reading of the Koran shows that wife abuse, like genital mutilation and "honour killings" are a result of culture rather than religion.

Arabs↗

Fertility attitudes and behavior of Saudi Arabian students enrolled in U.S. universities.

Although fertility declines have taken place in several Arab countries, the Arab nations are growing rapidly. In Saudi Arabia, the total fertility rate (TFR) is 7.1, and the growth rate is 3.5 per cent per year, among the highest in the world. This research examines the structural determinants (indirect indicators) of fertility attitudes and behavior among Saudi Arabian students studying in American universities. Specifically, this study examined the relationship between fertility attitudes and behavior, and background characteristics which included age, religiosity, education, income, length of stay in the U.S., and wife's age and wife's education. Results indicate a highly significant effect of religiosity as a major positive determinant of fertility attitudes. However, the major determinant of fertility behavior, the number of children respondents had, was wife's education which was negatively related with family size.

Adult↗

Systemic lupus erythematosus among Arabs.

BACKGROUND: The prevalence of clinical manifestations and laboratory parameters in systemic lupus erythematosus differ among various ethnic groups. Few studies have reported on SLE in Arabs. OBJECTIVES: To summarize the demographic, clinical and laboratory features of Arab SLE patients and to compare them with other series from different Arab countries. METHODS: We reviewed the charts of all Arab SLE patients who had been seen at the Carmel Medical Center in Halfa, the Nazareth Hospital and the Holy Family Hospital in Nazareth, and a professional clinic (a referral outpatient clinic of the largest health maintenance organization in Israel) in Acre--all cities in northern Israel. Only patients with symptoms of more than one year were included. Demographic, clinical and laboratory parameters were documented and compared with those of four series from different Arab countries. RESULTS: The study group comprised 34 patients. The majority of the patients was Moslem; there were a few Druze and one Christian. There was no statistical difference between our patients and any of the other Arab series in terms of arthritis, neuropsychiatric manifestations and VDRL. The presence of serositis and mucocutaneous manifestations was significantly lower in our series compared to some of the other series. However, there was significantly less renal involvement in our patients compared to each of the other series. CONCLUSIONS: The prevalence of most clinical and laboratory parameters in Israeli Arab SLE patients is comparable to that of other series of SLE patients from different Arab countries. The prevalence of renal involvement in Israeli Arab SLE patients seems to be lower than in SLE patients from different Arab countries.

Adult↗

Mental health services and research in the Arab world.

Although there are 22 Arab countries in the Arab League, the mental health services provided in those countries show several forms of variation. Economic, political, social and cultural factors seem to play a major role in determining the state of the psychiatric profession and the access of the service to citizens. The different needs expressed by Arab colleagues at times seem incompatible with the available allocated resources. Some Arab countries enjoy the highest income per capita, yet this is inconsistent with the quality of mental health services available there. The per capita mental health services, the availability of a Mental Health Act, and the space allocated for mental health in medical curricula are but a few of the concerns that have been expressed by colleagues from the different countries of the Arab region. The following review will attempt to draw up a profile of the situation for mental health services and research in the region, and to suggest some measures for intervention.

Delivery of Health Care↗

Ethnic differences in self-reported lack of access to a regular doctor: a population-based study.

OBJECTIVE: The aim of this study was to investigate ethnic differences in self-reported lack of access to a regular doctor in Malmö, Sweden. DESIGN: The public health survey in Malmö 1994 was a cross sectional population study. Data were collected from 5600 people aged 20-80 years using a postal questionnaire. The participation rate was 71%. The population was categorised according to country of birth: born in Sweden, other Nordic countries, other Western countries, Yugoslavia, Eastern Europe, Arabic speaking countries and other countries. Multivariate logistic regression analysis was performed in order to investigate the importance of possible confounders on the differences by country of origin in lack of access to a regular doctor. RESULTS: A 56.3% proportion of all men and 48.8% of all women lacked access to a regular doctor. The odds ratios of lacking access were significantly higher among men born in Nordic countries, Arabic countries and other countries compared to men born in Sweden but disappeared after adjustment for age. The same patterns were observed for women born in Eastern Europe, Arabic countries and other countries compared to women born in Sweden, and remained after adjustment for age. In the multivariate analysis including age, education, ability to pay bills every month and self-reported health, no significant differences in lack of access to a regular doctor remained among men, while the odds ratios were significantly lower among women born in other Western countries, but still significantly higher among women born in Arabic speaking countries and all other countries. CONCLUSION: Self-reported lack of access to a regular doctor was significantly higher among men born in Nordic countries, Arabic countries and other countries compared to men born in Sweden, but all these differences disappeared after adjument for age and in the multivariate analysis. Women born in Arabic speaking countries and other countries lacked access to a regular doctor to a significantly higher extent compared with women born in Sweden, and these differences remained in the multivariate analysis.

Adult↗

Nutritive value of traditional sweets consumed in the Arab Gulf countries.

Proximate, mineral, fatty acid and cholesterol composition of eight traditional sweets commonly consumed in the Arab Gulf countries were determined. Four sweets were obtained from Bahrain, whereas the other sweets were obtained from Oman. Protein level ranged from 0.2 to 9.0%, while the fat content ranged from 7.9 to 18.0%. In general, the sweets were found to be high in energy content but poor in most minerals. Iron and zinc contents were low (less than 2 and less than 1 mg/100 g for iron and zinc, respectively). Cholesterol was high in four sweets (range from 10.6 to 20.4 mg/100 g), mainly because of the use of animal fat in preparation of these sweets. The fatty acids profiles showed that palmitic and oleic acids were predominant. One sweet (eggbaith) was found to be very high in linoleic (42%) and low in palmitic (9.6%) acids. The study showed that some traditional sweets are nutritious, while others should be consumed with moderation.

Adolescent↗

Incidence and severity of gestational diabetes mellitus according to country of birth in women living in Australia.

Gestational diabetes mellitus (GDM) was diagnosed in 1928 of 35,253 (5.5%) tested pregnancies at the Mercy Maternity Hospital in Melbourne between 1979 and the end of 1988. Compared with women born in Australia and New Zealand, the incidence of GDM was significantly greater in women born on the Indian subcontinent (15%); in women born in Africa (9.4%), Vietnam (7.3%), Mediterranean countries (7.3%), and Egypt and Arabic countries (7.2%); and in Chinese (13.9%) and other Asian (10.9%) women. There was no significant difference for women born in the United Kingdom and northern Europe (5.2%), Oceania (5.7%), North America (4.0%), or South America (2.2%). With the World Health Organization criteria as a guide to the severity of hyperglycemia, compared with mothers born in Australia and New Zealand, there were significant increases in the incidences of the more severe grades of GDM in parturients born in the Mediterranean region, Asia, the Indian subcontinent, Egypt, and Arabic countries. The incidence of GDM increased significantly in all racial groups, rising from 3.3% during 1979-1983 to 7.5% during 1984-1988.

Africa↗