Prehospital Care (EMS) in Yemen: Brief Report.

OBJECTIVE: A well-organized emergency medical system with adequate prehospital care can save lives and prevent disability. In Yemen, there are no data available about its prehospital care system. This qualitative, cross-sectional study aims to assess the status of prehospital care or emergency medical services in Yemen. METHODS: Data were collected from January to February 2019 through interviews and a questionnaire obtained from the Prehospital Trauma Care Systems Guideline published by the World Health Organization (WHO). Respondents were key representatives of the Ministry of Public Health and Population (MoPHP), Civil Defense/Police departments, and Yemeni Red Crescent Association (YRCA). RESULTS: Overall, based on 153 responses, it was found that, despite the availability of some formal services, the prehospital care system in Yemen is uncoordinated, fragmented, and insufficient. CONCLUSIONS: Given the importance of regulation, legislation, and funding support in the establishment of an effective prehospital care system, these areas merit the greatest attention and efforts. Future policies and strategies should also strive to improve communication and coordination between existing prehospital care providers, to establish a lead agency, and to increase accessibility to training.

Surgery for pelvic organ prolapse and stress urinary incontinence and female sexual functions: A quasi-experimental study.

OBJECTIVES: To assess the effect of pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) on various domains of female sexual functions in patients before and after reconstructive surgery for these pelvic floor disorders. METHODS: We conducted a quasi-experimental study of 126 women aged 25-65 years, presenting with POP / SUI, from January 1st 2019 to December 31st 2019 at Aga Khan University Hospital. POP surgery was performed only in patients with symptomatic POP ≥ stage 2 according to POP-Q (quantification). Sexual functions were assessed using Female Sexual Function Index (FSFI) questionnaire, among sexually active women at baseline and 18 months after surgery. RESULTS: Mean age of the participants was 51.6, with a mean parity of four. Out of 126 patients, 31 patients underwent vaginal hysterectomy, pelvic floor repair and mid-urethral sling (MUS), 55 had vaginal hysterectomy with pelvic floor repair, 12 women had only pelvic floor repair and 10 patients had uterine suspension surgery for prolapse, while 18 patients underwent MUS operation alone for SUI. There was a statistically significant difference in female sexual functions after surgery for POP and/or SUI (p<0.01). This improvement was observed in both total and individual scores of each domain of FSFI with an overall improvement in sexual function from a mean of 18.5 pre-surgery to 20.8 post-surgery. CONCLUSIONS: This study reveals that women sexual functions are affected by POP and SUI and improve remarkably after reconstructive surgeries for these pelvic floor disorders.

Emergency and disaster management training; knowledge and attitude of Yemeni health professionals- a cross-sectional study.

BACKGROUND: Medical professionals together with other first responder teams are the first to attend an emergency or disaster. Knowledge and training in emergency and disaster preparedness are important in responding effectively. This study aims to assess the current knowledge, attitude and training in emergency and disaster preparedness among Yemeni health professionals. METHOD: A descriptive, cross-sectional, non-probability based study was conducted in Yemen using self-reported on-line and paper surveys in 2017. A total of 531 health professionals responded. The Chi-Square test was used to identify any significant difference in the knowledge and attitude of the professional categories. The p-value of <0.05 was used as a statistical significant. RESULTS: The overall knowledge status of Yemeni health professionals was insufficient with regards to emergency and disaster preparedness. Of all respondents, 32.0% had good knowledge, 53.5% had fair and 14.5% exhibited poor knowledge. The educational level was a key factor in the knowledge gap amongst respondents. Regardless of the period of experience, postgraduate staff were more knowledgeable than graduates. Physicians were better in knowledge than other subgroups of health specialties. Health administrators seemed insufficiently qualified in emergency and disaster planning. Medical teachers performed better in responding to knowledge test than managers. However, the majority of study respondents appeared in the 'positive attitudes' level to emergency and disaster preparedness. 41.0% of all respondents had received no courses in disaster preparedness. The trained staff used NGOs, and online-related programs more frequently for learning disaster planning (15.7%, and 13.6%) respectively. In contrast, formal resources such as MoPHP, health facility, medical schooling programs were used by (10.2%, 9.6, and 7.3%) of respondents, respectively. 58.9% of respondents had not participated in any exercise in emergency and disaster preparedness. Of all respondents, triage and mass causality response exercises were attended by only (13.5%, and 9.7%) respectively. CONCLUSION: The absence of teaching programs is a major issue in the lack of knowledge of health professionals regarding disaster preparedness. Thus, emergency and disaster preparedness has to be included in the primary medical school curricula and continuing medical education programs of the health facilities. Long-term formal training such as undergraduate and postgraduate programs is necessary. Operational simulations enrolled key personnel of multi-agencies focus on an organizational training rather than individual based training are recommended.

Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2016: A Systematic Analysis for the Global Burden of Disease Study.

Importance: The increasing burden due to cancer and other noncommunicable diseases poses a threat to human development, which has resulted in global political commitments reflected in the Sustainable Development Goals as well as the World Health Organization (WHO) Global Action Plan on Non-Communicable Diseases. To determine if these commitments have resulted in improved cancer control, quantitative assessments of the cancer burden are required. Objective: To assess the burden for 29 cancer groups over time to provide a framework for policy discussion, resource allocation, and research focus. Evidence Review: Cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life-years (DALYs) were evaluated for 195 countries and territories by age and sex using the Global Burden of Disease study estimation methods. Levels and trends were analyzed over time, as well as by the Sociodemographic Index (SDI). Changes in incident cases were categorized by changes due to epidemiological vs demographic transition. Findings: In 2016, there were 17.2 million cancer cases worldwide and 8.9 million deaths. Cancer cases increased by 28% between 2006 and 2016. The smallest increase was seen in high SDI countries. Globally, population aging contributed 17%; population growth, 12%; and changes in age-specific rates, -1% to this change. The most common incident cancer globally for men was prostate cancer (1.4 million cases). The leading cause of cancer deaths and DALYs was tracheal, bronchus, and lung cancer (1.2 million deaths and 25.4 million DALYs). For women, the most common incident cancer and the leading cause of cancer deaths and DALYs was breast cancer (1.7 million incident cases, 535 000 deaths, and 14.9 million DALYs). In 2016, cancer caused 213.2 million DALYs globally for both sexes combined. Between 2006 and 2016, the average annual age-standardized incidence rates for all cancers combined increased in 130 of 195 countries or territories, and the average annual age-standardized death rates decreased within that timeframe in 143 of 195 countries or territories. Conclusions and Relevance: Large disparities exist between countries in cancer incidence, deaths, and associated disability. Scaling up cancer prevention and ensuring universal access to cancer care are required for health equity and to fulfill the global commitments for noncommunicable disease and cancer control.

Five years cancer incidence in Aden Cancer Registry, Yemen (2002-2006).

The population-based Aden Cancer Registry (ACR) started its activities in 1997. The objective of the registry is to establish a reliable magnitude of cancer in the area covered and the first report was published in 2003. The present article describes data from the second report of cancer incidence over a five year period (2002-2006). Internationally accepted standardized cancer registration methodologies described by IACR and IARC were used. CanReg-4 using ICDO-3 and ICD-10 were applied in the data processing and analysis. Results showed no difference in the overall incidence between the males and females (ratio was 0.83:1) and age standardized rate s(ASR) per 100,000 inhabitants were 30.2 and 31.1. The five most common cancers were breast cancer, leukemia, non-Hodgkin's lymphomas (NH lymphoma), brain cancer and Hodgkin's disease (16.6%, 12.6%, 7.8%, 5.2% and 4.4%, respectively). Among males, leukemia was the first followed by NH lymphoma, Hodgkin's disease, brain and liver. In females, breast was the first, then leukemia, NH lymphoma, thyroid and brain cancer. The highest ASR for males (145 per 100,00 inhabitants) was observed at age 70-74 years whereas for females, two peaks (each 105 per 100,000 inhabitants) were equally noticed at age 60-64 and 70-74 years. Generally, females showed equal or higher incidence compared to males until age 55-59 where males reported higher incidence. The overall pattern of cancer incidence in this report is not much different from that in the previous report. Furthermore, the report generally indicates that the pattern of the most common registered cancer bears some similarities with the adjacent Gulf Cooperation Council States with which we share many characteristics, despite differences that warrant further investigation.