It appears that the burden of poverty, chronic disease and low education in this population, which suffers from multiple stressors, is disproportionate and should be addressed by the authorities, together with concrete plans to improve the education of the younger generations. Clearly, the association between discriminating policies and deprivation with psychological distress is not unique to the case of the Palestinian minority in Israel and therefore this study will allow for the examination and generalization of the current findings to other discriminated and disadvantaged minorities.
This institutional discrimination of Palestinian citizens of Israel has been legally endorsed with the adoption of the Nation State Bill (Basic Law: Israel: The Nation-State of the Jewish People), on 19.7.2018 by the Israeli Parliament, causing additional anxiety and concern in the Arab population.
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Sample size was determined so that it would provide adequate statistical power for comparisons of subjects with and without one or more chronic conditions. The prevalence of one or more chronic conditions, according to previous data, was 14.5% [50]. The necessary sample size was estimated to include 2250 families.
In order to be able to compare our findings regarding psychological distress with those of other Israeli studies, it was necessary to re-categorize our data. The studies we chose for comparison analyzed GHQ-12 in different ways - some using categories with different cut-off points, others dichotomizing the data and still others using mean total scores. In Fig. 1 our data are presented using the four categories proposed by Ponizovsky et al. (2018) [18].
When included in a multivariate analysis, gender, educational level, geographical district, obesity and the presence of chronic disease remained significantly associated with high psychological distress but age did not (Table 2). Women were 1.8 times more likely than men to report high distress, and subjects with little or no education were 2.1 and 3.5 times more likely, respectively, to report distress than those with academic education. Subjects living in the Northern district were twice as likely as those living in the Haifa district to report high distress, while those living in the Central and Southern districts did not significantly differ from those in the Haifa district. Subjects classified as obese were 1.4 times more likely than normal-weight subjects to report psychological distress, and those with one or two or more chronic diseases were 2.0 and 2.1 times more likely, respectively, to report distress than those who reported no chronic diseases. In order to test whether the addition of poverty to the model would modify these findings, we performed a separate analysis that included poverty as a variable in the multivariate analysis. The addition of poverty did not significantly change the findings as reported in Table 2; however, it reduced the number of subjects by 14%. Thus, we only present the multivariate analysis, which includes all the subjects (Table 2).
This study, which addresses the broad complexity of factors associated with psychological distress and poor self-assessment of health, has given us the opportunity to identify some of the most salient risk factors for these constructs in the Palestinian minority in Israel, using the GHQ-12 and SRH measures, respectively. Although the risk factors for psychological distress and poor SRH somewhat overlap, the extent of the risk associated with each of the factors is very different for the two constructs. For psychological distress, sociodemographic factors have a greater impact, while for poor SRH the existence of actual chronic conditions is the strongest predictor.
With respect to psychological distress, as measured by the GHQ-12 scale, mean global scores in our population were 20.7 for women and 17.5 for men. Multivariate analysis showed that the risk of high psychological distress was greater among women, those with low education, those in the obese weight category and those with one or more chronic health conditions, over and above the effect of the other variables.
Our finding that high psychological distress in our study was strongly associated with low education (subjects with no education at all or only primary school level were 3.4 and 2.1 times more likely, respectively, to report high psychological distress than subjects with academic education), is in accordance with other studies conducted in a variety of populations [9, 21], and among the Palestinians in Israel in particular [24]. For the Palestinian population of Israel, this finding is one with a high potential impact, since in this minority population group, 38% were categorized as having a very low educational level (11% reported having no formal education at all, and a further 27% reported having only a primary school educational level). This, in comparison with 12.3% of the Jewish Israeli population [57].
Although poverty, defined in or study as being below the poverty line according to income, was strongly associated with psychological distress in the univariate analysis, it is not presented in our multivariate analysis due to a high percentage of missing values (14.1%). It should be pointed out, however, that almost 50% of the Arab population in Israel are below the poverty line, as compared with 27.8% in the general population [29], putting a large proportion of the population at risk of psychological distress.
The overall profile emerging from this study is one of poverty, which affects women more than men, and of a population with a relatively low educational level and high rates of chronic morbidity. Phelan et al. (2010) propose that resources such as money, knowledge, prestige, power and beneficial social connections are relevant to protect health in any population, and these resources are largely missing among Palestinians in Israel [60]. This composite picture of a disadvantaged minority population is in accordance with the approach of Veenstra (2011) [26], and Dogra, 2012 [61], who emphasized the importance of considering the complex interplay between multiple stressors, which are mutually reinforcing one another, being, as they are, intrinsically entwined.
We describe three different procedures based on metadata standards for enabling automated retrieval of scientific data from digital repositories utilising the persistent identifier of the dataset with optional specification of the attributes of the data document such as filename or media type.
The procedures are demonstrated using the JSmol molecular visualizer as a component of a web page and Avogadro as a stand-alone modelling program. We compare our methods for automated retrieval of data from a standards-compliant data repository with those currently in operation for a selection of existing molecular databases and repositories.
In an earlier article on this theme [3], we argued a case for scientific articles to be cast as a datument, being a document in which the data within it is clearly identified in both a syntactical and a semantic manner, together with the associated narrative logical flow from which new knowledge can emerge. Our example used HTML mark-up to achieve a co-existence of these components, whilst retaining the narrative in a form more familiar not only to most readers but also the putative authors of the content. More recently we have adopted a refined model, recognising there are significant differences in how either narrative or data can be best expressed and published. This new model makes use of digital repositories as a more optimal medium for publishing data, whilst retaining the conventional journal article for the narrative. To achieve this model, we made use [4] of persistent identifiers such as the well-known DOI or digital object identifier for both the narrative and the data.
The use of the DOI to uniquely identify journal articles is now essentially universal amongst most publishers of scientific journals and is supported by the DOI registration agency CrossRef [5]. The CrossRef DOI infrastructures, which are now more than 10 years old, have inevitably been optimised for the purpose of linking to individual journal articles. Because most journals are in fact commercial activities, the infrastructure has evolved to recognise this feature; a DOI does not point to an article itself, but to what is called its landing page. This page, the layout and structure of which may vary according to the publisher, provides the mechanism for the reader to acquire the article itself. This in turn may require the reader to have access to an institutional subscription to the journal, or if this is not available, to provide a credit card to pay for the individual article. In some domains such as chemistry, only a small proportion of articles are currently placed outside of this paywall for unrestricted open access [6]. Crucially, the same landing page is used to provide links to the SI associated with the article, allowing the reader to download a PDF or other type of file containing the data. This link will probably but not invariably be outside the paywall. A small proportion of data might be provided in a more suitable structured form such as a CIF file [2] containing crystallographic information, but in general the media type [7] for the data is not declared and is not discoverable. Navigation of the landing page tends to be unique to each journal. There are no declared standards for automated discovery of information there and there cannot be any certainty that the navigational paths off the landing page will be static and not change if the landing page is redesigned. Access to the SI cannot be assumed to be persistent; the reader has to interpret each parochial landing page for the mechanism to acquire supporting information, then download and store it locally. Even at this stage, the data is often found in inappropriate containers such as the PDF format, one that was never designed for the purpose of managing data. Finally appropriate software to read and manipulate the data must be identified; this often reduces to the base level of a simple text editor, again a tool not necessarily optimised for extracting or manipulating data. There is rarely other supporting infrastructure to help the reader in this task; data is more than likely to be un-indexed, which means that searches for appropriate sub-components such as molecular connections or properties are unavailable. This lack of metadata means that the data may only eventually become discoverable via the traditional commercial abstracting agencies such as SciFinder, Reaxys or CCDC, where the expense of using humans to recover or curate the semantics and validation is reflected in the costs of the institutional licenses that are required to access that data. 2ff7e9595c
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