Nearly 5.6 million Syrian refugees have been displaced by the country's civil war, of which roughly half are children. A digital analysis of features in children's drawings potentially represents a rapid, cost-effective, and non-invasive method for collecting information about children's mental health. Using data collected from free drawings and self-portraits from 2480 Syrian refugee children in Jordan across two distinct datasets, we use LASSO machine-learning techniques to understand the relationship between psychological trauma among refugee children and digitally coded features of their drawings. We find that children's drawing features retained using LASSO are consistent with historical correlations found between specific drawing features and psychological distress in clinical settings. We then use drawing features within LASSO to predict exposure to violence and refugee integration into host countries, with findings consistent with anticipated associations. Results serve as a proof-of-concept for the potential use of children's drawings as a diagnostic tool in human crisis settings.
Healthcare quality measures aim to evaluate providers and health plans so that consumers can make informed decisions on aspects of quality that matter most to them. Yet, most existing quality measures are based on a narrow set of health outcomes and do not effectively evaluate outcomes that are important to individuals themselves. This “one-size-fits-all” approach to measurement is particularly misaligned when evaluating care for older adults with complex needs. This population—including those with functional limitations, comorbidities, or both—frequently requires services and supports that extend beyond traditional medical care, and choices about treatment options that require complicated calculations of tradeoffs. To address the need for quality measures that reflect what matters most to individuals, we tested two approaches to personalized goal setting: goal attainment scaling (GAS) and person-reported outcome measures (PROM). Across six organizations, 34 clinicians (including physicians, nurse practitioners, registered nurses, and social workers) piloted the approaches with 232 older adults (GAS n=184; PROM n=49). Results demonstrate that older adults articulated a range of personalized outcomes important to them but not captured through current quality measures. Quantitative analyses show that on average 73% of older adults in the study with follow-up achieved the personalized goal they had selected over six months, but also revealed variation in achievement rates across organizations (range: 56–100%). Qualitative results highlight that despite the greater initial perceived workload, providers and older adults preferred the individualized GAS approach to the more structured PROM approach. GAS proved feasible for quality measurement across diverse settings of care.
Recent evidence suggests that conditional cash transfer programs for schooling are effective in raising school enrollment and attendance. However, there is also reason to believe that such programs can affect other outcomes, such as the sexual behavior of their young beneficiaries. Zomba Cash Transfer Program is a randomized, ongoing conditional cash transfer intervention targeting young women in Malawi that provides incentives (in the form of school fees and cash transfers) to current schoolgirls and recent dropouts to stay in or return to school. An average offer of US$10/month conditional on satisfactory school attendance plus direct payment of secondary school fees led to significant declines in early marriage, teenage pregnancy, and self-reported sexual activity among program beneficiaries after just one year of program implementation. For program beneficiaries who were out of school at baseline, the probability of getting married and becoming pregnant declined by more than 40 percent and 30 percent, respectively. In addition, the incidence of the onset of sexual activity was 38 percent lower among all program beneficiaries than the control group. Overall, these results suggest that conditional cash transfer programs not only serve as useful tools for improving school attendance, but may also reduce sexual activity, teen pregnancy, and early marriage.
MEPI was a $130 million competitively awarded grant by President's Emergency Plan for AIDS Relief (PEPFAR) and National Institutes of Health (NIH) to 13 Medical Schools in 12 Sub-Saharan African countries and a Coordinating Centre (CC). Implementation was led by Principal investigators (PIs) from the grantee institutions supported by Health Resources and Services Administration (HRSA), NIH and the CC from September, 2010 to August, 2015. The goals were to increase the capacity of the awardees to produce more and better doctors, strengthen locally relevant research, promote retention of the graduates within their countries and ensure sustainability. MEPI ignited excitement and stimulated a broad range of improvements in the grantee schools and countries. Through in-country consortium arrangements African PIs expanded the programme from the 13 grantees to over 60 medical schools in Africa, creating vibrant South-South and South-North partnerships in medical education, and research. Grantees revised curricular to competency based models, created medical education units to upgrade the quality of education and established research support centres to promote institutional and collaborative research. MEPI stimulated the establishment of ten new schools, doubling of the students' intake, in some schools, a three-fold increase in post graduate student numbers, and faculty expansion and retention.Sustainability of the MEPI innovations was assured by enlisting the support of universities and ministries of education and health in the countries thus enabling integration of the new programs into the regular national budgets. The vibrant MEPI annual symposia are now the largest medical education events in Africa attracting global participation. These symposia and innovations will be carried forward by the successor of MEPI, the African Forum for Research and Education in Health (AFREhealth). AFREhealth promises to be more inclusive and transformative bringing together other health professionals including nurses, pharmacists, and dentists.
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