Abstract Background Cash transfers are an increasingly common intervention in the Syrian refugee response to meet basic needs, though there is little known of their potential secondary impact on health outcomes in humanitarian settings. Methods A quasi-experimental prospective cohort study was implemented from October 2018 through January 2020 to assess the effectiveness of multi-purpose cash (MPC), community health volunteer (CHV)-led education, combined with conditional cash transfers (CCT) with respect to health measures among Syrian refugees with type II diabetes in Jordan. Results CHV + CCT participants had the highest expenditures at endline and were the only group with statistically significant increases in payments for outpatient diabetes care (25.3%, P < 0.001) and monthly medication costs (13.6%, P < 0.001). Conversely, monthly spending on diabetes medication decreased significantly in the CHV only group (− 18.7%, P = 0.001) yet increased in the MPC and CHV + CCT groups. Expenditures on glucose monitoring increased in all groups but significantly more in the CHV + CCT group (39.2%, P < 0.001). The proportion of participants reporting regular diabetes care visits increased significantly only in the CHV + CCT group (15.1%, P = 0.002). Specialist visits also increased among CHV + CCT participants (16.8%, P = 0.001), but decreased in CHV only participants (− 27.8%, P < 0.001). Decreases in cost-motivated provider selection (− 22.8%, P < 0.001) and not receiving all needed care because of cost (− 26.2%, P < 0.001) were significant only in the CHV + CCT group. A small significant decrease in BMI was observed in the CHV + CCT group (− 1.0, P = 0.005). Decreases in HbA1C were significant in all groups with magnitudes ranging from − 0.2 to − 0.7%. The proportion of CHV + CCT participants with normal blood pressure increased significantly from baseline to endline by 11.3% ( P = 0.007). Conclusions Combined conditional cash and health education were effective in improving expenditures, health service utilization, medication adherence, blood pressure, and diabetes control. The lower cost health education intervention was similarly effective in improving diabetes control, whereas unconditional cash transfers alone were least effective. Study findings suggest that conditional cash or combined cash and health education are promising strategies to support diabetes control among refugees and that where the purpose of MPC is to improve health outcomes, this alone is insufficient to achieve improvements in the health of refugees with diabetes.
The Supermarket Healthy Options Project (SHOP) is a large, randomised, controlled trial designed to evaluate the effect of tailored nutrition education and price discounts on supermarket food purchases. A key objective was to recruit approximately equal numbers of Māori, Pacific and non-Māori, non-Pacific shoppers. This paper describes the recruitment strategies used and evaluates their impact on recruitment of Māori, Pacific and non-Māori, non-Pacific trial participants.
We describe a case of oncogenic osteomalacia secondary to solitary plasmacytoma of the vertebral body of T3. The patient presented with symptoms of hypophosphataemia. Following the initial diagnosis, the lesion was surgically resected with good results, although several follow-up procedures, including bone grafting, were necessary to stabilize the thoracic spine. The lesion recurred almost 15 years after its initial resection, again presenting with hypophosphataemia and neurological symptoms suggestive of local tumour recurrence. A variety of radiological examinations were performed in an attempt to confirm and localize recurrent tumour, including bone scintigraphy, 111indium octreotide scintigraphy, high-resolution CT and MRI of the thoracic spine, but these yielded only negative or equivocal results owing, in part, to the presence of extensive post-operative changes, and also to a difference in the MR signals of the recurrent and original tumours. Positron emission tomography (PET/CT) demonstrated a solitary focus of intense fluorodeoxyglucose uptake in the T3 vertebral body, enabling a definitive diagnosis of recurrent plasmacytoma. This case illustrates the diagnostic value of PET/CT in the setting of challenging post-operative changes in the surrounding tissue and in the appearance of the tumour itself. Relevant related imaging literature is also reviewed.
Cash assistance has rapidly expanded in the Syrian refugee response in Jordan and global humanitarian programming, yet little is known about the effect of multipurpose cash transfers (MPC) on health in humanitarian contexts. A prospective cohort study was conducted from May 2018 through July 2019 to evaluate the effectiveness of MPC in improving access to healthcare and health expenditures by Syrian refugees in Jordan. Households receiving MPCs (US$113-219 monthly) were compared to control households not receiving MPCs using difference-in-difference analyses. Overall health care-seeking was consistently high (>85%). Care-seeking for child illness improved among MPCs but declined among controls with a significant adjusted difference in change of 11.1% (P<0.05). In both groups, child outpatient visits significantly increased while emergency room visits decreased. Changes in care-seeking and medication access for adult acute illness were similar between groups; however, hospital admissions decreased among MPCs, yet increased among controls (-8.3% significant difference in change; P<0.05). There were no significant differences in change in chronic illness care utilization. Health expenditures were higher among MPCs at baseline and endline; the only significant difference in health expenditure measures' changes between groups was in borrowing money to pay for health costs, which decreased among MPCs and increased among controls with an adjusted difference in change of -10.3% (P<0.05). The impacts of MPC on health were varied and significant differences were observed for few outcomes. MPC significantly improved care-seeking for child illness, reduced hospitalizations for adult acute illness, and lowered rates of borrowing to pay for health expenditures. No significant improvements in chronic health condition indicators or shifts in sector of care-seeking were associated with MPC. While MPC should not be considered as a stand-alone health intervention, findings may be positive for humanitarian response financing given the potential for investment in MPC to translate to health sector response savings.
Background The burden of chronic obstructive pulmonary disease
(COPD) across many world regions is high. We aim to estimate COPD
prevalence and number of disease cases for the years 1990 and 2010
across world regions based on the best available evidence in publicly
accessible scientific databases.
Methods We conducted a systematic search of Medline, EMBASE and
Global Health for original, population–based studies providing spirometry–
based prevalence rates of COPD across the world from January
1990 to December 2014. Random effects meta–analysis was conducted
on extracted crude prevalence rates of COPD, with overall summaries
of the meta–estimates (and confidence intervals) reported separately for
World Health Organization (WHO) regions, the World Bank's income
categories and settings (urban and rural). We developed a meta–regression
epidemiological model that we used to estimate the prevalence of
COPD in people aged 30 years or more.
Findings Our search returned 37 472 publications. A total of 123 studies
based on a spirometry–defined prevalence were retained for the review.
From the meta–regression epidemiological model, we estimated
about 227.3 million COPD cases in the year 1990 among people aged
30 years or more, corresponding to a global prevalence of 10.7% (95%
confidence interval (CI) 7.3%–14.0%) in this age group. The number
of COPD cases increased to 384 million in 2010, with a global prevalence
of 11.7% (8.4%–15.0%). This increase of 68.9% was mainly driven
by global demographic changes. Across WHO regions, the highest
prevalence was estimated in the Americas (13.3% in 1990 and 15.2%
in 2010), and the lowest in South East Asia (7.9% in 1990 and 9.7% in
2010). The percentage increase in COPD cases between 1990 and 2010
was the highest in the Eastern Mediterranean region (118.7%), followed
by the African region (102.1%), while the European region recorded the
lowest increase (22.5%). In 1990, we estimated about 120.9 million
COPD cases among urban dwellers (prevalence of 13.2%) and 106.3
million cases among rural dwellers (prevalence of 8.8%). In 2010, there
were more than 230 million COPD cases among urban dwellers (prevalence
of 13.6%) and 153.7 million among rural dwellers (prevalence
of 9.7%). The overall prevalence in men aged 30 years or more was
14.3% (95% CI 13.3%–15.3%) compared to 7.6% (95% CI 7.0%–
8.2%) in women.
Conclusions Our findings suggest a high and growing prevalence of
COPD, both globally and regionally. There is a paucity of studies in Africa,
South East Asia and the Eastern Mediterranean region. There is a
need for governments, policy makers and international organizations to
consider strengthening collaborations to address COPD globally
Clinically unsuspected foci of abnormal FDG uptake are often detected on PET/CT; without careful assessment, these may be interpreted as metastatic disease given the background of pre-existing malignancy in these patients. Knowledge of normal physiological biodistribution patterns of FDG is essential to avoid confusing normal uptake with that caused by pathologies. As an index of increased tissue metabolism, FDG uptake accompanies a wide variety of benign reactive or inflammatory conditions that can mimic malignancy; interpretation of findings in the light of the clinical picture helps to minimize this possibility. Close correlation with the anatomical information provided by the CT component of the study, and comparison of the intensity of uptake of primary and suspected secondary lesions, will help to maximize diagnostic accuracy. Increased uptake of 18F-FDG may reflect normal organ-specific physiology or a wide variety of benign or malignant pathologies. Knowledge of the normal variations, artefacts and processes that may mimic pathology on PET/CT studies is essential to their accurate interpretation, as is an appreciation of the common patterns of metastatic spread of different primary tumours. Furthermore, it is important to be familiar with both the normal physiological distribution and uptake of 18F-FDG on PET/CT and the common causes and clinical significance of incidentally detected abnormal 18F-FDG uptake that may be encountered on PET/CT imaging in oncology patients.
•. Clinically unsuspected foci of abnormal fluorodeoxyglucose (FDG) uptake are often detected on positron emission tomography (PET)/CT, which without careful assessment may be interpreted as metastatic disease, given the background of pre-existing malignancy in these patients. •. Knowledge of physiological distribution of patterns of FDG is essential to avoid confusing normal uptake with pathological causes. •. As a marker of increased tissue metabolism, FDG uptake accompanies a wide variety of benign reactive/inflammatory conditions that can mimic malignancy; interpretation of findings in the light of the clinical picture helps to minimise this possibility. •. Close correlation with the anatomical information provided by the CT component of the study and comparison of the intensity of uptake of primary and suspected secondary lesions will help to maximise diagnostic accuracy. Clinically unsuspected foci of abnormal fluorodeoxyglucose (FDG) uptake are often detected on positron emission tomography (PET)/CT, which without careful assessment may be interpreted as metastatic disease, given the background of pre-existing malignancy in these patients. Knowledge of physiological distribution of patterns of FDG is essential to avoid confusing normal uptake with pathological causes.
'%3e%3cpath fill='%23012169' d='M0 0v30h60V0z'/%3e%3cpath stroke='%23fff' stroke-width='6' d='m0 0 60 30m0-30L0 30'/%3e%3cpath stroke='%23C8102E' stroke-width='4' d='m0 0 60 30m0-30L0 30' clip-path='url(%23b)'/%3e%3cpath stroke='%23fff' stroke-width='10' d='M30 0v30M0 15h60'/%3e%3cpath stroke='%23C8102E' stroke-width='6' d='M30 0v30M0 15h60'/%3e%3c/g%3e%3c/svg%3e)
'/%3e%3cuse xlink:href='%23a' transform='rotate(72 0 0)'/%3e%3cuse xlink:href='%23a' transform='rotate(-72 0 0)'/%3e%3cuse xlink:href='%23a' transform='scale(-1 1) rotate(72)'/%3e%3c/g%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h1200v600H0z'/%3e%3cpath stroke='%23FFF' stroke-width='60' d='m0 0 600 300M0 300 600 0' clip-path='url(%23b)'/%3e%3cpath stroke='%23C8102E' stroke-width='40' d='m0 0 600 300M0 300 600 0' clip-path='url(%23c)'/%3e%3cpath stroke='%23FFF' stroke-width='100' d='M300 0v300M0 150h600' clip-path='url(%23b)'/%3e%3cpath stroke='%23C8102E' stroke-width='60' d='M300 0v300M0 150h600' clip-path='url(%23b)'/%3e%3cuse xlink:href='%23d' fill='%23FFF' transform='matrix(45.4 0 0 45.4 900 120)'/%3e%3cuse xlink:href='%23d' fill='%23C8102E' transform='matrix(30 0 0 30 900 120)'/%3e%3cg transform='rotate(82 900 240)'%3e%3cuse xlink:href='%23d' fill='%23FFF' transform='rotate(-82 519.022 -457.666) scale(40.4)'/%3e%3cuse xlink:href='%23d' fill='%23C8102E' transform='rotate(-82 519.022 -457.666) scale(25)'/%3e%3c/g%3e%3cg transform='rotate(82 900 240)'%3e%3cuse xlink:href='%23d' fill='%23FFF' transform='rotate(-82 668.57 -327.666) scale(45.4)'/%3e%3cuse xlink:href='%23d' fill='%23C8102E' transform='rotate(-82 668.57 -327.666) scale(30)'/%3e%3c/g%3e%3cuse xlink:href='%23d' fill='%23FFF' transform='matrix(50.4 0 0 50.4 900 480)'/%3e%3cuse xlink:href='%23d' fill='%23C8102E' transform='matrix(35 0 0 35 900 480)'/%3e%3c/svg%3e)
'/%3e%3c/defs%3e%3cpath fill='%23012169' d='M0 0h10080v5040H0z'/%3e%3cpath stroke='%23fff' stroke-width='.6' d='m0 0 6 3m0-3L0 3' clip-path='url(%23b)' transform='scale(840)'/%3e%3cpath stroke='%23e4002b' stroke-width='.4' d='m0 0 6 3m0-3L0 3' clip-path='url(%23c)' transform='scale(840)'/%3e%3cpath stroke='%23fff' stroke-width='840' d='M2520 0v2520M0 1260h5040'/%3e%3cpath stroke='%23e4002b' stroke-width='504' d='M2520 0v2520M0 1260h5040'/%3e%3cg fill='%23fff'%3e%3cuse xlink:href='%23d' x='2520' y='3780'/%3e%3cuse xlink:href='%23a' x='7560' y='4200'/%3e%3cuse xlink:href='%23a' x='6300' y='2205'/%3e%3cuse xlink:href='%23a' x='7560' y='840'/%3e%3cuse xlink:href='%23a' x='8680' y='1869'/%3e%3cuse xlink:href='%23e' x='8064' y='2730'/%3e%3c/g%3e%3c/svg%3e)