Global Learning for Health Equity: A Survey of Five Global Learning Sites in the United States.

Global learning is the practice of adopting and adapting global ideas to local challenges. To advance the field of global learning, we performed a case study of five communities that had implemented global health models to advance health equity in a U.S. setting. Surveys were developed using a Consolidated Framework for Implementation Research (CFIR) framework, and each site completed surveys to characterize their global learning experience with respect to community context, the learning and implementation process, implementation science considerations, and health equity. The immense diversity of sites and their experiences underscored the heterogenous nature of global learning. Nonetheless, all cases highlighted core themes of addressing social determinants of health through strong community engagement. Cross-sector participation and implementation science evaluation were strategies applied by many but not all sites. We advocate for continued global learning that advances health equity and fosters equitable partnerships with mutual benefits to origination and destination sites.

Nb/a-Si/Nb-junction Josephson arbitrary waveform synthesizers for quantum information.

We demonstrate Josephson arbitrary waveform synthesizers (JAWS) with increased operating temperature range for temperatures below 4 K. These JAWS synthesizers were fabricated with externally-shunted Nb/a-Si/Nb junctions whose critical current exhibits improved temperature stability compared to the self-shunted Nb/Nb0.15Si0.85/Nb junctions typically used. Vertical stud resistors made of 230 nm of PdAu were developed to provide the milliohm shunt resistance required for junction overdamping while maintaining a small footprint suitable for high-density series arrays embedded in a coplanar waveguide. We evaluated the performance of these resistors from 3.8 K down to 20 mK. We designed, fabricated and tested a JAWS circuit with 4650 externally shunted Nb/a-Si/Nb JJs with a critical current density (Jc) of 0.12 mA∕µm2 and critical current (Ic) of 3 mA. This circuit was designed to be mounted to the 3 K stage of a dilution refrigerator and used to control and calibrate a qubit mounted at the 10 mK stage. To increase the circuit density of the JAWS circuits we made arrays of two-junction vertical stacks. Current-voltage (I-V) curves of this JAWS circuit with stacked junctions under microwave excitation show Shapiro steps with quantum-locking ranges similar to those of JAWS circuits used for qubit control.

Chronic disease and disability among Iraqi populations displaced in Jordan and Syria.

The Iraq conflict resulted in the largest displacement in the Middle East since the Palestinian crisis, and provision of health services to the displaced population presents a critical challenge. The study aimed to provide information on chronic medical conditions and disability to inform humanitarian assistance planning. Nationally representative cross-sectional surveys of Iraqi populations displaced in Jordan and Syria were conducted in late 2008 and early 2009. Clusters of 10 household were randomly selected using probability-based sampling; a total of 1200 and 813 Iraqi households in Jordan and Syria, respectively, were interviewed. The majority of respondents in both countries perceived healthcare as unaffordable but accessible; cost was an important barrier to care. In Jordan, most routine health expenditures were for medications where in Syria, expenses were divided between medical consultations and medication. Chronic disease prevalence among adults was 51.5% (confidence interval (CI): 49.4-53.5) in Syria and 41.0% (CI: 39.4-42.7) in Jordan, most common were hypertension and musculoskeletal problems. Overall disability rates were 7.1% (CI: 6.3-8.0) in Syria and 3.4% (CI: 3.0-3.9) in Jordan. In both countries, the majority of disability was attributed to conflict, prevalence was higher in men than women, and depression was the leading cause of mental health disability. Chronic illnesses, disabilities and psychological health are key challenges for the Iraqi population and the health systems in Jordan and Syria. Continued attention to the development of systems to manage conditions that require secondary and tertiary care is essential, particularly given reported difficulties in accessing care and the anticipated prolonged displacement.

Food security and humanitarian assistance among displaced Iraqi populations in Jordan and Syria.

The Iraq conflict resulted in the largest displacement in the Middle East in recent history, and provision of health services to the displaced population presents a critical challenge. With an increase in the number of people affected by complex emergencies and the number of people displaced in urban settings, the international community must adapt intervention strategies to meet the specific demands and contexts of this population. The study aimed to provide information on food security and livelihoods for Iraqi refugees in Syria and Jordan to inform humanitarian assistance planning. National cross-sectional cluster sample surveys of displaced Iraqi populations displaced were conducted in Jordan (October 2008) and Syria (March 2009). Clusters of ten households were randomly selected using probability-based sampling; a total of 1200 and 813 Iraqi households in Jordan and Syria, respectively, were interviewed about food security and receipt of humanitarian assistance. In Syria, 60% of households reported the household food situation had declined since the arrival period as compared to 46% in Jordan. Food aid receipt was reported by 18.0% of households in Jordan and 90.3% of households in Syria. In Jordan, 10.2% of households received cash assistance and in Syria 25.3% of households received cash assistance. In Jordan, cash assistance was associated with low socioeconomic status, large household size, and UNHCR registration. In Syria, female headed households, Damascus residents, families with children, and those registered with UNHCR were more likely to receive cash assistance. Food insecurity remains a concern among displaced Iraqi households in both Jordan and Syria. Improved targeting of both food and cash assistance and the expansion of cash-based programs could lead to a more effective use of funds and facilitate the implementation of assistance programs that are sustainable in the context of declining funding availability.

Psychosocial health in displaced Iraqi care-seekers in non-governmental organization clinics in Amman, Jordan: an unmet need.

INTRODUCTION: Populations displaced by conflict face numerous threats to their psychological well-being; consequently, the prevalence of mental health problems, including anxiety, depression, and post-traumatic stress disorder can be elevated as compared to populations who have not experienced forced displacement. PROBLEM: Little is known about the mental health needs of displaced Iraqis. The factors associated with a need for psychological services among patients at seven clinics served by two NGOs that are known sources of care for the displaced Iraqi population in Amman, Jordan were explored. METHODS: The survey was conducted in January and February 2008 and included a random sample of care seekers from seven clinics selected using interval sampling. Interviews on the health needs of displaced Iraqis and their access to services, including mental health services lasting approximately 20 minutes were conducted. RESULTS: Of the 664 survey participants, 49% (95% CI = 45-53%) of respondents reported needing mental health services and 5% (95% CI = 3-8%) of those in need had access to services. The length of time spent in Jordan (adjusted OR = 1.08; 95% CI = 1.00-1.11) was associated with the need for mental health services and the adjusted odds of requiring psychological services was 39% less for individuals from outside of Baghdad as compared to Baghdad residents (OR = 0.61; 95% CI = 0.38-0.98). Responders citing violence as a factor were twice as likely to be from Baghdad (OR = 2.28; 95% CI = 1.03-6.91), while interviewees reporting displacement as a cause for needing mental health services were twice as likely to be female (OR = 2.14; 95% CI = 1.12-4.18). In individuals 35-44 years of age (OR = 0.36; 95% CI = 0.14-0.87) the need for mental health services due to displacement decreased by 64%, while being a part of a female-headed household decreased the need by 81% (OR = 0.19; 95% CI = 0.06-0.57%). CONCLUSIONS: More attention should be given to expanding the local Jordanian health system capacity for the provision of mental service. Targeted social and psychiatric interventions that are culturally sensitive and aligned with Inter-Agency Standing Committee recommendations should be developed to compliment and expand the existing mental health service capacity in Jordan.

Family planning in displaced populations: an unmet need among Iraqis in Amman, Jordan.

CONTEXT: Studies have been done to characterize primary "urgent" health needs in displaced populations; few studies have explored specifically family planning (FP) needs. OBJECTIVE: To investigates the hypothesis that there exists an unmet need for FP among Iraqi nationals in Amman, Jordan. DESIGN: Married Iraqi individuals attending seven nongovernmental organization clinics were asked a subset of survey questions to ascertain FP health needs and access. RESULTS: 16.1 percent (n = 76) of respondents reported need for FP services, of which 16 percent (n = 397) report having access to FP counseling, and 43 percent (n = 33) had access to contraceptives. After 30 years of age, need for FP decreased yearly 12 percent (OR = 0.88, CI = 0.84-0.92, p = 0.00). After one year of living in Amman, Jordan, the odds of needing FP services increases yearly 13 percent (OR = 1.13, CI = 1.05-1.22, p = 0.001). In addition, if the respondent has one or more children younger than 5 years in the same household, the odds of needing FP services increases by 85 percent (OR = 1.85, CI = 1.0-3.44, p = 0.05). CONCLUSIONS: This study illustrates a clear unmet need in FP services among Iraqis in Amman, Jordan, especially among the long-term displaced.

State of emergency medicine in Azerbaijan.

BACKGROUND: There has been no previous study into the state of emergency medicine in Azerbaijan. As a legacy of the Soviet Semashko system, the "specialty" model of emergency medicine and integrated emergency departments do not exist here. Instead, pre-hospital emergency care is delivered by ambulance physicians and in-hospital care by individual departments, often in specialty hospitals. Emergency care is therefore fragmented, highly specialized and inefficient. AIMS: The Emergency Medicine Development Initiative (EMDI) of the International Medical Corps (IMC) was designed to improve the quality of emergency care in four pilot regional centers in Azerbaijan. The objective of this study was to assess the baseline emergency medical capacity of these four centers. METHODS: EMDI staff conducted a four-part baseline survey in April 2006 to assess emergency care in Ganja (the second largest city in Azerbaijan), Kurdamir, Shamkir and Yevlakh. Data collection involved interviews with relevant personnel and a retrospective records review in each city. RESULTS: Pre-hospital: The number of ambulance teams per 10,000 inhabitants is below the number required by local regulations. On average, 45% of 27 medications and 37% of 17 pieces of critical equipment were available. Of the emergency procedures, 21% could be performed in the pre-hospital setting. In-hospital: Admission rates were near 100% for the admissions department-an area that is supposed to function as an emergency department would. On average 57% of 40 medications and 42% of 22 pieces of critical equipment were available. Of the emergency procedures, 62% could be performed in the in-hospital setting. CONCLUSIONS: The emergency medical system surveyed in Azerbaijan is inefficiently organized, under-financed, poorly equipped and lacks adequately trained staff. Reforms need to be directed towards achieving international standards, while adapting new models for service delivery into the existing framework and improving system capacity as highlighted by this baseline assessment.