BackgroundTackling the high non-communicable disease (NCD) burden among Syrian refugees poses a challenge to humanitarian actors and host countries. Current response priorities are the identification and integration of key interventions for NCD care into humanitarian programs as well as sustainable financing. To provide evidence for effective NCD intervention planning, we conducted a cross-sectional survey among non-camp Syrian refugees in northern Jordan to investigate the burden and determinants for high NCDs prevalence and NCD multi-morbidities and assess the access to NCD care.MethodsWe used a two-stage cluster design with 329 randomly selected clusters and eight households identified through snowball sampling. Consenting households were interviewed about self-reported NCDs, NCD service utilization, and barriers to care.We estimated the adult prevalence of hypertension, diabetes type I/II, cardiovascular- and chronic respiratory conditions, thyroid disease and cancer and analysed the pattern of NCD multi-morbidities. We used the Cox proportional hazard model to calculate the prevalence ratios (PR) to analyse determinants for NCD prevalence and logistic regression to determine risk factors for NCD multi-morbidities by calculating odds ratios (ORs).ResultsAmong 8041 adults, 21.8%, (95% CI: 20.9–22.8) suffered from at least one NCD; hypertension (14.0, 95% CI: 13.2–14.8) and diabetes (9.2, 95% CI: 8.5–9.9) were the most prevalent NCDs. NCD multi-morbidities were reported by 44.7% (95% CI: 42.4–47.0) of patients. Higher age was associated with higher NCD prevalence and the risk for NCD-multi-morbidities; education was inversely associated.Of those patients who needed NCD care, 23.0% (95% CI: 20.5–25.6) did not seek it; 61.5% (95% CI: 54.7–67.9) cited provider cost as the main barrier. An NCD medication interruption was reported by 23.1% (95% CI: 20–4-26.1) of patients with regular medication needs; predominant reason was unaffordability (63.4, 95% CI: 56.7–69.6).ConclusionThe burden of NCDs and multi-morbidities is high among Syrian refugees in northern Jordan. Elderly and those with a lower education are key target groups for NCD prevention and care, which informs NCD service planning and developing patient-centred approaches.Important unmet needs for NCD care exist; removing the main barriers to care could include cost-reduction for medications through humanitarian pricing models. Nevertheless, it is still essential that international donors agencies and countries fulfill their commitment to support the Syrian-crisis response.Electronic supplementary materialThe online version of this article (10.1186/s13031-018-0168-7) contains supplementary material, which is available to authorized users.
Cancer causes 14% of all deaths in Jordan. This paper presents the incidence of cancer in Jordan from 1996 to 2005. Over the 10-year period there were 33 661 cases of cancer. The average crude incidence rate was 66.2 per 100 000 for males and 70.0 per 100 000 for females (age-standardized rates: 119 per 100 000 adult males and 116 per 100 000 adult females). The 5 most frequently reported cancers among adult males were: lung (10.6%), colorectal (9.8%), leukaemia (9.3%), urinary and bladder (8.6%) and prostate (7.4%). For adult females these were: breast (32.0%), colorectal (9.0%), leukaemia (6.7%), thyroid (4.9%) and corpus uteri (4.6%). Cancer rates have changed little since 1996. RÉSUMÉ Le cancer est à l'origine de 14 % des décès en Jordanie. Cet article présente l'incidence du cancer en Jordanie entre 1996 et 2005. Au cours de la période de 10 ans sur laquelle a porté l'étude, 33 661 cas de cancer ont été détectés. Le taux d'incidence brut moyen était de 66,2 pour 100 000 chez les hommes et de 70,0 pour 100 000 chez les femmes (taux d'incidence standardisé en fonction de l'âge : 119 pour 100 000 chez les hommes et 116 pour 100 000 chez les femmes). Les cinq cancers les plus fréquents chez les hommes étaient le cancer du poumon (10,6 %), le cancer colorectal (9,8 %), la leucémie (9,3 %), le cancer urinaire et de la vessie (8,6 %) et le cancer de la prostate (7,4 %). Chez les femmes, les cinq cancers les plus fréquemment observés étaient le cancer du sein (32,0 %), le cancer colorectal (9,0 %), la leucémie (6,7 %), le cancer de la thyroïde (4,9 %) et le cancer du corps utérin (4,6 %). Les taux de cancer ont peu évolué depuis 1996.
Cancer is now the fastest growing killing disease in the Middle East. Accordingly, there is an urgent need to train local health professionals: oncologists, palliative care experts, oncology nurses, psychologists, along with social workers, physiotherapists and spiritual counselors on strategies for early detection, curative therapies and palliation. Professionals in the region, along with the public, need to convince medical administrators, regulators and policymakers about investing in education and training of YOUNG professionals, as well as those with already proven experience in cancer care. Training is the basis for any future cancer care program, which aims at the integration of palliative care practices into standard oncology care across the trajectory of the illness.
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Problem statement: Layer hen enterprises suffer from low profitability or losses in many of developing countries all over the world. Jordan is not an acceptance. Approach: This study aimed at investigating the influence of ten main factors affecting the profitability of layer hen producers. The investigated factors include price of purchased pullet, feed price, cost of labor, cost of veterinary service and medicine, building and machinery depreciation, repairs and maintenance and miscellaneous costs, length of production cycle, feed conversion ratio, mortality rate, egg sale price and laying percentage. Results: The study used a multiple regression profit model to estimate the effect of the above mentioned factors on profit per kg egg produced. The direction and quantity of relationship between profit per kg egg and variables affecting profit were investigated. Data from 40 operating and randomly selected egg production enterprises in the country was collected. Data was obtained directly from the producers during April to mid August 2010. Semi structured interviews were conducted with a pre-tested questionnaire. The data obtained via interview surveys were processed to calculate profit per kg egg and other relevant information for inclusion in a profit function model. Fifteen eggs are registered to be 1 kg in the study. Cost and income items used to calculate profit in the study. The results of the study revealed that the feed price was found to be the factor which has the highest negative impact on the profitability showing the coefficient-3.01. The egg sale price was with high positive impact on profitability showing the coefficient 2.633. Conclusion/Recommendations: From the results of the study it could be concluded that higher prices of purchased or breeding pullet, higher feed price, higher cost of labor, higher cost of veterinary service and medicine, higher other costs including building and machinery depreciation, repairs and maintenance and miscellaneous costs, higher feed quantity to be converted to eggs and higher mortality rate are associated with lower profitability of laying hen enterprises, while higher length of production cycle, higher egg sale price and higher laying percentage are associated with higher profitability. Critical limits indicated for various cost components should be used as a guideline to adjust budget in commercial egg operation thereby, ensuring higher net profit per bird.
An experiment was conducted to indicate the effect of feeding high energy diet for 45 days on male and female Awassi lambs’ performance, carcass percentage, and cost of production. A total of twenty four Awassi lambs (12 males, and 12 females) averaging 18.2±0.70 kg body weight were used. Lambs were assigned randomly to two different groups (groups A and B); each group had twelve lambs (6 males and 6 females) and fed two different diets (low energy diet and high energy diet). Feed intake, total gain, average daily gain and feed conversion ratio was calculated and body measurements (height and length) were recorded. Lambs were slaughtered at the end of experiment, to evaluate carcass percentage. Cost of production was calculated based on ingredients’ price at the time of the experiment. Final body weight, weight gain, and average daily gain were greater (p < 0.05); while feed conversion ratio was lower (p < 0.05) for lambs fed high energy diet than lambs fed low energy diet. Body length differences measured to be greater (p < 0.05) for male lambs fed high energy diet than other lambs. Fasted weight, hot carcass weight, and dressing percentage were higher (p < 0.05) for lambs fed the high energy diet. Cost of gain was lower (p < 0.05) for lambs in group B compared to lambs in group A. Therefore, the economical efficiency in this experiment was greater for lambs fed high energy diet than lambs fed the control diet during 45 days fattening period.
Patient: Male, 68Final Diagnosis: Pyoderma gangrenosumSymptoms: Worsening lower extremity woundMedication: —Clinical Procedure: —Specialty: Infectious DiseasesObjective:Rare diseaseBackground:Pyoderma gangrenosum is a rare, ulcerative cutaneous condition that was first described by Brocq in 1916. This diagnosis is quite challenging as the histopathological findings are nonspecific. Pyoderma gangrenosum is usually associated with inflammatory bowel disease, leukemia, and hepatitis C. We describe a rare clinical case of a patient with hepatitis C (HCV), mixed cryoglubinemia, and pyoderma gangrenosum, which was successfully treated with prednisone in combination with the new antiviral medication ledipasvir/sofosbuvir.Case Report:A 68-year-old male with a history of untreated HCV presented to the clinic with a left lower extremity ulcer that had progressively worsened over 4 days after the patient sustained a minor trauma to the left lower extremity. Examination revealed a 2×3 cm purulent ulcer with an erythematous rim on medial aspect of his left lower leg. HCV viral load and genotype analysis revealed genotype 1A with polymerase chain reaction (PCR) showing viral counts of 9,506,048 and cryoglobulinemia. With a worsening and enlarging erythematous ulcer and failure of IV antibiotic therapy, the patient underwent skin biopsy, which showed acanthotic epidermis with superficial and deep perivascular lymphoplasmacytic dermatitis admixed with mild neutrophilic infiltrate. The patient was subsequently started on ledipasvir/sofosbuvir and prednisone with a high suspicion of pyoderma gangrenosum. At one-month follow-up at the hepatology clinic, the patient demonstrated a near resolution of the lower extremity ulcer with undetectable viral load.Conclusions:Pyoderma gangrenosum is an inflammatory process of unknown etiology, and establishing the correct diagnosis can be a difficult task. For this reason it is prudent for clinicians to consider Pyoderma gangrenosum in their differential diagnosis, especially in the setting of a nonhealing surgical wound or skin infection.
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