World Bank [to 6 September 2014]
http://www.worldbank.org/en/news/all

Forum Highlights Importance of Global Standards to Advance Responsible Digital Finance
September 3, 2014
PERTH, September 3, 2014 — The fifth annual Responsible Finance Forum took place on August 28-29, 2014 in Perth, Australia, convening over 100 industry, government and private sector leaders to discuss how digital financial services can be delivered in a transparent, fair and safe manner. Focusing exclusively on the use of technology to provide financial services and products for the poor, the Forum enabled participants to share specific approaches that private and public sector actors can take to address emerging risks from the expansion of digital financial services.
Participants noted that unreliability of digital financial services and inadequate customer recourse mechanisms can dampen the trust in such services among the poor and thus limit their uptake and usage. Results from a global survey taken ahead of the Forum revealed that a majority of respondents believed that global principles, standards and codes of conduct for responsible digital finance are needed. There was broad consensus among the participants at the Responsible Finance Forum to explore the development of such guidance as part of a multi-year global dialogue among all stakeholders…
…The Forum also marked the launch of the live web-platform, a one stop shop for sharing and accessing knowledge, discussing and collaborating on responsible finance. The RFF Platform will provide a central space for stakeholders and practitioners to advance responsible finance and move towards the goal of full finance inclusion by 2020, responsibly…

BMC Medical Ethics
(Accessed 6 September 2014)
http://www.biomedcentral.com/bmcmedethics/content

Debate
The social value of clinical research
Michelle GJL Habets, Johannes JM van Delden and Annelien L Bredenoord
Author Affiliations
BMC Medical Ethics 2014, 15:66 doi:10.1186/1472-6939-15-66
Published: 5 September 2014
Abstract (provisional)
Background
International documents on ethical conduct in clinical research have in common the principle that potential harms to research participants must be proportional to anticipated benefits. The anticipated benefits that can justify human research consist of direct benefits to the research participant, and societal benefits, also called social value. In first-in-human research, no direct benefits are expected and the benefit component of the risks-benefit assessment thus merely exists in social value. The concept social value is ambiguous by nature and is used in numerous ways in the research ethics literature. Because social value justifies involving human participants, especially in early human trials, this is problematic.
Discussion
Our analysis and interpretation of the concept social value has led to three proposals. First, as no direct benefits are expected for the research participants in first-in-human trials, we believe it is better to discuss a risk- value assessment instead of a risk – benefit assessment. This will also make explicit the necessity to have a clear and common use for the concept social value. Second, to avoid confusion we propose to limit the concept social value to the intervention tested. It is the expected improvement the intervention can bring to the wellbeing of (future) patients or society that is referred to when we speak about social value. For the sole purpose of gaining knowledge, we should not expose humans to potential harm; the ultimate justification of involving humans in research lies in the anticipated social value of the intervention. Third, at the moment only the validity of the clinical research proposal is a prerequisite for research to take place. We recommend making the anticipated social value a prerequisite as well.

British Medical Journal
06 September 2014(vol 349, issue 7973)
http://www.bmj.com/content/349/7973

Editorials
The 2030 sustainable development goal for health
BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g5295 (Published 26 August 2014) Cite this as: BMJ 2014;349:g5295
Gavin Yamey, evidence to policy initiative lead1, Rima Shretta, malaria elimination initiative deputy lead1, Fred Newton Binka, vice chancellor2
Author affiliations
Must balance bold aspiration with technical feasibility
Excerpt
In the year 2000, 193 countries adopted the millennium development goals (MDGs), a milestone in global development. The eight goals were simple to grasp, measurable, and time bound, ending in 2015. Goals 4, 5, and 6 focused on reducing child, maternal, and infectious disease mortality, respectively, raising health to the top of the global agenda and mobilising new health financing.1 Although the three health related goals are unlikely to be met, there has been substantial progress towards their achievement, particularly for infectious diseases.2
As the MDGs come to an end, a new set of sustainable development goals (SDGs) will be debated during the UN General Assembly that starts on 24 September 2014. These goals will have a 2030 end date. They could catalyse further transformations in global health.
An intergovernmental open working group is writing the new goals and has just published its first draft.3 Whereas the MDGs were “‘top-down goals’ formulated by policy elites,”4 the working group deserves credit for drafting the new goals using a bottom-up approach, based on wide ranging consultations. There is much to like in the draft: …

Bulletin of the World Health Organization
Volume 92, Number 9, September 2014, 621-696
http://www.who.int/bulletin/volumes/92/9/en/

Editorials
The 2014 Ebola outbreak: ethical use of unregistered interventions
Ruediger Krech a & Marie-Paule Kieny a
a. World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland.
Bulletin of the World Health Organization 2014;92:622. doi: http://dx.doi.org/10.2471/BLT.14.145789

The large number of cases and wide geographical spread distinguish the current 2014 outbreak of Ebola virus disease in west Africa from all known earlier outbreaks.1 In the past, outbreaks of this disease have been stopped by identifying all cases, tracing all contacts and making sure that those caring for patients use correct protective gear at all times. However, the success of such methods depends on the presence of: (i) functional health systems; (ii) health workers who are trained, paid, willing to be deployed and adequately protected in a dangerous work environment; (iii) experts in public health with the skills needed to manage the tracing of people and monitor the evolution of the disease effectively; and (iv) people with solid skills in social engagement and development who are available to work with at-risk communities.2 Such systems and individuals were largely absent from the area where the current outbreak of Ebola virus disease is believed to have begun – a border area between three countries that all have fragile health systems and that are emerging from the traumas of civil war.

Encouragingly, research efforts over the past decade have led to the development, for the first time, of a range of potential treatments and vaccines that could support efforts to control Ebola virus disease. However, although some of these interventions have proven effective in animal models, none has completed clinical testing in humans – a step that is indispensable for the registration of any medical intervention as proven and safe. Why have there been no clinical trials, given that we have known the Ebola virus for 40 years? Why is there no effective registered vaccine or treatment available? At the onset of the current Ebola outbreak – despite some resources provided by the governments of Canada and the United States of America – substantial financial investment was still needed to evaluate and develop several interventions for the control and treatment of Ebola virus disease. Until now – as seen with several other neglected diseases – this disease has received little attention because it was affecting mostly poor people in poor countries.

The above shortcomings aggravate an ethical dilemma. If the treatments for Ebola virus disease that are currently under development could save lives – as the results of animal studies indicate – should they not be used immediately, since far too many people have already died? On the other hand, if there is a possibility that a treatment might cause substantial adverse effects in humans that have not been seen in animal testing, should it not be withheld?3

On 11 August 2014, the World Health Organization (WHO) convened a consultation to consider and assess the ethical implications of the potential use of unregistered interventions, such as drugs, vaccines and passive immunotherapy, in the current Ebola outbreak. The results of this consultation have been widely discussed in the media.4

In summary, the consultation’s panel of experts advised WHO that, in the particular circumstances of the current outbreak – and provided certain conditions are met – it would be ethical to offer unproven interventions – with as yet unknown efficacy and adverse effects – for the potential treatment or prevention of Ebola virus disease. One of the conditions that need to be met is that ethical principles must guide the provision of such interventions. For example, there must be transparency about all aspects of care, informed consent, freedom of choice, confidentiality, respect for the person, preservation of dignity, and involvement of the community.
To understand the safety and efficacy of these interventions, the panel of experts advised that – when and if any of the unregistered interventions is used to treat patients – there is a moral obligation to collect and share all of the data generated, including data arising from any treatment provided for compassionate use – i.e. the use of an unregistered drug outside of a clinical trial.5

What can we learn from this crisis? Robust health systems are key for controlling disease outbreaks. Let us make sure that development efforts are designed to strengthen health systems. Well trained and motivated health workers are indispensable. They should be paid and receive the support they need to carry out their duties. And, finally, increasing investment into research and development for the treatment, control and prevention of diseases that currently mostly affect poor people and poor countries should be a key priority for policy-makers worldwide. Let us not forget these lessons when the current Ebola outbreak no longer appears on the front pages of our newspapers.

References
Ebola virus disease update – west Africa [Disease Outbreak News, 13 August 2014]. Geneva: World Health Organization; 2014. Available from: http://who.int/csr/don/2014_08_13_ebola [cited 2014 Aug 15].
Key components of a well functioning health system. Geneva: World Health Organization; 2014. Available from: http://who.int/healthsystems/EN_HSSkeycomponents.pdf [cited 2014 Aug 15].
International ethical guidelines for biomedical research involving human subjects. Geneva: Council for International Organizations of Medical Sciences; 2002. Available from: http://www.cioms.ch/publications/layout_guide2002.pdf [cited 2014 Aug 15].
Ethical considerations for use of unregistered interventions for Ebola virus disease (EVD): summary of the panel discussion [WHO statement, 12 August 2014]. Geneva: World Health Organization; 2014. Available from: http://who.int/mediacentre/news/statements/2014/ebola-ethical-review-summary [cited 2014 Aug 15].
Ethical considerations for use of unregistered interventions for Ebola virus disease. Report of an advisory panel to WHO. Geneva: World Health Organization; 2014. Available from: http://www.who.int/csr/resources/publications/ebola/ethical-considerations/en/ [cited 2014 Aug 18].
Perspectives
The Global Vaccine Safety Initiative: enhancing vaccine pharmacovigilance capacity at country level
Christine G Maure a, Alexander N Dodoo b, Jan Bonhoeffer c & Patrick LF Zuber a
a. Department of Essential Medicines and Health Products, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.
b. Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana, Accra, Ghana.
c. Brighton Collaboration Foundation, Basel, Switzerland.
(Submitted: 19 March 2014 – Accepted: 21 March 2014 – Published online: 31 July 2014.)
Bulletin of the World Health Organization 2014;92:695-696. doi: http://dx.doi.org/10.2471/BLT.14.138875
Excerpt
“…The Decade of Vaccines, which was launched in 2010, aims to increase coordination within the vaccine community worldwide. The Global Vaccine Action Plan1 – the framework endorsed by the World Health Assembly for the Decade of Vaccines – includes a vaccine safety strategy, the Global Vaccine Safety Blueprint.2
The aim of the blueprint is to enhance the safety of vaccines through effective use of pharmacovigilance principles and methods. Its three strategic goals are: to assist LMICs to have at least minimal capacity for vaccine safety activities; to enhance capacity for vaccine safety assessment in countries that introduce newly developed vaccines, that introduce vaccines in settings with novel characteristics, or that manufacture and use prequalified vaccines; and to establish a global support structure for vaccine safety. The blueprint proposes eight complementary strategic objectives. Four of these objectives aim to improve the technical aspects of spontaneous reporting, active surveillance and risk communication; and to ensure the availability of harmonized methods and tools. The remaining four objectives promote the establishment of effective managerial principles to facilitate international collaboration and information exchange relating to vaccine safety monitoring. Implementing the blueprint is a task that requires coordinated participation of vaccine safety stakeholders worldwide. To that end, the World Health Organization (WHO) launched the Global Vaccine Safety Initiative in March 2012.
In its initial phase, the Global Vaccine Safety Initiative is attempting to build a global support structure by linking existing vaccine safety initiatives. Numerous projects are already addressing one or more of the blueprint’s strategic objectives. Some of the top priorities for the initiative are to identify such projects and engage their sponsors in collaboration, and to help disseminate their products and experiences. Therefore, a Global Vaccine Safety Initiative portfolio of activities has been assembled, where activities are prioritized based on their expected impact, geographical relevance, feasibility, usefulness and sustainability.3 For each activity, the portfolio recognizes the roles of initiators, managers and donors. All stakeholders in global pharmacovigilance can use this portfolio to help identify ongoing efforts, allow for better synergies, minimize duplications and enable resource mobilization…

Disasters
October 2014 Volume 38, Issue 4 Pages ii–ii, 673–877
http://onlinelibrary.wiley.com/doi/10.1111/disa.2014.38.issue-4/issuetoc

Papers
Changing tracks as situations change: humanitarian and health response along the Liberia–Côte d’Ivoire border
Katharine Derderian*
Article first published online: 5 SEP 2014
DOI: 10.1111/disa.12078
Abstract
In recent years, protracted crises and fragile post-conflict settings have challenged the co-existence, and even the linear continuum, of relief and development aid. Forced migration has tested humanitarian and development paradigms where sudden-onset emergencies, violence and displacement arise alongside ongoing development work. Drawing on Médecins Sans Frontières interventions in the region from December 2010 to May 2011, this paper examines aid and healthcare responses to displacement in Côte d’Ivoire and Liberia; it focuses on challenges to the maintenance of preparedness for such foreseeable emergencies and to adaptation in response to changing situations of displacement and insecurity. This ‘backsliding’ from development to emergency remains a substantial challenge to aid; yet, in exactly such cases, it also presents the opportunity to ensure access to medical care that is much more urgently needed in times of crisis, including the suspension of user fees for medical care

Disasters
October 2014 Volume 38, Issue 4 Pages ii–ii, 673–877
http://onlinelibrary.wiley.com/doi/10.1111/disa.2014.38.issue-4/issuetoc

Papers
Moderating effects of empathic concern and personal distress on the emotional reactions of disaster volunteers
Ioana A. Cristea1,2, Emanuele Legge3, Marta Prosperi4, Mario Guazzelli5, , Daniel David6,7 and
Claudio Gentili8,*
Article first published online: 5 SEP 2014
DOI: 10.1111/disa.12075
Abstract
This study examines stress and mood outcomes in community volunteers who undertook one week’s worth of post-disaster relief work in L’Aquila, Italy, which had been hit by an earthquake four months earlier. The study team obtained pre- and post-relief work data from 130 volunteers involved in activities such as preparing food for the displaced, cleaning the camps and distributing clean linen. The Perceived Stress Scale, the State-Trait Anxiety Inventory and the Profile of Mood States were administered at the start and at the end of the aid activities. Psychopathological symptoms and empathy were assessed in the beginning, using the Symptom Checklist 90 Revised and the Interpersonal Reactivity Index, respectively. The results show that, following the assistance work, volunteers displayed decreases in perceived stress, general distress, anxiety and anger, as well as increases in positive emotions. The empathy facets empathic concern and personal distress showed different patterns in modulating the post-disaster relief work adaptation for some of the mood outcomes.

Emergency Medicine Journal
September 2014, Volume 31, Issue 9
http://emj.bmj.com/content/current

Review
Non-resuscitative first-aid training for children and laypeople: a systematic review
Zhimin He, Persephone Wynn, Denise Kendrick
Author Affiliations
Division of Primary Care, School of Community Health Sciences, University Park, Nottingham, UK
Received 16 January 2013
Revised 10 October 2013
Accepted 21 November 2013
Published Online First 18 December 2013
Abstract
Background Relatively little is currently known about the effectiveness of first-aid training for children and laypeople. We have undertaken a systematic review to synthesise the evidence and inform policy and practice in this area.
Methods A range of bibliographic databases were searched. Studies were eligible if they used experimental designs, provided first-aid training to laypeople or children and reported first-aid knowledge, skills behaviours or confidence. Studies were selected for inclusion, data extracted and risk of bias assessed by two independent reviewers. Findings were synthesised narratively.
Results 23 studies (14 randomised controlled trials and 9 non-randomised studies) were included, 12 of which recruited children or young people (≤19 years old). Most studies reported significant effects favouring the intervention group; 11 out of 16 studies reported significant increases in first-aid knowledge; 11 out of 13 studies reported significant increases in first-aid skills; 2 out of 5 studies reported significant improvements in helping behaviour; and 2 out of 3 studies reported significant increases in confidence in undertaking first aid. Only one study undertook an economic evaluation; finding an intensive instructor-led course was more effective, but had significantly higher costs than either a less-intensive instructor-led course or a video-delivered course. Most studies were at risk of bias, particularly selection, performance or detection bias.
Conclusions There is some evidence to support provision of first-aid training, particularly for children or young people, but many studies were judged to be at risk of bias. Conclusions cannot be drawn about which first-aid training courses or programmes are most effective or the age at which training can be most effectively provided. Few studies evaluated training in adult laypeople. High-quality studies are required assessing effectiveness and cost-effectiveness of standardised first-aid training to inform policy development and provision of first-aid training.

Globalization and Health
[Accessed 6 September 2014]
http://www.globalizationandhealth.com/

Research
Learning from developing countries in strengthening health systems: an evaluation of personal and professional impact among global health volunteers at Addis Ababa University’s Tikur Anbessa Specialized Hospital (Ethiopia)
Heidi Busse1*, Ephrem A Aboneh2 and Girma Tefera1
Author Affiliations
Globalization and Health 2014, 10:64 doi:10.1186/s12992-014-0064-x
Published: 5 September 2014
Abstract (provisional)
Background
The positive impact of global health activities by volunteers from the United States in low-and middle-income countries has been recognized. Most existing global health partnerships evaluate what knowledge, ideas, and activities the US institution transferred to the low- or middle-income country. However, what this fails to capture are what kinds of change happen to US-based partners due to engagement in global health partnerships, both at the individual and institutional levels. ?Reverse innovation? is the term that is used in global health literature to describe this type of impact. The objectives of this study were to identify what kinds of impact global partnerships have on health volunteers from developed countries, advance this emerging body of knowledge, and improve understanding of methods and indicators for assessing reverse innovation.
Methods
The study population consisted of 80 US, Canada, and South Africa-based health care professionals who volunteered at Tikur Anbessa Specialized Hospital in Ethiopia. Surveys were web-based and included multiple choice and open-ended questions to assess global health competencies. The data were analyzed using IBRM SPSS? version 21 for quantitative analysis; the open-ended responses were coded using constant comparative analysis to identify themes.
Results
Of the 80 volunteers, 63 responded (79 percent response rate). Fifty-two percent of the respondents were male, and over 60 percent were 40?years of age and older. Eighty-three percent reported they accomplished their trip objectives, 95 percent would participate in future activities and 96 percent would recommend participation to other colleagues. Eighty-nine percent reported personal impact and 73 percent reported change on their professional development. Previous global health experience, multiple prior trips, and the desire for career advancement were associated with positive impact on professional development.
Conclusion
Professionally and personally meaningful learning happens often during global health outreach. Understanding this impact has important policy, economic, and programmatic implications. With the aid of improved monitoring and evaluation frameworks, the simple act of attempting to measure ?reverse innovation? may represent a shift in how global health partnerships are perceived, drawing attention to the two-way learning and benefits that occur and improving effectiveness in global health partnership spending.

Health Policy and Planning
Volume 29 Issue 6 September 2014
http://heapol.oxfordjournals.org/content/current

Global health in foreign policy—and foreign policy in health? Evidence from the BRICS
Nicola F Watt1,*, Eduardo J Gomez2 and Martin McKee1
1European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, 15-17, Tavistock Place, London WC1H 9SH, UK and 2King’s International Development Institute, King’s College London, Strand, London, WC2R 2LS, UK
Accepted July 19, 2013.
Abstract
Amidst the growing literature on global health, much has been written recently about the Brazil, Russia, India, China, South Africa (BRICS) countries and their involvement and potential impact in global health, particularly in relation to development assistance. Rather less has been said about countries’ motivations for involvement in global health negotiations, and there is a notable absence of evidence when their motivations are speculated on. This article uses an existing framework linking engagement in global health to foreign policy to explore differing levels of engagement by BRICS countries in the global health arena, with a particular focus on access to medicines. It concludes that countries’ differing and complex motivations reinforce the need for realistic, pragmatic approaches to global health debates and their analysis. It also underlines that these analyses should be informed by analysis from other areas of foreign policy.

Human Organization
Volume 73, Number 3 / Fall 2014
http://sfaa.metapress.com/content/j2q1g276gm72/?p=76f6fdab022e4b4bbf2f1e6c69dbd88c&pi=0

Ethiopian Labor Migrants and the “Free Visa” System in Qatar
Silvia Pessoa1, Laura Harkness2, Andrew M. Gardner3
1English and Socio-linguistics, Carnegie Mellon University in Qatar
2Carnegie Mellon University in Qatar
3University of Puget Sound, Tacoma, Washington
Abstract
Labor migrants in Qatar and neighboring states are regulated and governed by the kafala, or sponsorship system. By law, all foreign migrants are locked to a particular sponsor-employer for the duration of their stay. While the kafala has been a central feature in analyses of migration throughout the region, little attention has been devoted to the informal and widespread “free visa” system that has arisen in the shadows of the kafala. Through a mixed methods approach utilizing the region’s first representative sample of low-income labor migrants, a focus group with “free visa” holders in the Ethiopian community, and a set of semi-structured interviews with Ethiopian migrants, this paper explores the experiences and perspectives of Ethiopian migrants in the “free visa” system in Qatar. The “free visa” is neither free nor legal, and it produces significant vulnerabilities for transnational migrants who work under this arrangement. While those vulnerabilities characterize the lived experience of “free visa” holders, many transnational migrants opt for the “free visa” in order to secure the freedom to choose their employer and abandon exploitative situations. We conclude that the “free visa” system can be understood as a byproduct of the strictures of the sponsorship system.

International Journal of Disaster Risk Reduction
Volume 10, Part A, In Progress (December 2014)
http://www.sciencedirect.com/science/journal/22124209/9

Elder abuse and neglect in disasters: Types, prevalence and research gaps
Review Article
Pages 38-47
Gloria M. Gutman, Yongjie Yon
Abstract
A systematic review of literature and of information from key organizations was conducted to provide an overview of what is known about elder mistreatment in disaster situations, identify research gaps and to discuss possible policy interventions. While there has been growth in recent years in research on prevalence, incidence and risk factors for morbidity and mortality of seniors in disasters and on elder abuse, research specifically on elder abuse and neglect in disaster situations was limited and only 19 articles were found. The types of abuse most commonly addressed in these articles were financial (theft in shelters and contractor fraud), neglect (primarily abandonment), and physical abuse (domestic violence). Evidence was mainly anecdotal except for contractor fraud, where some prevalence data were available. Research is needed to fill the substantial information gaps. Increase in use of services has been employed to document increases in child abuse and domestic violence during and after disasters. The same methodology could be employed for elder abuse and neglect. Research on best practices (shelter-in-place vs. evacuation) is needed for end-of-life care patients and frail elders in institutional settings. Training and awareness programs for first responders are also needed so that they can better recognize seniors who may have come from abusive environments and to prevent abuse from occurring in emergency housing to which seniors are relocated.

International Journal of Disaster Risk Reduction
Volume 10, Part A, In Progress (December 2014)
http://www.sciencedirect.com/science/journal/22124209/9

A method to improve trust in disaster risk managers: Voluntary action to share a common fate
Original Research Article
Pages 59-66
Kazuya Nakayachi, Taku Ozaki
Abstract
In this study, the effect of voluntary action to share a common fate on trust was empirically examined. Voluntary actions to share a common fate involve decisions by risk managers that place them at an equal risk as the public during times of disaster. Participants included 118 housewives who were randomly assigned to one of the three conditions: voluntary sharing of a common fate, passive sharing of a common fate, and non-sharing of a common fate. The results of the analysis indicated that trust ratings of risk managers in the voluntary condition were greater than were the ratings in the other two conditions; moreover, the trust ratings in the passive and non-sharing conditions were at equally low levels. Furthermore, the results indicated that perceived value similarity for trust had a high explanatory power in both the passive and non-sharing conditions. These results suggested that risk managers can improve their trust by voluntarily sharing the fate of the general public. The results also indicated that when trust level is low, individual differences in trust are explained by the perception that the values are shared between risk managers and the public. Finally, the relationship between trust in risk managers and the forecast of risk reduction was discussed.

JAMA Pediatrics
September 2014, Vol 168, No. 9
http://archpedi.jamanetwork.com/issue.aspx

Integrating Curricula on Human Trafficking Into Medical Education and Residency Training
Aimee M. Grace, MD, MPH; Roy Ahn, MPH, ScD; Wendy Macias Konstantopoulos, MD, MPH
Today in the United States, human trafficking occurs in cities, suburbs, and rural areas across all 50 US states.1 “Severe forms” of human trafficking are defined under the US Trafficking Victims Protection Act of 2000 as the following: (1) sex trafficking in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such act has not attained 18 years of age or (2) the recruitment, harboring, transportation, provision, or obtaining of a person for labor or services, through the use of force, fraud, or coercion for the purpose of subjection to involuntary servitude, peonage, debt bondage, or slavery. According to data collected by the US Human Trafficking Reporting System between January 2008 and July 2010, 83% of confirmed sex trafficking victims were US citizens, and 95% of confirmed labor trafficking victims were foreign-born nationals. Moreover, 87% of sex trafficking victims were younger than 25 years, compared with 38% of labor trafficking victims.2

JAMA Pediatrics
September 2014, Vol 168, No. 9
http://archpedi.jamanetwork.com/issue.aspx

Confronting Commercial Sexual Exploitation and Sex Trafficking of Minors
Angela Diaz, MD, MPH; Ellen Wright Clayton, MD, JD; Patti Simon, MPH
Health care professionals who routinely interact with young people have an important role to play in preventing, identifying, and responding to commercial sexual exploitation and sex trafficking of minors. These crimes—which include any sexual activity with someone younger than 18 years in exchange for something of value—occur every day in the United States and have serious, long-term consequences for individuals who have experienced this violence and exploitation. Unfortunately, pediatricians may not recognize children and adolescents who are at risk or who may be abused. A recent report from the Institute of Medicine and the National Research Council sheds light on these crimes and provides recommendations designed to increase awareness, advance understanding, and support efforts to prevent and respond to this abuse.

Journal of Immigrant and Minority Health
Volume 16, Issue 5, October 2014
http://link.springer.com/journal/10903/16/4/page/1

Screening and Vaccines in an Urban Primary Care Practice: A Retrospective Chart Review
Barbara Waldorf, Christopher Gill, Sondra S. Crosby
Abstract
In the United States, 38.5 million people are foreign-born, one in three arriving since 2000. Health issues include high rates of hepatitis B, human immunodeficiency virus infection, parasitic infections, and M. tuberculosis. We sought to determine rates of provider adherence to accepted national guidelines for immigrant and refugee health screening and vaccines done at the primary care clinics at Boston Medical Center. Randomized, retrospective chart review of foreign born patients in the primary care clinics. We found low screening and immunization rates that do not conform to CDC/ACIP guidelines. Only 43 % of immigrant patients had tuberculosis screening, 36 % were screened for HIV and hepatitis B, and 33 % received tetanus vaccinations. Organizational changes incorporating multi-disciplinary approaches such as creative use of nursing staff, protocols, standing orders, EMR reminders, and web based educational tools can contribute to better outcomes by identifying patients and improving utilization of guidelines.

New England Journal of Medicine
August 28, 2014 Vol. 371 No. 9
http://www.nejm.org/toc/nejm/medical-journal

Original Article
Influenza Vaccination of Pregnant Women and Protection of Their Infants
Shabir A. Madhi, M.D., Ph.D., Clare L. Cutland, M.D., Locadiah Kuwanda, M.Sc., Adriana Weinberg, M.D., Andrea Hugo, M.D., Stephanie Jones, M.D., Peter V. Adrian, Ph.D., Nadia van Niekerk, B.Tech., Florette Treurnicht, Ph.D., Justin R. Ortiz, M.D., Marietjie Venter, Ph.D., Avy Violari, M.D., Kathleen M. Neuzil, M.D., Eric A.F. Simões, M.D., Keith P. Klugman, M.D., Ph.D., and Marta C. Nunes, Ph.D. for the Maternal Flu Trial (Matflu) Team
N Engl J Med 2014; 371:918-931September 4, 2014DOI: 10.1056/NEJMoa1401480
Background
There are limited data on the efficacy of vaccination against confirmed influenza in pregnant women with and those without human immunodeficiency virus (HIV) infection and protection of their infants.
Methods
We conducted two double-blind, randomized, placebo-controlled trials of trivalent inactivated influenza vaccine (IIV3) in South Africa during 2011 in pregnant women infected with HIV and during 2011 and 2012 in pregnant women who were not infected. The immunogenicity, safety, and efficacy of IIV3 in pregnant women and their infants were evaluated until 24 weeks after birth. Immune responses were measured with a hemagglutination inhibition (HAI) assay, and influenza was diagnosed by means of reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays of respiratory samples.
Results
The study cohorts included 2116 pregnant women who were not infected with HIV and 194 pregnant women who were infected with HIV. At 1 month after vaccination, seroconversion rates and the proportion of participants with HAI titers of 1:40 or more were higher among IIV3 recipients than among placebo recipients in both cohorts. Newborns of IIV3 recipients also had higher HAI titers than newborns of placebo recipients. The attack rate for RT-PCR–confirmed influenza among both HIV-uninfected placebo recipients and their infants was 3.6%. The attack rates among HIV-uninfected IIV3 recipients and their infants were 1.8% and 1.9%, respectively, and the respective vaccine-efficacy rates were 50.4% (95% confidence interval [CI], 14.5 to 71.2) and 48.8% (95% CI, 11.6 to 70.4). Among HIV-infected women, the attack rate for placebo recipients was 17.0% and the rate for IIV3 recipients was 7.0%; the vaccine-efficacy rate for these IIV3 recipients was 57.7% (95% CI, 0.2 to 82.1).
Conclusions
Influenza vaccine was immunogenic in HIV-uninfected and HIV-infected pregnant women and provided partial protection against confirmed influenza in both groups of women and in infants who were not exposed to HIV. (Funded by the Bill and Melinda Gates Foundation and others; ClinicalTrials.gov numbers, NCT01306669 and NCT01306682.)

PLoS Medicine
(Accessed 6 September 2014)
http://www.plosmedicine.org/

Oral Cholera Vaccine Development and Use in Vietnam
Dang Duc Anh, Anna Lena Lopez mail, Hung Thi Mai Tran, Nguyen Van Cuong, Vu Dinh Thiem,
Mohammad Ali, Jacqueline L. Deen, Lorenz von Seidlein, David A. Sack
Published: September 02, 2014
DOI: 10.1371/journal.pmed.1001712
Summary Points
:: Vietnam is the first and only country in the world to regularly use oral cholera vaccines (OCVs) in their cholera control program.
:: From 1998 to 2012, more than 10.9 million doses of the locally produced OCV were deployed in the country through its public health system.
:: We present an overview of cholera epidemiology in Vietnam and the development and deployment of the OCV.
:: Since 1997, the number of cholera cases in Vietnam has declined, in association with increased OCV use as well as improvements in socioeconomic and water and sanitation conditions. It is not possible to establish the relative contributions of each of these to the reduction in cholera rates.
:: Hue, the only province to use OCVs consistently every year, has not reported any cholera case since 2003.
:: As WHO organizes a stockpile of OCV for use in emergencies and recommends the use of OCVs together with traditional means of control, the experience in Vietnam will be helpful to other at-risk countries as they look towards adopting the vaccine in their cholera control programs.

Cholera: A Continuing Public Health Threat
The emergence of cholera in Haiti highlighted the difficulties in containing cholera outbreaks with only safe water, sanitation, hygiene, and appropriate case management. In less developed settings where cholera occurs, these basic needs are often not met or are rapidly overwhelmed during man-made or natural disasters. Prior to the Haitian outbreak, countries in Africa and Asia had borne most of the cholera burden, with an estimated 1.4 billion people at risk, 2.8 million cases, and 100,000 to 200,000 deaths occurring annually [1],[2]; however, because of difficulties in surveillance and differences in reporting systems, only 245,393 cases with 3,034 deaths were reported to the World Health Organization (WHO) in 2012 [1]. This figure does not include the large number of acute watery diarrhoea cases reported in Asia, of which a significant proportion is caused by Vibrio cholerae. As cholera continues to be a global public health problem, in 2011, the World Health Assembly called for an integrated and comprehensive approach to cholera control, including oral cholera vaccines (OCVs) [3].
OCVs have been available for more than 20 years, but public health use has been limited. Vietnam is the first and currently the only country in the world to use killed OCVs routinely in its public health program. This article describes the cholera problem in Vietnam and how an oral cholera vaccine was developed and used as a component of a public health strategy against the disease…

Sustainability
Volume 6, Issue 9 (September 2014), Pages 5512-
http://www.mdpi.com/2071-1050/6/8

Social Investment for Sustainability of Groundwater: A Revealed Preference Approach
by Edna Tusak Loehman
Sustainability 2014, 6(9), 5598-5638; doi:10.3390/su6095598
Received: 4 March 2014; in revised form: 23 July 2014 / Accepted: 31 July 2014 / Published: 27 August 2014
Abstract:
Groundwater is a form of natural capital that is valued for the goods it provides, including ecosystem health, water quality, and water consumption. Degradation of groundwater could be alleviated through social investment such as for water reuse and desalination to reduce the need for withdrawals from groundwater. This paper develops a participatory planning process—based on combining revealed preference with economic optimization—to choose a desired future for sustaining groundwater. Generation of potential groundwater futures is based on an optimal control model with investment and withdrawal from groundwater as control variables. In this model, groundwater stock and aquatic health are included as inter-temporal public goods. The social discount rate expressing time preference—an important parameter that drives optimization—is revealed through the participatory planning process. To implement the chosen future, a new method of inter-temporal pricing is presented to finance investment and supply costs. Furthermore, it is shown that the desired social outcome could be achieved by a form of privatization in which the pricing method, the appropriate discount rate, and the planning period are contractually specified.

Sustainability
Volume 6, Issue 9 (September 2014), Pages 5512-
http://www.mdpi.com/2071-1050/6/8

Poverty Alleviation through Pro-Poor Tourism: The Role of Botswana Forest Reserves
by Haretsebe Manwa and Farai Manwa
Sustainability 2014, 6(9), 5697-5713; doi:10.3390/su6095697
Received: 11 June 2014; in revised form: 15 August 2014 / Accepted: 18 August 2014 / Published: 28 August 2014
Abstract:
Both government and international donor agencies now promote the use of tourism to alleviate poverty. The Botswana government has embraced tourism as a meaningful and sustainable economic activity and diversification opportunity, which now ranks second after mining in its contribution to the country’s gross domestic product. The study reported in this paper investigates perceptions of stakeholders on the opportunities that would be created for the poor by opening up Botswana’s forest reserves for ecotourism. Data was collected through mixed methods involving in-depth interviews with government departments, traditional leaders, quasi-government organisations and the Hospitality and Tourism Association of Botswana. Focus group discussions were also held with village development committees, Chobe Enclave Conservation Trust (CECT) and Kasane, Lesoma and Pandematenga Trust (KALEPA) members, and a consultative national workshop of stakeholders was also held. The findings indicate that opening up forest reserves for ecotourism has the potential to alleviate poverty among the disadvantaged groups living adjacent to forest reserves through direct (employment, small- and medium-sized enterprises (SMEs)), secondary (linkages/partnerships) and dynamic effects (sustainable livelihoods). The study concludes by cautioning that whilst pro-poor tourism may yield short- and medium-term benefits, in keeping with sustainability objectives, participants in the programme need to be mindful of forestry encroachment and come up with strategies to ensure the sustainability of the Botswana forest reserves.

New York Times
http://www.nytimes.com/
Accessed 6 September 2014
Cuts at W.H.O. Hurt Response to Ebola Crisis
SHERI FINK
3 September 2014
With treatment centers overflowing, and alarmingly little being done to stop Ebola from sweeping through West African villages and towns, Dr. Joanne Liu, the president of Doctors Without Borders, knew that the epidemic had spun out of control.
The only person she could think of with the authority to intensify the global effort was Dr. Margaret Chan, the director general of the World Health Organization, which has a long history of fighting outbreaks. If the W.H.O., the main United Nations health agency, could not quickly muster an army of experts and health workers to combat an outbreak overtaking some of the world’s poorest countries, then what entity in the world would do it?
“I wish I could do that,” Dr. Chan said when the two met at the W.H.O.’s headquarters in Geneva this summer, months after the outbreak burgeoned in a Guinean rain forest and spilled into packed capital cities. The W.H.O. simply did not have the staffing or ability to flood the Ebola zone with help, said Dr. Chan, who recounted the conversation. It was a fantasy, she argued, to think of the W.H.O. as a first responder ready to lead the fight against deadly outbreaks around the world.
The Ebola epidemic has exposed gaping holes in the ability to tackle outbreaks in an increasingly interconnected world, where diseases can quickly spread from remote villages to cities housing millions of people.
The W.H.O., the United Nations agency assigned in its constitution to direct international health efforts, tackle epidemics and help in emergencies, has been badly weakened by budget cuts in recent years, hobbling its ability to respond in parts of the world that need it most. Its outbreak and emergency response units have been slashed, veterans who led previous fights against Ebola and other diseases have left, and scores of positions have been eliminated — precisely the kind of people and efforts that might have helped blunt the outbreak in West Africa before it ballooned into the worst Ebola epidemic ever recorded…