BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 7 November 2015)

.
Research article
Rapid Evidence Assessment of the Literature (REAL © ): streamlining the systematic review process and creating utility for evidence-based health care
Cindy Crawford, Courtney Boyd, Shamini Jain, Raheleh Khorsan, Wayne Jonas BMC Research Notes 2015, 8:631
Abstract
Background
Systematic reviews (SRs) are widely recognized as the best means of synthesizing clinical research. However, traditional approaches can be costly and time-consuming and can be subject to selection and judgment bias. It can also be difficult to interpret the results of a SR in a meaningful way in order to make research recommendations, clinical or policy decisions, or practice guidelines. Samueli Institute has developed the Rapid Evidence Assessment of the Literature (REAL) SR process to address these issues. REAL provides up-to-date, rigorous, high quality SR information on health care practices, products, or programs in a streamlined, efficient and reliable manner. This process is a component of the Scientific Evaluation and Review of Claims in Health Care (SEaRCH™) program developed by Samueli Institute, which aims at answering the question of “What works?” in health care.
Methods/design
The REAL process (1) tailors a standardized search strategy to a specific and relevant research question developed with various stakeholders to survey the available literature; (2) evaluates the quantity and quality of the literature using structured tools and rulebooks to ensure objectivity, reliability and reproducibility of reviewer ratings in an independent fashion and; (3) obtains formalized, balanced input from trained subject matter experts on the implications of the evidence for future research and current practice.
Results
Online tools and quality assurance processes are utilized for each step of the review to ensure a rapid, rigorous, reliable, transparent and reproducible SR process.
Conclusions
The REAL is a rapid SR process developed to streamline and aid in the rigorous and reliable evaluation and review of claims in health care in order to make evidence-based, informed decisions, and has been used by a variety of organizations aiming to gain insight into “what works” in health care. Using the REAL system allows for the facilitation of recommendations on appropriate next steps in policy, funding, and research and for making clinical and field decisions in a timely, transparent, and cost-effective manner.

BMJ Open
2015, Volume 5, Issue 10
http://bmjopen.bmj.com/content/current

.
Health policy
Research
Understanding the motivation and performance of community health volunteers involved in the delivery of health programmes in Kampala, Uganda: a realist evaluation
Gaëlle Vareilles, Bruno Marchal, Sumit Kane, Taja Petrič, Gabriel Pictet, Jeanine Pommier
BMJ Open 2015;5:e008614 doi:10.1136/bmjopen-2015-008614

.
Health services research
Research
Disparities in health and access to healthcare between asylum seekers and residents in Germany: a population-based cross-sectional feasibility study
Christine Schneider, Stefanie Joos, Kayvan Bozorgmehr
BMJ Open 2015;5:e008784 doi:10.1136/bmjopen-2015-008784

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 7 November 2015]

.
Review
Child health in Syria: recognising the lasting effects of warfare on health
Devakumar D, Birch M, Rubenstein LS, Osrin D, Sondorp E and Wells JCK Conflict and Health 2015, 9:34 (3 November 2015)
Abstract
The war in Syria, now in its fourth year, is one of the bloodiest in recent times. The legacy of war includes damage to the health of children that can last for decades and affect future generations. In this article we discuss the effects of the war on Syria’s children, highlighting the less documented longer-term effects. In addition to their present suffering, these children, and their own children, are likely to face further challenges as a result of the current conflict. This is essential to understand both for effective interventions and for ethical reasons.

Developing World Bioethics
December 2015 Volume 15, Issue 3 Pages iii–iii, 115–275
http://onlinelibrary.wiley.com/doi/10.1111/dewb.2015.15.issue-2/issuetoc

.
Considerations for a Human Rights Impact Assessment of a Population Wide Treatment for HIV Prevention Intervention (pages 115–124)
Johanna Hanefeld, Virginia Bond, Janet Seeley, Shelley Lees and Nicola Desmond
Article first published online: 8 NOV 2013 | DOI: 10.1111/dewb.12038
Abstract
Increasing attention is being paid to the potential of anti-retroviral treatment (ART) for HIV prevention. The possibility of eliminating HIV from a population through a universal test and treat intervention, where all people within a population are tested for HIV and all positive people immediately initiated on ART, as part of a wider prevention intervention, was first proposed in 2009. Several clinical trials testing this idea are now in inception phase. An intervention which relies on universally testing the entire population for HIV will pose challenges to human rights, including obtaining genuine consent to testing and treatment. It also requires a context in which people can live free from fear of stigma, discrimination and violence, and can access services they require. These challenges are distinct from the field of medical ethics which has traditionally governed clinical trials and focuses primarily on patient researcher relationship. This paper sets out the potential impact of a population wide treatment as prevention intervention on human rights. It identifies five human right principles of particular relevance: participation, accountability, the right to health, non-discrimination and equality, and consent and confidentiality. The paper proposes that explicit attention to human rights can strengthen a treatment as prevention intervention, contribute to mediating likely health systems challenges and offer insights on how to reach all sections of the population.

.
Perceived Quality of Informed Refusal Process: A Cross-Sectional Study from Iranian Patients’ Perspectives (pages 172–178)
Mehrdad Farzandipour, Abbas Sheikhtaheri and Monireh Sadeqi Jabali
Article first published online: 11 APR 2014 | DOI: 10.1111/dewb.12054
Abstract
Patients have the right to refuse their treatment; however, this refusal should be informed. We evaluated the quality of the informed refusal process in Iranian hospitals from patients’ viewpoints. To this end, we developed a questionnaire that covered four key aspects of the informed refusal process including; information disclosure, voluntariness, comprehension, and provider-patient relationship. A total of 284 patients who refused their treatment from 12 teaching hospitals in the Isfahan Province, Iran, were recruited and surveyed to produce a convenience sample. Patients’ perceptions about the informed refusal process were scored and the mean scores of the four components were calculated. The findings showed that the practice of information disclosure (9.6 ± 6.4 out of 22 points) was perceived to be moderate, however, comprehension (2.3 ± 1.4 out of 4 points), voluntariness (8.7 ± 1.5 out of 12 points) and provider–patient relationship (10.2 ±  5.2 out of 16 points) were perceived to be relatively good. We found that patients, who refused their care before any treatment had commenced, reported a lower quality of information disclosure and voluntariness. Patients informed by nurses and those who had not had a previous related admission, reported lower scores for comprehension and relationship. In conclusion, the process of obtaining informed refusal was relatively satisfactory except for levels of information disclosure. To improve current practices, Iranian patients need to be better informed about; different treatment options, consequences of treatment refusal, costs of not continuing treatment and follow-ups after refusal. Developing more informative refusal forms is needed.

.
Enhancing Research Ethics Review Systems in Egypt: The Focus of an International Training Program Informed by an Ecological Developmental Approach to Enhancing Research Ethics Capacity (pages 199–207)
Hillary Anne Edwards, Tamer Hifnawy and Henry Silverman
Article first published online: 3 JUN 2014 | DOI: 10.1111/dewb.12062
Abstract
Recently, training programs in research ethics have been established to enhance individual and institutional capacity in research ethics in the developing world. However, commentators have expressed concern that the efforts of these training programs have placed ‘too great an emphasis on guidelines and research ethics review’, which will have limited effect on ensuring ethical conduct in research. What is needed instead is a culture of ethical conduct supported by national and institutional commitment to ethical practices that are reinforced by upstream enabling conditions (strong civil society, public accountability, and trust in basic transactional processes), which are in turn influenced by developmental conditions (basic freedoms of political freedoms, economic facilities, social opportunities, transparency guarantees, and protective security). Examining this more inclusive understanding of the determinants of ethical conduct enhances at once both an appreciation of the limitations of current efforts of training programs in research ethics and an understanding of what additional training elements are needed to enable trainees to facilitate national and institutional policy changes that enhance research practices. We apply this developmental model to a training program focused in Egypt to describe examples of such additional training activities.

.
Improving the Quality of Host Country Ethical Oversight of International Research: The Use of a Collaborative ‘Pre-Review’ Mechanism for a Study of Fexinidazole for Human African Trypanosomiasis (pages 241–247)
Carl H. Coleman, Chantal Ardiot, Séverine Blesson, Yves Bonnin, Francois Bompart, Pierre Colonna, Ames Dhai, Julius Ecuru, Andrew Edielu, Christian Hervé, François Hirsch, Bocar Kouyaté, Marie-France Mamzer-Bruneel, Dionko Maoundé, Eric Martinent, Honoré Ntsiba, Gérard Pelé, Gilles Quéva, Marie-Christine Reinmund, Samba Cor Sarr, Abdoulaye Sepou, Antoine Tarral, Djetodjide Tetimian, Olaf Valverde, Simon Van Nieuwenhove and Nathalie Strub-Wourgaft
Article first published online: 14 JUL 2014 | DOI: 10.1111/dewb.12068
Abstract
Developing countries face numerous barriers to conducting effective and efficient ethics reviews of international collaborative research. In addition to potentially overlooking important scientific and ethical considerations, inadequate or insufficiently trained ethics committees may insist on unwarranted changes to protocols that can impair a study’s scientific or ethical validity. Moreover, poorly functioning review systems can impose substantial delays on the commencement of research, which needlessly undermine the development of new interventions for urgent medical needs. In response to these concerns, the Drugs for Neglected Diseases Initiative (DNDi), an independent nonprofit organization founded by a coalition of public sector and international organizations, developed a mechanism to facilitate more effective and efficient host country ethics review for a study of the use of fexinidazole for the treatment of late stage African Trypanosomiasis (HAT). The project involved the implementation of a novel ‘pre-review’ process of ethical oversight, conducted by an ad hoc committee of ethics committee representatives from African and European countries, in collaboration with internationally recognized scientific experts. This article examines the process and outcomes of this collaborative process.

.
To What did They Consent? Understanding Consent Among Low Literacy Participants in a Microbicide Feasibility Study in Mazabuka, Zambia (pages 248–256)
Esther Munalula-Nkandu, Paul Ndebele, Seter Siziya and JC Munthali
Article first published online: 1 AUG 2014 | DOI: 10.1111/dewb.12069

We conducted a study to review the consenting process in a vaginal Microbicide feasibility study conducted in Mazabuka, Zambia. Participants were drawn from those participating in the microbicide study. A questionnaire and focus group discussion were used to collect information on participants understanding of study aims, risks and benefits. Altogether, 200 participants took part in this study. The results of the study showed that while all participants signed or endorsed their thumbprints to the consent forms, full informed consent was not attained from most of the participants since 77% (n = 154) of the participants had numerous questions about the study and 34% (n = 68) did not know who to get in touch with concerning the study. Study objectives were not fully understood by over 61% of the participants. Sixty four percent of the participants were not sure of the risks of taking part in the microbicide study. A significant number thought the study was all about determining their HIV status. Some participants were concerned that their partners were not on the trial as they were convinced that being on the study meant that that they had a lifetime protection from HIV infection. The process of obtaining consent was inadequate as various phases of the study were not fully understood. We recommend the need for researchers to reinforce the consenting process in all studies and more so when studies are conducted in low literacy populations.

Disaster Medicine and Public Health Preparedness
Volume 9 – Issue 06 – December 2015
http://journals.cambridge.org/action/displayIssue?jid=DMP&tab=currentissue

.
Resilience of Nurses in the Face of Disaster
Stephanie B. Turner
Disaster Medicine and Public Health Preparedness / Volume 9 / Issue 06 / December 2015, pp 601 – 604
Abstract
Objective
On April 27, 2011, the state of Alabama encountered a horrific day of tornados that left a trail of damage throughout the state. The city of Tuscaloosa was devastated by an EF-4 that resulted in many victims and casualties. Druid City Hospital in Tuscaloosa had a massive inflow of victims with both mild and major injuries. When disasters such as this occur, nurses must respond with efficiency and effectiveness to help as many victims as possible. However, little is known about the psychological effects of disasters on nurses and how these impact nurses both personally and professionally. Because resilience can directly impact how a nurse responds to a situation, this article aimed to examine the resilience levels of nurses working during the disaster.
Methods
This study was part of a larger study examining the needs of nurses both before and after disasters. Ten nurses were interviewed and completed a 10-item survey on resilience, the Connor-Davidson Resilience Scale (CD-RISC). The full range of scores on this scale is from 0 to 40, with higher scores reflecting greater resilience.
Results
In this survey of 10 nurses, the scores ranged from 33 to 40, with a mean score of 36.7.
Conclusions
The nurses who were interviewed and completed the survey possessed a high level of resilience. More research should be done on the causes of increased resilience in nurses after disasters. (Disaster Med Public Health Preparedness. 2015;9:601–604)

.
Notes from Nepal: Is There a Better Way to Provide Search and Rescue?
Kobi Peleg
Disaster Medicine and Public Health Preparedness, Volume 9, Issue 06, December 2015
Abstract
This article discusses a possibility for overcoming the limited efficiency of international search and rescue teams in saving lives after earthquakes, which was emphasized by the recent disaster in Nepal and in other earthquakes all over the world. Because most lives are actually saved by the locals themselves long before the international teams arrive on scene, many more lives could be saved by teaching the basics of light rescue to local students and citizens in threatened countries. (Disaster Med Public Health Preparedness. 2015;9:650–652)

Forum for Development Studies
Volume 42, Issue 3, 2015
http://www.tandfonline.com/toc/sfds20/current

.
Financialization and the Push for Non-state Social Service Provision: Philanthropic Activities of Islamic and Conventional Banks in Turkey
Fulya Apaydin
pages 441-465

.
Building Resilient Organizations for Effective Service Delivery in Developing Countries: The Experience of Ghana Water Company Limited
Joshua Jebuntie Zaato & Frank L.K. Ohemeng
pages 507-528

Health Affairs
November 2015; Volume 34, Issue 11
http://content.healthaffairs.org/content/current

.
Food & Health
Food Insecurity And Health Outcomes
Craig Gundersen1,* and James P. Ziliak2
Author Affiliations
1Craig Gundersen (cggunder@illinois.edu) is the Soybean Industry Endowed Professor in Agricultural Strategy in the Department of Agricultural and Consumer Economics, University of Illinois, in Urbana.
2James P. Ziliak is the Carol Martin Gatton Endowed Chair in Microeconomics in the Department of Economics, University of Kentucky, in Lexington.
Abstract
Almost fifty million people are food insecure in the United States, which makes food insecurity one of the nation’s leading health and nutrition issues. We examine recent research evidence of the health consequences of food insecurity for children, nonsenior adults, and seniors in the United States. For context, we first provide an overview of how food insecurity is measured in the country, followed by a presentation of recent trends in the prevalence of food insecurity. Then we present a survey of selected recent research that examined the association between food insecurity and health outcomes. We show that the literature has consistently found food insecurity to be negatively associated with health. For example, after confounding risk factors were controlled for, studies found that food-insecure children are at least twice as likely to report being in fair or poor health and at least 1.4 times more likely to have asthma, compared to food-secure children; and food-insecure seniors have limitations in activities of daily living comparable to those of food-secure seniors fourteen years older. The Supplemental Nutrition Assistance Program (SNAP) substantially reduces the prevalence of food insecurity and thus is critical to reducing negative health outcomes.

Health Policy and Planning
Volume 30 Issue 10 December 2015
http://heapol.oxfordjournals.org/content/current

.
Assessing the pro-poor effect of different contracting schemes for health services on health facilities in rural Afghanistan
Olakunle Alonge1,*, Shivam Gupta1, Cyrus Engineer1, Ahmad Shah Salehi2 and David H Peters1
Author Affiliations
1Department of International Health, Johns Hopkins Bloomberg School of Public Health, Suite E8622, 615 N Wolfe Street, Baltimore, MD 21205, USA and
2Department of Health Economics and Finance, Afghanistan Ministry of Public Health, Kabul, Afghanistan
Accepted October 30, 2014.
Abstract
Background Despite progress in improving health outcomes in Afghanistan by contracting public health services through non-governmental organizations (NGOs), inequity in access persists between the poor and non-poor. This study examined the distributive effect of different contracting types on primary health services provision between the poor and non-poor in rural Afghanistan.
Method Contracts to NGOs were made to deliver a common set of primary care services in each province, with the funding agencies determining contract terms. The contracting approaches could be classified into three contracting out types (CO-1, CO-2 and CO-3) and a contracting-in (CI) approach based on the contract terms, design and implementation. Exit interviews of patients attending randomly sampled primary health facilities were collected through systematic sampling across 28 provinces at two time points. The outcome, the odds that a client attending a health facility is poor, was modelled using logistic regression with a robust variance estimator, and the effect of contracting was estimated using the difference-in-difference approach combined with stratified analyses.
Results The sample covered 5960 interviews from 306 health facilities in 2005 and 2008. The adjusted odds of a poor client attending a health facility over time increased significantly for facilities under CO-1 and CO-2, with odds ratio of 2.82 (1.49, 5.36) P-value 0.001 and 2.00 (1.33, 3.02) P-value 0.001, respectively. The odds ratios for those under CO-3 and CI were not statistically significantly different over time. When compared with the non-contracting facilities, the adjusted ratio of odds ratios of poor status among clients was significantly higher for only those under CO-1, ratio of 2.50 (1.32, 4.74) P-value 0.005.
Conclusions CO-1 arrangement which allows contractors to decide on how funds are allocated within a fixed lump sum with non-negotiable deliverables, and actively managed through an independent government agency, is effective in improving equity of health services provision.

.
Use of health care among febrile children from urban poor households in Senegal: does the neighbourhood have an impact?
Georges Karna Kone1,*, Richard Lalou2, Martine Audibert3, Hervé Lafarge4, Stéphanie Dos Santos2, Alphousseyni Ndonky2 and Jean-Yves Le Hesran5
Author Affiliations
1Centre de Recherche du Centre Hospitalier de l’Université de Montréal (CR CHUM) et Université de Daloa (Cote d’ivoire), 850 rue saint Denis Montréal, Canada,
2UMR 151 IRD/AMU, Laboratoire Population–Environnement–Développement, Aix-Marseille Université, centre Saint-Charles, Case 10, 3, place Victor-Hugo, 13331 Marseille cedex 3, France,
3CERDI, CNRS, 65 Boulevard François Mitterrand, 63000 Clermont-Ferrand, France,
4University of Paris Dauphine 32, avenue Henri Varagnat 93143 Bondy cedex, France
Accepted December 31, 2014.
Abstract
Urban malaria is considered a major public health problem in Africa. The malaria vector is well adapted in urban settings and autochthonous malaria has increased. Antimalarial treatments prescribed presumptively or after rapid diagnostic tests are also highly used in urban settings. Furthermore, health care strategies for urban malaria must comply with heterogeneous neighbourhood ecosystems where health-related risks and opportunities are spatially varied. This article aims to assess the capacity of the urban living environment to mitigate or increase individual or household vulnerabilities that influence the use of health services. The data are drawn from a survey on urban malaria conducted between 2008 and 2009. The study sample was selected using a two-stage randomized sampling. The questionnaire survey covered 2952 households that reported a case of fever episode in children below 10 years during the month before the survey.
Self-medication is a widespread practice for children, particularly among the poorest households in Dakar. For rich households, self-medication for children is more a transitional practice enabling families to avoid opportunity costs related to visits to health facilities. For the poorest, it is a forced choice and often the only treatment option. However, the poor that live in well-equipped neighbourhoods inhabited by wealthy residents tend to behave as their rich neighbours. They grasp the opportunities provided by the area and adjust their behaviours accordingly. Though health care for children is strongly influenced by household socio-economic characteristics, neighbourhood resources (facilities and social networks) will promote health care among the poorest and reduce access inequalities. Without being a key factor, the neighbourhood of residence—when it provides resources—may be of some help to overcome the financial hurdle. Findings suggest that the neighbourhood (local setting) is a relevant scale for health programmes in African cities.

.
Perceptions of usage and unintended consequences of provision of ready-to-use therapeutic food for management of severe acute child malnutrition. A qualitative study in Southern Ethiopia
Elazar Tadesse1,2, Yemane Berhane2, Anders Hjern3, Pia Olsson1 and Eva-Charlotte Ekström1,*
Author Affiliations
1Department Women’s and Children’s Health, International Maternal and Child Health Uppsala University, SE-75185 Uppsala, Sweden,
2Department of Reproductive Health, Population and Nutrition, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia and
3Clinical Epidemiology, Department of Medicine, Karolinska Institutet and Centre for Health Equity Studies, Stockholm, Sweden
Accepted January 16, 2015.
Abstract
Background: Severe acute child malnutrition (SAM) is associated with high risk of mortality. To increase programme effectiveness in management of SAM, community-based management of acute malnutrition (CMAM) programme that treats SAM using ready-to-use-therapeutic foods (RUTF) has been scaled-up and integrated into existing government health systems. The study aimed to examine caregivers’ and health workers perceptions of usages of RUTF in a chronically food insecure area in South Ethiopia.
Methods: This qualitative study recorded, transcribed and translated focus group discussions and individual interviews with caregivers of SAM children and community health workers (CHWs). Data were complemented with field notes before qualitative content analysis was applied.
Results: RUTF was perceived and used as an effective treatment of SAM; however, caregivers also see it as food to be shared and when necessary a commodity to be sold for collective benefits for the household. Caregivers expected prolonged provision of RUTF to contribute to household resources, while the programme guidelines prescribed RUTF as a short-term treatment to an acute condition in a child. To get prolonged access to RUTF caregivers altered the identities of SAM children and sought multiple admissions to CMAM programme at different health posts that lead to various control measures by the CHWs.
Conclusion: Even though health workers provide RUTF as a treatment for SAM children, their caregivers use it also for meeting broader food and economic needs of the household endangering the effectiveness of CMAM programme. In chronically food insecure contexts, interventions that also address economic and food needs of entire household are essential to ensure successful treatment of SAM children. This may need a shift to view SAM as a symptom of broader problems affecting a family rather than a disease in an individual child.

.
Breast cancer in the global south and the limitations of a biomedical framing: a critical review of the literature
Catia C. Confortini* and Brianna Krong
Author Affiliations
Peace and Justice Studies Program, Wellesley College, 106 Central Street, Wellesley, MA 02481, USA
Accepted November 21, 2014.
Abstract
Public health researchers are devoting increasing attention to the growing burden of breast cancer in low-and middle-income countries (LMICs), previously thought to be minimally impacted by this disease. A critical examination of this body of literature is needed to explore the assumptions, advantages and limitations of current approaches. In our critical literature review, we find that researchers and public health practitioners predominantly privilege a biomedical perspective focused on patients’ adherence (or non-adherence) to ‘preventive’ practices, screening behaviours and treatment regimens. Cost-effective ‘quick fixes’ are prioritized, and prevention is framed in terms of individual ‘risk behaviours’. Thus, individuals and communities are held responsible for the success of the biomedical system; traditional belief systems and ‘harmful’ social practices are problematized. Inherently personal, social and cultural experiences of pain and suffering are neglected or reduced to the issue of chemical palliation. This narrow approach obscures the complex aetiology of the disease and perpetuates silence around power relations. This article calls for a social justice-oriented interrogation of the role of power and inequity in the global breast cancer epidemic, which recognizes the agency and experiences of women (and men) who experience breast cancer in the global south.

Humanitarian Exchange Magazine
Number 65 November 2015
http://odihpn.org/wp-content/uploads/2015/10/HE_65_web.pdf
The crisis in Iraq

.
Human trafficking in crises: a neglected protection concern
by Laura Lungarotti, Sarah Craggs and Agnes Tillinac

.
Connecting humanitarian actors and displaced communities: the IDP call centre in Iraq
by Gemma Woods and Sarah Mace

.
Unleashing the multi-purpose power of cash
by Su’ad Jarbawi
Iraq is an upper middle-income country with high literacy rates, sound infrastructure, functioning markets and a comprehensive hawala cash transfer network covering all 18 governorates, making it an appropriate context for cash transfer programmes. Despite this, cash transfers have been on the periphery of the Iraq humanitarian response. As of the last Humanitarian Response Plan in June 2015, cash transfer programmes (both conditional and unconditional) constituted only 3% of the total funding appeal of $497.9 million

.
Hello, money: the impact of technology and e-money in the Nepal earthquake response
by Erik Johnson, Glenn Hughson and Alesh Brown
On 30 April 2015, five days after the massive earthquake in Nepal, the UN Office for the Coordination of Humanitarian Affairs (OCHA) hosted humanitarian agencies in the UN com-pound to start what came to be known as the Cash Coordination Group (CCG). Four working groups were established, focusing on geographical mapping of which agencies were doing cash and where; market analysis; analysis and comparison of financial service providers; and standardising transfer amounts. This article, written by three members of the CCG, highlights learning on market analysis through the use of a mobile application, the identification and use of financial service providers and e-cash.

.
Using participatory tools to assess remittances in disasters
by Loic Le De, J. C. Gaillard and Wardlow Friesen
In many low-income countries, remittances help to sustain people’s livelihoods and reduce their vulnerability to disasters. However, most studies on this topic are short-term and rely on econometric methods and analysis. Research suggests that aid agencies are aware of the importance of remittances in disasters, but rarely consider them within their relief actions and recovery programmes since their understanding of such mechanisms is generally very limited. Drawing on fieldwork in Samoa, this article concludes that participatory methods, despite some limitations and challenges, contribute to a better understanding of the complexity of remittances and their importance in people’s livelihoods following disaster.

Journal of Community Health
Volume 40, Issue 6, December 2015
http://link.springer.com/journal/10900/40/4/page/1

.
Original Paper
Knowledge, Behavioral, and Sociocultural Factors Related to Human Papillomavirus Infection and Cervical Cancer Screening Among Inner-City Women in Panama
Cheryl A. Vamos, Arlene E. Calvo, Ellen M. Daley…

Journal of Epidemiology & Community Health
November 2015, Volume 69, Issue 11
http://jech.bmj.com/content/current

.
Editorial
Transnational research partnerships: leveraging big data to enhance US health
Casey Crump1, Kristina Sundquist2,3, Marilyn A Winkleby3
Author Affiliations
1Department of Medicine, Stanford University, Stanford, California, USA
2Center for Primary Health Care Research, Lund University, Malmö, Sweden
3Stanford Prevention Research Center, Stanford University, Stanford, California, USA
Published Online First 12 March 2015
Extract
In the current era of big data and small research budgets, new strategies are needed for more cost-effective leveraging of big data to enhance our nation’s health. One strategy is to promote transnational partnerships to tap into the rich, extensive databases available in other countries, particularly in Europe. The National Institutes of Health (NIH) has increasingly recognised that new collaborations that bring together multiple data sources will play a critical role in advancing our knowledge of disease causation, improving patient care, and promoting healthier communities. However, given cuts in research funding and fierce competition for US grants, some question whether US dollars should be diverted to fund ‘foreign’ studies. In this commentary, we argue that transnational research partnerships offer significant advantages for enhancing the health of the US population as well as the broader global community.

.
Contextual socioeconomic factors associated with childhood mortality in Nigeria: a multilevel analysis
Victor T Adekanmbi1,2, Ngianga-Bakwin Kandala1,3, Saverio Stranges1,4, Olalekan A Uthman5,6
Author Affiliations
1Division of Health Sciences, University of Warwick Medical School, Coventry, UK
2Center for Evidence-based Global Health, Ilorin, Nigeria
3Division of Epidemiology and Biostatistics, University of Witwatersrand, School of Public Health, Johannesburg, South Africa
4Department of Population Health, Luxembourg Institute of Health (LIH), Luxembourg
5Division of Health Sciences, Warwick-Centre for Applied Health Research and Delivery (WCAHRD), University of Warwick Medical School, Coventry, UK
6International Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
Published Online First 10 June 2015
Abstract
Background Childhood mortality is a well-known public health issue, particularly in the low and middle income countries. The overarching aim of this study was to examine whether neighbourhood socioeconomic disadvantage is associated with childhood mortality beyond individual-level measures of socioeconomic status in Nigeria.
Methods Multilevel logistic regression models were applied to data on 31 482 under-five children whether alive or dead (level 1) nested within 896 neighbourhoods (level 2) from the 37 states in Nigeria (level 3) using the most recent 2013 Nigeria Demographic and Health Survey (DHS).
Results More than 1 of every 10 children studied had died before reaching the age of 5 years (130/1000 live births). The following factors independently increased the odds of childhood mortality: male sex, mother’s age at 15–24 years, uneducated mother or low maternal education attainment, decreasing household wealth index at individual level (level 1), residing in rural area and neighbourhoods with high poverty rate at level 2. There were significant neighbourhoods and states clustering in childhood mortality in Nigeria.
Conclusions The study provides evidence that individual-level and neighbourhood-level socioeconomic conditions are important correlates of childhood mortality in Nigeria. The findings of this study also highlight the need to implement public health prevention strategies at the individual level, as well as at the area/neighbourhood level. These strategies include the establishment of an effective publicly funded healthcare system, as well as health education and poverty alleviation programmes.

Journal of Health Care for the Poor and Underserved (JHCPU)
Volume 26, Number 3, August 2015
https://muse.jhu.edu/journals/journal_of_health_care_for_the_poor_and_underserved/toc/hpu.26.3.html

.
Barriers and Facilitators to Engaging Communities in Gender-Based Violence Prevention following a Natural Disaster
pp. 1377-1390
Elizabeth Sloand, Cheryl Killion, Faye A. Gary, Betty Dennis, Nancy Glass, Mona Hassan, Doris W. Campbell, Gloria B Callwood

Journal of Medical Ethics
November 2015, Volume 41, Issue 11
http://jme.bmj.com/content/current

.
Viewpoint
Ethical challenges of containing Ebola: the Nigerian experience
Omosivie Maduka1, Osaretin Odia2
Abstract
Responding effectively to an outbreak of disease often requires routine processes to be set aside in favour of unconventional approaches. Consequently, an emergency response situation usually generates ethical dilemmas. The emergence of the Ebola virus in the densely populated cities of Lagos and Port Harcourt in Nigeria brought bleak warnings of a rapidly expanding epidemic. However, these fears never materialised largely due to the swift reaction of emergency response and incident management organisations, and the WHO has now declared Nigeria free of Ebola. However, numerous ethical issues arose in relation to the response to the outbreak. This paper discusses some of these ethical challenges and the vital lessons learned. Ethical challenges relating to confidentiality, the dignity of persons, non-maleficence, stigma and the ethical obligations of health workers are examined. Interventions implemented to ensure that confidentiality and the dignity of persons improved and stigma was reduced, included community meetings, knowledge communication and the training of media personnel in the ethical reporting of Ebola issues. In addition, training in infection prevention and control helped to allay the fears of health workers. A potential disaster was also averted when the use of an experimental medicine was reconsidered. Other countries currently battling the epidemic can learn a lot from the Nigerian experience

The Lancet
Nov 07, 2015 Volume 386 Number 10006 p1795-1916 e27-e36
http://www.thelancet.com/journals/lancet/issue/current

.
Comment
Providing incentives to share data early in health emergencies: the role of journal editors
Christopher J M Whitty, Trevor Mundel, Jeremy Farrar, David L Heymann, Sally C Davies, Mark J Walport
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00758-8
Summary
The recent epidemic of Ebola virus disease in west Africa showed the power of data generated and analysed by the responder and academic communities to help shape and improve the public health response in international health emergencies. The swift response of clinical, public health, and academic professionals from diverse backgrounds was exemplary. Data and insights from many sciences, especially in peer-reviewed papers and online data, were crucial to planning the immediate and medium-term strategy.

.
The Lancet Commissions
Health and climate change: policy responses to protect public health
Nick Watts, W Neil Adger, Paolo Agnolucci, Jason Blackstock, Peter Byass, Wenjia Cai, Sarah Chaytor, Tim Colbourn, Mat Collins, Adam Cooper, Peter M Cox, Joanna Depledge, Paul Drummond, Paul Ekins, Victor Galaz, Delia Grace, Hilary Graham, Michael Grubb, Andy Haines, Ian Hamilton, Alasdair Hunter, Xujia Jiang, Moxuan Li, Ilan Kelman, Lu Liang, Melissa Lott, Robert Lowe, Yong Luo, Georgina Mace, Mark Maslin, Maria Nilsson, Tadj Oreszczyn, Steve Pye, Tara Quinn, My Svensdotter, Sergey Venevsky, Koko Warner, Bing Xu, Jun Yang, Yongyuan Yin, Chaoqing Yu, Qiang Zhang, Peng Gong, Hugh Montgomery, Anthony Costello
Summary
The 2015 Lancet Commission on Health and Climate Change has been formed to map out the impacts of climate change, and the necessary policy responses, in order to ensure the highest attainable standards of health for populations worldwide. This Commission is multidisciplinary and international in nature, with strong collaboration between academic centres in Europe and China.

Nature Medicine
November 2015, Volume 21 No 11 pp1235-1371
http://www.nature.com/nm/journal/v21/n11/index.html

.
Nature Medicine | Editorial
Sharing data to save lives
Published online 05 November 2015
Journals can and should ensure that they erect no barriers to fast and wide sharing of critical data during major public health emergencies. But funders and scientists must also play a part.
On 1–2 September in Geneva, the World Health Organization (WHO) gathered a group of public health experts, scientists, funders, editors, industry and government representatives for a consultation related to the sharing of data during public health emergencies. Many attendees were directly involved in pathogen genome sequencing and in generating or using clinical, epidemiological and observational data during the 2014 Ebola epidemic in West Africa. Their experiences illustrate that improvements to the norms and process of data sharing in such scenarios are urgently needed.

A notable example was the way in which pathogen genome sequence data was handled. Although two batches of Ebola genome sequences obtained from patient samples were released in April and July 2014, no additional virus genome sequences were released until November that same year. Although restricted availability of patient samples hampered the sequencing of genomes, it is acknowledged that some viral genome sequence data were generated but not publicly released during this interval.

These viral genome sequences would remain useful to investigators seeking to understand the molecular features of virus evolution no matter when they are released. However, their utility to those seeking to trace the chain of transmission (e.g., human-to-human or animal-to-human), to determine whether a pathogen is genetically stable or rapidly mutating, and to track new pathogen variants entering the population, wanes days to weeks after the sequences are generated. Moreover, this ‘real-time’ utility is not restricted to pathogen genome sequence data; clinical trial and observational studies of the efficacy—or lack thereof—of candidate therapies can also enable clinicians to adapt in real-time. Waiting to release these data months after their generation during a public health emergency risks allowing medical workers to repeatedly test therapies that other clinicians had determined were ineffective.

Why are such data not rapidly and widely released in a systematic manner? Many barriers to data sharing were identified during the meeting in Geneva, including patient privacy concerns, government restrictions on the export of patient samples, lack of access to advanced technology in limited resource settings, and lack of personnel and time.
As editors, we wish to address another concern, which a consensus felt was a formidable barrier to early data release: the perception that public release of data will have a negative effect on later scientific publication of the same data. More specifically, many data producers worry that if they publicly release their data prior to submitting a manuscript to a peer-reviewed journal, the editors of the journal may consider the released data no longer novel and reject their manuscript for that reason. In addition, especially when data producers are on the ground working to stem an outbreak and are thus occupied with tasks more important than writing manuscripts, other scientists may analyze the released data, submit the resulting manuscript, and ultimately ‘scoop’ the data-producing lab.

Allaying the first concern is the responsibility of scientific journals. Encouragingly, all editors in attendance emphatically declared that their journals do not wish to hinder real-time sharing of data that could have a clinical impact during public health emergencies. Reflecting this sentiment, the WHO summary released after the consultation states, “It was unequivocally agreed by representatives from leading biomedical journals that public disclosure of important information of potential relevance to public health emergencies should not be delayed by publication timelines, and that pre-publication disclosure must not and will not prejudice journal publication.” The Nature journals agree with this statement; it is consistent with our long-standing policy of not penalizing authors for posting most data on preprint servers. Moving forward, although we already require that all data be available to editors and referees at the time of submission—and freely available to all at the time of publication—when we feel that the data in a submitted manuscript may be useful more broadly to agencies working to stem a public health emergency, we will encourage authors to publicly release the data immediately. We will use editorial discretion in defining major public health emergencies and the relevance of the data in question. To regularly remind readers of these principles, we will ask authors of papers that present data that were released prior to submission or publication to add a sentence to the final published paper explicitly stating this fact.

But these steps address just one part of the problem. Scientists, funders and governments must work to solve the rest. For instance, journals become aware of the existence of data when it is submitted for consideration for publication; yet this could be months after it was initially generated. Only scientists, with the cooperation of governments, can ensure that the data are broadly released as quickly as possible. Scientists are also responsible for ensuring that data users are aware of any limitations of rapidly released potentially preliminary data.

Just as crucially, journals cannot allay concerns about scientists scooping each other. Communities of data producers and users must agree on guidelines for the etiquette of data sharing and data use. Useful precedents might be found in guidelines crafted by other communities that successfully grappled with similar challenges, such as the 2006 Global Initiative on Sharing Avian Influenza Data. Once data producers and users coalesce around a set of guidelines, funders can create policies to ensure that they are followed as often as possible, and that data producers remain incentivized to quickly share their results.

Attendees at the WHO consultation agreed on a list of practical steps that can be taken to remove all identified barriers to data sharing. A list of these steps was submitted to the WHO emergency R&D preparedness blueprint Advisory Group, and it awaits endorsement by the WHO and its partners.

The Nature journals’ commitment to enable rather than hinder data sharing in major public health emergencies is effective immediately.

Pediatrics
November 2015, VOLUME 136 / ISSUE 5 http://pediatrics.aappublications.org/content/136/5?current-issue=y

.
Deferred Consent for Randomized Controlled Trials in Emergency Care Settings
Katie Harron, Kerry Woolfall, Kerry Dwan, Carrol Gamble, Quen Mok, Padmanabhan Ramnarayan, Ruth Gilbert
Abstract
BACKGROUND: There is limited experience in using deferred consent for studies involving children, which was legalized in the United Kingdom in 2008. We aimed to inform future studies by evaluating consent rates and reasons for nonconsent in a large randomized controlled trial in pediatric intensive care.
METHODS: In the CATCH trial, eligible children from 14 PICUs in England and Wales were randomly assigned to 3 types of central venous catheters. To avoid delay in treatment, children admitted on an emergency basis were first randomly assigned to a trial central venous catheter, and we deferred seeking consent to use already collected data and blood samples until after stabilization.
RESULTS: Consent was obtained for 984/1358 (72%) of children admitted on an emergency basis. Failure to obtain consent resulted mainly from a lack of opportunity (early discharge or transfer) for survivors and difficulties in seeking consent for children who died. For admissions where there was an opportunity to approach (n = 1298), inclusion rates differed according to survival status: 93/984 (9%) of consented patients died, compared with 58/314 (18%) of nonconsented patients. For children admitted on an emergency basis whose families were approached, 984/1178 (84%) provided deferred consent (n = 15 sites), compared with 441/641 (69%) of children admitted on an elective basis who were approached for prospective consent (n = 9 sites).
CONCLUSIONS: Design of emergency randomized controlled trials should balance the potential burden that seeking consent in difficult situations may cause against risk of bias by disproportionately excluding children who die or are transferred. Ethics committees could consider approving the use of already collected data when best efforts to obtain deferred consent are unsuccessful.

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 7 November 2015]

.
Who Is Worst Off? Developing a Severity-scoring Model of Complex Emergency Affected Countries in Order to Ensure Needs Based Funding
November 3, 2015 · Research article
Background: Disasters affect close to 400 million people each year. Complex Emergencies (CE) are a category of disaster that affects nearly half of the 400 million and often last for several years. To support the people affected by CE, humanitarian assistance is provided with the aim of saving lives and alleviating suffering. It is widely agreed that funding for this assistance should be needs-based. However, to date, there is no model or set of indicators that quantify and compare needs from one CE to another. In an effort to support needs-based and transparent funding of humanitarian assistance, the aim of this study is to develop a model that distinguishes between levels of severity among countries affected by CE.
Methods: In this study, severity serves as a predictor for level of need. The study focuses on two components of severity: vulnerability and exposure. In a literature and Internet search we identified indicators that characterize vulnerability and exposure to CE. Among the more than 100 indicators identified, a core set of six was selected in an expert ratings exercise. Selection was made based on indicator availability and their ability to characterize preexisting or underlying vulnerabilities (four indicators) or to quantify exposure to a CE (two indicators). CE from 50 countries were then scored using a 3-tiered score (Low-Moderate, High, Critical).
Results: The developed model builds on the logic of the Utstein template. It scores severity based on the readily available value of four vulnerability and four exposure indicators. These are 1) GNI per capita, PPP, 2) Under-five mortality rate, per 1 000 live births, 3) Adult literacy rate, % of people ages 15 and above, 4) Underweight, % of population under 5 years, and 5) number of persons and proportion of population affected, and 6) number of uprooted persons and proportion of population uprooted.
Conclusion: The model can be used to derive support for transparent, needs-based funding of humanitarian assistance. Further research is needed to determine its validity, the robustness of indicators and to what extent levels of scoring relate to CE outcome.

.
Mass Casualty Decontamination in a Chemical or Radiological/Nuclear Incident with External Contamination: Guiding Principles and Research Needs
November 2, 2015 · Perspective
Hazardous chemical, radiological, and nuclear materials threaten public health in scenarios of accidental or intentional release which can lead to external contamination of people. Without intervention, the contamination could cause severe adverse health effects, through systemic absorption by the contaminated casualties as well as spread of contamination to other people, medical equipment, and facilities. Timely decontamination can prevent or interrupt absorption into the body and minimize opportunities for spread of the contamination, thereby mitigating the health impact of the incident. Although the specific physicochemical characteristics of the hazardous material(s) will determine the nature of an incident and its risks, some decontamination and medical challenges and recommended response strategies are common among chemical and radioactive material incidents. Furthermore, the identity of the hazardous material released may not be known early in an incident. Therefore, it may be beneficial to compare the evidence and harmonize approaches between chemical and radioactive contamination incidents. Experts from the Global Health Security Initiative’s Chemical and Radiological/Nuclear Working Groups present here a succinct summary of guiding principles for planning and response based on current best practices, as well as research needs, to address the challenges of managing contaminated casualties in a chemical or radiological/nuclear incident.

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 7 November 2015]

.
Research
Intimate partner violence and termination of pregnancy: a cross-sectional study of married Bangladeshi women
Mosfequr Rahman Reproductive Health 2015, 12:102 (5 November 2015)

Science
6 November 2015 vol 350, issue 6261, pages 597-712
http://www.sciencemag.org/current.dtl

.
Editorial
Eradicating polio
Anthony Adams1,*, David M. Salisbury2,
1Anthony Adams is a former professor of public health at the Australian National University and the former Chief Medical Officer of Australia.
2David M. Salisbury is an associate fellow at the Centre for Global Health Security, Chatham House, London, UK.

On 20 September 2015, the Global Commission for the Certification of Poliomyelitis Eradication (GCC) declared that type 2 wild poliovirus had been eradicated. The GCC examined reports from 189 of 195 countries around the world and studied separate data [held by the World Health Organization (WHO)] from the remaining countries. According to WHO, nearly 2 million appropriate clinical samples had been tested, and no type 2 wild polioviruses were found. The announcement is the first step toward eradicating all three wild poliovirus types. But this landmark will only be declared when the GCC is confident that there have been no wild virus cases of any type for 3 years.

The last case of type 3 wild poliovirus occurred in northern Nigeria 3 years ago. In theory, declaration of its eradication could happen now. However, the polio programs from 18 African countries have not yet been scrutinized by the African Regional Certification Commission to ensure that no cases have been missed. This assessment will happen 3 years after each country’s last case of any wild poliovirus. By the end of 2017, all African countries must have gone successfully through their regional commission’s scrutiny, and no wild virus cases must have occurred. If that happens, all countries in the world will submit their data to the GCC and type 3 wild poliovirus eradication can be declared.

That will leave just the type 1 poliovirus, which is still circulating in Pakistan and Afghanistan. To date, the 51 cases of 2015 are far fewer than the 334 cases reported in 2014. This is probably the result of improved access to vaccination in key regions. But there are always fewer cases the year after high numbers are reported, because natural infection reduces the numbers of children susceptible to polio in the following year. The polio programs in both countries must further accelerate their activities. If transmission is interrupted by the end of 2016, then the world can be declared polio-free in 2019.

One underappreciated consequence of the path toward eradication is that all polioviruses (wild and vaccine strains) in laboratory, research, and manufacturing facilities will have to be destroyed or securely contained. Last month, the WHO Strategic Advisory Group of Experts on immunization reaffirmed April 2016 as the date for the globally synchronized withdrawal of type 2 oral poliovirus vaccine. This first step toward the eventual phased removal of all three vaccine types brings urgency to completing the destruction, and securing the containment, of type 2 wild polioviruses in all facilities. The fewer the places that hold either polioviruses or specimens that could contain polioviruses, the more certain we can be that they will not be released inadvertently. This means that the vaccine industry will have to comply with high levels of assurance of containment in their manufacturing processes. Researchers and institutions holding samples collected from places where there could have been polioviruses must ensure that these are destroyed or secured under appropriate biocontainment levels. Countries will need to submit inventories of all laboratories to the GCC for review, and manufacturers and laboratories planning to retain type 2 polioviruses will need to be inspected for compliance with containment guidelines.

In 1980, smallpox was declared eradicated after a global immunization campaign led by WHO. But 2 years earlier, a year after the last natural smallpox case (in Somalia), there was an inadvertent release of smallpox virus from a research lab in the United Kingdom, from which one person died. While we wait for Pakistan and Afghanistan to stop the spread of type 1, we must prepare to safely and securely contain all polioviruses. A second human virus may soon be consigned to history. Until then, the whole world, especially countries with fragile health systems, remains at risk of this disease.
A.A. and D.M.S. are writing on behalf of the GCC: Anthony Adams (Chair), Supamit Chunsuttiwat, Arlene King, Rose Gana F. Leke, Yagob Al Mazrou, and David M. Salisbury.

Science
6 November 2015 vol 350, issue 6261, pages 597-712
http://www.sciencemag.org/current.dtl

Policy Forum
Research Ethics
Evidence gaps and ethical review of multicenter studies
Ann-Margret Ervin1,*, Holly A. Taylor1,2, Curtis L. Meinert1, Stephan Ehrhardt1
Author Affiliations
1Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
2Johns Hopkins Berman Institute of Bioethics, Baltimore, MD, USA.

Large, multicenter clinical studies are the backbone of evidence-based prevention and health care. Ethical review of multicenter research is usually conducted by the institutional review board (IRB) of each participating institution. However, variation in interpretation of regulations by IRBs is common and can have ethical and scientific implications (1, 2). Recent mandates in the United States aim to reduce the administrative burden and to expedite multicenter research by conducting ethical review with a single, central IRB of record (CIRB). Yet the quality of ethical review must not suffer. We characterize current models of ethical review in the United States and identify research gaps that must be addressed before such policies are instituted.