The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 25 June 2016

This weekly digest is intended to aggregate and distill key content from a broad spectrum of practice domains and organization types including key agencies/IGOs, NGOs, governments, academic and research institutions, consortia and collaborations, foundations, and commercial organizations. We also monitor a spectrum of peer-reviewed journals and general media channels. The Sentinel’s geographic scope is global/regional but selected country-level content is included. We recognize that this spectrum/scope yields an indicative and not an exhaustive product. Comments and suggestions should be directed to:

David R. Curry
Editor &
Founding Managing Director
GE2P2 – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: The Sentinel_ week ending 25 June 2016

:: Journal Watch

The Sentinel will track key peer-reviewed journals which address a broad range of interests in human rights, humanitarian response, health and development. It is not intended to be exhaustive. We will add to those monitored below as we encounter relevant content and upon recommendation from readers. We selectively provide full text of abstracts and other content but note that successful access to some of the articles and other content may require subscription or other access arrangement unique to the publisher. Please suggest additional journals you feel warrant coverage.

BMC Infectious Diseases
http://www.biomedcentral.com/bmcinfectdis/content
(Accessed 25 June 2016)
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Research article
Clinical features of suspected Ebola cases referred to the Moyamba ETC, Sierra Leone: challenges in the later stages of the 2014 outbreak
The last ebola virus disease (EVD) outbreak has been the most important since 1976. EVD cases decreased drastically in Sierra Leone at the beginning of 2015. We aim to determine the clinical findings and evolu…
Javier Arranz, Karen Marie Lundeby, Shoaib Hassan, Luis Matías Zabala Fuentes, Pedro San José Garcés, Yngvar Lunde Haaskjold, Hakon Angell Bolkan, Kurt Osthuus Krogh, James Jongopi, Sindre Mellesmo, Ola Josendal, Asmund Opstad, Erling Svensen, Alfred Sandy Kamara, David P. Roberts, Paul D. Stamper…
BMC Infectious Diseases 2016 16:308
Published on: 22 June 2016

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Debate
Towards cash transfer interventions for tuberculosis prevention, care and control: key operational challenges and research priorities
Cash transfer interventions are forms of social protection based on the provision of cash to vulnerable households with the aim of reduce risk, vulnerability, chronic poverty and improve human capital.
Delia Boccia, Debora Pedrazzoli, Tom Wingfield, Ernesto Jaramillo, Knut Lönnroth, James Lewis, James Hargreaves and Carlton A. Evans
BMC Infectious Diseases 2016 16:307
Published on: 21 June 2016

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Research article
Dual rapid lateral flow immunoassay fingerstick wholeblood testing for syphilis and HIV infections is acceptable and accurate, Port-au-Prince, Haiti
Dual rapid tests for HIV and syphilis infections allow for detection of HIV infection and syphilis at the point-of-care. Those tests have been evaluated in laboratory settings and show excellent performance but…
Claire C. Bristow, Linda Severe, Jean William Pape, Marjan Javanbakht, Sung-Jae Lee, Warren Scott Comulada and Jeffrey D. Klausner
BMC Infectious Diseases 2016 16:302

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 25 June 2016)

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Opinion
Beyond viral suppression of HIV – the new quality of life frontier
Jeffrey V. Lazarus, Kelly Safreed-Harmon, Simon E. Barton, Dominique Costagliola, Nikos Dedes, Julia del Amo Valero, Jose M. Gatell, Ricardo Baptista-Leite, Luís Mendão, Kholoud Porter, Stefano Vella and Jürgen Kurt Rockstroh
BMC Medicine 2016 14:94
Published on: 22 June 2016
Abstract
Background
In 2016, the World Health Organization (WHO) adopted a new Global Health Sector Strategy on HIV for 2016–2021. It establishes 15 ambitious targets, including the ‘90-90-90’ target calling on health systems to reduce under-diagnosis of HIV, treat a greater number of those diagnosed, and ensure that those being treated achieve viral suppression.
Discussion
The WHO strategy calls for person-centered chronic care for people living with HIV (PLHIV), implicitly acknowledging that viral suppression is not the ultimate goal of treatment. However, it stops short of providing an explicit target for health-related quality of life. It thus fails to take into account the needs of PLHIV who have achieved viral suppression but still must contend with other intense challenges such as serious non-communicable diseases, depression, anxiety, financial stress, and experiences of or apprehension about HIV-related discrimination. We propose adding a ‘fourth 90’ to the testing and treatment target: ensure that 90 % of people with viral load suppression have good health-related quality of life. The new target would expand the continuum-of-services paradigm beyond the existing endpoint of viral suppression. Good health-related quality of life for PLHIV entails attention to two domains: comorbidities and self-perceived quality of life.
Conclusions
Health systems everywhere need to become more integrated and more people-centered to successfully meet the needs of virally suppressed PLHIV. By doing so, these systems can better meet the needs of all of their constituents – regardless of HIV status – in an era when many populations worldwide are living much longer with multiple comorbidities.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 25 June 2016)

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Research article
Knowledge, practice and associated factors of essential newborn care at home among mothers in Gulomekada District, Eastern Tigray, Ethiopia, 2014
Haftom Gebrehiwot Misgna, Haftu Berhe Gebru and Mulugeta Molla Birhanu
Published on: 21 June 2016
Abstract
Background
Around the world, more than three million newborns die in their first months of life every year. In Ethiopia during the last five years period; neonatal mortality is 37 deaths per 1000 live births. Even though there is an improvement compared to the past five years, there is still high home delivery 90 %, and high neonatal mortality about the Millennium Development Goal, which aims to be less than 32/1000 live births in Ethiopia. The purpose of this study is to assess maternal knowledge, practice and associated factors of essential newborn care at home in Gulomekada District Eastern Tigray, Ethiopia.

Methods
A community-based cross-sectional study is conducted in 296 mothers from Gulomekada District by using simple random sampling technique. Data entry and analysis is carried out by using Statistical Package for Social Sciences-20. The magnitude of the association between different variables about the outcome variable is measured by odds ratio with 95 % confidence interval. A binary logistic regression analysis is made to obtain odds ratio and the confidence interval of statistical associations. The goodness of fit had tested by Hosmer-Lemeshow statistic and all variables with P-value greater than 0.05 are fitted to the multivariate model. Variables with P < 0.2 in the bivariate analysis are included in the final model, and statistical significance is declared at P < 0.05.

Result
Eighty percent (80.4 %) study participants had good knowledge on essential new born care and 92.9 % had the good practice of essential new born care. About 60 % of mothers applied butter or oil on the cord stump for their last baby. Marital status and education are significantly associated with knowledge, whereas urban residence mothers with good knowledge on essential newborn care and employed mothers are significantly associated with mothers’ practice of essential newborn care.

Conclusion
Almost all mothers know and practice essential newborn care correctly except oil or butter application to the cord stump is highly practiced which should be avoided. Only marital status and educational status are significantly associated with mothers’ knowledge.

BMC Research Notes
http://www.biomedcentral.com/bmcresnotes/content
(Accessed 25 June 2016)

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Research article
Involving hard-to-reach ethnic minorities in low-budget health research: lessons from a health survey among Moluccans in the Netherlands
Adee J. Bodewes and Anton E. Kunst
BMC Research Notes 2016 9:319
Published on: 21 June 2016
Abstract
Background
There is little evidence on which strategies are effective in recruiting minority groups in low-budget health surveys. We evaluated different recruitment strategies for their impact on response rates in a hard-to-reach minority population in the Netherlands.
Methods
We conducted a health survey in 19 Moluccan districts (MDs). Each MD had its own set of recruitment strategies, such as information meetings, involving social or local media, involving community organizations, and door-to-door collection. The association between recruitment strategies and MD-specific response rates was assessed with logistic regression analysis.
Results
The overall response rate was 24 %, and varied from 9 to 58 %. Higher rates were obtained when the strategy included door-to-door collection (OR 1.57) and ‘active’ key informants (OR 1.68). No positive associations with response rates were observed of the other strategies.
Conclusions
The overall low response rate in this study may be due to high levels of distrust, segmentation within the community and high respect for privacy among Moluccans. Our study shows that in such communities, response may be increased by a highly personal recruitment approach and a strong commitment and participation of community key-figures.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 June 2016]

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Research
Local and foreign authorship of maternal health interventional research in low- and middle-income countries: systematic mapping of publications 2000–2012
Matthew F. Chersich, Duane Blaauw, Mari Dumbaugh, Loveday Penn-Kekana, Ashar Dhana, Siphiwe Thwala, Leon Bijlmakers, Emily Vargas, Elinor Kern, Francisco Becerra-Posada, Josephine Kavanagh, Priya Mannava, Langelihle Mlotshwa, Victor Becerril-Montekio, Katharine Footman and Helen Rees
Published on: 23 June 2016
Abstract
Background
Researchers in low- and middle-income countries (LMICs) are under-represented in scientific literature. Mapping of authorship of articles can provide an assessment of data ownership and research capacity in LMICs over time and identify variations between different settings.
Methods
Systematic mapping of maternal health interventional research in LMICs from 2000 to 2012, comparing country of study and of affiliation of first authors. Studies on health systems or promotion; community-based activities; and haemorrhage, hypertension, HIV/STIs and malaria were included. Following review of 35,078 titles and abstracts, 2292 full-text publications were included. Data ownership was measured by the proportion of articles with an LMIC lead author (author affiliated with an LMIC institution).
Results
The total number of papers led by an LMIC author rose from 45.0/year in 2000–2003 to 98.0/year in 2004–2007, but increased only slightly thereafter to 113.1/year in 2008–2012. In the same periods, the proportion of papers led by a local author was 58.4 %, 60.8 % and 60.1 %, respectively. Data ownership varies markedly between countries. A quarter of countries led more than 75 % of their research; while in 10 countries, under 25 % of publications had a local first author. Researchers at LMIC institutions led 56.6 % (1297) of all papers, but only 26.8 % of systematic reviews (65/243), 29.9 % of modelling studies (44/147), and 33.2 % of articles in journals with an Impact Factor ≥5 (61/184). Sub-Saharan Africa authors led 54.2 % (538/993) of studies in the region, while 73.4 % did in Latin America and the Caribbean (223/304). Authors affiliated with United States (561) and United Kingdom (207) institutions together account for a third of publications. Around two thirds of USAID and European Union funded studies had high-income country leads, twice as many as that of Wellcome Trust and Rockefeller Foundation.
Conclusions
There are marked gaps in data ownership and these have not diminished over time. Increased locally-led publications, however, does suggest a growing capacity in LMIC institutions to analyse and articulate research findings. Differences in author attribution between funders might signal important variations in funders’ expectations of authorship and discrepancies in how funders understand collaboration. More stringent authorship oversight and reconsideration of authorship guidelines could facilitate growth in LMIC leadership. Left unaddressed, deficiencies in research ownership will continue to hinder alignment between the research undertaken and knowledge needs of LMICs.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 25 June 2016]

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Research
Training the next generation of global health experts: experiences and recommendations from Pacific Rim universities
Mellissa Withers, David Press, Heather Wipfli, Judith McCool, Chang-Chuan Chan, Masamine Jimba, Christopher Tremewan and Jonathan Samet
Published on: 23 June 2016
Abstract
Background
Finding solutions to global health problems will require a highly-trained, inter-disciplinary workforce. Global health education and research can potentially have long-range impact in addressing the global burden of disease and protecting and improving the health of the global population.
Methods
We conducted an online survey of twelve higher education institutions in the Pacific Rim that spanned the period 2005–2011. Program administrators provided data on program concentrations, student enrollment and student funding opportunities for 41 public health programs, including those specific to global health.
Results
The Master of Public Health (MPH) was the most common degree offered. A growing demand for global health education was evident. Enrollment in global health programs increased over three-fold between 2005–2011. Very few institutions had specific global health programs or offered training to undergraduates. Funding for student scholarships was also lacking.
Conclusions
The growing demand for global health education suggests that universities in the Pacific Rim should increase educational and training opportunities in this field. Schools of medicine may not be fully equipped to teach global health-related courses and to mentor students who are interested in global health. Increasing the number of dedicated global health research and training institutions in the Pacific Rim can contribute to building capacity in the region. Faculty from different departments and disciplines should be engaged to provide multi-disciplinary global health educational opportunities for undergraduate and graduate students. New, innovative ways to collaborate in education, such as distance education, can also help universities offer a wider range of global health-related courses. Additional funding of global health is also required.

Health and Human Rights
Volume 18, Issue 1, June 2016
http://www.hhrjournal.org/

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Special Section: Tuberculosis and the Right to Health
in collaboration with the International Human Rights Clinic, University of Chicago Law School
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Editorial: Developing a Human Rights-Based Approach to Tuberculosis
Brian Citro, Evan Lyon, Mihir Mankad, Kiran Raj Pandey, and Camila Gianella, Guest Editors

Falling Short of the Rights to Health and Scientific Progress: Inadequate TB Drug Research and Access
Mike Frick, Ian Henry, and Erica Lessem

TB in Vulnerable Populations: The Case of an Indigenous Community in the Peruvian Amazon
Camila Gianella, César Ugarte-Gil, Godofredo Caro, Rula Aylas, César Castro, and Claudia Lema

Double Standards in Global Health: Medicine, Human Rights Law, and Multidrug-Resistant TB Treatment Policy
Thomas Nicholson, Catherine Admay, Aaron Shakow, and Salmaan Keshavjee

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Perspective Essays on TB and the Right to Health
Petition 329: A Legal Challenge to the Involuntary Confinement of TB Patients in Kenyan Prisons
Allan Maleche and Nerima Were

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General Papers
An Independent Review and Accountability Mechanism for the Sustainable Development Goals: The Possibilities of a Framework Convention on Global Health
Eric A. Friedman

Essential Medicines in National Constitutions: Progress Since 2008
S. Katrina Perehudoff, Brigit Toebes, and Hans Hogerzeil

Human Trafficking Identification and Service Provision in the Medical and Social Service Sectors
Corinne Schwarz, Erik Unruh, Katie Cronin, Sarah Evans-Simpson, Hannah Britton, and Megha Ramaswamy

Indigenous Child Health in Brazil: The Evaluation of Impacts as a Human Rights Issue
Anna R. Coates, Sandra del Pino Marchito, and Bernardino Vitoy

Assessing and Improving Children’s Rights in Hospitals: Case Studies from Kyrgyzstan, Tajikistan, and Moldova
Ana Isabel Fernandes Guerreiro, Aigul Kuttumuratova, Kubanychbek Monolbaev, Larisa Boderscova, Zulfiya Pirova, and Martin W. Weber

Human Rights-Based Approaches to Mental Health: A Review of Programs
Sebastian Porsdam Mann, Valerie J. Bradley, and Barbara J. Sahakian

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Perspective Essays
Medical Hostages: Detention of Women and Babies in Hospitals
Delan Devakumar and Rob Yates

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 25 June 2016]

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Short Report
Good laboratory practices guarantee biosafety in the Sierra Leone-China friendship biosafety laboratory
Qin Wang, Wei-Min Zhou, Yong Zhang, Huan-Yu Wang, Hai-Jun Du, Kai Nie, Jing-Dong Song, Kang Xiao, Wen-Wen Lei, Jian-Qiang Guo, He-Jiang Wei, Kun Cai, Yan-Hai Wang, Jiang Wu, Gerard Kamara, Idrissa Kamara…
Published on: 23 June 2016
Abstract
Background
The outbreak of Ebola virus disease (EVD) in West Africa between 2014 and 2015 was the largest EDV epidemic since the identification of Ebola virus (EBOV) in 1976, and the countries most strongly affected were Sierra Leone, Guinea, and Liberia.
Findings
The Sierra Leone-China Friendship Biological Safety Laboratory (SLE-CHN Biosafety Lab), a fixed Biosafety Level 3 laboratory in the capital city of Sierra Leone, was established by the Chinese government and has been active in EBOV detection since 11 March 2015. Complete management and program documents were created for the SLE-CHN Biosafety Lab, and it was divided into four zones (the green, yellow, brown, and red zones) based on the risk assessment. Different types of safe and appropriate personnel protection equipment (PPE) are used in different zones of the laboratory, and it fully meets the Biosafety Level 3 laboratory standards of the World Health Organization.
Conclusion
Good preparedness, comprehensive risk assessment and operation documents, appropriate PPE, effective monitoring and intensive training, together with well-designed and reasonable laboratory sectioning are essential for guaranteeing biosafety.

International Journal of Infectious Diseases
July 2016 Volume 48, p1-124 Open Access
http://www.ijidonline.com/current

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Editorial
Why is the yellow fever outbreak in Angola a ‘threat to the entire world’?
J.P. Woodall, T.M. Yuill
p96–97
Published online: May 6 2016
Preview
The short answer to the World Health Organization (WHO) declaration is because yellow fever has spread throughout the country, causing probably thousands of cases and hundreds of deaths, and the world has run out of vaccine. This is very bad because cases so far have been imported into the Democratic Republic of the Congo (DRC), Mauritania, Kenya, and even China, the first time in history that cases have been confirmed in Asia. In fact, more travelers infected with yellow fever have now been seen than in the last 50 years, each one with the potential to spread it on arrival, and still further to more countries worldwide via international airlines.

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Reviews
Traditional and syndromic surveillance of infectious diseases and pathogens
Cédric Abat, Hervé Chaudet, Jean-Marc Rolain, Philippe Colson, Didier Raoult
p22–28
Published online: April 30 2016
Preview
Classified as the second leading cause of death in humans by the World Health Organization, with approximately 15 million deaths worldwide every year,1 infectious diseases remain a serious public health problem in the 21st century. Among them, HIV/AIDS, tuberculosis, and malaria have been nicknamed the ‘big three’ because of their important impact on global human health. In 2011, tuberculosis infected two billion people and killed 1.3 million, malaria infected 207 million people and killed 62 700, and HIV infected 35.3 million people and killed 1.6 million.

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Original Papers
Yellow fever vaccination status and safety in hemodialysis patients
Tila Facincani, Maia Nogueira Crown Guimarães, Sigrid De Sousa dos Santos
p91–95
Published online: May 18 2016
Preview
The live attenuated yellow fever vaccine seems to be safe in patients on hemodialysis in a transition area.

International Migration Review
Summer 2016 Volume 50, Issue 2 Pages 267–533, e17–e32
http://onlinelibrary.wiley.com/doi/10.1111/imre.2016.50.issue-2/issuetoc

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IMMIGRATION POLICIES: STATE, CHURCH, AND NON-GOVERNMENTAL ACTORS
Alternative Approaches to the Governance of Transnational Labor Recruitment (pages 269–314)
Patricia Pittman
Version of Record online: 11 FEB 2015 | DOI: 10.1111/imre.12164
Abstract
As globalization advances, the governance challenges relating to cross-border labor recruitment have also grown. Transnational companies that manage the employment-based migration process often take advantage of individuals seeking work abroad. While some states have implemented recruitment regulations, a combination of jurisdictional constraints and economic interests have limited states’ capacity and political will to take action. Supplemental strategies are emerging led by international organizations, non-governmental organizations (NGOs), labor unions, and corporate trade groups. This paper reviews the strengths and weaknesses of strategies led by each of these different types of actors and explores potential synergies among them.

Journal of Immigrant and Minority Health
Volume 18, Issue 3, June 2016
http://link.springer.com/journal/10903/18/2/page/1
[Issue focus on a range of health parameters and challenges among Latino migrants]

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Open Access :: Original Paper
First Online: 21 June 2016
Mental Health of Refugees and Non-refugees from War-Conflict Countries: Data from Primary Healthcare Services and the Norwegian Prescription Database
DOI: 10.1007/s10903-016-0450-y
Melanie L. Straiton, Anne Reneflot, Esperanza Diaz
Abstract
High rates of mental health problems are consistently found among immigrants from refugee generating countries. While refugees and their family members may have experienced similar traumas, refugees are more likely to have undergone a stressful asylum period. This study aims to determine whether their mental health differs. Using national registry data, refugees and non-refugees from the same countries were compared on primary healthcare service use for mental health problems and purchase of psychotropic medicine. Refugees had higher odds of using primary health care services than non-refugees. Refugee women were more likely to purchase psychotropic medicine than non-refugee women. Refugee men were more likely to purchase anti-depressants. The findings suggest that refugees have poorer mental health than non-refugees. This may be due to a combination of greater pre-migration trauma and post-migration stressors such as enduring a difficult asylum period.

The Lancet
Jun 25, 2016 Volume 387 Number 10038 p2575-2664 e30
http://www.thelancet.com/journals/lancet/issue/current

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Editorial
What can public health do for mental health?
The Lancet
Summary
Public health practitioners should prioritise and advance the public’s mental health wherever possible, argues Better Mental Health For All, a report published last week by the UK’s Faculty of Public Health, in collaboration with the Mental Health Foundation. The report aims to be a resource for public health professionals to support the promotion of mental wellbeing and the primary prevention of mental ill health.

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Comment
Who should finance WHO’s work on emergencies?
Y-Ling Chi, Jaya Krishnakumar, Jürgen Maurer, Dejan Loncar, Antoine Flahault
Summary
In May, 2015, the 68th World Health Assembly approved the decision to reform the work of WHO on emergencies by creating a single programme for outbreaks and health emergencies, and an accompanying Contingency Fund for Emergencies (CFE).1 According to latest estimations, the core funding needs for the programme and the initial capital of the CFE will, respectively, range about US$300 million per year and $100 million.2 To respond effectively to emergencies, these resources should be flexible, predictable, and directly accessible.

New England Journal of Medicine
June 23, 2016 Vol. 374 No. 25
http://www.nejm.org/toc/nejm/medical-journal

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Perspective
From Patient to Patient — Sharing the Data from Clinical Trials
Charlotte J. Haug, M.D., Ph.D.
N Engl J Med 2016; 374:2409-2411 June 23, 2016 DOI: 10.1056/NEJMp1605378
[Excerpt]
…Instead of spending time and resources on complicated techniques to try to deidentify and anonymize complex patient data — and risk failing and making populations or patient groups skeptical about the whole concept of data sharing — it may be better to define a core set of data that can be released (and freely accessed) from all trials and to allow sharing of the more complex data only through real and inclusive collaborations, the way successful data sharing related to specific diseases already happens in global health today. “It is not only about sharing of the raw data, but sharing of the questions, the problems, and the code that everybody is using,” Shasha Jumbe said. “It means collaborations throughout the whole process, definition of the goals, framing of the questions — and also thinking about inclusive attribution all the way from subjects that are part of these studies to the data science team.”

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Perspective
A Global, Neutral Platform for Sharing Trial Data
Barbara E. Bierer, M.D., Rebecca Li, Ph.D., Mark Barnes, J.D., LL.M., and Ida Sim, M.D., Ph.D.
N Engl J Med 2016; 374:2411-2413 June 23, 2016 DOI: 10.1056/NEJMp1605348

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 25 June 2016]

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Research Article
Behavior Problems and Post-traumatic Stress Symptoms in Children Beginning School: A Comparison of Pre- and Post-Earthquake Groups
June 22, 2016 ·
Introduction: Literature reviews caution that estimating the effects of disasters on the behavior of children following a disaster is difficult without baseline information and few studies report the effects of earthquakes on young children. In addition the relationship between age at the time of disaster and consequential behavior problems have not been reported for young children who experience disaster-related stress during a developmentally sensitive period.

Methods: Behavior problems and symptoms of post-traumatic stress (PTS) were reported for two groups of children from nearby neighborhoods during their first term at school, using the Behavior Problem Index by teacher report, following approved informed consent procedures. Data on one group, “Pre-EQ” (N=297), was collected four years before the beginning of the earthquakes on children born 2001-2002. Data on the second group, “Post-EQ” (N=212), was collected approximately three to four years after the beginning of the earthquakes on children born 2007-2009 and living in heavily damaged neighborhoods. The Post-EQ group had significantly more children from high socioeconomic neighborhoods but no other significant differences on main demographic characteristics.

Results: The mean behavior problem score was significantly higher in the Post-EQ group (Mean =6.11) as compared to the Pre-EQ group (Mean = 3.78). PTS symptoms were also significantly higher in the Post-EQ group (Mean =2.91) as compared to the Pre-EQ group (Mean=1.98) and more children had high PTS scores (20.9% v. 8.8%, OR= 2.73, 95%CI =1.57, 4.76). Model testing identified that a younger age at the time of exposure was the only significant predictor of high numbers of PTS symptoms in the Post-EQ group.

Discussion: Rates of teacher-reported behavior problems in young children more than doubled following the Christchurch earthquakes. Younger children may be more vulnerable to the effects of earthquakes that occur during a developmentally sensitive period. Additional research is needed to consider the effects of age and duration of disaster effects to better understand the effects of disasters on children, their families and communities.

PLoS Medicine
http://www.plosmedicine.org/
(Accessed 25 June 2016)

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Essay
Why Most Clinical Research Is Not Useful
John P. A. Ioannidis
Essay | published 21 Jun 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002049
Summary Points
:: Blue-sky research cannot be easily judged on the basis of practical impact, but clinical research is different and should be useful. It should make a difference for health and disease outcomes or should be undertaken with that as a realistic prospect.
:: Many of the features that make clinical research useful can be identified, including those relating to problem base, context placement, information gain, pragmatism, patient centeredness, value for money, feasibility, and transparency.
:: Many studies, even in the major general medical journals, do not satisfy these features, and very few studies satisfy most or all of them. Most clinical research therefore fails to be useful not because of its findings but because of its design.
:: The forces driving the production and dissemination of nonuseful clinical research are largely identifiable and modifiable.
:: Reform is needed. Altering our approach could easily produce more clinical research that is useful, at the same or even at a massively reduced cost.
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Research Article
Exclusive Breastfeeding and Cognition, Executive Function, and Behavioural Disorders in Primary School-Aged Children in Rural South Africa: A Cohort Analysis
Tamsen J. Rochat, Brian Houle, Alan Stein, Hoosen Coovadia, Anna Coutsoudis, Chris Desmond, Marie-Louise Newell, Ruth M. Bland
| published 21 Jun 2016 | PLOS Medicine
http://dx.doi.org/10.1371/journal.pmed.1002044

PLoS One
http://www.plosone.org/
[Accessed 25 June 2016]
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Research Article
The Challenge of Timely, Responsive and Rigorous Ethics Review of Disaster Research: Views of Research Ethics Committee Members
M Hunt, CM Tansey, J Anderson, RF Boulanger…
Published: June 21, 2016
http://dx.doi.org/10.1371/journal.pone.0157142
Abstract
Background
Research conducted following natural disasters such as earthquakes, floods or hurricanes is crucial for improving relief interventions. Such research, however, poses ethical, methodological and logistical challenges for researchers. Oversight of disaster research also poses challenges for research ethics committees (RECs), in part due to the rapid turnaround needed to initiate research after a disaster. Currently, there is limited knowledge available about how RECs respond to and appraise disaster research. To address this knowledge gap, we investigated the experiences of REC members who had reviewed disaster research conducted in low- or middle-income countries.
Methods
We used interpretive description methodology and conducted in-depth interviews with 15 respondents. Respondents were chairs, members, advisors, or coordinators from 13 RECs, including RECs affiliated with universities, governments, international organizations, a for-profit REC, and an ad hoc committee established during a disaster. Interviews were analyzed inductively using constant comparative techniques.
Results
Through this process, three elements were identified as characterizing effective and high-quality review: timeliness, responsiveness and rigorousness. To ensure timeliness, many RECs rely on adaptations of review procedures for urgent protocols. Respondents emphasized that responsive review requires awareness of and sensitivity to the particularities of disaster settings and disaster research. Rigorous review was linked with providing careful assessment of ethical considerations related to the research, as well as ensuring independence of the review process.
Conclusion
Both the frequency of disasters and the conduct of disaster research are on the rise. Ensuring effective and high quality review of disaster research is crucial, yet challenges, including time pressures for urgent protocols, exist for achieving this goal. Adapting standard REC procedures may be necessary. However, steps should be taken to ensure that ethics review of disaster research remains diligent and thorough.

PLoS One
http://www.plosone.org/
[Accessed 25 June 2016]
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Health and Ethical Consequences of Outsourcing Pivotal Clinical Trials to Latin America: A Cross-Sectional, Descriptive Study
Núria Homedes, Antonio Ugalde
Research Article | published 23 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0157756
Abstract
Introduction
The implications of conducting clinical trials in low and middle income countries on the financial accessibility and safety of the pharmaceutical products available in those markets have not been studied. Regulatory practices and ethical declarations lead to the commercialization of the new products, referred to as New Molecular Entities (NMEs), in the countries where tested as soon as they are approved in high surveillance countries. Patients and patients’ associations use the Latin American courts to access new and expensive treatments, regardless of their safety profile and therapeutic value.
Design and Objectives
Cross-sectional, descriptive study. To determine the therapeutic value and safety profile of the NMEs approved by the Food and Drug Administration (FDA) in 2011 and 2012 that had been tested in Latin America, and the implications of their market approval for the pharmaceutical budgets in the countries where tested.
Setting
Latin America.
Measures
To assess the therapeutic value and safety of the NMEs commercialized in the different countries we used f independent drug bulletins. The prices of the NMEs for the consumers were obtained from the pharmaceutical price observatories of the countries were the medicines had been tested. If the price was not available in the observatories, it was obtained from pharmaceutical distributors. We used the countries’ minimum wage and per capita income to calculate the financial accessibility of a course of treatment with the NMEs.
Results
We found that 33 NMEs approved by the FDA in 2011 and 2012 have been tested in Latin America. Of these, 26 had been evaluated by independent drug bulletins and only five were found to add some value to a subset of patients and had significant side-effects. The pharmaceutical prices were very high, varied widely across countries and were unrelated to the countries’ income per capita or minimum wage.
Conclusion
The implementation of clinical trials in Latin America results in the commercialization of medicines with questionable safety profiles and limited therapeutic value, putting patients at risk and causing budgetary strains in pharmaceutical budgets.

PLoS One
http://www.plosone.org/
[Accessed 25 June 2016]
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Hitting the Optimal Vaccination Percentage and the Risks of Error: Why to Miss Right
Michael J. Harvey, Lisa A. Prosser, Mark L. Messonnier, David W. Hutton
Research Article | published 22 Jun 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0156737
Abstract
Objective
To determine the optimal level of vaccination coverage defined as the level that minimizes total costs and explore how economic results change with marginal changes to this level of coverage.
Methods
A susceptible-infected-recovered-vaccinated model designed to represent theoretical infectious diseases was created to simulate disease spread. Parameter inputs were defined to include ranges that could represent a variety of possible vaccine-preventable conditions. Costs included vaccine costs and disease costs. Health benefits were quantified as monetized quality adjusted life years lost from disease. Primary outcomes were the number of infected people and the total costs of vaccination. Optimization methods were used to determine population vaccination coverage that achieved a minimum cost given disease and vaccine characteristics. Sensitivity analyses explored the effects of changes in reproductive rates, costs and vaccine efficacies on primary outcomes. Further analysis examined the additional cost incurred if the optimal coverage levels were not achieved.
Results
Results indicate that the relationship between vaccine and disease cost is the main driver of the optimal vaccination level. Under a wide range of assumptions, vaccination beyond the optimal level is less expensive compared to vaccination below the optimal level. This observation did not hold when the cost of the vaccine cost becomes approximately equal to the cost of disease.
Discussion and Conclusion
These results suggest that vaccination below the optimal level of coverage is more costly than vaccinating beyond the optimal level. This work helps provide information for assessing the impact of changes in vaccination coverage at a societal level.