New England Journal of Medicine
July 14, 2016 Vol. 375 No. 2
http://www.nejm.org/toc/nejm/medical-journal

.
Perspective
History of Clinical Trials: Medicine, Monopoly, and the Premodern State — Early Clinical Trials
A. Rankin and J. Rivest

PLOS Currents: Disasters
http://currents.plos.org/disasters/
[Accessed 16 July 2016]

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Research Article
Coping Strategies for Landslide and Flood Disasters: A Qualitative Study of Mt. Elgon Region, Uganda
July 11, 2016
Introduction: The occurrence of landslides and floods in East Africa has increased over the past decades with enormous Public Health implications and massive alterations in the lives of those affected. In Uganda, the Elgon region is reported to have the highest occurrence of landslides and floods making this area vulnerable. This study aimed at understanding both coping strategies and the underlying causes of vulnerability to landslides and floods in the Mt. Elgon region.
Methods: We conducted a qualitative study in three districts of Bududa, Manafwa and Butalejja in the Mt. Elgon region in eastern Uganda. Six Focus Group Discussions (FGDs) and eight Key Informant Interviews (KIIs) were conducted. We used trained research assistants (moderator and note taker) to collect data. All discussions were audio taped, and were transcribed verbatim before analysis. We explored both coping strategies and underlying causes of vulnerability. Data were analysed using latent content analysis; through identifying codes from which basis categories were generated and grouped into themes.
Results: The positive coping strategies used to deal with landslides and floods included adoption of good farming methods, support from government and other partners, livelihood diversification and using indigenous knowledge in weather forecasting and preparedness. Relocation was identified as unsustainable because people often returned back to high risk areas. The key underlying causes of vulnerability were; poverty, population pressure making people move to high risk areas, unsatisfactory knowledge on disaster preparedness and, cultural beliefs affecting people’s ability to cope.
Conclusion: This study revealed that deep rooted links to poverty, culture and unsatisfactory knowledge on disaster preparedness were responsible for failure to overcome the effects to landslides and floods in disaster prone communities of Uganda. However, good farming practices and support from the government and implementation partners were shown to be effective in enabling the community to lessen the negative effects disasters. This calls for high impact innovative interventions focused in addressing these underlying causes as well as involvement of all stakeholders in scaling the effective coping strategies in order to build resilience in this community and other similarly affected areas.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
[Accessed 16 July 2016]

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The Vaccination of 35,000 Dogs in 20 Working Days Using Combined Static Point and Door-to-Door Methods in Blantyre, Malawi
Andrew D Gibson, Ian G Handel, Kate Shervell, Tarryn Roux, Dagmar Mayer, Stanford Muyila, Golden B Maruwo, Edwin M. S Nkhulungo, Rachel A Foster, Patrick Chikungwa, Bernard Chimera, Barend M.deC Bronsvoort, Richard J Mellanby, Luke Gamble
Research Article | published 14 Jul 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004824

PLoS One
http://www.plosone.org/
[Accessed 16 July 2016]

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Research Article
Community Willingness to Participate in a Dengue Study in Aceh Province, Indonesia
Harapan Harapan, Samsul Anwar, Aslam Bustaman, Arsil Radiansyah, Pradiba Angraini, Riny Fasli, Salwiyadi Salwiyadi, Reza Akbar Bastian, Ade Oktiviyari, Imaduddin Akmal, Muhammad Iqbalamin, Jamalul Adil, Fenni Henrizal, Darmayanti Darmayanti, Rovy Pratama, Jonny Karunia Fajar, Abdul Malik Setiawan, Allison Imrie, Ulrich Kuch, David Alexander Groneberg, R. Tedjo Sasmono, Meghnath Dhimal, Ruth Müller
Research Article | published 12 Jul 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0159139
Abstract
Background
Dengue virus infection is the most rapidly spreading vector-borne disease in the world. Essential research on dengue virus transmission and its prevention requires community participation. Therefore, it is crucial to understand the factors that are associated with the willingness of communities in high prevalence areas to participate in dengue research. The aim of this study was to explore factors associated with the willingness of healthy community members in Aceh province, Indonesia, to participate in dengue research that would require phlebotomy.
Methodology/Principal Findings
A community-based cross-sectional study was carried out in nine regencies and municipalities of Aceh from November 2014 to March 2015. Interviews using a set of validated questionnaires were conducted to collect data on demography, history of dengue infection, socioeconomic status, and knowledge, attitude and practice regarding dengue fever. Two-step logistic regression and Spearman’s rank correlation (rs) analysis were used to assess the influence of independent variables on dependent variables. Among 535 participants, less than 20% had a good willingness to participate in the dengue study. The factors associated with good willingness to participate were being female, working as a civil servant, private employee or entrepreneur, having a high socioeconomic status and good knowledge, attitude and practice regarding dengue. Good knowledge and attitude regarding dengue were positive independent predictors of willingness to participate (OR: 2.30 [95% CI: 1.36–3.90] and 3.73 [95% CI: 2.24–6.21], respectively).
Conclusion/Significance
The willingness to participate in dengue research is very low among community members in Aceh, and the two most important associated factors are knowledge and attitude regarding dengue. To increase participation rate, efforts to improve the knowledge and attitude of community members regarding dengue fever and dengue-related research is required before such studies are launched.

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 16 July 2016)

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Social Sciences – Social Sciences – Biological Sciences – Medical Sciences:
Equity and length of lifespan are not the same
Benjamin Seligman, Gabi Greenberg, and Shripad Tuljapurkar
PNAS 2016 ; published ahead of print July 11, 2016, doi:10.1073/pnas.1601112113
Significance
We find that the causes of death that have led to greater equality among lifespans are different from the causes that have led to longer average lifespan, also called life expectancy. Control of leading causes of death, such as heart disease, increased life expectancy, whereas medical interventions on infant mortality led to greater equality. Action to promote health equity will require further mitigation of the killers of young people rather than solely focusing on the most common causes of death.
Abstract
Efforts to understand the dramatic declines in mortality over the past century have focused on life expectancy. However, understanding changes in disparity in age of death is important to understanding mechanisms of mortality improvement and devising policy to promote health equity. We derive a novel decomposition of variance in age of death, a measure of inequality, and apply it to cause-specific contributions to the change in variance among the G7 countries (Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States) from 1950 to 2010. We find that the causes of death that contributed most to declines in the variance are different from those that contributed most to increase in life expectancy; in particular, they affect mortality at younger ages. We also find that, for two leading causes of death [cancers and cardiovascular disease (CVD)], there are no consistent relationships between changes in life expectancy and variance either within countries over time or between countries. These results show that promoting health at younger ages is critical for health equity and that policies to control cancer and CVD may have differing implications for equity.

Reproductive Health
http://www.reproductive-health-journal.com/content
[Accessed 16 July 2016]

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Study protocol
Zika virus infection in pregnant women in Honduras: study protocol
Although there is increasing evidence for a relationship between symptomatic Zika virus (ZIKV) maternal infection, and microcephaly, a firm causal relation has yet to be established by epidemiologic studies.
Pierre Buekens, Jackeline Alger, Fernando Althabe, Eduardo Bergel, Amanda M. Berrueta, Carolina Bustillo, Maria-Luisa Cafferata, Emily Harville, Karla Rosales, Dawn M. Wesson and Concepcion Zuniga
Reproductive Health 2016 13:82
Published on: 16 July 2016

.

Research
Male involvement in reproductive, maternal and child health: a qualitative study of policymaker and practitioner perspectives in the Pacific
The importance of involving men in reproductive, maternal and child health programs is increasingly recognised globally. In the Pacific region, most maternal and child health services do not actively engage ex…
Jessica Davis, Joseph Vyankandondera, Stanley Luchters, David Simon and Wendy Holmes
Reproductive Health 2016 13:81
Published on: 16 July 2016

Risk Management and Healthcare Policy
Volume 9, 2016
https://www.dovepress.com/risk-management-and-healthcare-policy-archive56
[Accessed 16 July 2016]

.
Original Research
The Lebanese–Syrian crisis: impact of influx of Syrian refugees to an already weak state
Cherri Z, Arcos González P, Castro Delgado R
Risk Management and Healthcare Policy 2016, 9:165-172
Published Date: 14 July 2016
Abstract
Background: Lebanon, a small Middle Eastern country facing constant political and national unity challenges with a population of approximately 300,000 Palestinian and Iraqi refugees, has welcomed more than 1.2 million Office of the United Nations Commissioner for Refugees (UNHCR)-registered Syrian refugees since 2012. The Government of Lebanon considers individuals who crossed Lebanese–Syrian borders since 2011 as “displaced”, emphasizing its long-standing position that Lebanon is not a state for refugees, refusing to establish camps, and adopting a policy paper to reduce their numbers in October 2014. Humanitarian response to the Syrian influx to Lebanon has been constantly assembling with the UNHCR as the main acting body and the Lebanon Crisis Response Plan as the latest plan for 2016.
Methods: Review of secondary data from gray literature and reports focusing on the influx of Syrian refugees to Lebanon by visiting databases covering humanitarian response in complex emergencies. Limitations include obtaining majority of the data from gray literature and changing statistics due to the instability of the situation.
Results: The influx of Syrian refugees to Lebanon, an already weak and vulnerable state, has negatively impacted life in Lebanon on different levels including increasing demographics, regressing economy, exhausting social services, complicating politics, and decreasing security as well as worsened the life of displaced Syrians themselves.
Conclusion: Displaced Syrians and Lebanese people share aggravating hardships of a mutual and precarious crisis resulting from the Syrian influx to Lebanon. Although a lot of response has been initiated, both populations still lack much of their basic needs due to lack of funding and nonsustainable program initiatives. The two major recommendations for future interventions are to ensure continuous and effective monitoring and sustainability in order to alleviate current and future suffering in Lebanon.

Science
15 July 2016 Vol 353, Issue 6296
http://www.sciencemag.org/current.dtl
Special Issue – Natural Hazards

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Reviews
Human influence on tropical cyclone intensity
By Adam H. Sobel, Suzana J. Camargo, Timothy M. Hall, Chia-Ying Lee, Michael K. Tippett, Allison A. Wing
Science15 Jul 2016 : 242-246

Global trends in satellite-based emergency mapping
By Stefan Voigt, Fabio Giulio-Tonolo, Josh Lyons, Jan Kučera, Brenda Jones, Tobias Schneiderhan, Gabriel Platzeck, Kazuya Kaku, Manzul Kumar Hazarika, Lorant Czaran, Suju Li, Wendi Pedersen, Godstime Kadiri James, Catherine Proy, Denis Macharia Muthike, Jerome Bequignon, Debarati Guha-Sapir
Science15 Jul 2016 : 247-252

.

Policy Forum
Crisis informatics—New data for extraordinary times
By Leysia Palen, Kenneth M. Anderson
Science15 Jul 2016 : 224-225
Focus on behaviors, not on fetishizing social media tools

.
Perspectives
Butterfly communities under threat
By Jeremy A. Thomas
Science15 Jul 2016 : 216-218
Butterfly populations are declining worldwide as a result of habitat loss and degradation

How much biodiversity loss is too much?
By Tom H. Oliver
Science15 Jul 2016 : 220-221
Widespread biodiversity losses are observed but safe-limit thresholds remain uncertain

The Sentinel

Human Rights Action :: Humanitarian Response :: Health :: Education :: Heritage Stewardship ::
Sustainable Development
__________________________________________________
Week ending 9 July 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 Global Foundation – Center for Governance, Evidence, Ethics, Policy, Practice
david.r.curry@ge2p2center.net

pdf version: The Sentinel_ week ending 9 July 2016

Contents [click on link below to move to associated content]
:: Week in Review
:: Key Agency/IGO/Governments Watch – Selected Updates from 30+ entities
:: INGO/Consortia/Joint Initiatives Watch – Media Releases, Major Initiatives, Research
:: Foundation/Major Donor Watch -Selected Updates
:: Journal Watch – Key articles and abstracts from 100+ peer-reviewed journals

:: 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.

Annals of Internal Medicine
5 July 2016, Vol. 165. No. 1
http://annals.org/issue.aspx

,
Original Research
Cost-Effectiveness of HIV Preexposure Prophylaxis for People Who Inject Drugs in the United States
Cora L. Bernard, MS; Margaret L. Brandeau, PhD; Keith Humphreys, PhD; Eran Bendavid, MD, MS; Mark Holodniy, MD; Christopher Weyant, MS; Douglas K. Owens, MD, MS; and Jeremy D. Goldhaber-Fiebert, PhD
Abstract
Background: The total population health benefits and costs of HIV preexposure prophylaxis (PrEP) for people who inject drugs (PWID) in the United States are unclear.
Objective: To evaluate the cost-effectiveness and optimal delivery conditions of PrEP for PWID.
Design: Empirically calibrated dynamic compartmental model.
Data Sources: Published literature and expert opinion.
Target Population: Adult U.S. PWID.
Time Horizon: 20 years and lifetime.
Intervention: PrEP alone, PrEP with frequent screening (PrEP+screen), and PrEP+screen with enhanced provision of antiretroviral therapy (ART) for individuals who become infected (PrEP+screen+ART). All scenarios are considered at 25% coverage.
Outcome Measures: Infections averted, deaths averted, change in HIV prevalence, discounted costs (in 2015 U.S. dollars), discounted quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios.
Results of Base-Case Analysis: PrEP+screen+ART dominates other strategies, averting 26 700 infections and reducing HIV prevalence among PWID by 14% compared with the status quo. Achieving these benefits costs $253 000 per QALY gained. At current drug prices, total expenditures for PrEP+screen+ART could be as high as $44 billion over 20 years.
Results of Sensitivity Analysis: Cost-effectiveness of the intervention is linear in the annual cost of PrEP and is dependent on PrEP drug adherence, individual transmission risks, and community HIV prevalence.
Limitation: Data on risk stratification and achievable PrEP efficacy levels for U.S. PWID are limited.
Conclusion: PrEP with frequent screening and prompt treatment for those who become infected can reduce HIV burden among PWID and provide health benefits for the entire U.S. population, but, at current drug prices, it remains an expensive intervention both in absolute terms and in cost per QALY gained.
Primary Funding Source: National Institute on Drug Abuse.

.

Reviews
Addressing Infection Prevention and Control in the First U.S. Community Hospital to Care for Patients With Ebola Virus Disease: Context for National Recommendations and Future Strategies
Kristin J. Cummings, MD, MPH; Mary J. Choi, MD, MPH; Eric J. Esswein, MSPH, CIH; Marie A. de Perio, MD; Joshua M. Harney, MS, CIH; Wendy M. Chung, MD, MS; David L. Lakey, MD; Allison M. Liddell, MD; and Pierre E. Rollin, MD
Abstract
Health care personnel (HCP) caring for patients with Ebola virus disease (EVD) are at increased risk for infection with the virus. In 2014, a Texas hospital became the first U.S. community hospital to care for a patient with EVD; 2 nurses were infected while providing care. This article describes infection control measures developed to strengthen the hospital’s capacity to safely diagnose and treat patients with EVD. After admission of the first patient with EVD, a multidisciplinary team from the Centers for Disease Control and Prevention (CDC) joined the hospital’s infection preventionists to implement a system of occupational safety and health controls for direct patient care, handling of clinical specimens, and managing regulated medical waste. Existing engineering and administrative controls were strengthened. The personal protective equipment (PPE) ensemble was standardized, HCP were trained on donning and doffing PPE, and a system of trained observers supervising PPE donning and doffing was implemented. Caring for patients with EVD placed substantial demands on a community hospital. The experiences of the authors and others informed national policies for the care of patients with EVD and protection of HCP, including new guidance for PPE, a rapid system for deploying CDC staff to assist hospitals (“Ebola Response Team”), and a framework for a tiered approach to hospital preparedness. The designation of regional Ebola treatment centers and the establishment of the National Ebola Training and Education Center address the need for HCP to be prepared to safely care for patients with EVD and other high-consequence emerging infectious diseases.

BMC Cost Effectiveness and Resource Allocation
http://resource-allocation.biomedcentral.com/
(Accessed 9 July 2016)

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Research
An extended cost-effectiveness analysis of schizophrenia treatment in India under universal public finance
Neha Raykar, Aditi Nigam and Dan Chisholm
Published on: 8 July 2016
Abstract
Background
Schizophrenia remains a priority condition in mental health policy and service development because of its early onset, severity and consequences for affected individuals and households.
Aims and methods
This paper reports on an ‘extended’ cost-effectiveness analysis (ECEA) for schizophrenia treatment in India, which seeks to evaluate through a modeling approach not only the costs and health effects of intervention but also the consequences of a policy of universal public finance (UPF) on health and financial outcomes across income quintiles.
Results
Using plausible values for input parameters, we conclude that health gains from UPF are concentrated among the poorest, whereas the non-health gains in the form of out-of-pocket private expenditures averted due to UPF are concentrated among the richest income quintiles. Value of insurance is the highest for the poorest quintile and declines with income.
Conclusions
Universal public finance can play a crucial role in ameliorating the adverse economic and social consequences of schizophrenia and its treatment in resource-constrained settings where health insurance coverage is generally poor. This paper shows the potential distributional and financial risk protection effects of treating schizophrenia.

BMC Health Services Research
http://www.biomedcentral.com/bmchealthservres/content
(Accessed 9 July 2016)

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Research article
Clinical and demographic correlates of medication and visit adherence in a large randomized controlled trial
Patient characteristics are associated with adherence, which has implications for planning clinical research or designing payment systems that reward superior outcomes. It is unclear to what extent clinician e…
Jeff Whittle, José-Miguel Yamal, Jeffrey D. Williamson, Charles E. Ford, Jeffrey L. Probstfield, Barbara L. Beard, Horia Marginean, Bruce P. Hamilton, Pamela S. Suhan and Barry R. Davis
BMC Health Services Research 2016 16:236
Published on: 8 July 2016

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Research article
Organizational factors associated with Health Care Provider (HCP) influenza campaigns in the Veterans health care system: a qualitative study
It is an important goal to vaccinate a high proportion of health care providers (HCPs) against influenza, to prevent transmission to patients. Different aspects of how a HCP vaccination campaign is conducted m…
Zayd Razouki, Troy Knighton, Richard A. Martinello, Pamela R. Hirsch, Kathleen M. McPhaul, Adam J. Rose and Megan McCullough
BMC Health Services Research 2016 16:211
Published on: 4 July 2016

BMC Medicine
http://www.biomedcentral.com/bmcmed/content
(Accessed 9 July 2016)

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Commentary
Frugal innovation in medicine for low resource settings
Viet-Thi Tran and Philippe Ravaud
BMC Medicine 2016 14:102
Published on: 7 July 2016
Abstract
Whilst it is clear that technology is crucial to advance healthcare: innovation in medicine is not just about high-tech tools, new procedures or genome discoveries. In constrained environments, healthcare providers often create unexpected solutions to provide adequate healthcare to patients. These inexpensive but effective frugal innovations may be imperfect, but they have the power to ensure that health is within reach of everyone. Frugal innovations are not limited to low-resource settings: ingenuous ideas can be adapted to offer simpler and disruptive alternatives to usual care all around the world, representing the concept of “reverse innovation”. In this article, we discuss the different types of frugal innovations, illustrated with examples from the literature, and argue for the need to give voice to this neglected type of innovation in medicine.

BMC Pregnancy and Childbirth
http://www.biomedcentral.com/bmcpregnancychildbirth/content
(Accessed 9 July 2016)

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Research article
Decision-making for delivery location and quality of care among slum-dwellers: a qualitative study in Uttar Pradesh, India
In 2013, the Government of India launched the National Urban Health Mission (NUHM) in order to better address the health needs of urban populations, including the nearly 100 million living in slums. Maternal a…
May Sudhinaraset, Naomi Beyeler, Sandhya Barge and Nadia Diamond-Smith
BMC Pregnancy and Childbirth 2016 16:148
Published on: 7 July 2016

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Research article
Dirty and 40 days in the wilderness: Eliciting childbirth and postnatal cultural practices and beliefs in Nepal
Pregnancy and childbirth are socio-cultural events that carry varying meanings across different societies and cultures. These are often translated into social expectations of what a particular society expects …
Sheetal Sharma, Edwin van Teijlingen, Vanora Hundley, Catherine Angell and Padam Simkhada
BMC Pregnancy and Childbirth 2016 16:147
Published on: 5 July 2016

BMC Public Health
http://bmcpublichealth.biomedcentral.com/articles
(Accessed 9 July 2016)

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Research article
Economic interventions to improve population health: a scoping study of systematic reviews
Mishal S. Khan, Bernie Y. Guan, Jananie Audimulam, Francisco Cervero Liceras, Richard J. Coker and Joanne Yoong
BMC Public Health 2016 16:528
Published on: 7 July 2016
Abstract
Background
Recognizing the close relationship between poverty and health, national program managers, policy-makers and donors are increasingly including economic interventions as part of their core strategies to improve population health. However, there is often confusion among stakeholders about the definitions and operational differences between distinct types of economic interventions and financial instruments, which can lead to important differences in interpretation and expectations.
Methods
We conducted a scoping study to define and clarify concepts underlying key economic interventions – price interventions (taxes and subsidies), income transfer programs, incentive programs, livelihood support programs and health-related financial services – and map the evidence currently available from systematic reviews.
Results
We identified 195 systematic reviews on economic interventions published between 2005 and July 2015. Overall, there was an increase in the number of reviews published after 2010. The majority of reviews focused on price interventions, income transfer programs and incentive programs, with much less evidence available from systematic reviews on livelihood support programs and health-related financial services. We also identified a lack of evidence on: health outcomes in low income countries; unintended or perverse outcomes; implementation challenges; scalability and cost-effectiveness of economic interventions.
Conclusions
We conclude that while more research is clearly needed to assess suitability and effectiveness of economic interventions in different contexts, before interventions are tested and further systematic reviews conducted, a consistent and accurate understanding of the fundamental differences in terminology and approaches is essential among researchers, public health policy makers and program planners.
.
Research article
Utilisation of health services and the poor: deconstructing wealth-based differences in facility-based delivery in the Philippines
Despite achieving some success, wealth-related disparities in the utilisation of maternal and child health services persist in the Philippines. The aim of this study is to decompose the principal factors driving…
Andrew Hodge, Sonja Firth, Raoul Bermejo, Willibald Zeck and Eliana Jimenez-Soto
BMC Public Health 2016 16:523
Published on: 6 July 2016

Bulletin of the World Health Organization
Volume 94, Number 7, July 2016, 481-556
http://www.who.int/bulletin/volumes/94/7/en/

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EDITORIALS
Creating a supportive legal environment for universal health coverage
David Clarke, Dheepa Rajan & Gerard Schmets
http://dx.doi.org/10.2471/BLT.16.173591
[Initial text]
In this edition of the Bulletin, Marks-Sultan et al.1 propose that the World Health Organization (WHO) should provide capacity-building for drafting health laws in Member States. They highlight that WHO has the authority and credibility to work with countries to make their national laws easier to access, understand, monitor and evaluate. WHO’s new technical support work related to universal health coverage (UHC) laws is a good example of its support for Member States in this important area.
Strengthening countries’ legal and regulatory frameworks and engaging in universal health coverage-compliant law reforms has been missing from the universal health coverage agenda. WHO calls on Member States to align their health system policies with universal health coverage goals such as equity, efficiency, health service quality and financial risk protection. Strengthening health systems using health laws and legal frameworks is a pivotal means for attaining these goals2 and achieving sustainable results in health security and resilience…

EDITORIALS
Improving reporting of health estimates
Gretchen A Stevens, Daniel R Hogan & Ties Boerma
http://dx.doi.org/10.2471/BLT.16.179259

RESEARCH
Health policy and systems research training: global status and recommendations for action
Tara M Tancred, Meike Schleiff, David H Peters & Dina Balabanova
http://dx.doi.org/10.2471/BLT.15.162818
Objective
To investigate the characteristics of health policy and systems research training globally and to identify recommendations for improvement and expansion.
Methods
We identified institutions offering health policy and systems research training worldwide. In 2014, we recruited participants from identified institutions for an online survey on the characteristics of the institutions and the courses given. Survey findings were explored during in-depth interviews with selected key informants.
Findings
The study identified several important gaps in health policy and systems research training. There were few courses in central and eastern Europe, the Middle East, North Africa or Latin America. Most (116/152) courses were instructed in English. Institutional support for courses was often lacking and many institutions lacked the critical mass of trained individuals needed to support doctoral and postdoctoral students. There was little consistency between institutions in definitions of the competencies required for health policy and systems research. Collaboration across disciplines to provide the range of methodological perspectives the subject requires was insufficient. Moreover, the lack of alternatives to on-site teaching may preclude certain student audiences such as policy-makers.
Conclusion
Training in health policy and systems research is important to improve local capacity to conduct quality research in this field. We provide six recommendations to improve the content, accessibility and reach of training. First, create a repository of information on courses. Second, establish networks to support training. Third, define competencies in health policy and systems research. Fourth, encourage multidisciplinary collaboration. Fifth, expand the geographical and language coverage of courses. Finally, consider alternative teaching formats.

PERSPECTIVES
Research capacity for sexual and reproductive health and rights
Rita Kabra, Moazzam Ali, A Metin Gulmezoglu & Lale Say
http://dx.doi.org/10.2471/BLT.15.163261
[Initial text]
Research is important for improving health outcomes and is a critical element of a functioning health system. Without locally generated data and analysis, well-intentioned programmes do not often respond to the realities where they are implemented.1 Hence strengthening research capacity in low-and middle-income countries is one of the most powerful, cost–effective and sustainable measures of advancing health, health care and development.2
The world health report 2013: research for universal health coverage referred to research capacity as “the abilities of individuals, institutions and networks, nationally and internationally, to undertake and disseminate research findings of the highest quality”.3 The report provides examples of efforts that build research capacity by national and international agencies focusing on the particular element of capacity building. However, best results in capacity building are obtained when there are interactions between individuals, institutions and networks to support research. For example, graduate and postgraduate training are more likely to be effective when the host institutions are also strong.3
Since 1990 the number of initiatives on strengthening research capacity in low- and middle-income countries has increased to over 300.4 However, in many countries there is still insufficient capacity to engage in research that will influence evidence-based policies and programming at country level.5 Lack of funding, expertise in preparing manuscripts for publication6 and protected time for research pursuits, as well as the infrastructure of institutions, are key constraints faced by researchers.7…

Conflict and Health
http://www.conflictandhealth.com/
[Accessed 9 July 2016]

.
Research
Open Access
Psychosocial wellbeing and physical health among Tamil schoolchildren in northern Sri Lanka
Alexander Hamilton, Charlie Foster, Justin Richards and Rajendra Surenthirakumaran
Conflict and Health201610:13
DOI: 10.1186/s13031-016-0081-x
Published: 6 July 2016
Abstract
Background
Mental disorders contribute to the global disease burden and have an increased prevalence among children in emergency settings. Good physical health is crucial for mental well-being, although physical health is multifactorial and the nature of this relationship is not fully understood. Using Sri Lanka as a case study, we assessed the baseline levels of, and the association between, mental health and physical health in Tamil school children.
Methods
We conducted a cross sectional study of mental and physical health in 10 schools in Kilinochchi town in northern Sri Lanka. All Grade 8 children attending selected schools were eligible to participate in the study. Mental health was assessed using the Sri Lankan Index for Psychosocial Stress – Child Version. Physical health was assessed using Body Mass Index for age, height for age Z scores and the Multi-stage Fitness Test. Association between physical and mental health variables was assessed using scatterplots and correlation was assessed using Pearson’s R.
Results
There were 461 participants included in the study. Girls significantly outperformed boys in the MH testing t (459) = 2.201, p < 0.05. Boys had significantly lower average Body Mass Index for age and height for age Z scores than girls (BMI: t (459) = −4.74, p <0.001; Height: t (459) = −3.54, p  < 0.001). When compared to global averages, both sexes underperformed in the Multi-Stage Fitness Test, and had a higher prevalence of thinness and stunting. We identified no meaningful association between the selected variables.
Conclusions
Our results do not support the supposition that the selected elements of physical health are related to mental health in post-conflict Sri Lanka. However, we identified a considerable physical health deficit in Tamil school children.

Developing World Bioethics
August 2016 Volume 16, Issue 2 Pages 61–120
http://onlinelibrary.wiley.com/doi/10.1111/dewb.2016.16.issue-2/issuetoc

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EDITORIAL
Zika virus, women and ethics (pages 62–63)
Debora Diniz
Version of Record online: 5 JUL 2016 | DOI: 10.1111/dewb.12119
[No abstract]

.

ORIGINAL ARTICLES
The Challenges of Research Informed Consent in Socio-Economically Vulnerable Populations: A Viewpoint From the Democratic Republic of Congo (pages 64–69)
Marion Kalabuanga, Raffaella Ravinetto, Vivi Maketa, Hypolite Muhindo Mavoko, Blaise Fungula, Raquel Inocêncio da Luz, Jean-Pierre Van Geertruyden and Pascal Lutumba
Version of Record online: 7 SEP 2015 | DOI: 10.1111/dewb.12090
Abstract
In medical research, the ethical principle of respect for persons is operationalized into the process of informed consent. The consent tools should be contextualized and adapted to the different socio-cultural environment, especially when research crosses the traditional boundaries and reaches poor communities. We look at the challenges experienced in the malaria Quinact trial, conducted in the Democratic Republic of Congo, and describe some lessons learned, related to the definition of acceptable representative, the role of independent witness and the impact of socio-economic vulnerability.
To ensure children’s protection, consent is required by the parents or, in their absence, by a legally mandated representative. In our setting, children’s responsibility is often entrusted permanently or temporarily to relatives or friends without a tribunal mandate. Hence, a notion of ‘culturally acceptable representative’ under supervision of the local Ethics Committee may be more suitable.
To ensure protection of illiterate subjects, an independent witness is required to confirm that the consent was freely given. However, in low-literacy contexts, potential witnesses often don’t have any previous relationship with patient and there may be power-unbalance in their relationship, rather than genuine dialogue.
In poor communities, trial participation may be seen as an opportunity to secure access to healthcare. Poverty may also lead to ‘competition’ to access the research-related benefits, with a risk of disturbance at societal or household level.
Adjusting consent procedures to sociocultural and socioeconomic realities is essential for fulfilling the underlying ethical principles. This requires a collaborative dialogue between researchers, regulators and ethics committees.

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ORIGINAL ARTICLES
Attitudes toward Post-Trial Access to Medical Interventions: A Review of Academic Literature, Legislation, and International Guidelines (pages 70–79)
Kori Cook, Jeremy Snyder and John Calvert
Version of Record online: 5 JUN 2015 | DOI: 10.1111/dewb.12087
Abstract
There is currently no international consensus around post-trial obligations toward research participants, community members, and host countries. This literature review investigates arguments and attitudes toward post-trial access. The literature review found that academic discussions focused on the rights of research participants, but offered few practical recommendations for addressing or improving current practices. Similarly, there are few regulations or legislation pertaining to post-trial access. If regulatory changes are necessary, we need to understand the current arguments, legislation, and attitudes towards post-trial access and participants and community members. Given that clinical trials conducted in low-income countries will likely continue, there is an urgent need for consideration of post-trial benefits for participants, communities, and citizens of host countries. While this issue may not be as pressing in countries where participants have access to healthcare and medicines through public schemes, it is particularly important in regions where this may not be available.

Emerging Infectious Diseases
Volume 22, Number 7—July 2016
http://wwwnc.cdc.gov/eid/

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Synopses
A Literature Review of Zika Virus PDF Version [PDF – 800 KB – 8 pages]
A. R. Plourde and E. M. Bloch
Abstract
Zika virus is a mosquitoborne flavivirus that is the focus of an ongoing pandemic and public health emergency. Previously limited to sporadic cases in Africa and Asia, the emergence of Zika virus in Brazil in 2015 heralded rapid spread throughout the Americas. Although most Zika virus infections are characterized by subclinical or mild influenza-like illness, severe manifestations have been described, including Guillain-Barre syndrome in adults and microcephaly in babies born to infected mothers. Neither an effective treatment nor a vaccine is available for Zika virus; therefore, the public health response primarily focuses on preventing infection, particularly in pregnant women. Despite growing knowledge about this virus, questions remain regarding the virus’s vectors and reservoirs, pathogenesis, genetic diversity, and potential synergistic effects of co-infection with other circulating viruses. These questions highlight the need for research to optimize surveillance, patient management, and public health intervention in the current Zika virus epidemic.