Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 14 May 2016]
.
Research
The use of technology enhanced learning in health research capacity development: lessons from a cross country research partnership
E. Byrne, L. Donaldson, L. Manda-Taylor, R. Brugha, A. Matthews, S. MacDonald, V. Mwapasa, M. Petersen and A. Walsh
Globalization and Health 2016 12:19
Published on: 10 May 2016
Abstract
Background
With the recognition of the need for research capacity strengthening for advancing health and development, this research capacity article explores the use of technology enhanced learning in the delivery of a collaborative postgraduate blended Master’s degree in Malawi. Two research questions are addressed: (i) Can technology enhanced learning be used to develop health research capacity?, and: (ii) How can learning content be designed that is transferrable across different contexts?
Methods
An explanatory sequential mixed methods design was adopted for the evaluation of technology enhanced learning in the Masters programme. A number of online surveys were administered, student participation in online activities monitored and an independent evaluation of the programme conducted.
Results
Remote collaboration and engagement are paramount in the design of a blended learning programme and support was needed for selecting the most appropriate technical tools. Internet access proved problematic despite developing the content around low bandwidth availability and training was required for students and teachers/trainers on the tools used. Varying degrees of engagement with the tools used was recorded, and the support of a learning technologist was needed to navigate through challenges faced.
Conclusion
Capacity can be built in health research through blended learning programmes. In relation to transferability, the support required institutionally for technology enhanced learning needs to be conceptualised differently from support for face-to-face teaching. Additionally, differences in pedagogical approaches and styles between institutions, as well as existing social norms and values around communication, need to be embedded in the content development if the material is to be used beyond the pilot resource-intensive phase of a project.
.

Research
Analysis of the corporate political activity of major food industry actors in Fiji
Non-communicable diseases (NCDs) are the leading cause of mortality in Fiji, a middle-income country in the Pacific. Some food products processed sold and marketed by the food industry are major contributors t…
Melissa Mialon, Boyd Swinburn, Jillian Wate, Isimeli Tukana and Gary Sacks
Globalization and Health 2016 12:18
Published on: 10 May 2016
Abstract
Background
Non-communicable diseases (NCDs) are the leading cause of mortality in Fiji, a middle-income country in the Pacific. Some food products processed sold and marketed by the food industry are major contributors to the NCD epidemic, and the food industry is widely identified as having strong economic and political power. However, little research has been undertaken on the attempts by the food industry to influence public health-related policies and programs in its favour. The “corporate political activity” (CPA) of the food industry includes six strategies (information and messaging; financial incentives; constituency building; legal strategies; policy substitution; opposition fragmentation and destabilisation). For this study, we aimed to gain a detailed understanding of the CPA strategies and practices of major food industry actors in Fiji, interpreted through a public health lens.
Methods and results
We implemented a systematic approach to monitor the CPA of the food industry in Fiji for three months. It consisted of document analysis of relevant publicly available information. In parallel, we conducted semi-structured interviews with 10 stakeholders involved in diet- and/or public health-related issues in Fiji. Both components of the study were thematically analysed. We found evidence that the food industry adopted a diverse range of strategies in an attempt to influence public policy in Fiji, with all six CPA strategies identified. Participants identified that there is a substantial risk that the widespread CPA of the food industry could undermine efforts to address NCDs in Fiji.
Conclusions
Despite limited public disclosure of information, such as data related to food industry donations to political parties and lobbying, we were able to identify many CPA practices used by the food industry in Fiji. Greater transparency from the food industry and the government would help strengthen efforts to increase their accountability and support NCD prevention. In other low- and middle-income countries, it is likely that a systematic document analysis approach would also need to be supplemented with key informant interviews to gain insight into this important influence on NCD prevention.

Health Affairs
May 2016; Volume 35, Issue 5
http://content.healthaffairs.org/content/current
.
Prescription Drugs, Global Health & More
From The Editor-in-Chief
Prescription Drugs, Global Health, And Population Health
Alan R. Weil
This month’s issue of Health Affairs covers a broad range of topics. We begin with prescription drugs, noting the recent report from IMS Health that drug spending increased by 8.5 percent in 2015.
Prescription Drugs
Unit prices for cancer drugs are higher in the United States than other developed countries. Sebastian Salas-Vega and Elias Mossialos compare the value in lives saved for cancer drug spending in nine countries, including the United States. Assigning a standard value for extended life-years, the authors calculate a $32.6 billion net positive return from cancer drug care in 2014 in the United States—a lower return per dollar spent than in all other countries analyzed. Japan achieved almost seven times the US rate of return.
Anomalies in the US drug market often yield price increases over time after a drug has been released. Caroline Bennette and colleagues set out to understand why. Analyzing data for twenty-four cancer drugs over six …
.
Global Health
Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia’s Experience
Ravindra P. Rannan-Eliya, Chamara Anuranga, Adilius Manual, Sondi Sararaks, Anis S. Jailani,
Abdul J. Hamid, Izzanie M. Razif, Ee H. Tan, and Ara Darzi
Author Affiliations
1Ravindra P. Rannan-Eliya (raviofficelk@gmail.com) is executive director of the Institute for Health Policy, in Colombo, Sri Lanka.
2Chamara Anuranga is a research associate at the Institute for Health Policy.
3Adilius Manual is a research officer at the Institute for Health Systems Research, National Institutes of Health (NIH), in Selangor, Malaysia.
4Sondi Sararaks is a senior medical officer at the Institute for Health Systems Research, NIH, Malaysia.
5Anis S. Jailani is a research officer at the Institute for Health Systems Research, NIH, Malaysia.
6Abdul J. Hamid is a research officer at the Institute for Health Systems Research, NIH, Malaysia.
7Izzanie M. Razif is a research officer in the National Health Financing Unit of the Ministry of Health, in Putrajaya, Malaysia.
8Ee H. Tan is senior principal assistant director of the Oral Health Division of the Ministry of Health, in Putrajaya.
9Ara Darzi is executive chair of the World Innovation Summit for Health, Qatar Foundation, and director of the Institute of Global Health Innovation, Imperial College London, in the United Kingdom.
Abstract
Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia’s health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia’s results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia’s hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia’s hybrid health system presents continuing unresolved policy challenges, but the country’s experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources.

Health Policy and Planning
Volume 31 Issue 5 June 2016
http://heapol.oxfordjournals.org/content/current
.
Original Articles
The composition of demand for newly launched vaccines: results from the pneumococcal and rotavirus vaccine introductions in Ethiopia and Malawi
B Adam Williams, Teklay Kidane, Geoffrey Chirwa, Neghist Tesfaye, Marta R Prescott, Soleine T Scotney, Moussa Valle, Sintayehu Abebe, Adija Tambuli, Bridget Malewezi, Tahir Mohammed, Emily Kobayashi, Emily Wootton, Renee Wong, Rahima Dosani, Hamsa Subramaniam, Jessica Joseph, Elif Yavuz, Aliza Apple, Yann Le Tallec, and Alice Kang’ethe
Health Policy Plan. (2016) 31 (5): 563-572 doi:10.1093/heapol/czv103
Abstract
Understanding post-launch demand for new vaccines can help countries maximize the benefits of immunization programmes. In particular, low- and middle-income countries (LMICs) should ensure adequate resource planning with regards to stock consumption and service delivery for new vaccines, whereas global suppliers must produce enough vaccines to meet demand. If a country underestimates the number of children seeking vaccination, a stock-out of commodities will create missed opportunities for saving lives. We describe the post-launch demand for the first dose of pneumococcal conjugate vaccine (PCV1) in Ethiopia and Malawi and the first dose of rotavirus vaccine (Rota1) in Malawi, with focus on the new birth cohort and the ‘backlog cohort’, comprised of older children who are still eligible for vaccination at the time of launch. PCV1 and Rota1 uptake were compared with the demand for the first dose of pentavalent vaccine (Penta1), a routine immunization that targets the same age group and immunization schedule. In the first year, the total demand for PCV1 was 37% greater than that of Penta1 in Ethiopia and 59% greater in Malawi. In the first 6 months, the demand of Rota1 was only 5.9% greater than Penta1 demand in Malawi. Over the first three post-introduction months, 70.7% of PCV1 demand in Ethiopia and 71.5% of demand in Malawi came from children in the backlog cohort, whereas only 28.0% of Rota1 demand in Malawi was from the backlog cohort. The composition of demand was impacted by time elapsed since vaccine introduction and age restrictions. Evidence suggests that countries’ plans should account for the impact of backlog demand, especially in the first 3 months post-introduction. LMICs should request for higher stock volumes when compared with routine needs, plan social mobilization activities to reach the backlog cohort and allocate human resources and cold chain capacity to accommodate high demand following vaccine introduction.
.
Resource needs and gap analysis in achieving universal access to HIV/AIDS services: a data envelopment analysis of 45 countries
Wu Zeng, Donald S Shepard, Carlos Avila-Figueroa, and Haksoon Ahn
Abstract
Background—To manage the human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) epidemic, international donors have pledged unprecedented commitments for needed services. The Joint United Nations Programme on HIV/AIDS (UNAIDS) projected that low- and middle-income countries needed $25 billion to meet the 2010 HIV/AIDS goal of universal access to AIDS prevention and care, using the resource needs model (RNM).
Methods—Drawing from the results from its sister study, which used a data envelopment analysis (DEA) and a Tobit model to evaluate and adjust the technical efficiency of 61 countries in delivering HIV/AIDS services from 2002 to 2007, this study extended the DEA and developed an approach to estimate resource needs and decompose the performance gap into efficiency gap and resource gap. In the DEA, we considered national HIV/AIDS spending as the input and volume of voluntary counseling and testing (VCT), prevention of mother to child transmission (PMTCT) and antiretroviral treatment (ART) as the outputs. An input-oriented DEA model was constructed to project resource needs in achieving 2010 HIV/AIDS goal for 45 countries using the data in 2006, assuming that all study countries maximized efficiency.
Findings—The DEA approach demonstrated the potential to include efficiency of national HIV/AIDS programmes in resource needs estimation, using macro-level data. Under maximal efficiency, the annual projected resource needs for the 45 countries was $6.3 billion, ∼47% of their UNAIDS estimate of $13.5 billion. Given study countries’ spending of $3.9 billion, improving efficiency could narrow the gap from $9.6 to $2.4 billion. The results suggest that along with continued financial commitment to HIV/AIDS, improving the efficiency of HIV/AIDS programmes would accelerate the pace to reach 2010 HIV/AIDS goals. The DEA approach provides a supplement to the AIDS RNM to inform policy making.

Human Rights Quarterly
Volume 38, Number 2, May 2016
http://muse.jhu.edu/issue/33495
.
Articles
The Rights of Man and the Rights of the Man-Made: Corporations and Human Rights
Turkuler Isiksel
ABSTRACT:
The Citizens United and Hobby Lobby decisions of the US Supreme Court stoked the longstanding controversy over the court’s doctrine that corporations are persons entitled to certain constitutional rights on the same basis as citizens. It is less widely noted that, in some fields of international economic law, firms are increasingly considered not just legal persons but bearers of human rights. This article critically examines the incipient arrogation of human rights discourse in the context of international investment arbitration, where the claims of firms are often articulated and adjudicated with language and standards borrowed from human rights law. This development, which the article describes as the dehumanization of human rights, is part of a larger process whereby international economic institutions accord legal recognition and certain protections to private economic actors. The article traces the important implications of business corporations being considered as bearers of human rights for determining the proper scope and purpose of international human rights norms, and for conceptualizing their relationship to constitutional democracy.
.
Chronicity and Pseudo Inheritance of Social Exclusion: Differences According to the Poverty of the Family of Origin Among Trash Pickers in León, Nicaragua
José Juan Vázquez, Sonia Panadero
ABSTRACT:
People living in extreme poverty or social exclusion mainly come from poor families, and their social difficulties tend to become chronic. This situation appears to be especially pronounced in countries with lower levels of development. This article analyzes different aspects of people (n = 99) who make their living collecting trash from dumps in León, Nicaragua, one of the countries with the lowest levels of development in Latin America. This group is difficult to access, heavily stigmatized, lives in chronic and extreme poverty and their families were also poor. The results show that the pickers in León whose families were poorest had the highest illiteracy rates, were poorest in health, had experienced more stressful life events, and had poorer future expectations. Negative health and life circumstances, low levels of education, and fatalism may lead to the pickers’ situations of social exclusion becoming chronic.
.
Nepali Widows’ Access to Legal Entitlements: A Human Rights Issue
Pamela G. Poon, Kiely Houston, Abina Shrestha, Rajin Rayamajhi, Lily Thapa, Pamela J. Surkan
Abstract
Despite legal reforms, Nepali widows face barriers in exercising their property rights. This article provides a qualitative perspective on Nepali widows’ understanding of their rights and their ability to pursue legal entitlements due to widowhood. In-depth interviews and focus groups were conducted with seventy-six Nepali widows, four paralegals, and three key informants. They demonstrate that widows have limited success in exercising their property rights and seeking government benefits primarily because of a dominant patriarchal society, familial traditions, and bureaucratic restrictions. Nepali widows’ continued denial of property constitutes a human rights violation that Nepal’s new government should seek to redress.
.
Forced Marriage, Slavery, and Plural Legal Systems: An African Example
Jody Sarich, Michele Olivier, Kevin Bales
Abstract
Slavery, long abolished under international law, left a devastating imprint on Africa. However, enslavement of women through forced marriages remains a common phenomenon in many African states. These African states share the common feature of legal pluralism where traditional legal systems continue to be observed alongside national laws in which slavery is outlawed. Where traditional practices condone the marriage of underage girls who are legally unable to consent, the questioning of age-old accepted forms of marriage can generate strong reactions. This article traces the position of forced and child marriages in international law, and investigates how legality becomes a moveable target when legal systems exist in parallel. Despite international and African Union conventions on slavery and human rights declaring that marriages not based on the full and free consent of both parties are considered a violation of human rights and a form of slavery, these practices persist. These instruments are assessed to gauge the level of conformity (or variance) of African state practice where forced marriages commonly occur. Importantly, the reasons behind noncompliance and the impact of legal pluralism are explored in African states where forced marriages commonly occur.

Human Vaccines & Immunotherapeutics (formerly Human Vaccines)
Volume 12, Issue 4, 2016
http://www.tandfonline.com/toc/khvi20/current
.
Reviews
Vaccines in pregnancy: The dual benefit for pregnant women and infants
pages 848-856
H. Marshall, M. McMillan, R. M. Andrews, K. Macartney & K. Edwards
ABSTRACT
Maternal immunization has the potential to reduce the burden of infectious diseases in the pregnant woman and her infant. Many countries now recommend immunization against influenza at any stage of pregnancy and against pertussis in the third trimester. Despite evidence of the safety and effectiveness of these vaccines when administered during pregnancy, uptake generally remains low for influenza and moderate for pertussis vaccine. Enhancing confidence in both immunization providers and pregnant women by increasing the evidence-base for the safety and effectiveness of vaccines during pregnancy, improving communication and access by incorporating immunization into standard models of antenatal care are likely to improve uptake. Developing a framework for implementation of vaccines for pregnant women which is cognizant of local and national cultural, epidemiological, behavioral and societal factors will enable a smooth transition and high uptake for new vaccines currently in development for pregnant women.
.
Reviews
Improving rates of maternal immunization: Challenges and opportunities
pages 857-865
Donna M. MacDougall & Scott A. Halperin
ABSTRACT
Objectives: An increasing number of vaccines are recommended or are being developed for use during pregnancy to protect women, fetuses, and/or newborns. For vaccines that are already recommended, vaccine uptake is variable and well below desired target. We reviewed the literature related to factors that affect a healthcare provider’s recommendation and a woman’s willingness to be vaccinated during pregnancy. Design: A scoping review of published literature from 2005 to 2015 was undertaken and all relevant articles were abstracted, summarized, and organized thematically. Results: Barriers and facilitators were identified that either decreased or increased the likelihood of a healthcare provider offering and a pregnant woman accepting vaccination during pregnancy. Concern about the safety of vaccines given during pregnancy was the most often cited barrier among both the public and healthcare providers. Other barriers included doubt about the effectiveness of the vaccine, lack of knowledge about the burden of disease, and not feeling oneself to be at risk of the infection. Major facilitators for maternal immunization included specific safety information about the vaccine in pregnant women, strong national recommendations, and healthcare providers who both recommended and provided the vaccine to their patients. Systems barriers such as inadequate facilities and staffing, vaccine purchase and storage, and reimbursement for vaccination were also cited. Evidence-based interventions were few, and included text messaging reminders, chart reminders, and standing orders. Conclusions: In order to have an effective vaccination program, improvements in the uptake of recommended vaccines during pregnancy are needed. A maternal immunization platform is required that normalizes vaccination practice among obstetrical care providers and is supported by basic and continuing education, communication strategy, and a broad range of research.
.
Review
Current status of new tuberculosis vaccine in children
DOI:10.1080/21645515.2015.1120393
Yu Pangab#, Aihua Zhaoc#, Chad Cohend, Wanli Kanga, Jie Lue, Guozhi Wangc, Yanlin Zhaob & Suhua Zhenga*
pages 960-970
ABSTRACT
Pediatric tuberculosis contributes significantly to the burden of TB disease worldwide. In order to achieve the goal of eliminating TB by 2050, an effective TB vaccine is urgently needed to prevent TB transmission in children. BCG vaccination can protect children from the severe types of TB such as TB meningitis and miliary TB, while its efficacy against pediatric pulmonary TB ranged from no protection to very high protection. In recent decades, multiple new vaccine candidates have been developed, and shown encouraging safety and immunogenicity in the preclinical experiments. However, the limited data on protective efficacy in infants evaluated by clinical trials has been disappointing, an example being MVA85A. To date, no vaccine has been shown to be clinically safer and more effective than the presently licensed BCG vaccine. Hence, before a new vaccine is developed with more promising efficacy, we must reconsider how to better use the current BCG vaccine to maximize its effectiveness in children.

Infectious Diseases of Poverty
http://www.idpjournal.com/content
[Accessed 14 May 2016]

.
Research Article
Prevalence of chronic infections and susceptibility to measles and varicella-zoster virus in Latin American immigrants
Yves Jackson, Lilian Santos, Isabelle Arm-Vernez, Anne Mauris, Hans Wolff, François Chappuis and Laurent Getaz
Published on: 11 May 2016
Abstract
Background
Large numbers of Latin American immigrants recently arrived in Western Europe. Curative and preventive programmes need to take account of their risk of suffering and transmitting imported chronic infections and of their susceptibility to cosmopolitan infections. We aimed to assess the prevalence and co-occurrence of imported chronic infections among Latin American immigrants, and their susceptibility to highly prevalent cosmopolitan infections.
Methods
Adult participants were recruited in the community and in a primary health centre in Geneva in 2008. Serological tests were performed on stored sera for HIV, HBV, syphilis, Strongyloides stercoralis, Trypanosoma cruzi, varicella and measles. We considered only chronic active infections in the analysis.
Results and discussion
The 1 012 participants, aged 37.2 (SD 11.3) years, were mostly female (82.5 %) and Bolivians (48 %). Overall, 209 (20.7 %) had at least one and 27 (2.7 %) two or more chronic infections. T. cruzi (12.8 %) and S. stercoralis (8.4 %) were the most prevalent chronic active infections compared to syphilis (0.4 %), HBV (0.4 %) and HIV (1.4 %). Concomitant infections affected 28.2 and 18.5 % of T. cruzi and S. stercoralis infected cases. Bolivian origin (aOR: 13.6; 95 % CI: 3.2–57.9) was associated with risk of multiple infections. Susceptibilities for VZV and measles were 0.7 and 1.4 %, respectively. Latin American immigrants are at risk of complications and possible reactivation of chronic parasitic infections but have overall low risks of chronic viral and syphilitic active infections.
Conclusions
Systematic screening for chronic active parasitic infections is therefore necessary especially among Bolivians. The high protection rate against measles and VZV doesn’t require specific preventive interventions.

International Health
Volume 8 Issue 3 May 2016
http://inthealth.oxfordjournals.org/content/current

.
EDITORIAL
Africa in transition: the case of malaria
Kevin Marsh
Extract
Int. Health (2016) 8 (3): 155-156 doi:10.1093/inthealth/ihw022
In 2000, the Economist carried an infamous cover describing Africa as ‘the hopeless continent’. In 2013 this was replaced with one designating Africa ‘the hopeful continent’. The idea of ‘Africa rising’ is in the air and although this is a hotly debated area, no one doubts that Africa is in a period of dramatic transition. Most African economies are growing at around 5% per annum; the current GDP of Africa of around $2.4 trillion is expected to rise more than tenfold by 2050, when its population is predicted to be above 2 billion, with 60% living in urban areas. These changes will be paralleled by equally dramatic changes in health, a process which is already well underway. Much has been written about the dual challenges of persisting infectious diseases at the same time as an increasing burden of non-communicable diseases. Tackling these challenges will call for a major investment in research and here there are exciting transitions too. The launch by the African Academy of Sciences (ASS), in-partnership with NEPAD and a group of international partners, of the Alliance for Accelerating Excellence in Science in Africa (AESA) (http://aasciences.ac.ke/programmes/easa/alliance-for-accelerating-excellence-in-science-in-africa-aesa/) marks a genuine shift in the centre of gravity for health research in Africa. One particularly welcome manifestation of this …

.
Commentaries
Collecting data on violence against children and young people: need for a universal standard
Karen M. Devriesa,*, Dipak Nakerb, Adrienne Monteath-van Dokc, Claire Milligand and Alice Shirleyd
Author Affiliations
aLondon School of Hygiene and Tropical Medicine, 15–17 Tavistock Place, WC1H 9SH, UK
bRaising Voices, 16 Tufnell Drive, Kamwokya P. O. Box 6770, Kampala, Uganda
cPlan International, Dukes Court, Block A, Duke Street, Woking, Surrey GU21 5BH, UK
dSave the Children, St John’s Lane, London, EC1 M 4AR, UK
*Corresponding author: E-mail: karen.devries@lshtm.ac.uk
Abstract
Preventing and responding to violence against children is an aim of the new Sustainable Development Goals. Numerous agencies are now collecting data from children about violence, including academics, non-governmental organisations, government agencies, consultants and others. Data are necessary to ensure appropriate prevention and response, but there is a real risk of harm to children if ethical standards are not adhered to. There are additional complexities in settings where child protection systems are not well developed. We propose specific suggestions for good practice, based on our past experience and policies, and call for all agencies to adhere to high ethical standards.
.

Original Articles
Ethical challenges in research with orphans and vulnerable children: a qualitative study of researcher experiences
Int. Health (2016) 8 (3): 187-196 doi:10.1093/inthealth/ihw020
Maureen C. Kelley, Tracy Brazg, Benjamin S. Wilfond, Liliana J. Lengua, Beth E. Rivin, Susanne P. Martin-Herz, and Douglas S. Diekema
Corresponding author: Present address: The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus – Roosevelt Drive, Oxford OX3 7LF; Tel: +44 186 561 7805; E-mail: maureen.kelley@ethox.ox.ac.uk
Abstract
Background Orphans and vulnerable children (OVCs) represent a significant population worldwide, enduring poor health and living conditions. Evidence-based interventions are needed. However, without parents, ethical concerns about including OVCs in research persist. The aim of our study was to better understand the ethical challenges facing researchers who work with OVCs.
Methods We conducted semi-structured interviews with 12 international pediatric researchers working with OVCs in seven countries. We used descriptive content analysis to characterize the ethical rationale for inclusion and associated challenges.
Results Researchers believed research was justified as a necessary means for informing evidence-based interventions to benefit OVCs directly or as a population. Ethical challenges included difficulty identifying OVCs given variation among children living without parents; difficulty identifying guardians among a range of caregivers; concerns about meaningfulness of guardian consent; difficulty assessing risk; and responding to children’s many needs.
Conclusions A range of caregivers bear responsibility to protect OVC’s interests in place of parents in research but are often not prepared to do so. This places greater burden on researchers to assess risks and respond to children’s needs. Findings suggest that we should improve support and rethink the roles of guardians, researchers and older children in research participation and protection.

International Journal of Infectious Diseases
May 2016 Volume 46, p1-126
http://www.ijidonline.com/current

.
Original Reports
Taking forward the World TB Day 2016 theme ‘Unite to End Tuberculosis’ for the WHO Africa Region
Francine Ntoumi, Pontiano Kaleebu, Eusebio Macete, Sayoki Mfinanga, Jeremiah Chakaya, Dorothy Yeboah-Manu, Matthew Bates, Peter Mwaba, Markus Maeurer, Eskild Petersen, Alimuddin Zumla
p34–37
Published online: March 8 2016
Preview
Tuberculosis (TB) has remained a global emergency ever since it was declared as such by the World Health Organization (WHO) in 1993.1 The theme designated for this year’s World TB Day, March 24, 2016, is ‘Unite to End TB’.2 World TB Day is held to commemorate the day in 1882 when Professor Robert Koch announced his ground-breaking discovery of the cause of TB, the bacillus Mycobacterium tuberculosis.3 At the time of Koch’s announcement in Berlin, TB was widespread and rampaging through Europe and the Americas, causing the death of one out of every seven people.

JAMA
May 10, 2016, Vol 315, No. 18
http://jama.jamanetwork.com/issue.aspx

.
Viewpoint
The Emerging Zika Virus Epidemic in the Americas: Research Priorities FREE
Helen M. Lazear, PhD; Elizabeth M. Stringer, MD; Aravinda M. de Silva, PhD
Excerpt
…CONCLUSIONS
The size of the current ZIKV epidemic, its potential for further spread, and the potential teratogenic effects of this virus require development of ZIKV-specific diagnostic agents and a better understanding of pathogenic mechanisms. The association between ZIKV infection and microcephaly has been the cause of much alarm and has been the driving force behind a substantial public health response and a drive to develop vaccines and antivirals to combat ZIKV infection.
Zika virus represents just the most recent example of an epidemic of vector-borne disease brought about by the introduction of a virus to a new host population and ecological landscape. Although current research priorities must focus on the immediate need to develop specific diagnostic tools and understand the teratogenic potential of ZIKV, public health efforts to address the current epidemic must be informed by experience with previous outbreaks of viruses transmitted by Aedes mosquitoes.

JAMA Pediatrics
May 2016, Vol 170, No. 5
http://archpedi.jamanetwork.com/issue.aspx
.
Editorial
Adolescent and Young Adult Health
The Pertussis Problem and a Possible Solution: Will Parents Go Along?
Mark H. Sawyer, MD
.
Adolescent and Young Adult Health
Human Papillomavirus Vaccination and Cervical Cytology Outcomes Among Urban Low-Income Minority Females
Annika M. Hofstetter, MD, PhD, MPH; Danielle C. Ompad, PhD; Melissa S. Stockwell, MD, MPH; Susan L. Rosenthal, PhD; Karen Soren, MD
.
Adolescent and Young Adult Health
Impact of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccinations on Reported Pertussis Cases Among Those 11 to 18 Years of Age in an Era of Waning Pertussis Immunity: A Follow-up Analysis
Tami H. Skoff, MS; Stacey W. Martin, MSc
.
Epidemiological and Economic Effects of Priming With the Whole-Cell Bordetella pertussis Vaccine
Haedi DeAngelis, MA; Samuel V. Scarpino, PhD; Meagan C. Fitzpatrick, PhD; Alison P. Galvani, PhD; Benjamin M. Althouse, PhD, ScM
Includes: Supplemental Content

Journal of Epidemiology & Community Health
June 2016, Volume 70, Issue 6
http://jech.bmj.com/content/current

.
Essay
Birth control policies in Iran: a public health and ethics perspective
Mehdi Aloosh1, Yashar Saghai2
Author Affiliations
1McGill University Health Centre, Montreal, Quebec, Canada
2Berman Institute of Bioethics, Johns Hopkins University, Baltimore, USA
Correspondence to Dr Mehdi Aloosh, McGill University, McGill University Health Centre, Montreal, Quebec, H4A 3J1, Canada; mehdi.aloosh@mail.mcgill.ca
Abstract
In less than one generation, a unique demographic transition has taken place in Iran. A population growth rate of 4.06% in 1984 fell to 1.15% in 1993 and a total fertility rate of 6.4 births per woman in 1984 declined to 1.9 in 2010. In 2012, Iranian policymakers shifted away from a birth control policy towards a pro-natalist policy. At first glance, this may seem reasonable since its goal is to avoid the consequences of an aging population. However, we argue that the policy package raises serious public health, socioeconomic, environmental and ethical concerns and is likely to fail on its own terms.

.

The influence of refugee status and secondary migration on preterm birth
Susitha Wanigaratne1,2, Donald C Cole3, Kate Bassil3, Ilene Hyman3, Rahim Moineddin4,
Marcelo L Urquia1,2,3
Author Affiliations
1Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
2Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
3Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
4Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
Correspondence to Dr Marcelo L Urquia, St. Michael’s Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada; marcelo.urquia@utoronto.ca
Abstract
Background It is unknown whether the risk of preterm birth (PTB) is elevated for forced (refugee) international migrants and whether prolonged displacement amplifies risk. While voluntary migrants who arrive from a country other than their country of birth (ie, secondary migrants) have favourable birth outcomes compared with those who migrated directly from their country of birth (ie, primary migrants), secondary migration may be detrimental for refugees who experience distinct challenges in transition countries. Our objectives were (1) to determine whether refugee status was associated with PTB and (2) whether the relation between refugee status and PTB differed between secondary and primary migrants.
Methods We conducted a retrospective population-based cohort study. Ontario immigration (2002–2010) and hospitalisation data (2002–2010) were linked to estimate adjusted cumulative odds ratios (ACOR) of PTB (22–31, 32–36, 37–41 weeks of gestation), with 95% CIs (95% CI) comparing refugees with non-refugees. We further included a product term between refugee status and secondary migration.
Results Overall, refugees (N=12 913) had 17% greater cumulative odds of short gestation (ACOR=1.17, 95% CI 1.07 to 1.28) compared with non-refugees (N=110 640). Secondary migration modified the association between refugee status and PTB (p=0.007). Secondary refugees had 58% greater cumulative odds of short gestation (ACOR=1.58, 95% CI 1.25 to 2.00) than secondary non-refugees, while primary refugees had 12% greater cumulative odds of short gestation (ACOR=1.12, 95% CI 1.02 to 1.23) than primary non-refugee immigrants.
Conclusions Refugee status, jointly with secondary migration, influences PTB among migrants.

Journal of Pediatrics
May 2016 Volume 172, p1-236
http://www.jpeds.com/current

.
Editor’s Persepctive
Lest we forget — the battle against malnutrition
Carlos A. Cuello-Garcia
p1–4
Published in issue: May 2016
Preview
We are now living in an era of postmillennium development goals and, although a significant number of them have been completed, a significant proportion of targets remain to be accomplished. Malnutrition is still a concern that affects millions worldwide. In this issue of The Journal, Chowdhury et al present a large scale population-based survey in Bangladesh, extracted from the Bangladesh Demographic Health Survey (2011). This could be considered a large and representative sample of a region where prevention of malnutrition is (and it should be kept as) a priority as a public health intervention.

.
Original Articles
Risk Factors for Child Malnutrition in Bangladesh: A Multilevel Analysis of a Nationwide Population-Based Survey
Mohammad Rocky Khan Chowdhury, Mohammad Shafiur Rahman, Mohammad Mubarak Hossain Khan, Mohammad Nazrul Islam Mondal, Mohammad Mosiur Rahman, Baki Billah
p194–201.e1

The Lancet
May 14, 2016 Volume 387 Number 10032 p1969-2062
http://www.thelancet.com/journals/lancet/issue/current

.
Viewpoint
Moving ahead: what will a renewed Countdown to 2030 for Women and Children look like?
Prof Zulfiqar A Bhutta, PhD, Mickey Chopra, MD
Published Online: 15 October 2015
Summary
The Countdown to 2015 initiative (Countdown) represents a remarkable consortium of academicians, UN agencies, and development partners, which over the past decade, has focused its attention on tracking and analysing coverage of key interventions for reproductive, maternal, newborn, and child health (RMNCH) across 75 high burden countries that account for more than 95% of global maternal and child deaths. Initially started to ensure follow-up on the landmark Lancet Child Survival series,1,2 with innovative consolidation and presentation of coverage data on key interventions by country and regions,3 Countdown rapidly evolved with an expansion of its mandate to include reproductive and maternal health indicators across the continuum of care4 and more recently, analysis of nutrition trends and health policies.

The Lancet Infectious Diseases
May 2016 Volume 16 Number 5 p507-618 e64-e81
http://www.thelancet.com/journals/laninf/issue/current
.
Editorial
Ebola PHEIC is over but emergency continues
The Lancet Infectious Diseases
Summary
On March 29, WHO Director-General Margaret Chan announced that the outbreak of Ebola virus disease in countries of west Africa was no longer a Public Health Emergency of International Concern (PHEIC). This decision was taken because, in the opinion of the International Health Regulations Emergency Committee on Ebola, the outbreak is no longer an extraordinary event, there is little risk of international spread, and affected countries have the capacity to rapidly respond to new cases. The Emergency Committee acknowledged that new clusters will continue to occur, but that they are happening at a decreasing frequency.
.
Articles
Group B streptococcus vaccination in pregnant women with or without HIV in Africa: a non-randomised phase 2, open-label, multicentre trial
Robert S Heyderman, Shabir A Madhi, Neil French, Clare Cutland, Bagrey Ngwira, Doris Kayambo, Robert Mboizi, Anthonet Koen, Lisa Jose, Morounfolu Olugbosi, Frederik Wittke, Karen Slobod, Peter M Dull
Open Access
Summary
Background
Neonates born to women infected with HIV are at increased risk for invasive group B streptococcus (GBS) disease. We aimed to compare safety and immunogenicity of trivalent glycoconjugate GBS vaccine in pregnant women with and without HIV in Malawi and South Africa.
Methods
In our non-randomised phase 2, open-label, multicentre study, we recruited pregnant women attending two antenatal clinics, one in Blantyre, Malawi, and one in Soweto, Johannesburg, South Africa. Participants were divided into three groups on the basis of their HIV infection status (no infection, infection and high CD4 cell count [>350 cells per μL], and infection and low CD4 cell count [>50 to ≤350 cells per μL]) and received a 5 μg dose of glycoconjugate GBS vaccine (serotypes Ia, Ib, and III, with CRM197 [Novartis Vaccines, Siena, Italy]) intramuscularly at 24–35 weeks’ gestation. GBS serotype-specific antibody concentrations were measured before vaccination (day 1), day 15, day 31, and at delivery, and in infants at birth and day 42 of life. The primary outcomes were safety in mothers and infants and the amount of placental transfer of GBS serotype-specific antibodies from mothers to their infants. All immunogenicity and safety analyses were done on the full analysis set, including participants who, or whose mother, correctly received the vaccine and who provided at least one valid assessable serum sample. This study is registered with ClinicalTrials.gov, number NCT01412801.
Findings
270 women and 266 infants were enrolled between Sept 26, 2011, and Dec 4, 2012 (90 women and 87 infants without HIV, 89 and 88 with HIV and high CD4 cell counts, and 91 and 91 with HIV and low CD4 cell counts, respectively). Seven women were lost to follow-up, six withdrew consent, one died, and two relocated. Eight infants died or were stillborn and two were lost to follow-up. Across serotypes, fold change in antibody concentrations were higher for the HIV-uninfected group than the HIV-infected groups. Transfer ratios were similar across all three groups (0·49–0·72; transfer ratio is infant geometric mean antibody concentration in blood collected within 72 h of birth divided by maternal geometric mean antibody concentration in blood collected at delivery); however, at birth, maternally derived serotype-specific antibody concentrations were lower for infants born to women infected with HIV (0·52–1·62 μg/mL) than for those born to women not infected with HIV (2·67–3·91 μg/mL). 151 (57%) of 265 women reported at least one solicited adverse reaction: 39 (45%) of 87 women with HIV and low CD4 cell counts, 52 (59%) of 88 women with HIV and high CD4 cell counts, and 60 (67%) of 90 women in the HIV-uninfected group. 49 (18%) of 269 women had at least one adverse event deemed possibly related to the vaccine (six [7%] in the HIV and low CD4 cell count group, 12 [13%] in the HIV and high CD4 cell count group, and 21 [23%] in the HIV-uninfected group), as did three (1%) of 266 neonates (zero, two [1%], and one [1%]); none of these events was regarded as serious.
Interpretation
The vaccine was less immunogenic in women infected with HIV than it was in those not infected, irrespective of CD4 cell count, resulting in lower levels of serotype-specific maternal antibody transferred to infants, which could reduce vaccine protection against invasive GBS disease. A validated assay and correlate of protection is needed to understand the potential protective value of this vaccine.
Funding
Novartis Vaccines and Diagnostics division (now part of the GlaxoSmithKline group of companies), Wellcome Trust UK, Medical Research Council: Respiratory and Meningeal Pathogens Research U

Lancet Global Health
May 2016 Volume 4 Number 5 e287-e343
http://www.thelancet.com/journals/langlo/issue/current

.
Editorial
Research capacity in Africa—will the sun rise again?
Justine Davies, Zoë Mullan
Published Online: 31 March 2016
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(16)30046-8
Summary
Africa has a problem. It has the greatest burden of disease and lowest density of health-care professionals in the world. This we know. We also know that although infectious diseases and maternal, child, and neonatal health are improving, the burden of non-communicable diseases (NCDs) has been steadily increasing in the past few decades. We know that the health-care successes in Africa have largely been driven by donor aid, providing vertical solutions to specific problems; however, NCDs require complex care and strong health systems.

.
Comment
How the MDGs gave up on measuring access to medicines
Dzintars Gotham, Kristine H Onarheim, Melissa J Barber
Open Access
DOI: http://dx.doi.org/10.1016/S2214-109X(16)00066-8
Summary
In March, 2016, the United Nations Statistics Commission agreed upon the metrics used to measure progress towards, or away from, the new Sustainable Development Goals (SDGs).1 These so-called indicators define the real-world, measurable counterparts to the targets within the visionary goals of the sustainable development agenda. In the context of health in the SDGs, we wish to highlight the little-known story of the Millennium Development Goals’ (MDG) target on access to medicines. Of the 21 targets in the eight MDGs that permeated the development debate over the past 15 years, it was the only target that was dropped from the MDG report.

.
Comment
Consigned to the margins: a call for global action to challenge intellectual disability stigma
Katrina Scior, Aseel Hamid, Richard Hastings, Shirli Werner, Catherine Belton, Adebisi Laniyan, Maya Patel, Nora Groce, Maria Kett
Summary
Stigma as an important public health concern has been recognised in relation to conditions as diverse as HIV, leprosy, and mental illness. Little attention has been paid to date, however, to the pernicious effects of stigma on the wellbeing and life chances of one heavily stigmatised population: people with intellectual disabilities. Of the 15 billion people globally affected by disability,1 an estimated 2%, or 300 million, have an intellectual disability. They experience the same disadvantages and inequities as do people with other types of disabilities, but often face the additional disadvantage of having their needs inadequately understood and met, having limited recourse to assert their rights, and being poorly represented, including within the Disability Rights movement.

New England Journal of Medicine
May 12, 2016 Vol. 374 No. 19
http://www.nejm.org/toc/nejm/medical-journal

.
Perspective
The Zika Challenge
C.J. Haug, M.P. Kieny, and B. Murgue
[Concluding text]
…Many lessons learned from the response to the recent Ebola outbreak have helped in the response to the ZIKV outbreak. Most important, there is general agreement on the need for international collaboration on regulatory issues, research, and data sharing. For example, major regulatory agencies (such as Brazil’s Agência Nacional de Vigilância Sanitária, the U.S. Food and Drug Administration, and the European Medicines Agency) have committed to prioritizing the expedited evaluation of Zika products and will proactively reach out to product developers to provide advice on regulatory issues. Regulators have also initiated collaborations and are sharing their experiences with each other.

Another major advance over the Ebola response has been the speed with which data are being shared — for example, through the real-time posting of data from pathogenesis experiments in nonhuman primates. The December 2015 statement from the International Committee of Medical Journal Editors clarifying that prepublication dissemination of critical information will not prejudice later journal publication related to ZIKV or future public health emergencies has been helpful. Similarly, a February 2016 statement on open data sharing in ZIKV has been transformative in signaling that funders expect proactive data sharing. ZIKV provides a case study of the need for expedited research to answer basic questions, which will allow for development of control measures.

We are working in a new area with many unknowns. But as the WHO meeting showed, there is ample experience and expertise from work with other viruses and vectors — ranging from basic science to field work and surveillance — to guide clinical practice, research, and product development. It is critical that we collaborate rather than compete to find answers to the questions that worry millions of women of child-bearing age in areas where ZIKV is spreading rapidly and may become endemic.

PLoS Neglected Tropical Diseases
http://www.plosntds.org/
(Accessed 14 May 2016)

.
Review
Socioeconomic Inequalities in Neglected Tropical Diseases: A Systematic Review
Tanja A. J. Houweling, Henrike E. Karim-Kos, Margarete C. Kulik, Wilma A. Stolk, Juanita A. Haagsma, Edeltraud J. Lenk, Jan Hendrik Richardus, Sake J. de Vlas
| published 12 May 2016 | PLOS Neglected Tropical Diseases
http://dx.doi.org/10.1371/journal.pntd.0004546
Abstract
Background
Neglected tropical diseases (NTDs) are generally assumed to be concentrated in poor populations, but evidence on this remains scattered. We describe within-country socioeconomic inequalities in nine NTDs listed in the London Declaration for intensified control and/or elimination: lymphatic filariasis (LF), onchocerciasis, schistosomiasis, soil-transmitted helminthiasis (STH), trachoma, Chagas’ disease, human African trypanosomiasis (HAT), leprosy, and visceral leishmaniasis (VL).
Methodology
We conducted a systematic literature review, including publications between 2004–2013 found in Embase, Medline (OvidSP), Cochrane Central, Web of Science, Popline, Lilacs, and Scielo. We included publications in international peer-reviewed journals on studies concerning the top 20 countries in terms of the burden of the NTD under study.
Principal findings
We identified 5,516 publications, of which 93 met the inclusion criteria. Of these, 59 papers reported substantial and statistically significant socioeconomic inequalities in NTD distribution, with higher odds of infection or disease among poor and less-educated people compared with better-off groups. The findings were mixed in 23 studies, and 11 studies showed no substantial or statistically significant inequality. Most information was available for STH, VL, schistosomiasis, and, to a lesser extent, for trachoma. For the other NTDs, evidence on their socioeconomic distribution was scarce.
The magnitude of inequality varied, but often, the odds of infection or disease were twice as high among socioeconomically disadvantaged groups compared with better-off strata. Inequalities often took the form of a gradient, with higher odds of infection or disease each step down the socioeconomic hierarchy. Notwithstanding these inequalities, the prevalence of some NTDs was sometimes also high among better-off groups in some highly endemic areas.
Conclusions
While recent evidence on socioeconomic inequalities is scarce for most individual NTDs, for some, there is considerable evidence of substantially higher odds of infection or disease among socioeconomically disadvantaged groups. NTD control activities as proposed in the London Declaration, when set up in a way that they reach the most in need, will benefit the poorest populations in poor countries.

PLoS One
http://www.plosone.org/
[Accessed 14 May 2016]

.
Research Article
Population-Level Impact of Ontario’s Infant Rotavirus Immunization Program: Evidence of Direct and Indirect Effects
Sarah E. Wilson, Laura C. Rosella, Jun Wang, Nicole Le Saux, Natasha S. Crowcroft, Tara Harris, Shelly Bolotin, Shelley L. Deeks
| published 11 May 2016 | PLOS ONE
http://dx.doi.org/10.1371/journal.pone.0154340
Abstract
Objective
To evaluate the direct and indirect population impact of rotavirus (RV) immunization on hospitalizations and emergency department (ED) visits for acute gastroenteritis (AGE) in Ontario before and after the publicly-funded RV immunization program.
Methods
Administrative data was used to identify ED visits and hospitalizations for all Ontarians using ICD-10 codes. We used two outcome definitions: RV-specific AGE (RV-AGE) and codes representing RV-, other viral and cause unspecified AGE (“overall AGE”). The pre-program and public program periods were August 1, 2005 to July 31, 2011; and August 1, 2011 to March 31, 2013, respectively. A negative binominal regression model that included the effect of time was used to calculate rates and rate ratios (RRs) and 95% confidence intervals (CIs) for RV-AGE and overall AGE between periods, after adjusting for age, seasonality and secular trends. Analyses were conducted for all ages combined and age stratified.
Results
Relative to the pre-program period, the adjusted RRs for RV-AGE and overall AGE hospitalizations in the public program period were 0.29 (95%CI: 0.22–0.39) and 0.68 (95%CI: 0.62–0.75), respectively. Significant reductions in RV-AGE hospitalizations were noted overall and for the following age bands: < 12 months, 12–23 months, 24–35 months, 3–4 years, and 5–19 years. Significant declines in overall AGE hospitalizations were observed across all age bands, including older adults > = 65 years (RR 0.80, 95%CI: 0.72–0.90). The program was associated with adjusted RRs of 0.32 (95% CI: 0.20–0.52) for RV-AGE ED visits and 0.90 (95% CI: 0.85–0.96) for overall AGE ED visits.
Conclusions
This large, population-based study provides evidence of the impact of RV vaccine in preventing hospitalizations and ED visits for RV-AGE and overall AGE, including herd effects.

Science
13 May 2016 Vol 352, Issue 6287
http://www.sciencemag.org/current.dtl

.
Editorial
Pursuit of integral ecology
Marcelo Sánchez Sorondo1,*, Veerabhadran Ramanathan2,†
Summary
Later this month (23 and 24 May), the United Nations will convene the first World Humanitarian Summit in Istanbul, where global and local leaders will commit to putting each and every person’s safety, dignity, freedom, and right to thrive at the heart of decision-making. More than 125 million people are in need of humanitarian assistance, a level of suffering not seen since World War II. The social problems are wide and deep, from war and human trafficking to the gross inequality between the wealthy 1% and the poorest 3 billion of the population. Included in the summit’s Agenda for Humanity are climate and natural disasters. Indeed, 1 year ago, Pope Francis emphasized, in the encyclical Laudato Si, that complex crises have both social and environmental dimensions. The bond between humans and the natural world means that we live in an “integral ecology,” and as such, an integrated approach to environmental and social justice is required.

.
Perspectives
Reconciliation in Sierra Leone
By Katherine Casey, Rachel Glennerster
Science13 May 2016 : 766-767
Short, low-cost interventions can help communities to recover from civil war
Summary
Since the end of World War II, there have been 259 armed conflicts in 159 locations (1). Sierra Leone’s civil war began 25 years ago, at a time when roughly 25% of all countries worldwide were experiencing civil war (2). How can individuals and groups recover from such violent conflicts? On page 787 of this issue, Cilliers et al. (3) provide rigorous evidence on the efficacy of one postwar reconciliation strategy that was implemented in 100 communities in Sierra Leone (4).

.
Refugee protection and resettlement problems
By Elizabeth Cullen Dunn
Science13 May 2016 : 772-773
Refugees face painful uncertainties that could be ameliorated by aid agency coordination
Summary
In 2015, more than a million refugees and other migrants entered the European Union. They are just a small part of the world’s rapidly burgeoning population of displaced people, which climbed by more than 37% between 2009 and 2015 to reach 59.5 million people. Humanitarian aid to these people has been dramatically insufficient, and many displaced people now lack adequate food, medical care, housing, or transportation. As a geographer, I spent 16 months between 2009 and 2013 conducting participant observation research in camps for displaced people in Georgia (see the photo), where I discovered serious shortfalls in the humanitarian aid system. Increasingly, humanitarian aid is a temporary solution to a permanent problem, a stopgap that not only does not help displaced people resettle but, instead, makes it more difficult for them to move on with their lives.

.
Reconciling after civil conflict increases social capital but decreases individual well-being
By Jacobus Cilliers, Oeindrila Dube, Bilal Siddiqi
Science13 May 2016 : 787-794
Exposure to the truth promotes social reconciliation, but at the cost of mental health.
Editor’s Summary
The psychological cost of reconciliation
During civil wars, individuals and communities who were previously good neighbors can end up fighting each other. One approach to reknit these sundered social ties is to bring perpetrators and victims together in truth and reconciliation forums. Cilliers et al. found that these forums have helped to reestablish social bonds in Sierra Leone, but that they have also imposed a cost on the victims’ mental health (see the Perspective by Casey and Glennerster).
Abstract
Civil wars divide nations along social, economic, and political cleavages, often pitting one neighbor against another. To restore social cohesion, many countries undertake truth and reconciliation efforts. We examined the consequences of one such effort in Sierra Leone, designed and implemented by a Sierra Leonean nongovernmental organization called Fambul Tok. As a part of this effort, community-level forums are set up in which victims detail war atrocities, and perpetrators confess to war crimes. We used random assignment to study its impact across 200 villages, drawing on data from 2383 individuals. We found that reconciliation had both positive and negative consequences. It led to greater forgiveness of perpetrators and strengthened social capital: Social networks were larger, and people contributed more to public goods in treated villages. However, these benefits came at a substantial cost: The reconciliation treatment also worsened psychological health, increasing depression, anxiety, and posttraumatic stress disorder in these same villages. For a subset of villages, we measured outcomes both 9 months and 31 months after the intervention. These results show that the effects, both positive and negative, persisted into the longer time horizon. Our findings suggest that policy-makers need to restructure reconciliation processes in ways that reduce their negative psychological costs while retaining their positive societal benefits.

.
Zika virus impairs growth in human neurospheres and brain organoids
By Patricia P. Garcez, Erick Correia Loiola, Rodrigo Madeiro da Costa, Luiza M. Higa, Pablo Trindade, Rodrigo Delvecchio, Juliana Minardi Nascimento, Rodrigo Brindeiro, Amilcar Tanuri, Stevens K. Rehen
Science13 May 2016 : 816-818
Zika virus infection in cell culture models damages human neural stem cells to limit growth and cause cell death.

Social Science & Medicine
Volume 155, Pages 1-102 (April 2016)
http://www.sciencedirect.com/science/journal/02779536/155

.
Review article
Global health diplomacy: A critical review of the literature
Review Article
Pages 61-72
Arne Ruckert, Ronald Labonté, Raphael Lencucha, Vivien Runnels, Michelle Gagnon
Abstract
Global health diplomacy (GHD) describes the practices by which governments and non-state actors attempt to coordinate and orchestrate global policy solutions to improve global health. As an emerging field of practice, there is little academic work that has comprehensively examined and synthesized the theorization of Global Health Diplomacy (GHD), nor looked at why specific health concerns enter into foreign policy discussion and agendas. With the objective of uncovering the driving forces behind and theoretical explanations of GHD, we conducted a critical literature review. We searched three English-language scholarly databases using standardized search terms which yielded 606 articles. After screening of abstracts based on our inclusion/exclusion criteria, we retained 135 articles for importing into NVivo10 and coding. We found a lack of rigorous theorizing about GHD and fragmentation of the GHD literature which is not clearly structured around key issues and their theoretical explanations. To address this lack of theoretical grounding, we link the findings from the GHD literature to how theoretical concepts used in International Relations (IR) have been, and could be invoked in explaining GHD more effectively. To do this, we develop a theoretical taxonomy to explain GHD outcomes based on a popular categorization in IR, identifying three levels of analysis (individual, domestic/national, and global/international) and the driving forces for the integration of health into foreign policy at each level.