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

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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

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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

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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.

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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.
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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]

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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]

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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.

Epidemics
Volume 16, In Progress (September 2016)
http://www.sciencedirect.com/science/journal/17554365

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Regular Articles
Using age-stratified incidence data to examine the transmission consequences of pertussis vaccination
Original Research Article
Pages 1-7
J.C. Blackwood, D.A.T. Cummings, S. Iamsirithaworn, P. Rohani
Abstract
Pertussis is a highly infectious respiratory disease that has been on the rise in many countries worldwide over the past several years. The drivers of this increase in pertussis incidence remain hotly debated, with a central and long-standing hypothesis that questions the ability of vaccines to eliminate pertussis transmission rather than simply modulate the severity of disease. In this paper, we present age-structured case notification data from all provinces of Thailand between 1981 and 2014, a period during which vaccine uptake rose substantially, permitting an evaluation of the transmission impacts of vaccination. Our analyses demonstrate decreases in incidence across all ages with increased vaccine uptake – an observation that is at odds with pertussis case notification data in a number of other countries. To explore whether these observations are consistent with a rise in herd immunity and a reduction in bacterial transmission, we analyze an age-structured model that incorporates contrasting hypotheses concerning the immunological and transmission consequences of vaccines. Our results lead us to conclude that the most parsimonious explanation for the combined reduction in incidence and the shift to older age groups in the Thailand data is vaccine-induced herd immunity.

Global Public Health
Volume 11, Issue 7-8, 2016
http://www.tandfonline.com/toc/rgph20/current
Special Issue: The trouble with ‘Categories’: Rethinking men who have sex with men, transgender and their equivalents in HIV prevention and health promotion

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Introduction
The trouble with ‘Categories’: Rethinking men who have sex with men, transgender and their equivalents in HIV prevention and health promotion
pages 819-823
Richard Parker, Peter Aggleton & Amaya G. Perez-Brumer
ABSTRACT
This double Special Issue of Global Public Health presents a collection of articles that seek more adequately to represent sexual and gender diversities and to begin to rethink the relationship to HIV prevention and health promotion – in both the resource rich nations of the global North, as well as in the more resource constrained nations of the global South. Reckoning with the reality that today the global response to HIV has failed to respond to the needs of gay, bisexual and other men who have sex with men, and transgender persons, we turn our attention to processes and practices of categorisation and classification, and the entanglement of the multiple social worlds that constitute our understanding of each of these categories and people within the categories. Jointly, these articles provide critical perspectives on how defining and redefining categories may impact the conceptual frameworks and empirical evidence that inform global understandings of HIV infection, those communities most vulnerable, and our collective response to the evolving HIV epidemic.

Globalization and Health
http://www.globalizationandhealth.com/
[Accessed 9 July 2016]

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Review
Why might regional vaccinology networks fail? The case of the Dutch-Nordic Consortium
Jan Hendriks and Stuart Blume
Globalization and Health 2016 12:38
Published on: 7 July 2016
Abstract
We analyzed an attempt to develop and clinically test a pneumococcal conjugate vaccine for the developing world, undertaken by public health institutions from the Netherlands, Sweden, Denmark, Norway and Finland: the Dutch Nordic Consortium (DNC), between 1990 and 2000. Our review shows that the premature termination of the project was due less to technological and scientific challenges and more to managerial challenges and institutional policies. Various impeding events, financial and managerial challenges gradually soured the initially enthusiastic collaborative spirit until near the end the consortium struggled to complete the minimum objectives of the project. By the end of 1998, a tetravalent prototype vaccine had been made that proved safe and immunogenic in Phase 1 trials in adults and toddlers in Finland. The planned next step, to test the vaccine in Asia in infants, did not meet approval by the local authorities in Vietnam nor later in the Philippines and the project eventually stopped.
The Dutch DNC member, the National Institute of Public Health and the Environment (RIVM) learned important lessons, which subsequently were applied in a following vaccine technology transfer project, resulting in the availability at affordable prices for the developing world of a conjugate vaccine against Haemophilus influenzae type b. We conclude that vaccine development in the public domain with technology transfer as its ultimate aim requires major front-end funding, committed leadership at the highest institutional level sustained for many years and a competent recipient-manufacturer, which needs to be involved at a very early stage of the development.
At the national level, RIVM’s policy to consolidate its national manufacturing task through securing a key global health position in support of a network of public vaccine manufacturers proved insufficiently supported by the relevant ministries of the Dutch government. Difficulties to keep up with high costs, high-risk innovative vaccine development and production in a public sector setting led to the gradual loss of production tasks and to the 2009 Government decision to privatize the vaccine production tasks of the Institute.

Intervention – Journal of Mental Health and Psychological Support in Conflict Affected Areas
July 2016 – Volume 14 – Issue 2 pp: 96-186
http://journals.lww.com/interventionjnl/pages/currenttoc.aspx

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Current affairs
Syria: the challenges of parenting in refugee situations of immediate displacement
El-Khani, Aala; Ulph, Fiona; Peters, Sarah;
Abstract
The way parents care for their children during displacement plays a key role in children’s emotional and behavioural outcomes. Yet, sparse literature exists regarding the parenting challenges faced by families fleeing conflict in transitional, pre-resettlement stages. This study, therefore, aimed to identify the parenting experiences of Syrian families living in refugee camps, focusing on understanding how their parenting had changed and the impact displacement had had on their parenting. Methods used included: interviews and focus groups discussions with 27 mothers living in refugee contexts, two interviews with professional aid workers, with the data analysed using thematic analysis. Data were structured in three themes; 1) environmental challenges; 2) child specific challenges; and 3) parent specific challenges. Results clearly showed that parents struggled physically and emotionally to support their children. Such challenges could be addressed by parenting interventions to reduce the trauma impact experienced by children.

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Being a refugee in Turkey and western Europe: how it affects mental health and psychosocial wellbeing
Anonymous
Abstract
In this personal reflection, the author is a Syrian refugee who describes his experiences as a psychosocial worker in Syria and with refugees in Turkey and Greece. He highlights how women and children lack safety in the camps. The second section discusses how he became a refugee himself. Due to his experiences in Syria, he now finds himself in a difficult situation in the Netherlands, the county where he applied for asylum and has received a permit, but his ‘cry for help’ remains unheard and unrecognised by the (health) workers in the asylum centre.

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Articles
Psychosocial support among refugees of conflict in developing countries: a critical literature review
Alfadhli, Khalifah; Drury, John
Abstract
The aim of this paper is to examine the psychosocial needs and stressors among refugees of conflicts within developing countries, and their group based, social support mechanisms. Systematic literature searches of peer reviewed journal articles (n = 60 articles) were carried out using the following factors: type (refugee); cause (conflicts); location (developing countries). As refugees move towards a prolonged urban displacement phase, needs and stressors became different than those of the acute phase. While daily stressors affect far more people than posttraumatic stress disorder, many psychosocial support interventions focus only on the latter. Positive effects of social support on the mental health of displaced people have been established, while the process is not yet clear, group processes and identities appear to be important. The authors suggest, therefore, that a social identity approach can be applied to understand the emergence of a common refugee identity, and its role in empowerment through activating social support networks.

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Psychological interventions for children and young people affected by armed conflict or political violence: a systematic literature review
O’Sullivan, Clodagh; Bosqui, Tania; Shannon, Ciaran
Abstract
Youths exposed to armed conflict have a higher prevalence of mental health and psychosocial difficulties. Diverse interventions exist that aim to ameliorate the effect of armed conflict on the psychological and psychosocial wellbeing of conflict affected youths. However, the evidence base for the effectiveness of these interventions is limited. Using standard review methodology, this review aims to address the effectiveness of psychological interventions employed among this population. The search was performed across four databases and grey literature. Article quality was assessed using the Downs and Black Quality Checklist (1998). Where possible, studies were subjected to meta-analyses. The remaining studies were included in a narrative synthesis. Eight studies concerned non clinical populations, while nine concerned clinical populations. Review findings conclude that Group Trauma Focused–Cognitive Behavioural Therapy is effective for reducing symptoms of posttraumatic stress disorder, anxiety, depression and improving prosocial behaviour among clinical cohorts. The evidence does not suggest that interventions aimed at non clinical groups within this population are effective. Despite high quality studies, further robust trials are required to strengthen the evidence base, as a lack of replication has resulted in a limited evidence base to inform practice.

JAMA Pediatrics
July 2016, Vol 170, No. 7
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint
Real-Time Sharing of Zika Virus Data in an Interconnected World FREE
Esper G. Kallas, MD, PhD; David H. O’Connor, PhD

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Viewpoint
Leveraging Behavioral Insights to Promote Vaccine Acceptance: One Year After Disneyland
Alison M. Buttenheim, PhD, MBA; David A. Asch, MD, MBA
Extract
This Viewpoint discusses several approaches to increase vaccination acceptance in the United States 1 year after the measles outbreak that originated in Disneyland and has been attributed to parents who chose not to vaccinate their children.

An outbreak of measles originating in Disneyland in December 2014 that ultimately led to more than 100 cases has been attributed to parents who chose not to vaccinate their children. One year later, the United States remains vulnerable to outbreaks of vaccine-preventable diseases because parents continue to bypass the recommended childhood immunization schedule through exemptions from state-mandated immunizations at school entry. These personal choices affect everyone by weakening the herd immunity conferred by widespread vaccination…

Journal of Epidemiology & Community Health
July 2016, Volume 70, Issue 7
http://jech.bmj.com/content/current
Health inequalities
Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010
Yannan Hu, Frank J van Lenthe, Gerard J Borsboom, Caspar W N Looman, Matthias Bopp, Bo Burström, Dagmar Dzúrová, Ola Ekholm, Jurate Klumbiene, Eero Lahelma, Mall Leinsalu, Enrique Regidor, Paula Santana, Rianne de Gelder, Johan P Mackenbach
J Epidemiol Community Health 2016;70:644-652 Published Online First: 19 January 2016 doi:10.1136/jech-2015-206780
Abstract
Background Between the 1990s and 2000s, relative inequalities in all-cause mortality increased, whereas absolute inequalities decreased in many European countries. Whether similar trends can be observed for inequalities in other health outcomes is unknown. This paper aims to provide a comprehensive overview of trends in socioeconomic inequalities in self-assessed health (SAH) in Europe between 1990 and 2010.
Methods Data were obtained from nationally representative surveys from 17 European countries for the various years between 1990 and 2010. The age-standardised prevalence of less-than-good SAH was analysed by education and occupation among men and women aged 30–79 years. Socioeconomic inequalities were measured by means of absolute rate differences and relative rate ratios. Meta-analysis with random-effects models was used to examine the trends of inequalities.
Results We observed declining trends in the prevalence of less-than-good SAH in many countries, particularly in Southern and Eastern Europe and the Baltic states. In all countries, less-than-good SAH was more prevalent in lower educational and manual groups. For all countries together, absolute inequalities in SAH were mostly constant, whereas relative inequalities increased. Almost no country consistently experienced a significant decline in either absolute or relative inequalities.
Conclusions Trends in inequalities in SAH in Europe were generally less favourable than those found for inequalities in mortality, and there was generally no correspondence between the two when we compared the trends within countries. In order to develop policies or interventions that effectively reduce inequalities in SAH, a better understanding of the causes of these inequalities is needed.

Journal of Medical Ethics
July 2016, Volume 42, Issue 7
http://jme.bmj.com/content/current

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The concise argument
Medical involvement in torture today?
Kenneth Boyd
J Med Ethics 2016;42:411-412 doi:10.1136/medethics-2016-103737
[Extract]
In the ethics classroom, medical involvement in torture is often discussed in terms of what happens or has happened elsewhere, in some imagined country far away, under a military dictatorship for example, or historically in Nazi Germany or Stalin’s Russia. In these contexts, at a distance in space or time, the healthcare professional’s moral dilemma can be clearly demonstrated. On the one hand, any involvement whatever in the practice of torture, countenancing or condoning as well as participating, is forbidden, formally by the World Medical Association 1957 Declaration of Tokyo, but more generally by the professional duty to do no harm. On the other hand, the professional duty of care, and more generally human decency and compassion, forbids standing idly by when no other professional with comparable skills is available to relieve the suffering of victims of torture. In such circumstances, the health professional’s impulse to exercise their duty of care, albeit thereby implicitly countenancing or condoning torture, may be strengthened by the knowledge that to refuse may put their own life or that of a member of their family in danger. But then again, they may also be all too aware that in exercising their duty of care they may simply be ‘patching up’ the victims in order for them to be tortured again.
Ethics classroom discussion of medical involvement in torture can be a productive way of exercising moral imagination in seeking possible ways of resolving or ameliorating apparently intractable moral dilemmas. In discussing such moral dilemmas, moral imagination can a.lso be exercised, and may be enlarged, by trying to understand these dilemmas from the poi

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Asylum
Are healthcare professionals working in Australia’s immigration detention centres condoning torture?
David Isaacs
J Med Ethics 2016;42:413-415 Published Online First: 23 December 2015 doi:10.1136/medethics-2015-103066
Abstract
Australian immigration detention centres are in secluded locations, some on offshore islands, and are subject to extreme secrecy, comparable with ‘black sites’ elsewhere. There are parallels between healthcare professionals working in immigration detention centres and healthcare professionals involved with or complicit in torture. In both cases, healthcare professionals are conflicted between a duty of care to improve the health of patients and the interests of the government. While this duality of interests has been recognised previously, the full implications for healthcare professionals working in immigration detention have not been addressed. The Australian Government maintains that immigration detention is needed for security checks, but the average duration of immigration detention has increased from 10 weeks to 14 months, and detainees are not informed of the progress of their application for refugee status. Long-term immigration detention causes major mental health problems, is illegal in international law and arguably fulfils the recognised definition of torture. It is generally accepted that healthcare professionals should not participate in or condone torture. Australian healthcare professionals thus face a major ethical dilemma: patients in immigration detention have pressing mental and physical health needs, but providing healthcare might support or represent complicity in a practice that is unethical. Individual healthcare professionals need to decide whether or not to work in immigration detention centres. If they do so, they need to decide for how long and to what extent restrictive contracts and gagging laws will constrain them from advocating for closing detention centres.

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Commentary: The clinician and detention
Howard Goldenberg
J Med Ethics 2016;42:416-417 Published Online First: 28 January 2016 doi:10.1136/medethics-2016-103371

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Commentary: Torture, healthcare and Australian immigration detention
Ryan Essex
J Med Ethics 2016;42:418-419 Published Online First: 22 February 2016 doi:10.1136/medethics-2016-103387

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Paper: Is Australia engaged in torturing asylum seekers? A cautionary tale for Europe
John-Paul Sanggaran,
Deborah Zion
J Med Ethics 2016;42:420-423 Published Online First: 22 June 2016 doi:10.1136/medethics-2015-103326
Abstract
Australian immigration detention has been identified as perpetuating ongoing human rights violations. Concern has been heightened by the assessment of clinicians involved and by the United Nations that this treatment may in fact constitute torture. We discuss the allegations of torture within immigration detention, and the reasons why healthcare providers have an ethical duty to report them. Finally, we will discuss the protective power of ratifying the Optional Protocol to the Convention against Torture and other Cruel, Inhuman or Degrading Treatment or Punishment as a means of providing transparency and ethical guidance.