JAMA Pediatrics
February 2016, Vol 170, No. 2
http://archpedi.jamanetwork.com/issue.aspx

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Children Exposed to Abuse in Youth-Serving Organizations: Results From National Sample Surveys
FREE ONLINE ONLY
Anne Shattuck, PhD; David Finkelhor, PhD; Heather Turner, PhD; Sherry Hamby, PhD
Abstract
Importance
Protecting children in youth-serving organizations is a national concern.
Objective
To provide clinicians, policymakers, and parents with estimates of children’s exposure to abuse in youth-serving organizations.
Design, Setting, and Participants
Telephone survey data from the 3 National Surveys of Children’s Exposure to Violence (2008, 2011, and 2014) were combined to create a sample of 13 052 children and youths aged 0 to 17 years. The survey participants included youths aged 10 to 17 years and caregivers of children aged 0 to 9 years.
Main Outcomes and Measures
Items from the Juvenile Victimization Questionnaire.
Results In the combined sample of 13 052 children and youths aged 0 to 17 years, the rate of abuse by persons in youth-serving organizations was 0.4% (95% CI, 0.2-0.7) for the past year and 0.8% (95% CI, 0.5-1.1) over the lifetime. Most of the maltreatment (63.2%) was verbal abuse and only 6.4% was any form of sexual violence or assault.
Conclusions and Relevance
Abuse in youth-serving organizations was a relatively rare form of abuse, dwarfed by abuse by family members and other adults.

JAMA Pediatrics
February 2016, Vol 170, No. 2
http://archpedi.jamanetwork.com/issue.aspx

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Viewpoint
Sepsis and the Global Burden of Disease in Children
Niranjan Kissoon, MD, FRCPC; Timothy M. Uyeki, MD, MPH, MPP
Initial text
This Viewpoint discusses the impact of sepsis on childhood mortality worldwide.
In 2010, an estimated 25% of disability-adjusted life-years—a metric that incorporates premature death by years of life lost and years lived with disability—and 13% of all deaths worldwide were in children younger than 5 years.1,2 While reductions in mortality in children younger than 5 years have occurred in many countries since 1990, mortality increased in young children in some parts of sub-Saharan Africa, with severe infections leading to sepsis being a major contributor.1 For instance, in the neonatal period, diarrhea, lower respiratory tract infections, and meningitis were important contributors to mortality in 2010, while in the postneonatal period, nearly 1 million estimated deaths (half of all deaths) were due to lower respiratory tract infections (respiratory syncytial virus, Haemophilus influenzae type B, Streptococcus pneumoniae), diarrheal diseases (rotavirus, Cryptosporidium), and malaria.2 Other infectious causes of death in children younger than 5 years were measles, pertussis, and human immunodeficiency virus/AIDS. We suggest that sepsis-related pediatric deaths are substantially underestimated and that efforts are needed to better assess the impact of sepsis on childhood mortality worldwide…

Journal of Medical Ethics
February 2016, Volume 42, Issue 2
http://jme.bmj.com/content/current

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Research ethics
Paper: Obtaining informed consent for genomics research in Africa: analysis of H3Africa consent documents
Nchangwi Syntia Munung, Patricia Marshall, Megan Campbell, Katherine Littler, Francis Masiye,
Odile Ouwe-Missi-Oukem-Boyer, Janet Seeley, D J Stein, Paulina Tindana, Jantina de Vries
J Med Ethics 2016;42:132-137 Published Online First: 7 December 2015 doi:10.1136/medethics-2015-102796
Abstract
Background
The rise in genomic and biobanking research worldwide has led to the development of different informed consent models for use in such research. This study analyses consent documents used by investigators in the H3Africa (Human Heredity and Health in Africa) Consortium.
Methods
A qualitative method for text analysis was used to analyse consent documents used in the collection of samples and data in H3Africa projects. Thematic domains included type of consent model, explanations of genetics/genomics, data sharing and feedback of test results.
Results
Informed consent documents for 13 of the 19 H3Africa projects were analysed. Seven projects used broad consent, five projects used tiered consent and one used specific consent. Genetics was mostly explained in terms of inherited characteristics, heredity and health, genes and disease causation, or disease susceptibility. Only one project made provisions for the feedback of individual genetic results.
Conclusion
H3Africa research makes use of three consent models—specific, tiered and broad consent. We outlined different strategies used by H3Africa investigators to explain concepts in genomics to potential research participants. To further ensure that the decision to participate in genomic research is informed and meaningful, we recommend that innovative approaches to the informed consent process be developed, preferably in consultation with research participants, research ethics committees and researchers in Africa.

The Lancet
Feb 06, 2016 Volume 387 Number 10018 p505-618 e13-e19
http://www.thelancet.com/journals/lancet/issue/current

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Series
Ending preventable stillbirths
Stillbirths: progress and unfinished business
J Frederik Frøen, Ingrid K Friberg, Joy E Lawn, Zulfiqar A Bhutta, Robert C Pattinson, Emma R Allanson, Vicki Flenady, Elizabeth M McClure, Lynne Franco, Robert L Goldenberg, Mary V Kinney, Susannah Hopkins Leisher, Catherine Pitt, Monir Islam, Ajay Khera, Lakhbir Dhaliwal, Neelam Aggarwal, Neena Raina, Marleen Temmerman, The Lancet Ending Preventable Stillbirths Series study group
Summary
This first paper of the Lancet Series on ending preventable stillbirths reviews progress in essential areas, identified in the 2011 call to action for stillbirth prevention, to inform the integrated post-2015 agenda for maternal and newborn health. Worldwide attention to babies who die in stillbirth is rapidly increasing, from integration within the new Global Strategy for Women’s, Children’s and Adolescents’ Health, to country policies inspired by the Every Newborn Action Plan. Supportive new guidance and metrics including stillbirth as a core health indicator and measure of quality of care are emerging. Prenatal health is a crucial biological foundation to life-long health. A key priority is to integrate action for prenatal health within the continuum of care for maternal and newborn health. Still, specific actions for stillbirths are needed for advocacy, policy formulation, monitoring, and research, including improvement in the dearth of data for effective coverage of proven interventions for prenatal survival. Strong leadership is needed worldwide and in countries. Institutions with a mandate to lead global efforts for mothers and their babies must assert their leadership to reduce stillbirths by promoting healthy and safe pregnancies.

Ending preventable stillbirths
Stillbirths: rates, risk factors, and acceleration towards 2030
Joy E Lawn, Hannah Blencowe, Peter Waiswa, Agbessi Amouzou, Colin Mathers, Dan Hogan, Vicki Flenady, J Frederik Frøen, Zeshan U Qureshi, Claire Calderwood, Suhail Shiekh, Fiorella Bianchi Jassir, Danzhen You, Elizabeth M McClure, Matthews Mathai, Simon Cousens, Lancet Ending Preventable Stillbirths Series study group, The Lancet Stillbirth Epidemiology investigator group
Summary
An estimated 2·6 million third trimester stillbirths occurred in 2015 (uncertainty range 2·4–3·0 million). The number of stillbirths has reduced more slowly than has maternal mortality or mortality in children younger than 5 years, which were explicitly targeted in the Millennium Development Goals. The Every Newborn Action Plan has the target of 12 or fewer stillbirths per 1000 births in every country by 2030. 94 mainly high-income countries and upper middle-income countries have already met this target, although with noticeable disparities. At least 56 countries, particularly in Africa and in areas affected by conflict, will have to more than double present progress to reach this target. Most (98%) stillbirths are in low-income and middle-income countries. Improved care at birth is essential to prevent 1·3 million (uncertainty range 1·2–1·6 million) intrapartum stillbirths, end preventable maternal and neonatal deaths, and improve child development. Estimates for stillbirth causation are impeded by various classification systems, but for 18 countries with reliable data, congenital abnormalities account for a median of only 7·4% of stillbirths. Many disorders associated with stillbirths are potentially modifiable and often coexist, such as maternal infections (population attributable fraction: malaria 8·0% and syphilis 7·7%), non-communicable diseases, nutrition and lifestyle factors (each about 10%), and maternal age older than 35 years (6·7%). Prolonged pregnancies contribute to 14·0% of stillbirths. Causal pathways for stillbirth frequently involve impaired placental function, either with fetal growth restriction or preterm labour, or both. Two-thirds of newborns have their births registered. However, less than 5% of neonatal deaths and even fewer stillbirths have death registration. Records and registrations of all births, stillbirths, neonatal, and maternal deaths in a health facility would substantially increase data availability. Improved data alone will not save lives but provide a way to target interventions to reach more than 7000 women every day worldwide who experience the reality of stillbirth.

Ending preventable stillbirths
Stillbirths: economic and psychosocial consequences
Alexander E P Heazell, Dimitrios Siassakos, Hannah Blencowe, Christy Burden, Zulfiqar A Bhutta, Joanne Cacciatore, Nghia Dang, Jai Das, Vicki Flenady, Katherine J Gold, Olivia K Mensah, Joseph Millum, Daniel Nuzum, Keelin O’Donoghue, Maggie Redshaw, Arjumand Rizvi, Tracy Roberts, H E Toyin Saraki, Claire Storey, Aleena M Wojcieszek, Soo Downe, The Lancet Ending Preventable Stillbirths Series study group, The Lancet Ending Preventable Stillbirths investigator group
Summary
Despite the frequency of stillbirths, the subsequent implications are overlooked and underappreciated. We present findings from comprehensive, systematic literature reviews, and new analyses of published and unpublished data, to establish the effect of stillbirth on parents, families, health-care providers, and societies worldwide. Data for direct costs of this event are sparse but suggest that a stillbirth needs more resources than a livebirth, both in the perinatal period and in additional surveillance during subsequent pregnancies. Indirect and intangible costs of stillbirth are extensive and are usually met by families alone. This issue is particularly onerous for those with few resources. Negative effects, particularly on parental mental health, might be moderated by empathic attitudes of care providers and tailored interventions. The value of the baby, as well as the associated costs for parents, families, care providers, communities, and society, should be considered to prevent stillbirths and reduce associated morbidity.

The Lancet Infectious Diseases
Feb 2016 Volume 16 Number 2 p131-264 e10-e21
http://www.thelancet.com/journals/laninf/issue/current

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Editorial
Guinea worm disease nears eradication
The Lancet Infectious Diseases
DOI: http://dx.doi.org/10.1016/S1473-3099(16)00020-7
Summary
Only two infectious diseases have ever been eradicated: smallpox, of which the last naturally transmitted case occurred in 1977, and rinderpest, a disease of cattle and related ungulates, officially declared eradicated in 2011. This year might see a remarkable doubling in the list of eradicated diseases, with both polio (about which we wrote in the August, 2015, issue) and guinea worm no longer being naturally transmitted.

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Comment
Long-term protectiveness of BCG
Giovanni Sotgiu, Giovanni Battista Migliori
Published Online: 18 November 2015
DOI: http://dx.doi.org/10.1016/S1473-3099(15)00414-4
Summary
WHO has launched the End TB Strategy, which contains several elements supporting tuberculosis elimination.1–3 Pillar 1 consists of two tuberculosis prevention interventions: first, diagnosis and treatment of latent tuberculosis infection and, second, vaccination. A new, more effective vaccine is expected by 2025,2 but in the meantime, we still rely on BCG, which is more than a century old.4 Epidemiological studies of the BCG vaccine carried out in the past were not designed to provide high-quality evidence in the way that we define it today (ie, multicentre, randomised, double-blind, placebo-controlled clinical trials).

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Articles
Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: a retrospective population-based cohort study
Patrick Nguipdop-Djomo, Einar Heldal, Laura Cunha Rodrigues, Ibrahim Abubakar, Punam Mangtani
Summary
Background
Little is known about how long the BCG vaccine protects against tuberculosis. We assessed the long-term vaccine effectiveness (VE) in Norwegian-born individuals.
Methods
In this retrospective population-based cohort study, we studied Norwegian-born individuals aged 12–50 years who were tuberculin skin test (TST) negative and eligible for BCG vaccination as part of the last round of Norway’s mandatory mass tuberculosis screening and BCG vaccination programme between 1962 and 1975. We excluded individuals who had tuberculosis before or in the year of screening and those with unknown TST and BCG status. We obtained TST and BCG information and linked it to the National Tuberculosis Register, population and housing censuses, and the population register for emigrations and deaths. We followed individuals up to their first tuberculosis episode, emigration, death, or Dec 31, 2011. We used Cox regressions to estimate VE against all tuberculosis and just pulmonary tuberculosis by time since vaccination, adjusted for age, time, county-level tuberculosis rates, and demographic and socioeconomic indicators.
Findings
Median follow-up was 41 years (IQR 32–49) for 83 421 BCG-unvaccinated and 44 years (41–46) for 297 905 vaccinated individuals, with 260 tuberculosis episodes. Tuberculosis rates were 3·3 per 100 000 person-years in unvaccinated and 1·3 per 100 000 person-years in vaccinated individuals. The adjusted average VE during 40 year follow-up was 49% (95% CI 26–65), although after 20 years, the VE was not significant (up to 9 years VE [excluding tuberculosis episodes in the first 2 years] 61% [95% CI 24–80]; 10–19 years 58% [27–76]; 20–29 years 38% [–32 to 71]; 30–40 years 42% [–24 to 73]). VE against pulmonary tuberculosis up to 9 years (excluding tuberculosis episodes in the first 2 years) was 67% (95% CI 27–85), 10–19 years was 63% (32–80), 20–29 years was 50% (−19 to 79), and 30–40 years was 40% (−46 to 76).
Interpretation
Findings are consistent with long-lasting BCG protection, but waning of VE with time. The vaccine could be more cost effective than has been previously estimated
Funding
Norwegian Institute of Public Health and London School of Hygiene & Tropical Medicine.

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Personal View
Interventions to reduce zoonotic and pandemic risks from avian influenza in Asia
J S Malik Peiris, Benjamin J Cowling, Joseph T Wu, Luzhao Feng, Yi Guan, Hongjie Yu, Gabriel M Leung

Ebola: lessons learned and future challenges for Europe
GianLuca Quaglio, Charles Goerens, Giovanni Putoto, Paul Rübig, Pierre Lafaye, Theodoros Karapiperis, Claudio Dario, Paul Delaunois, Rony Zachariah

Maternal and Child Health Journal
Volume 20, Issue 2, February 2016
http://link.springer.com/journal/10995/20/2/page/1

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Original Paper
Assessing the Continuum of Care Pathway for Maternal Health in South Asia and Sub-Saharan Africa
Kavita Singh, William T. Story, Allisyn C. Moran
Abstract
Objective
We assess how countries in regions of the world where maternal mortality is highest—South Asia and Sub-Saharan Africa—are performing with regards to providing women with vital elements of the continuum of care.
Methods
Using recent Demographic and Health Survey data from nine countries including 18,036 women, descriptive and multilevel regression analyses were conducted on four key elements of the continuum of care—at least one antenatal care visit, four or more antenatal care visits, delivery with a skilled birth attendant and postnatal checks for the mother within the first 24 h since birth. Family planning counseling within a year of birth was also included in the descriptive analyses.
Results
Results indicated that a major drop-out (>50 %) occurs early on in the continuum of care between the first antenatal care visit and four or more antenatal care visits. Few women (<5 %) who do not receive any antenatal care go on to have a skilled delivery or receive postnatal care. Women who receive some or all the elements of the continuum of care have greater autonomy and are richer and more educated than women who receive none of the elements.
Conclusion
Understanding where drop-out occurs and who drops out can enable countries to better target interventions. Four or more ANC visits plays a pivotal role within the continuum of care and warrants more programmatic attention. Strategies to ensure that vital services are available to all women are essential in efforts to improve maternal health.

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Original Paper
Differences in Human Papillomavirus Vaccination Among Adolescent Girls in Metropolitan Versus Non-metropolitan Areas: Considering the Moderating Roles of Maternal Socioeconomic Status and Health Care Access
Shannon M. Monnat, Danielle C. Rhubart…
Abstract
Objectives This study is among the first to examine metropolitan status differences in human papillomavirus (HPV) vaccine initiation and completion among United States adolescent girls and is unique in its focus on how maternal socioeconomic status and health care access moderate metropolitan status differences in HPV vaccination. Methods Using cross-sectional data from 3573 girls aged 12–17 in the U.S. from the 2008–2010 Behavioral Risk Factor Surveillance System, we estimate main and interaction effects from binary logistic regression models to identify subgroups of girls for which there are metropolitan versus non-metropolitan differences in HPV vaccination. Results Overall 34 % of girls initiated vaccination, and 19 % completed all three shots. On average, there were no metropolitan status differences in vaccination odds. However, there were important subgroup differences. Among low-income girls and girls whose mothers did not complete high school, those in non-metropolitan areas had significantly higher probability of vaccine initiation than those in metropolitan areas. Among high-income girls and girls whose mothers completed college, those in metropolitan areas had significantly higher odds of vaccine initiation than those in non-metropolitan areas. Moreover, among girls whose mothers experienced a medical cost barrier, non-metropolitan girls were less likely to initiate vaccination compared to metropolitan girls. Conclusions Mothers remain essential targets for public health efforts to increase HPV vaccination and combat cervical cancer. Public health experts who study barriers to HPV vaccination and physicians who come into contact with mothers should be aware of group-specific barriers to vaccination and employ more tailored efforts to increase vaccination.

Nonprofit and Voluntary Sector Quarterly
February 2016; 45 (1)
http://nvs.sagepub.com/content/current

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Articles
Episodic Volunteering and Retention – An Integrated Theoretical Approach
Melissa K. Hyde1,2; Jeff Dunn1,2,3; Caitlin Bax4; Suzanne K. Chambers1,2,3,5,6
1Griffith Health Institute, Griffith University, Gold Coast, Queensland, Australia
2Cancer Council Queensland, Spring Hill, Australia
3School of Social Science, University of Queensland, St. Lucia, Australia
4School of Applied Psychology, Griffith University, Mt. Gravatt, Queensland, Australia
5Prostate Cancer Foundation of Australia, St. Leonards, New South Wales, Australia
6Health and Wellness Institute Edith Cowan University, Perth, Western Australia, Australia
Melissa K. Hyde, Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland 4222, Australia. Email: melissa.hyde@griffith.edu.au
Abstract
Episodic volunteers (EVs) are vital for non-profit organization activities. However, theory-based research on episodic volunteering is scant and the determinants of episodic volunteering are not well understood. This study integrates the volunteer process model and three-stage model of volunteers’ duration of service to explore determinants of EV retention. A cross-sectional survey of 340 EVs assessed volunteering antecedents, experiences, and retention. Social/enjoyment (β = .17) and benefit (β = −.15) motives, social norm (β = .20), and satisfaction (β = .56) predicted Novice EV (first experience) retention; satisfaction (β = .47) and commitment (β = .38) predicted Transition EV (2-4 years intermittently) retention; and supporting the organization financially (β = .31), social norm (β = .18), satisfaction (β = .41), and commitment (β = .19) predicted Sustained EV (5-6 years consecutively) retention. Integrated theoretical approaches appear efficacious for understanding EV retention. An Episodic Volunteer Engagement and Retention model is proposed for further testing in prospective work.

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Systematic Review
Nonprofit Organizations Becoming Business-Like
Florentine Maier1; Michael Meyer1; Martin Steinbereithner1
1WU Vienna University of Economics and Business, Austria
Florentine Maier, WU Vienna University of Economics and Business, Welthandelsplatz 1, Vienna 1020, Austria. Email: florentine.maier@wu.ac.at
Abstract
By now, the becoming business-like of nonprofit organizations (NPOs) is a well-established global phenomenon that has received ever-growing attention from management and organization studies. However, the field remains hard to grasp in its entirety, as researchers use a multitude of similar, yet distinct, key concepts. The considerable range and complexity of these overlapping notions create major challenges: Scholars struggle to position their work in a larger context; it is not easy to build on previous findings and methodological developments; and research gaps are difficult to identify. The present article presents the first systematic literature review to confront those challenges by reviewing 599 relevant sources. In a first step, various key concepts are clarified. Second, the field is mapped according to three research foci: causes of NPOs becoming business-like, organizational structures and processes of becoming business-like, and effects of becoming business-like. From this, we draw conclusions and make suggestions for further research.

PLoS Currents: Outbreaks
http://currents.plos.org/outbreaks/
(Accessed 6 February 2016)

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Residency Training at the Front of the West African Ebola Outbreak: Adapting for a Rare Opportunity
February 2, 2016 · Discussion
Medical trainees face multiple barriers to participation in major outbreak responses such as that required for Ebola Virus Disease through 2014-2015 in West Africa. Hurdles include fear of contracting and importing the disease, residency requirements, scheduling conflicts, family obligations and lack of experience and maturity. We describe the successful four-week deployment to Liberia of a first year infectious diseases trainee through the mechanism of the Global Outbreak Alert and Response Network of the World Health Organization. The posting received prospective approval from the residency supervisory committees and employing hospital management and was designed with components fulfilling the Accreditation Council for Graduate Medical Education (ACGME) core competencies. It mirrored conventional training with regards to learning objectives, supervisory framework and assessment methods. Together with Centers for Disease Control and Prevention and many other partners, the team joined the infection prevention and control efforts in Monrovia. Contributions were made to a ‘ring fencing’ infection control approach that was being introduced, including enhancement of triage, training and providing supplies in high priority health-care facilities in the capital and border zones. In addition the fellow produced an electronic database that enabled monitoring infection control standards in health facilities. This successful elective posting illustrates that quality training can be achieved, even in the most challenging environments, with support from the pedagogic and sponsoring institutions. Such experiential learning opportunities benefit both the outbreak response and the trainee, and if scaled up would contribute towards building a global health emergency workforce. More should be done from residency accreditation bodies in facilitating postings in outbreak settings.

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Epidemiology of Chikungunya Virus in Bahia, Brazil, 2014-2015
February 1, 2016 · Discussion
Chikungunya is an emerging arbovirus that is characterized into four lineages. One of these, the Asian genotype, has spread rapidly in the Americas after its introduction in the Saint Martin island in October 2013. Unexpectedly, a new lineage, the East-Central-South African genotype, was introduced from Angola in the end of May 2014 in Feira de Santana (FSA), the second largest city in Bahia state, Brazil, where over 5,500 cases have now been reported. Number weekly cases of clinically confirmed CHIKV in FSA were analysed alongside with urban district of residence of CHIKV cases reported between June 2014 and October collected from the municipality’s surveillance network. The number of cases per week from June 2014 until September 2015 reveals two distinct transmission waves. The first wave ignited in June and transmission ceased by December 2014. However, a second transmission wave started in January and peaked in May 2015, 8 months after the first wave peak, and this time in phase with Dengue virus and Zika virus transmission, which ceased when minimum temperature dropped to approximately 15°C. We find that shorter travelling times from the district where the outbreak first emerged to other urban districts of FSA were strongly associated with incidence in each district in 2014 (R2).

PNAS – Proceedings of the National Academy of Sciences of the United States of America
http://www.pnas.org/content/early/
(Accessed 6 February 2016)

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Social Sciences – Sustainability Science – Biological Sciences – Sustainability Science:
Policy impacts of ecosystem services knowledge
Stephen M. Posnera,b,1, Emily McKenziec,d,e, and Taylor H. Rickettsa,b
Author Affiliations
Significance
Our study introduces a conceptual framework and empirical approach to explore how knowledge impacts decision-making. We illustrate this approach with knowledge about ecosystem services (ES), but the approach itself can be applied broadly. Our results indicate that the legitimacy of knowledge (i.e., perceived as unbiased and representative of multiple points of view) is of paramount importance for impact. More surprisingly, we found that credibility of knowledge is not a significant predictor of impact. To enhance legitimacy, ES researchers must engage meaningfully with decision-makers and stakeholders in processes of knowledge coproduction that incorporate diverse perspectives transparently. Our results indicate how research can be designed and carried out to maximize the potential impact on real-world decisions.
Abstract
Research about ecosystem services (ES) often aims to generate knowledge that influences policies and institutions for conservation and human development. However, we have limited understanding of how decision-makers use ES knowledge or what factors facilitate use. Here we address this gap and report on, to our knowledge, the first quantitative analysis of the factors and conditions that explain the policy impact of ES knowledge. We analyze a global sample of cases where similar ES knowledge was generated and applied to decision-making. We first test whether attributes of ES knowledge themselves predict different measures of impact on decisions. We find that legitimacy of knowledge is more often associated with impact than either the credibility or salience of the knowledge. We also examine whether predictor variables related to the science-to-policy process and the contextual conditions of a case are significant in predicting impact. Our findings indicate that, although many factors are important, attributes of the knowledge and aspects of the science-to-policy process that enhance legitimacy best explain the impact of ES science on decision-making. Our results are consistent with both theory and previous qualitative assessments in suggesting that the attributes and perceptions of scientific knowledge and process within which knowledge is coproduced are important determinants of whether that knowledge leads to action.

Prehospital & Disaster Medicine
Volume 31 – Issue 01 – February 2016
https://journals.cambridge.org/action/displayIssue?jid=PDM&tab=currentissue

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Original Research
Developing a Performance Assessment Framework and Indicators for Communicable Disease Management in Natural Disasters
Javad Babaie, Ali Ardalan, Hasan Vatandoost, Mohammad Mehdi Goya and Ali Akbarisari
Prehospital and Disaster Medicine / Volume 31 / Issue 01 / February 2016, pp 27 – 35
Abstract
Introduction
Communicable disease management (CDM) is an important component of disaster public health response operations. However, there is a lack of any performance assessment (PA) framework and related indicators for the PA. This study aimed to develop a PA framework and indicators in CDM in disasters.
Methods
In this study, a series of methods were used. First, a systematic literature review (SLR) was performed in order to extract the existing PA frameworks and indicators. Then, using a qualitative approach, some interviews with purposively selected experts were conducted and used in developing the PA framework and indicators. Finally, the analytical hierarchy process (AHP) was used for weighting of the developed indicators.
Results
The input, process, products, and outcomes (IPPO) framework was found to be an appropriate framework for CDM PA. Seven main functions were revealed to CDM during disasters. Forty PA indicators were developed for the four categories.
Conclusion
There is a lack of any existing PA framework in CDM in disasters. Thus, in this study, a PA framework (IPPO framework) was developed for the PA of CDM in disasters through a series of methods. It can be an appropriate framework and its indicators could measure the performance of CDM in disasters.

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Special Reports
Protecting the Health and Well-being of Populations from Disasters: Health and Health Care in The Sendai Framework for Disaster Risk Reduction 2015-2030
Amina Aitsi-Selmi and Virginia Murray
Prehospital and Disaster Medicine / Volume 31 / Issue 01 / February 2016, pp 74 – 78
DOI: http://dx.doi.org/10.1017/S1049023X15005531 Published online: 17 December 2015
Abstract
The Sendai Framework for Disaster Risk Reduction (DRR) 2015-2030 is the first of three United Nations (UN) landmark agreements this year (the other two being the Sustainable Development Goals due in September 2015 and the climate change agreements due in December 2015). It represents a step in the direction of global policy coherence with explicit reference to health, economic development, and climate change. The multiple efforts of the health community in the policy development process, including campaigning for safe schools and hospitals, helped to put people’s mental and physical health, resilience, and well-being higher up the DRR agenda compared with its predecessor, the 2005 Hyogo Framework for Action. This report reflects on these policy developments and their implications and reviews the range of health impacts from disasters; summarizes the widened remit of DRR in the post-2015 world; and finally, presents the science and health calls of the Sendai Framework to be implemented over the next 15 years to reduce disaster losses in lives and livelihoods.

Science
05 February 2016 Vol 351, Issue 6273
http://www.sciencemag.org/current.dtl

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In Depth
Infectious Disease
The race for a Zika vaccine is on
Jon Cohen
Science 05 Feb 2016:
Vol. 351, Issue 6273, pp. 543-544
DOI: 10.1126/science.351.6273.543
Summary
Scientists first isolated Zika virus in 1947, but the disease it caused in humans was considered mild: It did nothing to 80% of the people it infected, and the ones who had symptoms only had temporary fevers and rashes. But last year, a high number of cases of brain-damaging microcephaly in newborns began to surface in Brazil in lockstep with the arrival of the Zika virus, which is spread by mosquitoes. The World Health Organization on 1 February declared these clusters of disease a “public health emergency of international concern,” and a rush of vaccinemakers has jumped into the race to develop a preventive. Vaccines exist against several other flaviviruses, the family Zika belongs to, and experts predict that this won’t be a major scientific challenge. They also say it may be possible to piggyback on the other flavivirus vaccines, like ones made for dengue and yellow fever. Then again, vaccine R&D takes time, and because this effort is starting from scratch, researchers say it will take at least a few years before a vaccine can prove itself safe and effective in large human efficacy studies.

Social Science & Medicine
Volume 150, Pages 1-290 (February 2016)
http://www.sciencedirect.com/science/journal/02779536/150

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Review article
Understanding the role of Indigenous community participation in Indigenous prenatal and infant-toddler health promotion programs in Canada: A realist review
Pages 128-143
Janet Smylie, Maritt Kirst, Kelly McShane, Michelle Firestone, Sara Wolfe, Patricia O’Campo
Abstract
Purpose
Striking disparities in Indigenous maternal-child health outcomes persist in relatively affluent nations such as Canada, despite significant health promotion investments. The aims of this review were two-fold: 1. To identify Indigenous prenatal and infant-toddler health promotion programs in Canada that demonstrate positive impacts on prenatal or child health outcomes. 2. To understand how, why, for which outcomes, and in what contexts Indigenous prenatal and infant-toddler health promotion programs in Canada positively impact Indigenous health and wellbeing.
Methods
We systematically searched computerized databases and identified non-indexed reports using key informants. Included literature evaluated a prenatal or child health promoting program intervention in an Indigenous population in Canada. We used realist methods to investigate how, for whom, and in what circumstances programs worked. We developed and appraised the evidence for a middle range theory of Indigenous community investment-ownership-activation as an explanation for program success.
Findings
Seventeen articles and six reports describing twenty programs met final inclusion criteria. Program evidence of local Indigenous community investment, community perception of the program as intrinsic (mechanism of community ownership) and high levels of sustained community participation and leadership (community activation) was linked to positive program change across a diverse range of outcomes including: birth outcomes; access to pre- and postnatal care; prenatal street drug use; breast-feeding; dental health; infant nutrition; child development; and child exposure to Indigenous languages and culture.
Conclusions
These findings demonstrate Indigenous community investment-ownership-activation as an important pathway for success in Indigenous prenatal and infant-toddler health programs.

Tropical Medicine & International Health
February 2016 Volume 21, Issue 2 Pages 157–291
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2016.21.issue-2/issuetoc

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Original Research Papers
Health status and disease burden of unaccompanied asylum-seeking adolescents in Bielefeld, Germany: cross-sectional pilot study (pages 210–218)
L. Marquardt, A. Krämer, F. Fischer and L. Prüfer-Krämer
Article first published online: 22 DEC 2015 | DOI: 10.1111/tmi.12649
Abstract
Objective
This exploratory pilot study aimed to investigate the physical and mental disease burden of unaccompanied asylum-seeking adolescents arriving in Bielefeld, a medium-size city in Germany.
Methods
A cross-sectional survey with purposive sampling of 102 unaccompanied asylum-seeking adolescents aged 12–18 years was performed. Information on general health status, selected infectious and non-communicable diseases, iron deficiency anaemia and mental illness was collected during routine check-up medical examinations upon arrival in Bielefeld, Germany. The data were analysed using descriptive statistics.
Results
The analysis revealed a complex disease burden with a high prevalence of infections (58.8%), mental illness (13.7%) and iron deficiency anaemia (17.6%) and a very low prevalence of non-communicable diseases (<2.0%). One in five of the refugees were infected with parasites. Whilst sub-Saharan Africans showed the highest prevalence of infections (86.7%), including highest prevalences of parasites (46.7%), West Asians had the highest prevalence of mental disorders (20.0%). Overall, the disease burden in females was higher.
Conclusion
A thorough medical and psychological screening after arrival is highly recommended to reduce the individual disease burden and the risk of infection for others. This promotes good physical and mental health, which is needed for successful integration into the receiving society. Barriers to health service access for unaccompanied asylum-seeking adolescents need to be lowered to allow need-specific health care and prevention.

Tropical Medicine & International Health
February 2016 Volume 21, Issue 2 Pages 157–291
http://onlinelibrary.wiley.com/doi/10.1111/tmi.2016.21.issue-2/issuetoc

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Reviews
Prevalence and causes of hearing impairment in Africa (pages 158–165)
W. Mulwafu, H. Kuper and R. J. H. Ensink
Article first published online: 14 DEC 2015 | DOI: 10.1111/tmi.12640
Abstract
Objective
To systematically assess the data on the prevalence and causes of hearing impairment in Africa.
Methods
Systematic review on the prevalence and causes of hearing loss in Africa. We undertook a literature search of seven electronic databases (EMBASE, PubMed, Medline, Global Health, Web of Knowledge, Academic Search Complete and Africa Wide Information) and manually searched bibliographies of included articles. The search was restricted to population-based studies on hearing impairment in Africa. Data were extracted using a standard protocol.
Results
We identified 232 articles and included 28 articles in the final analysis. The most common cut-offs used for hearing impairment were 25 and 30 dB HL, but this ranged between 15 and 40 dB HL. For a cut-off of 25 dB, the median was 7.7% for the children- or school-based studies and 17% for population-based studies. For a cut-off of 30 dB HL, the median was 6.6% for the children or school-based studies and 31% for population-based studies. In schools for the deaf, the most common cause of hearing impairment was cryptogenic deafness (50%) followed by infectious causes (43%). In mainstream schools and general population, the most common cause of hearing impairment was middle ear disease (36%), followed by undetermined causes (35%) and cerumen impaction (24%).
Conclusion
There are very few population-based studies available to estimate the prevalence of hearing impairment in Africa. Those studies that are available use different cut-offs, making comparison difficult. However, the evidence suggests that the prevalence of hearing impairment is high and that much of it is avoidable or treatable.

The Sentinel

Human Rights Action :: Humanitarian Response :: Health ::
Holistic Development :: Sustainable Resilience
__________________________________________________
Week ending 30 January 2016

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

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

pdf version: The Sentinel_ week ending 30 January 2016

blog edition: comprised of the 35+ entries  posted below on 3 February 2016

WHO statement on the first meeting of the International Health Regulations (2005) (IHR 2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations
WHO statement
1 February 2016

The first meeting of the Emergency Committee (EC) convened by the Director-General under the International Health Regulations (2005) (IHR 2005) regarding clusters of microcephaly cases and other neurologic disorders in some areas affected by Zika virus was held by teleconference on 1 February 2016, from 13:10 to 16:55 Central European Time.

The WHO Secretariat briefed the Committee on the clusters of microcephaly and Guillain-Barré Syndrome (GBS) that have been temporally associated with Zika virus transmission in some settings. The Committee was provided with additional data on the current understanding of the history of Zika virus, its spread, clinical presentation and epidemiology.

The following States Parties provided information on a potential association between microcephaly and/or neurological disorders and Zika virus disease: Brazil, France, United States of America, and El Salvador.

The Committee advised that the recent cluster of microcephaly cases and other neurologic disorders reported in Brazil, following a similar cluster in French Polynesia in 2014, constitutes a Public Health Emergency of International Concern (PHEIC).

The Committee provided the following advice to the Director-General for her consideration to address the PHEIC (clusters of microcephaly and neurologic disorders) and their possible association with Zika virus, in accordance with IHR (2005).

Microcephaly and neurologic disorders
:: Surveillance for microcephaly and GBS should be standardized and enhanced, particularly in areas of known Zika virus transmission and areas at risk of such transmission.
:: Research into the etiology of new clusters of microcephaly and neurologic disorders should be intensified to determine whether there is a causative link to Zika virus and/or other factors or co-factors.

As these clusters have occurred in areas newly infected with Zika virus, and in keeping with good public health practice and the absence of another explanation for these clusters, the Committee highlights the importance of aggressive measures to reduce infection with Zika virus, particularly among pregnant women and women of childbearing age.

As a precautionary measure, the Committee made the following additional recommendations:
Zika virus transmission
:: Surveillance for Zika virus infection should be enhanced, with the dissemination of standard case definitions and diagnostics to at-risk areas.
:: The development of new diagnostics for Zika virus infection should be prioritized to facilitate surveillance and control measures.
:: Risk communications should be enhanced in countries with Zika virus transmission to address population concerns, enhance community engagement, improve reporting, and ensure application of vector control and personal protective measures.
:: Vector control measures and appropriate personal protective measures should be aggressively promoted and implemented to reduce the risk of exposure to Zika virus.
:: Attention should be given to ensuring women of childbearing age and particularly pregnant women have the necessary information and materials to reduce risk of exposure.
:: Pregnant women who have been exposed to Zika virus should be counselled and followed for birth outcomes based on the best available information and national practice and policies.

Longer-term measures
:: Appropriate research and development efforts should be intensified for Zika virus vaccines, therapeutics and diagnostics.
:: In areas of known Zika virus transmission health services should be prepared for potential increases in neurological syndromes and/or congenital malformations.

Travel measures
:: There should be no restrictions on travel or trade with countries, areas and/or territories with Zika virus transmission.
:: Travellers to areas with Zika virus transmission should be provided with up to date advice on potential risks and appropriate measures to reduce the possibility of exposure to mosquito bites.
:: Standard WHO recommendations regarding disinsection of aircraft and airports should be implemented.

Data sharing
:: National authorities should ensure the rapid and timely reporting and sharing of information of public health importance relevant to this PHEIC.
:: Clinical, virologic and epidemiologic data related to the increased rates of microcephaly and/or GBS, and Zika virus transmission, should be rapidly shared with WHO to facilitate international understanding of the these events, to guide international support for control efforts, and to prioritize further research and product development.

Based on this advice the Director-General declared a Public Health Emergency of International Concern (PHEIC) on 1 February 2016. The Director-General endorsed the Committee’s advice and issued them as Temporary Recommendations under IHR (2005). The Director-General thanked the Committee Members and Advisors for their advice.

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List of Members of, and Advisers to, the International Health Regulations (2005) Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations

Life-Saving Aid Still Locked Out of Besieged, Hard-to-Reach Areas in Syria, Top United Nations Humanitarian Official Tells Security Council
Security Council 7612th Meeting (AM)
27 January 2016 SC/12223

Despite repeated calls to the Security Council and the parties to the conflict in Syria, the humanitarian community remained without access to the majority of the estimated 4.6 million people living in besieged or hard-to-reach areas, the senior United Nations humanitarian official said today during a briefing to the 15-member body.

Stephen O’Brien, Under-Secretary-General for Humanitarian Affairs and United Nations Emergency Relief Coordinator, said the continued suffering of the Syrian people could not be blamed on humanitarian organizations and staff, who stood ready to scale up assistance as soon as security conditions and more sustainable access would allow it. Rather, it was the failure of the parties and the international community, all of whom had allowed the conflict to continue for far too long…

Humanitarian missions to that town and to the similarly besieged areas of Zabadani, Foah and Kefraya — undertaken by the United Nations, International Committee of the Red Cross (ICRC) and the Syrian Arab Red Crescent over the last two weeks — had delivered sufficient food, medical and other aid to help more than 60,000 people for one month. However, medical supplies and teams were still urgently needed and humanitarian conditions in those areas remained severe, and the situation in Madaya was only the “tip of the iceberg”.

He went on to say that increasing numbers of people were living in areas that were besieged or hard to reach, and the continuing use of siege and starvation as weapons of war was “reprehensible”. In addition, the indiscriminate use of weapons against civilians, residential areas, aid supply routes, as well as civilian infrastructure protected under international law continued, “outrageously”, with total impunity, he noted, recalling that he had repeatedly asked the Council to demand that the parties to the conflict facilitate unhindered, unconditional and sustained access across Syria.

“But, this is simply not happening,” he continued. In 2015, just over 10 per cent of the 113 requests for interagency convoys had been successful. A further 10 per cent had been approved in principle, but could not proceed due to a lack of final approval, insecurity or lack of agreement on safe passage. Almost 75 per cent of requests had gone unanswered by the Government. “Such inaction is unacceptable for a Member State of the United Nations and a signatory of the United Nations Charter,” he stressed…

World: UN emergency fund releases US$100 million to assist millions of displaced and vulnerable people in nine underfunded crises
(Addis Ababa/New York, 29 January 2016) – United Nations Secretary-General Ban Ki-moon today released US$100 million from the UN Central Emergency Response Fund (CERF) for severely underfunded aid operations in nine neglected emergencies. The funds will enable life-saving help for millions of people forced from their homes in Central and Eastern Africa, those affected by conflict and food insecurity in Libya and Mali, and the most vulnerable and at risk of malnutrition in the Democratic People’s Republic of Korea.

“I am allocating US$100 million from the Central Emergency Response Fund to meet critical humanitarian needs in nine underfunded emergencies,” said the Secretary-General. “This funding is a lifeline for the world’s most vulnerable people. It is a concrete demonstration of our shared commitment to leave no one behind.”

Some $64 million from the CERF allocation will allow humanitarian partners to respond to the displacement crises in Central and Eastern Africa caused by conflict and violence in South Sudan, Burundi and the Democratic Republic of the Congo. Urgently needed funds will help an estimated 1.7 million refugees, internally displaced people and host communities in Burundi ($13 million), Ethiopia ($11 million), Kenya ($4 million), Sudan ($7 million), Tanzania ($11 million), and Uganda ($18 million).

A further $28 million will help relief agencies address the humanitarian needs of up to 350,000 people affected by conflict and food insecurity in Libya ($12 million); and in Mali ($16 million), where an estimated 300,000 people will be assisted, especially in the North.

An allocation of $8 million will support urgent life-saving humanitarian assistance for more than 2.2 million vulnerable people in DPR Korea, including 1.8 million children who need urgent nutrition assistance.

“With so many crises competing for attention around the world many people in need are forgotten. These CERF grants will help sustain life-saving assistance and protection in emergencies where the needs of the most vulnerable communities are alarmingly high but the resources enabling us to respond remain low,” said the Emergency Relief Coordinator, Stephen O’Brien. “I thank our donors for their support to CERF so far in 2016. A strong and well-resourced CERF will help us focus on addressing the most critical needs.”

CERF is one of the fastest and most effective ways to support rapid humanitarian response. The Fund pools donor contributions into a single fund so money is available to start or continue urgent relief work anywhere in the world at the onset of emergencies and for crises that have not attracted sufficient funding. Since 2006, 125 UN Member States and observers, private-sector donors and regional governments have supported the Fund. To date, CERF has allocated almost $4.2 billion for humanitarian operations in 94 countries and territories.

OECD and UNHCR call for scaling up integration policies in favour of refugees
Watch: press conference with OECD Secretary-General Angel Gurría and UN High Commissioner for Refugees Filippo Grandi
28/01/2016 – The heads of the OECD and UNHCR, at a joint high-level Conference on the integration of beneficiaries of international protection in Paris today, have called on governments to scale up their efforts to help refugees integrate and contribute to the societies and economies of Europe.

In 2015, more than 1 million people crossed the Mediterranean Sea to look for international protection in Europe. In total, about 1.5 million claimed asylum in OECD countries in 2015. This is almost twice the number recorded in 2014 and the highest number ever. At the same time, asylum seekers represent only about 0.1% of the total OECD population, and, even in Europe, they represent less than 0.3% of the total EU population.

The OECD and UNHCR stressed not only the moral imperative but also the clear economic incentive to help the millions of refugees living in OECD countries to develop the skills they need to work productively and safely in the jobs of tomorrow.

“Far from a problem, refugees can and should be part of the solution to many of the challenges our societies confront,” said OECD Secretary-General Angel Gurría at the joint Conference in Paris today. “They bring Hope: the hope of a better life and a better future for their children and ours. But to realise this potential, a substantial investment is needed to provide immediate support and help the refugees settle and adapt and develop their skills. It is a difficult and costly task in the short term, with a high pay-off for all in the medium to longer term” he said. “Our analysis demonstrates the benefits that well-managed migration can bring to the economies and societies of OECD countries. But this will largely depend on how well integration measures are designed and implemented. The earlier refugees get the required support, the better their integration prospects” Mr. Gurría added. (Read the full speech here)

“Integration is a dynamic two-way process which requires both the individual and society to make considerable efforts,” UN High Commissioner for Refugees Filippo Grandi said. “In order to play a full role in the social, economic, and cultural life of their host country, refugees need to achieve equality of rights and opportunities. States have an important role in this process, ensuring that refugees play a positive and active part in the integration process, particularly in terms of the services provided to them and in ensuring that they are received by welcoming communities.”

The OECD also released today a report Making Integration Work: Refugees and others in need of protection, which provides the main lessons from the experience of OECD countries in fostering the integration of refugees. The report highlights many good practices to tackle key barriers and support lasting integration of refugees and their children. It stresses the importance of early intervention, including providing access to language courses, employment programmes and integration services as soon as possible, including for asylum seekers with high prospects to remain. It also stresses the need to help migrants settle where jobs are and not necessarily where housing is cheaper. The report also underlines the need to adapt integration programmes to reflect migrants’ diversity in terms of skills and the specific needs of refugees.

UNHCR and partners seek over US$500mill for Nigeria and CAR refugee crises
25 January 2016
UNHCR, the UN Refugee Agency, and its partners on Monday called on donor nations for more than half-a-billion dollars this year to help hundreds of thousands of people forced to flee conflicts in Nigeria and the Central African Republic (CAR) and the host communities providing them with shelter and other basic services.

The two Regional Refugee Response Plans (RRRP), presented at a donor briefing in Yaoundé, Cameroon, include US$198.76 million for 230,000 Nigerian refugees and some 284,300 members of host communities in Niger, Chad and Cameroon as well as US$345.7 million for 476,300 CAR refugees and some 289,000 people hosting them in Chad, Cameroon, Democratic Republic of the Congo (DRC) and Republic of Congo.

Both RRRPs cover needs in sectors such as protection, education, food security, health and nutrition, livelihoods, shelter, basic aid and water, hygiene and sanitation. The CAR appeal is being made by 25 organizations, including UNHCR and other UN agencies as well as NGOs. The Nigeria appeal is made by 28 organizations. UNHCR alone is seeking US$189.54 million under the Central African Republic RRRP and US$62.33 million for the Nigeria one…