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1.
Sara E Casey Sarah K Chynoweth Nadine Cornier Meghan C Gallagher Erin E Wheeler 《Conflict and health》2015,9(Z1):S3
Background
Reproductive health (RH) care is an essential component of humanitarian response. Women and girls living in humanitarian settings often face high maternal mortality and are vulnerable to unwanted pregnancy, unsafe abortion, and sexual violence. This study explored the availability and quality of, and access barriers to RH services in three humanitarian settings in Burkina Faso, Democratic Republic of the Congo (DRC), and South Sudan.Methods
Data collection was conducted between July and October 2013. In total, 63 purposively selected health facilities were assessed: 28 in Burkina Faso, 25 in DRC, and nine in South Sudan, and 42 providers completed a questionnaire to assess RH knowledge and attitudes. Thirty-four focus group discussions were conducted with 29 members of the host communities and 273 displaced married and unmarried women and men to understand access barriers.Results
All facilities reported providing some RH services in the prior three months. Five health facilities in Burkina Faso, six in DRC, and none in South Sudan met the criteria as a family planning service delivery point. Two health facilities in Burkina Faso, one in DRC, and two in South Sudan met the criteria as an emergency obstetric and newborn care service delivery point. Across settings, three facilities in DRC adequately provided selected elements of clinical management of rape. Safe abortion was unavailable. Many providers lacked essential knowledge and skills. Focus groups revealed limited knowledge of available RH services and socio-cultural barriers to accessing them, although participants reported a remarkable increase in use of facility-based delivery services.Conclusion
Although RH services are being provided, the availability of good quality RH services was inconsistent across settings. Commodity management and security must be prioritized to ensure consistent availability of essential supplies. It is critical to improve the attitudes, managerial and technical capacity of providers to ensure that RH services are delivered respectfully and efficiently. In addition to ensuring systematic implementation of good quality RH services, humanitarian health actors should meaningfully engage crisis-affected communities in RH programming to increase understanding and use of this life-saving care.2.
Objectives
The aim of the current study was to examine the influence of socioeconomic status (SES) on physiological (lipid profile, obesity indices) and behavioral (dietary habits, physical activity) cardiovascular disease (CVD) risk factors among primary schoolchildren in Istanbul.Design
Cross sectional study.Setting
One private school and two public schools from different SES districts in Istanbul.Participants
510 randomly selected children aged 12 and 13 years old (257 boys, 253 girls).Results
The prevalence of overweight (15.2%) and the energy intake (p < 0.001 and p < 0.05 for boys and girls respectively) were found to be higher for the middle/ high SES group for both genders. Regarding biochemical indices, middle/ high SES children had higher values of High Density Lipoprotein-cholesterol (HDL-C) (p < 0.001 and p < 0.05 for boys and girls respectively) and lower values of TC/HDL-C ratio and LDL-C/HDL-C ratio (p < 0.05 and p < 0.001 for boys and girls respectively). This could be attributed to the higher physical activity levels observed for middle/ high SES children (p < 0.001).Conclusion
The findings of the current study revealed a coexistence of both overweight and higher energy intake in middle/ high SES children, as well as a coexistence of underweight and lower physical activity levels in low SES children. These observations should guide the public health policy in developing appropriate intervention strategies to efficiently tackle these health and social issues early in life.3.
Background
Temperament has been associated with child anxiety in a number of studies; however, research examining possible mechanisms of effect using longitudinal designs is scarce.Objective
This study tested a theoretically-derived model of anxiety development spanning infancy (6 months) to early childhood (approximately 72 months) that includes temperamental reactivity (i.e., behavioral inhibition), temperamental self-regulation (i.e., effortful control), and gender.Methods
Data used in this study were collected in phase I and phase II from 1226 children and their caregivers by the National Institute of Child Health and Human Development for their prospective, longitudinal Study of Early Child Care and Youth Development. Structural equation modeling procedures were used to test whether effortful control mediated the relation between behavioral inhibition and anxiety and whether such mediation varied by gender.Results
Results provided support for the model, suggesting that one mechanism linking the modest association between behavioral inhibition in infancy to anxiety symptoms in early childhood is through diminished effortful control. Further, moderated mediation analyses indicated that this mechanism was apparent only for girls.Conclusions
Modulation of temperamental reactivity via effortful control may be a protective factor in the translation of early behavioral inhibition to childhood anxiety for girls.4.
Background
Over 40% of all deaths among children under 5 are neonatal deaths (0–28 days), and this proportion is increasing. In 2012, 2.9 million newborns died, with 99% occurring in low- and middle-income countries. Many of the countries with the highest neonatal mortality rates globally are currently or have recently been affected by complex humanitarian emergencies. Despite the global burden of neonatal morbidity and mortality and risks inherent in complex emergency situations, research investments are not commensurate to burden and little is known about the epidemiology or best practices for neonatal survival in these settings.Methods
We used the Child Health and Nutrition Research Initiative (CHNRI) methodology to prioritize research questions on neonatal health in complex humanitarian emergencies. Experts evaluated 35 questions using four criteria (answerability, feasibility, relevance, equity) with three subcomponents per criterion. Using SAS 9.2, a research prioritization score (RPS) and average expert agreement score (AEA) were calculated for each question.Results
Twenty-eight experts evaluated all 35 questions. RPS ranged from 0.846 to 0.679 and the AEA ranged from 0.667 to 0.411. The top ten research priorities covered a range of issues but generally fell into two categories– epidemiologic and programmatic components of neonatal health. The highest ranked question in this survey was “What strategies are effective in increasing demand for, and use of skilled attendance?”Conclusions
In this study, a diverse group of experts used the CHRNI methodology to systematically identify and determine research priorities for neonatal health and survival in complex humanitarian emergencies. The priorities included the need to better understand the magnitude of the disease burden and interventions to improve neonatal health in complex humanitarian emergencies. The findings from this study will provide guidance to researchers and program implementers in neonatal and complex humanitarian fields to engage on the research priorities needed to save lives most at risk.5.
6.
Parent F Kahombo G Bapitani J Garant M Coppieters Y Levêque A Piette D 《Human resources for health》2004,2(1):16
Background
The problem of training human resources in health is a real concern in public health in Central Africa. What can be changed in order to train more competent health professionals? This is of utmost importance in primary health care.Methods
Taking into account the level of training of secondary-level nurses in the Democratic Republic of the Congo (DRC), a systemic approach, based on the PRECEDE PROCEED model of analysis, led to a better understanding of the educational determinants and of the factors favourable to a better match between training in health sciences and the expected competences of the health professionals. This article must be read on two complementary levels: one reading, focused on the methodological process, should allow our findings to be transferred to other problems (adaptation of a health promotion model to the educational sphere). The other reading, revolving around the specific theme and results, should provide a frame of reference and specific avenues for action to improve human resources in the health field (using the results of its application in health science teaching in the DRC).Results
The results show that it is important to start this training with a global and integrated approach shared by all the actors. The strategies of action entail the need for an approach taking into account all the aspects, i.e. sociological, educational, medical and public health.Conclusions
The analysis of the results shows that one cannot bring any change without integrated strategies of action and a multidisciplinary approach that includes all the complex determinants of health behaviour, and to do it within the organization of local structures and institutions in the ministry of health in the DRC.7.
Margaret L. Schmitt David Clatworthy Ruwan Ratnayake Nicole Klaesener-Metzner Elizabeth Roesch Erin Wheeler Marni Sommer 《Conflict and health》2017,11(1):19
Background
There is a significant gap in empirical evidence on the menstrual hygiene management (MHM) challenges faced by adolescent girls and women in emergency contexts, and on appropriate humanitarian response approaches to meet their needs in diverse emergency contexts. To begin filling the gap in the evidence, we conducted a study in two diverse contexts (Myanmar and Lebanon), exploring the MHM barriers facing girls and women, and the various relevant sectoral responses being conducted (e.g. water, sanitation and hygiene (WASH), Protection, Health, Education and Camp Management).Methods
Two qualitative assessments were conducted: one in camps for internally displaced populations in Myanmar, and one with refugees living in informal settlements and host communities in Lebanon. Key informant interviews were conducted with emergency response staff in both sites, and focus group discussion and participatory mapping activities conducted with adolescent girls and women.Results
Key findings included that there was insufficient access to safe and private facilities for MHM coupled with displacement induced shifts in menstrual practices by girls and women. Among staff, there was a narrow interpretation of what an MHM response includes, with a focus on supplies; significant interest in understanding what an improved MHM response would include and acknowledgement of limited existing MHM guidance across various sectors; and insufficient consultation with beneficiaries, related to discomfort asking about menstruation, and limited coordination between sectors.Conclusions
There is a significant need for improved guidance across all relevant sectors for improving MHM response in emergency context, along with increased evidence on effective approaches for integrating MHM into existing responses.8.
Background
A lack of access to sexual and reproductive health (SRH) care is the leading cause of morbidity and mortality among displaced women and girls of reproductive age. Efforts to address this public health emergency in humanitarian settings have included the widespread delivery of training programmes to address gaps in health worker capacity for SRH. There remains a lack of data on the factors which may affect the ability of health workers to apply SRH knowledge and skills gained through training programmes in humanitarian contexts.Methods
We searched four electronic databases and ten key organizations’ websites to locate literature on SRH training for humanitarian settings in low and lower-middle income countries. Papers were examined using content analysis to identify factors which contribute to health workers’ capacity to transfer SRH knowledge, skills and attitudes learned in training into practice in humanitarian settings.Results
Seven studies were included in this review. Six research papers focused on the response stage of humanitarian crises and five papers featured the disaster context of conflict. A range of SRH components were addressed including maternal, newborn health and sexual violence. The review identified factors, including appropriate resourcing, organisational support and confidence in health care workers that were found to facilitate the transfer of learning. The findings suggest the presence of factors that moderate the transfer of training at the individual, training, organisational, socio-cultural, political and health system levels.Conclusion
Supportive strategies are necessary to best assist trainees to apply newly acquired knowledge and skills in their work settings. These interventions must address factors that moderate the success of learning transfer. Findings from this review suggest that these are related to the individual trainee, the training program itself and the workplace as well as the broader environmental context. Organisations which provide SRH training for humanitarian emergencies should work to identify the system of moderating factors that affect training transfer in their setting and employ evidence-based strategies to ameliorate these.9.
Rose Bernard G. Bowsher C. Milner P. Boyle P. Patel R. Sullivan 《Zeitschrift fur Gesundheitswissenschaften》2018,26(5):509-514
Purpose
Open Source Intelligence (OSINT) and Signals Intelligence (SIGINT) from the clandestine intelligence sector are being increasingly employed in infectious disease outbreaks. The purpose of this article is to explore how such tools might be employed in the detection, reporting, and control of outbreaks designated as a ‘threat’ by the global community. It is also intended to analyse previous use of such tools during the Ebola and SARS epidemics and to discuss key questions regarding the ethics and legality of initiatives that further blur the military and humanitarian spaces.Methods
We undertake qualitative analysis of current discussions on OSINT and SIGINT and their intersection with global health. We also review current literature and describe the debates. We built on quantitative and qualitative research done into current health collection capabilities.Results
This article presents an argument for the use of OSINT in the detection of infectious disease outbreaks and how this might occur.Conclusion
We conclude that there is a place for OSINT and SIGINT in the detection and reporting of outbreaks. However, such tools are not sufficient on their own and must be corroborated for the intelligence to be relevant and actionable. Finally, we conclude that further discussion on key ethical issues needs to take place before such research can continue. In particular, this involves questions of jurisdiction, data ownership, and ethical considerations.10.
Background
Until now, the relations between the working alliance and trauma-related symptoms have received little or no study in residential-care settings. However, considering the high prevalence of past experiences of interpersonal trauma among young people in residential centers, it is essential to examine this issue more closely.Objective
This study aimed to determine to what extent the strength of the working alliance, as reported by adolescent girls in residential centers and their counselors, is associated with the trauma-related symptoms that these girls reported subsequently, in emerging adulthood.Methods
The sample consisted of 130 adolescent girls placed in residential center. Trauma-related symptoms were measured at intake and approximately 4 years later, when all the girls were out of the center. Working alliance was measured 3 months after the start of the placement. Hierarchical multiple regressions were performed to determine the strength of the relationships between the working alliance during treatment and trauma-related symptoms in emerging adulthood.Results
Findings showed that even after controlling for intake symptoms, the strength of the working alliance reported by the girls has modest, yet significant, negative associations with several trauma-related symptoms in emerging adulthood. The stronger the alliance the girls reported, the less they reported symptoms of depression, post-traumatic stress and externalization.Conclusions
Results suggest that a strong working alliance with adolescent girls may contribute to their recovery as it was associated with less trauma-related symptoms. Further research is needed to investigate the mechanisms and underlying factors explaining this relationship at short, medium and long term.11.
Naser Morina Simon M. Ewers Sandra Passardi Ulrich Schnyder Christine Knaevelsrud Julia Müller Richard A. Bryant Angela Nickerson Matthis Schick 《Conflict and health》2017,11(1):18
Background
Mental health problems resulting from persecution and forced migration are very common among refugees and asylum seekers and evolve into a major public health challenge in hosting societies. Language barriers often prevent timely access to appropriate health care, leading to chronic trajectories and abortive social integration. Tools for multilingual screening and assessment could be of great benefit for this particularly vulnerable population as well as for policy makers. This study aimed at testing the reliability, feasibility and usability of the Multi-Adaptive Psychological Screening Software (MAPSS), a newly developed Audio Computer-Assisted Self-Interview Software (ACASI) for touchscreen devices, for screening purposes in a clinical setting.Methods
In a randomized cross-over design including both MAPSS and paper-pencil clinician-administered interviews, 30 treatment-seeking refugees completed clinical measures and a feasibility questionnaire to rate the user interface of MAPSS. Five professionals performed given tasks in MAPSS and completed usability questionnaires for the administration interface.Results
Results showed no differences between the two assessment modalities with regard to symptom scores. The findings suggest good feasibility and usability of MAPSS in traumatized refugees. The administration via MAPSS was significantly shorter than the paper-pencil interview.Conclusion
MAPSS may be a cost-effective, flexible and valid alternative to interpreter-based psychometric screening and assessment.12.
Tony Akilimali Shindano Jeff Maotela Kabinda Patrick Mitashi Yves Horsmans 《Zeitschrift fur Gesundheitswissenschaften》2018,26(5):595-603
Aims
The Democratic Republic of Congo (DRC) is a country with a high endemicity of hepatitis B virus (HBV) even if no national survey of prevalence has been performed. Data are based on extrapolations or limited studies. This review aimed to summarize all information about HBV infection in DRC during the period 2000–2016 to provide refined estimates and contribute to a better knowledge of its epidemiology.Subject and methods
We conducted a systematic search in electronic databases of all prevalence studies published between January 1st, 2000 and September 30th, 2016. Additional data from manual search or gray literature were also considered. We included only moderate or high quality studies using the JBI’ tools for qualitative evaluation of researches. HBsAg prevalence was estimated at 95% confidence interval (CI) as result of simple pooling analysis.Results
Twenty-eight studies were included with data providing from 154,926 subjects: in the majority of these studies (18 out of 28), results were obtained from blood donors. The estimated HBsAg prevalence was 4.9% (95% CI 4.2–5.0). The prevalence was estimated at 5.0% (95% CI 4.9–5.1) in blood donors and at 5.0% (95% CI 3.0–5.9) in pregnant women.Conclusion
This review suggests that DRC is a country characterized by an intermediate level of HBV infection endemicity rate. It remains however an important public health problem and efforts should continue in prevention and in policy to control this viral disease.13.
Background
Children’s bullying involvement may arise from biases and deficiencies in social information processing, and it is important to consider cognitive and emotional aspects of bullying because social cognition is an important aspect of children’s social skills and their ability to get along with others. It is also important to understand how children see things from others’ point-of-view.Objective
The study examined whether empathic concern, perspective-taking, attitude towards bullying, and Theory-of-Mind were associated with non-physical form of bully perpetration and victimization in diverse sample of middle school students.Method
Participants included 310 students (grades 6–7) from a small, Midwestern town who completed a 45-min survey encompassing demographic questions and self-report measures of bullying, victimization, empathic concern, perspective-taking, and positive attitude towards bullying. Vignettes were also used to assess students’ Theory-of-Mind.Results
Non-physical bully perpetration was higher for African American students. We also found that students’ perspective-taking was negatively associated with non-physical bully perpetration, while positive attitude towards bullying was positively associated with non-physical bully perpetration.Conclusion
The findings suggest empathy and understanding of how youth see things from others’ point-of-view may be important factor in bullying.14.
Background
There has been increasing focus on tackling the growing burden of non-communicable diseases (NCD) in crisis settings. The complex and protracted crisis in Syria is unfolding against a background of increasing NCD burden. This study investigated factors influencing implementation of NCD healthcare in Syria.Methods
This is a qualitative study, whereby semi-structured interviews were conducted with fourteen humanitarian health staff working on NCD healthcare in Syria.Results
Challenges to NCD care implementation were reflected at several stages, from planning services through to healthcare delivery. There was a lack of information on unmet population need; little consensus among humanitarian actors regarding an appropriate health service package; and no clear approach for prioritising public health interventions. The main challenges to service delivery identified by participants were conflict-related insecurity and disruption to infrastructure, hampering continuity of chronic illness care. Collaboration was a key factor which influenced implementation at all stages.Conclusions
The historical context, the conflict situation, and the characteristics of health actors and their relationships, all impacted provision of NCD care. These factors influenced each other, so that the social views and values (of individuals and organisations), as well as politics and relationships, interacted with the physical environment and security situation. Infrastructure damage has implications for wider healthcare across Syria, and NCD care requires an innovative approach to improve continuity of care. There is a need for a transparent approach to resource allocation, which may be generalisable to the wider humanitarian health sector.15.
Background
Menarche is a milestone for adolescent girls. The timing of menarche is influenced by genetics, social status and nutritional status (e.g., height, weight and body mass index [BMI]) and impacts future health (e.g., obesity and breast cancer). There have been many studies on trends in age at menarche among adolescent girls in China, but few have investigated associations between growth status and the timing of menarche. This study examined the association between age at menarche and growth status among adolescent girls in Western China.Methods
The participants in this cross sectional study came from three geographical regions of Shaanxi Province. A total of 533 adolescent girls from urban and rural areas were randomly selected. Trained investigators administered a standard questionnaire to each participant during a face-to-face interview and carried out anthropometric measurements.Results
The average age at menarche was 13.3 years. There were statistically significant differences in BMI z-scores between pre-menarcheal and post-menarcheal girls of the same age and these differences were related to socioeconomic factors. Girls who had reached menarche, in particular those aged 13–14 years, were significantly taller (P?<?0.01) and had higher BMI (P?<?0.01) than girls in the same age group who had not reached menarche.Conclusions
BMI is associated with the timing of menarche but socioeconomic factors are also important.16.
Objective
In a pilot single centre study we found that treatment of undernourished older, community dwelling people for one year with oral testosterone (placebo-controlled) and a nutritional supplement (no control) was associated with a significant reduction in hospitalizations. A larger, multicentre study was conducted to investigate further this potentially important finding.Design
One year, randomized, placebo-controlled, multicentre, double-blind, trial.Setting
Community.Participants
53 undernourished men and women aged 65 years and older.Intervention
Oral testosterone undecanoate (40 mg/day women, 160 mg/day men) and high energy oral nutritional supplement (2108-2416 kJ/day) or placebo medication and low energy (142–191 kJ/day) “placebo” oral nutritional supplementation.Measurements
Hospital admissions, falls and other variables were assessed.Results
53 subjects were recruited (64% male and mean age 77 years), which was substantially less than planned. Sixteen subjects (30%) were admitted to hospital at least once, with a total of 29 admissions. Eight subjects (32%) in the placebo arm were admitted to hospital, whilst in the intervention group also there were eight (29%) subjects admitted to hospital during the study period. There was no difference in the number of hospitalisations (P = 0.842), length of hospitalization (P=0.645) or quality of life [mental health P=0.195 and physical health P=0.451) between the treatment arms.Conclusions
In undernourished older people, treatment with testosterone and a nutritional supplementation did not reduce the number and length of hospitalisations or improve quality of life.17.
Anita L. Hansen G. Ambroziak D. Thornton L. Dahl B. Grung 《The journal of nutrition, health & aging》2018,22(4):513-518
Objectives
To investigate the effect of a long-term fatty fish intervention on a pure cognitive mechanism important for self-regulation and mental health, i.e. working memory (WM), controlling for age and IQ.Design
A randomized controlled trial.Setting
A forensic facility.Participants
Eighty-four young to middle aged male forensic inpatients with psychiatric disorders.Intervention
Consumption of farmed salmon or control meal (meat) three times a week during 23 weeks.Measurement
Performance on WM tasks, both accuracy and mean reaction time, were recorded pre and post intervention.Results
Performance on a cognitive functioning tasks taxing WM seemed to be explained by age and IQ.Conclusion
Fatty fish consumption did not improve WM performance in a group of young to middle aged adults with mental health problems, as less impressionable factors such as aging and intelligence seemed to be the key components. The present study improves the knowledge concerning the interaction among nutrition, health and the aging process.18.
Sílvia Fraga Elisabete Ramos Henrique Barros 《Zeitschrift fur Gesundheitswissenschaften》2016,24(6):461-468
Aim
We aimed to assess the contribution of early characteristics in adolescence as associated factors of later involvement in physical fighting.Subject and methods
Based on data from a cohort of adolescents, we evaluated 1,687 participants, recruited in public and private schools in Porto, Portugal. Information on social and behavioural characteristics was collected using the same self-administered questions at 13 and 17 years of age. Logistic regression was used to estimate the magnitude of associations.Results
In both genders, physical fighting was significantly associated with living in a sole parent family, in particular only with the mother, and with early grade retention. Also, early cigarette smoking and alcohol drinking initiation were significantly associated with later involvement in fights.Conclusion
Our results show that family characteristics and modifiable behavioural trajectories are important determinants of later involvement in physical fighting.19.
Michael Baiocchi Benjamin Omondi Nickson Langat Derek B. Boothroyd Jake Sinclair Lee Pavia Munyae Mulinge Oscar Githua Neville H. Golden Clea Sarnquist 《Prevention science》2017,18(7):818-827
Design
The study’s design was a cluster-randomized, matched-pairs, parallel trial of a behavior-based sexual assault prevention intervention in the informal settlements.Methods
The participants were primary school girls aged 10–16. Classroom-based interventions for girls and boys were delivered by instructors from the same settlements, at the same time, over six 2-h sessions. The girls’ program had components of empowerment, gender relations, and self-defense. The boys’ program promotes healthy gender norms. The control arm of the study received a health and hygiene curriculum. The primary outcome was the rate of sexual assault in the prior 12 months at the cluster level (school level). Secondary outcomes included the generalized self-efficacy scale, the distribution of number of times victims were sexually assaulted in the prior period, skills used, disclosure rates, and distribution of perpetrators. Difference-in-differences estimates are reported with bootstrapped confidence intervals.Results
Fourteen schools with 3147 girls from the intervention group and 14 schools with 2539 girls from the control group were included in the analysis. We estimate a 3.7 % decrease, p?=?0.03 and 95 % CI?=?(0.4, 8.0), in risk of sexual assault in the intervention group due to the intervention (initially 7.3 % at baseline). We estimate an increase in mean generalized self-efficacy score of 0.19 (baseline average 3.1, on a 1–4 scale), p?=?0.0004 and 95 % CI?=?(0.08, 0.39).Interpretation
This innovative intervention that combined parallel training for young adolescent girls and boys in school settings showed significant reduction in the rate of sexual assault among girls in this population.20.
Jenni?Lehtisalo J.?Lindstr?m T.?Ngandu M.?Kivipelto S.?Ahtiluoto P.?Ilanne-Parikka S.?Kein?nen-Kiukaanniemi J.?G.?Eriksson J.?Tuomilehto J.?Luchsinger For The Finnish Diabetes Prevention Study 《The journal of nutrition, health & aging》2016,20(2):146-154