Should I stay or should I go? The decision to flee or stay home during civil war

The literature on forced migration reveals a linkage between conflict-related violence and displacement. However, it often neglects the potential that variable forms of violence have differential impacts on the decision to flee violence. Moreover, there is a mobility bias in the empirical literature, whereby analyses often focus upon individuals that leave their homes, neglecting to assess factors influencing decisions to remain at home during conflict. To address these dynamics, we focus upon Lebanon, which experienced a civil war between 1975 and 1990. We leverage a survey of 2,400 Lebanese residents who lived through the civil war. Our analyses suggest different forms of violence play distinct roles in the decisions taken by individuals who remained at home, those that fled internally, and those that fled abroad as refugees

Government Targeting of Refugees in the Midst of Epidemics

We investigate how the outbreak of epidemics can affect host governments’ targeting of refugees and violation of their physical integrity rights. We argue that governments target repression against refugees for two reasons. First, refugees are easily scapegoated for the arrival of epidemics at a time when governments are looking to shift the blame for their own poor performance. Second, crises provide circumstances for governments to engage in opportunistic repression to further their goal of coercing existing refugees to depart and deterring new refugees from arriving. Drawing upon a global dataset of countries for the years 1996 to 2015, we demonstrate that epidemic outbreaks do indeed increase the likelihood and scale of government repression targeting refugee populations. These effects are especially pronounced in countries with higher proportions of refugees hosted and in less democratic countries. Identification of this potential for government repression of refugees during epidemics is important in light of the grave scale of the ongoing COVID-19 pandemic. Our findings suggest the international community should be vigilant for signs of governments’ mistreatment of vulnerable refugee populations to shift focus away from their own poor handling of crises such as the ongoing COVID-19 pandemic and opportunistically advance their goal of reducing the numbers of refugees hosted locally

Kanuka honey versus aciclovir for the topical treatment of herpes simplex labialis : a randomised controlled trial

Objective To compare New Zealand medical grade kanuka honey with topical aciclovir for the treatment of herpes simplex labialis. Design Prospective parallel randomised controlled open-label superiority trial. Setting 76 community pharmacies across New Zealand between 10 September 2015 and 13 December 2017. Participants 952 adults randomised within the first 72 hours of a herpes simplex labialis episode. Interventions Random assignment 1:1 to either 5% aciclovir cream or medical grade kanuka honey (90%)/glycerine (10%) cream, both applied five times daily. Outcome measures The primary outcome was time from randomisation to return to normal skin (stage 7). Secondary outcomes included time from randomisation to stage 4 (open wound), time from stage 4 to 7, maximal pain, time to pain resolution and treatment acceptability. Results Primary outcome variable: Kaplan-Meier-based estimates (95% CI) for the median time in days for return to normal skin were 8 (8 to 9) days for aciclovir and 9 (8 to 9) for honey; HR (95% CI) 1.06 (0.92 to 1.22), p=0.56. There were no statistically significant differences between treatments for all secondary outcome variables. No related serious adverse events were reported. Conclusion There was no evidence of a difference in efficacy between topical medical grade kanuka honey and 5% aciclovir in the pharmacy-based treatment of herpes simplex labialis

ICS-formoterol reliever therapy stepwise treatment algorithm for adult asthma

--

Cohort feasibility study of an intermittent pneumatic compression device within a below-knee cast for the prevention of venous thromboembolism

OBJECTIVES: To determine the likely enrolment rate of eligible participants into a randomised controlled trial (RCT) in which a within-cast intermittent pneumatic compression device using Jet Impulse Technology (IPC/JIT) is 1 of 3 possible interventions in a RCT for the prevention of venous thromboembolism (VTE) in the clinical setting of isolated lower limb cast immobilisation. DESIGN: A prospective, open-label feasibility study of the IPC/JIT device placed within a lower limb cast. SETTING: Wellington Regional Hospital Fracture Clinic.PARTICIPANTS: Individuals aged 18-70 who presented with a lower limb injury requiring a minimum of 4 weeks below-knee cast immobilisation. INTERVENTION: Placement of an IPC/JIT device within lower limb cast. OUTCOME MEASURES: The main outcome measure was the proportion of eligible participants who participated in the feasibility study. Secondary outcome measures included adherence to device usage throughout the study, ease of application of the device and adverse events potentially associated with its use. RESULTS: The proportion of potentially eligible participants for the IPC/JIT device was only 7/142 (5%), 95% CI 2 to 9.9. Devices were used for a mean (range) of 4.1 (1.9 to 10.2) hours per day and none of 7 participants had adequate adherence to the device. 3 of the 7 participants suffered an adverse event, including 1 deep vein thrombosis, 2 dorsal foot ulcer and 1 skin maceration. CONCLUSIONS: A within-cast IPC/JIT device is unlikely to be a feasible randomisation arm for a RCT assessing possible interventions for the reduction of VTE risk in the clinical setting of lower limb injury requiring below knee cast immobilisation for a minimum of 4 weeks

Cohort feasibility study of an intermittent pneumatic compression device within a below-knee cast for the prevention of venous thromboembolism

OBJECTIVES: To determine the likely enrolment rate of eligible participants into a randomised controlled trial (RCT) in which a within-cast intermittent pneumatic compression device using Jet Impulse Technology (IPC/JIT) is 1 of 3 possible interventions in a RCT for the prevention of venous thromboembolism (VTE) in the clinical setting of isolated lower limb cast immobilisation. DESIGN: A prospective, open-label feasibility study of the IPC/JIT device placed within a lower limb cast. SETTING: Wellington Regional Hospital Fracture Clinic.PARTICIPANTS: Individuals aged 18-70 who presented with a lower limb injury requiring a minimum of 4 weeks below-knee cast immobilisation. INTERVENTION: Placement of an IPC/JIT device within lower limb cast. OUTCOME MEASURES: The main outcome measure was the proportion of eligible participants who participated in the feasibility study. Secondary outcome measures included adherence to device usage throughout the study, ease of application of the device and adverse events potentially associated with its use. RESULTS: The proportion of potentially eligible participants for the IPC/JIT device was only 7/142 (5%), 95% CI 2 to 9.9. Devices were used for a mean (range) of 4.1 (1.9 to 10.2) hours per day and none of 7 participants had adequate adherence to the device. 3 of the 7 participants suffered an adverse event, including 1 deep vein thrombosis, 2 dorsal foot ulcer and 1 skin maceration. CONCLUSIONS: A within-cast IPC/JIT device is unlikely to be a feasible randomisation arm for a RCT assessing possible interventions for the reduction of VTE risk in the clinical setting of lower limb injury requiring below knee cast immobilisation for a minimum of 4 weeks

The Journey Home: Violence, Anchoring, and Refugee Decisions to Return

While the UNHCR promotes voluntary repatriation as the preferred solution to refugee situations, there is little understanding of variation in refugees’ preferences regarding return. We develop a theoretical framework suggesting two mechanisms influencing refugees’ preferences. First, refugees’ lived experiences in their country of origin prior to displacement and in their new host country create a trade-off in feelings of being anchored to their origin or host country. Second, firsthand exposure to traumas of war provides some refugees with a sense of competency and self-efficacy, leading them to prefer to return home. We test these relationships with data from a survey among Syrian refugees hosted in Lebanon. We find refugees exposed to violence during the war have a sense of attachment to Syria and are most likely to prefer return. Refugees who have developed a detachment from Syria or an attachment to Lebanon are less likely to prefer return

How big is your bubble? : characteristics of self-isolating household units ('bubbles') during the COVID-19 Alert Level 4 period in New Zealand : a cross-sectional survey

Objective To characterise the self-isolating household units (bubbles) during the COVID-19 Alert Level 4 lockdown in New Zealand. Design, setting and participants In this cross-sectional study, an online survey was distributed to a convenience sample via Facebook advertising and the Medical Research Institute of New Zealand's social media platforms and mailing list. Respondents were able to share a link to the survey via their own social media platforms and by email. Results were collected over 6 days during Alert Level 4 from respondents living in New Zealand, aged 16 years and over. Main outcomes measures The primary outcome was the mean size of a self-isolating household unit or bubble. Secondary outcomes included the mean number of households in each bubble, the proportion of bubbles containing essential workers and/or vulnerable people, and the mean number of times the home was left each week. Results 14 876 surveys were included in the analysis. The mean (SD) bubble size was 3.58 (4.63) people, with mean (SD) number of households 1.26 (0.77). The proportion of bubbles containing one or more essential workers, or one or more vulnerable persons was 45.3% and 42.1%, respectively. The mean number of times individual bubble members left their home in the previous week was 12.9 (12.4). Bubbles that contained at least one vulnerable individual had fewer outings over the previous week compared with bubbles that did not contain a vulnerable person. The bubble sizes were similar by respondent ethnicity. Conclusion In this New Zealand convenience sample, bubble sizes were small, mostly limited to one household, and a high proportion contained essential workers and/or vulnerable people. Understanding these characteristics from a country which achieved a low COVID-19 infection rate may help inform public health interventions during this and future pandemics

RCT of the effect of berryfruit polyphenolic cultivar extract in mild steroid-naive asthma : a cross-over, placebo-controlled study

Objective: There is preclinical evidence that consumption of berryfruit extract may reduce chronic airways inflammation and modify airway remodelling in allergen-induced models of lung inflammation. We investigated the effect of berryfruit extract on the fractional expired nitric oxide (FeNO), a biomarker of eosinophilic airways inflammation, in adults with steroid-naïve asthma. Design: Randomised placebo-controlled cross-over double-blind trial. Setting: Single-centre community-based trial. Participants: 28 steroid-naïve mild asthmatics with FeNO >40 ppb, of whom 25 completed both study interventions. Interventions: Participants were randomised to receive, according to the cross-over design, 100 mg berryfruit polyphenolic extract (BFPE) or placebo for 4 weeks, with a 4-week washout period between the interventions. Primary outcome measure: The primary outcome variable was FeNO at 4 weeks, analysed by a mixed linear model, with a random effect for participant and baseline FeNo as a covariate. Results: The mean (SD) natural logarithm transformed (ln) FeNO after 4 weeks of treatment for the BFPE and placebo groups was 4.28 (0.47) and 4.22 (0.47), respectively. The paired change from baseline mean (SD) BFPE minus placebo ln FeNO was -0.03 (0.39), N=25. The mixed linear model estimate, with baseline covariate adjustment, difference in ln FeNO, was -0.002 (95% CI -0.15 to 0.14), p=0.98. This is equivalent to a ratio of geometric mean FeNO of 1.0 (95% CI 0.86 to 1.15). Conclusions: In steroid-naïve participants with mild asthma and elevated FeNO, there was no effect of BFPE on FeNO, a biomarker of eosinophilic airways inflammation. Caution is required in the extrapolation of apparent benefit in murine models of lung eosinophilia to clinical efficacy in patients with asthma