Is conflict sensitivity applicable to employment? Business in fragile and conflict-affected settings

"Conflict-sensitivity" is a catchword that addresses business practices in environments of armed conflict. The United Nations Global Compact and international finance institutions are devoting efforts into convincing companies to comply with principles aiming to provide the private sector with a role in peacebuilding. They portray employment creation as a key factor in attracting young people away from joining armed groups. This Working Paper introduces the term "conflict-sensitive employment" in order to shift the focus towards the job-related role of private business in conflict environments. A critical analysis of relevant documents and scholarly debates reveals major dilemmas. The almost complete absence of a regulatory state in the fragile and conflict-affected settings (FCAS) where protracted violence usually occurs contradicts the principle of the rule of law. The profit-orientation of investors and companies venturing into business in FCAS primarily tends to eclipse efforts towards decent employment. Workers may prefer offers provided by the war economy over civilian employment if it does not open up a long-term perspective. The Paper identifies two disparate narratives underlying the debate: The liberal peace ideal with its presumption of a harmonious society informs approaches to assign peacebuilding tasks to the private sector. A political economy perspective reveals that corrupt states and governments are an integral part of political marketplaces organized in the interest of businesspeople and competing powerholders. The tentative result of the analysis is that conflict-sensitive employment may be possible if it pays. Empirical research at the micro-level in FCAS is required to clarify if conflict- sensitivity is a viable approach

Afghanistan's cross-border trade with Pakistan and Iran and the responsibility for conflict-sensitive employment

Border areas are sites of intensive interaction between states and interregional business. Political tensions and armed conflicts have a particularly strong impact on trade flows. In fragile and conflict-affected settings (FCAS), where states have limited power and where the enforcement of laws, rules and regulations is weak, irregular economies tend to thrive along borders, where state officials often deal with border formalities in arbitrary ways. This Working Paper focuses on transporters, i. e. hauliers, as important actors in the border areas between Afghanistan and its neighbours Pakistan and Iran. The transport sector is sensitive to market fluctuations and a volatile business environment, reacting strongly with increasing or declining employment. This study addresses the question of how haulage companies and workers operate in an insecure environment as found in the border areas of FCAS and identifies strategies for conflict-sensitive employment. Based on the analysis of academic studies, bilateral treaties and their implementation, media reports and interviews with owners and managers of haulage companies and small hauliers, drivers and labourers, this Working Paper presents the particularities of formal and informal trade in the border areas of Afghanistan. A major finding is that states, large companies, small transporters and workers greatly differ in their perceptions of violent conflict, which range from views of alarming insecurity to regarding it as negligible. Moreover, businessmen tend to perceive corrupt practices by state officials and the police as a source of more uncertainty than acts by non-state armed groups. A third insight is that Pakistan and Iran consider cross-border trade with Afghanistan a minor issue as both states are pursuing particular interests in the larger region. Pakistan’s tense relationship with India and Iran’s struggle with Western sanctions inform the trade strategies of these countries, while Afghanistan is a marginal player in these power struggles. Some conflict-sensitive employment strategies, such as employing drivers and assistants according to cultural criteria to facilitate safe passage through areas under the control of various power holders and affected by violent conflict are adopted by cross-border haulage companies out of self-interest. The paper presents additional strategies that major companies can use

Occludin S408 phosphorylation regulates tight junction protein interactions and barrier function

Occludin S408 phosphorylation regulates interactions between occludin, ZO-1, and select claudins to define tight junction molecular structure and barrier function

Assessing the Efficacy of Pipelle Sampling as Outpatient Diagnostic Test in a Tertiary Care Hospital-Rawalpindi, 2020

Objective: To assess the effectiveness and enlist clinical factors, which may affect effectiveness of Pipelle sampling in diagnosing endometrial pathology in patients with abnormal uterine bleeding and Post-menopausal Bleeding. Study Design: ‘Analytical Cross-Sectional’ study. Place and duration: Gynecology Department at Combined Military Hospital Rawalpindi, in collaboration with Histo-Pathology Department, of six months duration i.e. from 1st  December 2019 to 31st May 2020. Patients and methods: 100 female patients of outpatient department with presenting complaints of either abnormal or post-menopausal bleeding were included in the study in the specified time frame. After informed written consent, Pipelle endometrial sampling was done on outpatient basis, and by consecutive sampling technique using lottery method, sample was sent for histopathological evaluation. Evaluated factors studied were:  indications for the procedure, age, parity, age of menarche. Results: Of the total patients evaluated, 91% (n=100) were non-malignant, while 4% (n=100) were malignant. Inadequate tissue was obtained in 5% samples. Most common histopathological findings among reproductive age group were Proliferative and Secretory phase endometrium 64% (n=100). While in Post-menopausal age group 4% (n=100) were Endometrial carcinoma on histopathology. Inadequate tissue samples 5% (n=100) were noted among the Post-menopausal group. 6% samples showed endometrial hyperplasia. Pipelle Endometrial Sampling had sensitivity and specificity, in diagnosing the endometrial pathologies is summarized in Table 3. Conclusion: Pipelle Endometrial Sampling is an effective, safe, simple and acceptable procedure for diagnosing endometrial pathology. It is cost effective requiring no anesthesia with high sensitivity and specificity for detecting endometrial pathology.

Clinical characteristics, obstetric and perinatal outcome of Covid-19 infection in pregnant women

Objective: To determine clinical characteristics, obstetrics and perinatal outcome of coronavirus disease 2019 infection in pregnant women. Method: The cross-sectional study was conducted at the Department of Obstetrics and Gynaecology of the Ruth Pfau Civil Hospital, Karachi, and Dow University of Health Sciences, Karachi, from August 2020 to July 2021, and comprised pregnant women with suspicion of coronavirus disease 2019 infection, who underwent recommended testing, and were found to be positive. Oral swabs for the presence of infection were also taken from the neonate within 24 hours of delivery. Data was analysed using Stata 11. Results: There were 41 women with a mean age of 27±5 years, a mean gestational age of 35±3 weeks, and mean parity 1.2±1.01. Of them, 3(7.3%) women died. Medical complications found along with coronavirus disease 2019 infection were pregnancy-induced hypertension 2(4.8%), eclampsia 4(11%) and diabetes mellitus 2(4.8%). Fever was the most common symptom seen in 12(30%) women, followed by cough 7(20%) and shortness of breath 6(14%). Majority 32(82%) of the women underwent caesarean section. The most common maternal complication was postpartum haemorrhage 6(20%). Also, 36(86%) women required intensive care unit stay for a mean 5±9 days. Conclusion: Fever, followed by cough and breathlessness, were the most common clinical features. Most common maternal and foetal complication was postpartum haemorrhage and low birth weight, respectively. Key Words: COVID-19, Pregnancy, Maternal outcome, Perinatal, Outcome

Supporting Depressed Mothers of Young Children with Intellectual Disability: Feasibility of an Integrated Parenting Intervention in a Low-Income Setting

As a lifelong condition, intellectual disability (ID) remains a public health priority. Parents caring for children with ID experience serious challenges to their wellbeing, including depression, anxiety, stress and health-related quality of life. Integrated parenting interventions, which have been well evidenced for depressed mothers, may also effectively support depressed parents with a child with ID in low-resource settings such as Pakistan, and in turn optimise child outcomes. We conducted a mixed-method rater-blind feasibility randomised controlled trial, which assessed the feasibility and acceptability of the Learning Through Play in My Own Way Plus (LTP-IMOW Plus) intervention. Mothers who screened positive for depression (n = 26) with a young child (age 3–6 years) with ID were recruited from two low-resource community settings. Participants in the intervention arm (n = 13) received 12 group sessions of LTP-IMOW Plus and others (n = 13) received routine care. The intervention was feasible and acceptable with 100% retention and 100% session attendance. The intervention improved depression, anxiety, parenting stress and child socialisation score outcomes relative to the routine care arm. The framework utilised to analyse the qualitative interviews with seven participants at pre-intervention identified a range of struggles experienced by the mothers, and at post-intervention, found improved knowledge of child development and practices, improved mother–child relationships, recommendations for the intervention and perceived practical barriers and facilitators. The findings highlight the prospects for a clinical and cost-effective trial of an integrated parenting intervention to manage long-term parental mental health needs and improve child outcomes

SENSE-Cog Asia: A Feasibility Study of a Hearing Intervention to Improve Outcomes in People With Dementia

Background: There are few evidence-based non-pharmacological interventions adapted for people with dementia (PwD) in lower- and middle-income countries (LMIC). Thus, there is value in culturally adapting existing interventions from other settings. One such intervention for PwD involves hearing rehabilitation, which may improve dementia-related outcomes. Objective: To culturally adapt and evaluate the feasibility and acceptability of a multi-faceted hearing support intervention to enhance quality of life in PwD for a LMIC setting, Pakistan. Design: This was a study in three phases: (1) training and capacity building to deliver the study, including Patient and Public Involvement (PPI); (2) cultural adaptation of the intervention; and (3) delivery of a single-group feasibility study with a pre-test post-test design. Setting: Home-based intervention, in two cities of Pakistan. Participants: Adults aged ≥ 60 with mild-moderate dementia and uncorrected or partially corrected hearing impairment, and their study partners (n = 14). Intervention: An adapted hearing support intervention (HSI) comprising a full assessment of hearing function, fitting of hearing aids, and home-based support from a “hearing support practitioner.” Outcomes: Ratings of the feasibility of the study procedures, and acceptability/tolerability of the adapted intervention were ascertained through questionnaires, participant diaries, therapist logbooks and semi-structured interviews. A signal of effectiveness of the intervention was also explored using a battery of dementia-related outcome measures. Results: Following cultural adaptation and capacity building for study conduct and delivery, we successfully implemented all intervention components in most participants, which were well-received and enacted by participant dyads. Acceptability (i.e., understanding, motivation, sense of achievement) and tolerability (i.e., effort, fatigue) ratings and safety of the intervention were within a priori target ranges. Recruitment and retention targets required improvement, due to the COVID-19 pandemic outbreak, as well as the lack of a clear clinical diagnostic pathway for dementia in both sites. Areas for future modification were clearly identified, including: the assessment/delivery logistics circuit; procedures for arranging visits; communication among referring clinicians and the study team. Conclusion: This is the first study in a LMIC of sensory enhancement to improve dementia outcomes. Positive feasibility, acceptability and tolerability findings suggest that a full-scale effectiveness trial, with certain modifications is warranted