A systematic review of school-based sexual health interventions to prevent STI/HIV in sub-Saharan Africa

Background The HIV/AIDS epidemic remains of global significance and there is a need to target (a) the adolescent age-groups in which most new infections occur; and (b) sub-Saharan Africa where the greatest burden of the epidemic lies. A focused systematic review of school-based sexual health interventions in sub-Saharan Africa to prevent HIV/AIDS and Sexually Transmitted Infections (STI) in this age group was therefore conducted. Methods Searches were conducted in Medline, Embase, Cinahl and PsychINFO according to agreed a priori criteria for studies published between 1986 and 2006. Further searches were conducted in UNAIDS and WHO (World Health Organization) websites, and 'Google'. Relevant journals were hand-searched and references cited in identified articles were followed up. Data extraction and quality assessment was carried out on studies selected for full text appraisal, and results were analysed and presented in narrative format. Results Some 1,020 possible titles and abstracts were found, 23 full text articles were critically appraised, and 12 articles (10 studies) reviewed, reflecting the paucity of published studies conducted relative to the magnitude of the HIV epidemic in sub-Saharan Africa. Knowledge and attitude-related outcomes were the most associated with statistically significant change. Behavioural intentions were more difficult to change and actual behaviour change was least likely to occur. Behaviour change in favour of abstinence and condom use appeared to be greatly influenced by pre-intervention sexual history. Conclusion There is a great need in sub-Saharan Africa for well-evaluated and effective school-based sexual health interventions

The roles of transparency and trust in the relationship between corruption and citizen satisfaction

Reducing corruption and improving citizen satisfaction are important aims of government, yet the link between these two policy aims has rarely been explored. This article reports a study into the roles played by transparency and trust in the relationship between governmental corruption and citizen satisfaction with public services. The study was based on data gathered in South Korea to evaluate a specific initiative that had sought to reduce corruption and increase citizen satisfaction with public works programmes. The data indicated that the relationship between corruption and satisfaction was moderated by transparency and partially mediated by trust. Points for practitioners: The study sheds light on the roles of transparency and trust in the relationship between corruption and citizen satisfaction with public services, and thus provides insights for developing policy aimed at curtailing corruption and improving satisfaction

Strategic management of the health workforce in developing countries: what have we learned?

The study of the health workforce has gained in prominence in recent years, as the dynamic interconnections between human resource issues and health system effectiveness have come into sharper focus. This paper reviews lessons relating to strategic management challenges emerging from the growing literature in this area. Workforce issues are strategic: they affect overall system performance as well as the feasibility and sustainability of health reforms. Viewing workforce issues strategically forces health authorities to confront the yawning gaps between policy and implementation in many developing countries. Lessons emerge in four areas. One concerns imbalances in workforce structure, whether from a functional specialization, geographical or facility lens. These imbalances pose a strategic challenge in that authorities must attempt to steer workforce distribution over time using a limited range of policy tools. A second group of lessons concerns the difficulties of central-level steering of the health workforce, often critically weak due to the lack of proper information systems and the complexities of public sector decentralization and service commercialization trends affecting the grassroots. A third cluster examines worker capacity and motivation, often shaped in developing countries as much by the informal norms and incentives as by formal attempts to support workers or to hold them accountable. Finally, a range of reforms centering on service contracting and improvements to human resource management are emerging. Since these have as a necessary (but not sufficient) condition some flexibility in personnel practices, recent trends towards the sharing of such functions with local authorities are promising. The paper identifies a number of current lines of productive research, focusing on the relationship between health policy reforms and the local institutional environments in which the workforce, both public and private, is deployed

Country development and manuscript selection bias: a review of published studies

BACKGROUND: Manuscript selection bias is the selective publication of manuscripts based on study characteristics other than quality indicators. One reason may be a perceived editorial bias against the researches from less-developed world. We aimed to compare the methodological quality and statistical appeal of trials from countries with different development status and to determine their association with the journal impact factors and language of publication. METHODS: Selection criteria: Based on the World Bank income criteria countries were divided into four groups. All records of clinical trials conducted in each income group during 1993 and 2003 were included if they contained abstract and study sample size. Data sources: Cochrane Controlled Trials Register was searched and 50 articles selected from each income group using a systematic random sampling method in years 1993 and 2003 separately. Data extraction: Data were extracted by two reviewers on the language of publication, use of randomization, blinding, intention to treat analysis, study sample size and statistical significance. Disagreement was dealt with by consensus. Journal impact factors were obtained from the institute for scientific information. RESULTS: Four hundred records were explored. Country income had an inverse linear association with the presence of randomization (chi2 for trend = 5.6, p = 0.02) and a direct association with the use of blinding (chi2 for trend = 6.9, p = 0.008); although in low income countries the probability of blinding was increased from 36% in 1993 to 46% in 2003. In 1993 the results of 68% of high income trials and 64.7% of other groups were statistically significant; but in 2003 they were 66% and 82% respectively. Study sample size and income were the only significant predictors of journal impact factor. CONCLUSION: The impact of country development on manuscript selection bias is considerable and may be increasing over time. It seems that one reason may be more stringent implementation of the guidelines for improving the reporting quality of trials on developing world researchers. Another reason may be the presumptions of the researchers from developing world about the editorial bias against their nationality

A critique of neo-mercantilist analyses of Icelandic political economy and crisis

Iceland’s journey from rags to riches in the 20th century is related, in the dominant discourse, to its gaining independence in 1944. This discourse played a significant role in both the legitimation of the finance-dominated growth model in the 1990s and 2000s and in the latter’s defence as it came under scrutiny before its collapse in October 2008. It is therefore ironic – or perhaps, in some sense, logical – to find dominant analyses of the crisis arising from the neo-mercantilist tradition. Drawing on Marxist critiques of neo-mercantilism, we challenge these interventions and thus seek to redress the neglect of social struggle in the dominant discourse

Gene expression and matrix turnover in overused and damaged tendons

Chronic, painful conditions affecting tendons, frequently known as tendinopathy, are very common types of sporting injury. The tendon extracellular matrix is substantially altered in tendinopathy, and these changes are thought to precede and underlie the clinical condition. The tendon cell response to repeated minor injuries or “overuse” is thought to be a major factor in the development of tendinopathy. Changes in matrix turnover may also be effected by the cellular response to physical load, altering the balance of matrix turnover and changing the structure and composition of the tendon. Matrix turnover is relatively high in tendons exposed to high mechanical demands, such as the supraspinatus and Achilles, and this is thought to represent either a repair or tissue maintenance function. Metalloproteinases are a large family of enzymes capable of degrading all of the tendon matrix components, and these are thought to play a major role in the degradation of matrix during development, adaptation and repair. It is proposed that some metalloproteinase enzymes are required for the health of the tendon, and others may be damaging, leading to degeneration of the tissue. Further research is required to investigate how these enzyme activities are regulated in tendon and altered in tendinopathy. A profile of all the metalloproteinases expressed and active in healthy and degenerate tendon is required and may lead to the development of new drug therapies for these common and debilitating sports injuries

Flood Proofing Low-Income Houses in India: an Application of Climate-Sensitive Probabilistic Benefit-Cost Analysis

Poor communities in high risk areas are disproportionately affected by disasters compared to their wealthy counterparts; yet, there are few analyses to guide public decisions on pro-poor investments in disaster risk reduction. This paper illustrates an application of benefit-cost analysis (BCA) for assessing investments in structural flood proofing of low-income, high-risk houses. The analysis takes account of climate change, which is increasingly viewed as an important consideration for assessing long-term investments. Specifically, the study focuses on the Rohini river basin of India and evaluates options for constructing non-permanent and permanent residential structures on a raised plinth to protect them against flooding. The estimates show a positive benefit-cost ratio for building new houses on a raised plinth, while the ratio is less than one for demolishing existing houses to rebuild on a raised plinth. Climate change is found to significantly affect the BCA results. From a policy perspective, the analysis demonstrates the potential economic returns of raised plinths for ‘building back better’ after disasters, or as a part of good housing design practice

The nuanced nature of work quality : evidence from rural Newfoundland and Ireland

This article explores the relationship between job and work quality and argues that while it is important to examine job quality, to understand workers’ experiences fully, the focus should be on the broader concept of work quality, which places the job against its wider socio-economic context. Based on the experiences of 88 rural workers gathered via interviews in Newfoundland and Ireland, it appears that the same or similar jobs can be regarded very differently depending upon the context in which they are embedded, as people at different locations and/or stages of life have an individual set of aspirations, expectations and life experiences. The study found that the factors that affect work quality are moulded by broader aspects of life – family, friends, community, lifestyle and past experiences – that shape an individual

Fatal myocarditis in a child with systemic onset juvenile idiopathic arthritis during treatment with an interleukin 1 receptor antagonist

<p>Abstract</p> <p>Background</p> <p>The pathologic diagnosis of isolated myocarditis without pericardial involvement is uncommonly encountered in systemic onset Juvenile Idiopathic Arthritis (soJIA).</p> <p>Case</p> <p>An eleven year-old boy with soJIA died suddenly while being treated with the interleukin 1 (IL-1) receptor inhibitor, anakinra. His autopsy revealed an enlarged heart and microscopic findings were consistent with myocarditis, but not pericarditis. Viral PCR testing performed on his myocardial tissue was negative.</p> <p>Conclusion</p> <p>This case illustrates myocarditis as a fatal complication of soJIA, potentially enabled by anakinra.</p