Friday, December 5, 2008

[EQ] Neglected Infections of Poverty in the USA

Neglected Infections of Poverty in the United States of America

 

Peter J. Hotez, Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University and Sabin Vaccine Institute, Washington, D.C., USA

PLoS Negl Trop Dis 2(6): e256. doi:10.1371/journal.pntd.0000256 - 2008

Editor: Simon Brooker, London School of Hygiene & Tropical Medicine, United Kingdom

 

 

Website: http://www.plosntds.org/article/info:doi%2F10.1371%2Fjournal.pntd.0000256

 

“…..In the United States, there is a largely hidden burden of diseases caused by a group of chronic and debilitating parasitic, bacterial, and congenital infections known as the neglected infections of poverty. Like their neglected tropical disease counterparts in developing countries, the neglected infections of poverty in the US disproportionately affect impoverished and under-represented minority populations. 1

 

The major neglected infections include the helminth infections, toxocariasis, strongyloidiasis, ascariasis, and cysticercosis; the intestinal protozoan infection trichomoniasis; some zoonotic bacterial infections, including leptospirosis; the vector-borne infections Chagas disease, leishmaniasis, trench fever, and dengue fever; and the congenital infections cytomegalovirus (CMV), toxoplasmosis, and syphilis.

 

These diseases occur predominantly in people of color living in the Mississippi Delta and elsewhere in the American South, in disadvantaged urban areas, and in the US–Mexico borderlands, as well as in certain immigrant populations and disadvantaged white populations living in Appalachia. Preliminary disease burden estimates of the neglected infections of poverty indicate that tens of thousands, or in some cases, hundreds of thousands of poor Americans harbor these chronic infections, which represent some of the greatest health disparities in the United States.

 

Specific policy recommendations include active surveillance (including newborn screening) to ascertain accurate population-based estimates of disease burden; epidemiological studies to determine the extent of autochthonous transmission of Chagas disease and other infections; mass or targeted treatments; vector control; and research and development for new control tools including improved diagnostics and accelerated development of a vaccine to prevent congenital CMV infection and congenital toxoplasmosis…….”

 

 

 

 *      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

 

 

 

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.  

[EQ] Child Maltreatment

Child Maltreatment The Lancet Series

 

Launched in London, UK, Dec 2, 2008

 

Website: http://www.thelancet.com/series/child-maltreatment [subscrition required]

Few topics are more emotive than child maltreatment. "Children, the most precious and vulnerable members of our societies, deserve closer attention to their care and education and better protection against abuse", states a Comment introducing the Series.

Executive summary

The Lancet has collaborated closely with the Royal College of Paediatrics and Child Health, London, UK, in formulating the Child Maltreatment Series. It is to clinicians and other professionals responsible for caring for children that The Lancet's Child Maltreatment Series is aimed, with the intention of providing them with a rigorous and up-to-date summary of scientific evidence and conceptual work on this complex and demanding topic.

 

Series Comments

When childhood dies

 

The landscape of child maltreatment


Supporting paediatricians who work in child maltreatment


Safeguarding children: a call to action


Series Papers

Burden and consequences of child maltreatment in high-income countries

Summary

“….Child maltreatment remains a major public-health and social-welfare problem in high-income countries. Every year, about 4—16% of children are physically abused and one in ten is neglected or psychologically abused. During childhood, between 5% and 10% of girls and up to 5% of boys are exposed to penetrative sexual abuse, and up to three times this number are exposed to any type of sexual abuse. However, official rates for substantiated child maltreatment indicate less than a tenth of this burden. Exposure to multiple types and repeated episodes of maltreatment is associated with increased risks of severe maltreatment and psychological consequences. Child maltreatment substantially contributes to child mortality and morbidity and has longlasting effects on mental health, drug and alcohol misuse (especially in girls), risky sexual behaviour, obesity, and criminal behaviour, which persist into adulthood. Neglect is at least as damaging as physical or sexual abuse in the long term but has received the least scientific and public attention. The high burden and serious and long-term consequences of child maltreatment warrant increased investment in preventive and therapeutic strategies from early childhood…’


Recognising and responding to child maltreatment

Summary

‘…..Professionals in child health, primary care, mental health, schools, social services, and law-enforcement services all contribute to the recognition of and response to child maltreatment. In all sectors, children suspected of being maltreated are under-reported to child-protection agencies. Lack of awareness of the signs of child maltreatment and processes for reporting to child-protection agencies, and a perception that reporting might do more harm than good, are among the reasons for not reporting. Strategies to improve recognition, mainly used in paediatric practice, include training, use of questionnaires for asking children and parents about maltreatment, and evidence-based guidelines for who should be assessed by child-protection specialists. Internationally, studies suggest that policies emphasising substantiation of maltreatment without concomitant attention to welfare needs lead to less service provision for maltreated children than do those in systems for which child maltreatment is part of a broad child and family welfare response…”


Interventions to prevent child maltreatment and associated impairment

Summary

 

“….Although a broad range of programmes for prevention of child maltreatment exist, the effectiveness of most of the programmes is unknown. Two specific home-visiting programmes—the Nurse—Family Partnership (best evidence) and Early Start—have been shown to prevent child maltreatment and associated outcomes such as injuries. One population-level parenting programme has shown benefits, but requires further assessment and replication. Additional in-hospital and clinic strategies show promise in preventing physical abuse and neglect. However, whether school-based educational programmes prevent child sexual abuse is unknown, and there are currently no known approaches to prevent emotional abuse or exposure to intimate-partner violence. A specific parent-training programme has shown benefits in preventing recurrence of physical abuse; no intervention has yet been shown to be effective in preventing recurrence of neglect. A few interventions for neglected children and mother—child therapy for families with intimate-partner violence show promise in improving behavioural outcomes. Cognitive-behavioural therapy for sexually abused children with symptoms of post-traumatic stress shows the best evidence for reduction in mental-health conditions. For maltreated children, foster care placement can lead to benefits compared with young people who remain at home or those who reunify from foster care; enhanced foster care shows benefits for children. Future research should ensure that interventions are assessed in controlled trials, using actual outcomes of maltreatment and associated health measures….”


Promotion of children’s rights and prevention of child maltreatment

Summary

 

“…..In medical literature, child maltreatment is considered as a public-health problem or an issue of harm to individuals, but less frequently as a violation of children's human rights. Public-health approaches emphasise monitoring, prevention, cost-effectiveness, and population strategies; protective approaches concentrate on the legal and professional response to cases of maltreatment.
Both approaches have been associated with improvement in outcomes for children, yet maltreatment remains a major global problem. We describe how children's rights provide a different perspective on child maltreatment, and contribute to both public-health and protective responses. Children's rights as laid out in the UN convention on the rights of the child (UNCRC) provide a framework for understanding child maltreatment as part of a range of violence, harm, and exploitation of children at the individual, institutional, and societal levels.
Rights of participation and provision are as important as rights of protection. The principles embodied in the UNCRC are concordant with those of medical ethics. The greatest strength of an approach based on the UNCRC is that it provides a legal instrument for implementing policy, accountability, and social justice, all of which enhance public-health responses. Incorporation of the principles of the UNCRC into laws, research, public-health policy, and professional training and practice will result in further progress in the area of child maltreatment….”

 

 

 

 *      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

 

 

 

 

 

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.  

[EQ] Guiding Good Research

Guiding Good Research

Biomedical Research Ethics and Ethics Review

 

Miriam Shergold

RAND Europe's Health Research System Observatory Documented Briefing series, funded by the UK Department of Health

2008

 

Available online PDF file [45p.] at: http://www.rand.org/pubs/documented_briefings/2008/RAND_DB536.pdf

 

“…….The purpose of the document is to brief non-specialists on the key aspects of the evolution, and current debate, of biomedical research ethics and the assessment of proposed research by ethics committees or review boards. Ethical approval is now an almost universal requirement in the research process, and various national and international fora have formulated appropriate ground rules.

 

However, practical interpretation of basic ethical principles, as well as the stringency and design of the review process, vary significantly from one location to the next. On the basis of desk research and expert interviews, this briefing highlights principal areas of consensus and tension, and outlines different approaches to the formal ethical scrutiny of proposed research. Its scope is international, with an emphasis on research intensive nations. It does not aim to deliver an exhaustive discussion of ethical principles, or take position regarding current controversies.

 

The report is organised in two parts. The first part provides an introduction to the history of research ethics, as well as key documents and current debates.
The second part presents key aspects of the ethics review process, and describes different models currently in use.

 

Summary: Key Points

 

• The codification of universal principles for ethics in health research is a 20th century achievement that has not, however, eliminated malpractice or dispute.

• Ethics guidance emanates from a range of different sources, resulting in a ‘normative polyphony’.

• Agreement on basic principles does not guarantee identical or even similar decisions on the ethical acceptability of a specific practical research endeavour.

• There are multiple models for the review process to safeguard ethical research, including choice and authority of the reviewers.

• Reviewing the ethical aspects of a research proposal is a demanding task, which researchers find burdensome and which has led to a range of streamlining efforts…”

 

Content:

Summary

Introduction

Ethics in Biomedical Research

Ethics Reviews

Outlook

Reference List

 

Also:

Health and Medical Research in:

Australia  -  Canada  - JapanSwedenNew ZealandUnited KingdomUnited States

 

 

 

 *      *      *     *

This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate
information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic
health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;
Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMS Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings
and interpretations included in the Materials are those of the authors and not necessarily of The Pan American
Health Organization PAHO/WHO or its country members”.

------------------------------------------------------------------------------------
PAHO/WHO Website
Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html

 

 

 

 

 

 

    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.