Can health promotion facilitate development in fragile states?: An instrumental variable estimation with panel data.

Despite the potential role of health being recognised for more than a decade in fragile contexts, there are still gaps in understanding the possible paths towards peace. Particularly, current literature on health and development presents limitations, including insufficient evidence, a lack of thorough consideration for fragility and tensions between humanitarian and developmental approaches. Building upon prior discussions and limitations, this study aims to investigate the association between health indicators and the levels of economic and human development, employing panel data of 60 fragile states covering the years 1995-2021. Seven health outcome measures and three proxy measures for economic and human developments, including GDP per capita and Human Development Index with and without inequality adjustment, are employed in instrumental variable estimation. The analysis shows a positive association between the development measures and corresponding health indicators. These results suggest that promoting the health of the people, particularly among marginalised groups such as pregnant women and children, not only has the potential to protect them but also to facilitate economic and human developments of the fragile states. There is a need for approaching with people-centred and human capability perspectives to achieve the goal of 'Health and Peace for All'.

Learning from a gender transformative intervention among faith-leaders in Woliso, Ethiopia: A qualitative study.

Violence against women and girls (VAWG) continues to be a pervasive issue globally, and in Ethiopia, that harms women and challenges progress towards a more gender-equal society. Many interrelated social, economic, and cultural factors impact VAWG. Religion is a complex factor that can contribute to and act as a preventative measure against VAWG. Thus, faith-leaders have been identified as key actors in VAWG prevention. This study examines Ethiopian Evangelical faith-leaders transformative knowledge change following a Channels of Hope for Gender training intervention. Focus group discussions were conducted with faith-leaders from five different Evangelical Church groups. The results show that the faith-leaders' experience of the Channels of Hope training challenged their gender norms and allowed them to enact relationship and community-level changes. Additionally, they demonstrated efforts and interest in generating change at the level of the Church. However, barriers remained to fully addressing VAWG and implement gender transformative learning more widely. Thus, we conclude that the Channels for Hope training is useful in generating mindset changes and improving relationship-level interactions, but that it requires a longer implementation timeframe and further support from other structures and interventions to achieve sustainable change to prevent VAWG.

Armed conflict effects in intimate partner violence: Revealing pathways using the socioecological framework.

We explored women's narratives about their experiences as victim-survivors of multiple forms of armed conflict violence and intimate partner violence (IPV) in Colombia and examined pathways that clarify the relationships between these two types of violence. Thematic analysis of 47 interviews identified connections that explain how armed conflict influences IPV at all levels of the socio-ecology. At the societal level, armed conflict events amplified patriarchal notions and intensified men's expressions of hypermasculinity through violence. At the community level, rules imposed by armed groups excused IPV if women did not comply with their traditional gender roles as wives and caretakers. At the relationship level, husbands/partners blamed victim-survivors of sexual violence perpetrated by armed groups, which intensified IPV situations. At the individual level, the armed conflict generated high levels of stress that contributed to increasing IPV. Results highlight the need to recognise armed conflict as an IPV risk factor that penetrates multiple socio-ecological domains. Post-conflict societies should consider the effects of the armed conflict on family dynamics and intimate partner relationships. Interventions should be developed to deconstruct hyper-militarised masculinity identities and traditional gender roles as an integral part of peace efforts.

An examination of sugar-sweetened beverage tax regulations in six jurisdictions: Applying a social justice perspective to beverage taxation and exemptions.

Taxes, legislation and politics are social determinants of health, which can impact health through multiple pathways. The purpose of this study was to review regulations regarding sugar-sweetened beverage (SSB) taxation and describe taxation/exemption of various beverage categories. We reviewed SSB taxation regulations from Mexico, the United Kingdom, Berkeley, Philadelphia, San Francisco and South Africa. Supplementary government documents and academic publications were also reviewed to further discern beverage taxation/exemption and zero-rating. There were a number of beverage types that fell clearly into typically taxed or exempt/zero-rated categories across all six jurisdictions (e.g. pop/soda as taxed and water as zero-rated). Exemptions and ambiguities within the six regulations can generally be grouped as a lack of clarity regarding the meaning and use of milk; the meaning of 'medical purposes' and 'supplemental'; the point at which a beverage is prepared; the form of concentrate (i.e. liquid/frozen/powder) or medium used (e.g. water, coffee); and location of preparation or business size of retailer. SSB tax regulations are complex, unclear, vary across jurisdiction and leave several beverage types with added sugar exempt from taxation or at risk of a legal challenge. Lastly, tax exemptions generally reflect and perpetuate existing sociopolitical dynamics within the food system.

The associations of spirituality and Hispanic ethnicity with neuroendocrine biomarkers among patients with colorectal cancer.

OBJECTIVE: Dealing with cancer evokes not only physical and emotional distress, but may also promote resilience through spirituality. Patients with cancer are vulnerable to neuroendocrine dysregulation. This longitudinal observational study examined the degree to which spirituality was associated with neuroendocrine biomarkers and the moderating role of Hispanic ethnicity. METHODS: Participants were adults who were recently diagnosed with colorectal cancer (n = 81, 55 years old, 66% male, 63% Hispanic, 72% advanced cancer, 7 months post-diagnosis). The domains of spirituality (faith, meaning, and peace) and ethnicity (Hispanic vs. non-Hispanic) were self-reported. Cortisol and alpha amylase (sAA) were assayed from saliva samples collected at waking and bedtime on seven consecutive days. Mean levels at waking and bedtime, and diurnal slopes over seven days were calculated. Age and cancer stage were covariates. RESULTS: Overall, patients reported moderate to high levels of spirituality. General linear modeling revealed that greater faith was associated with higher levels of sAA at waking and bedtime as well as more blunted diurnal pattern of sAA only among Hispanic patients (p ≤ .045). Greater peace was associated with steeper diurnal pattern of sAA, regardless of ethnicity (B = 0.021, p = .005). Meaning and cortisol were not significantly associated with study variables. CONCLUSIONS: Findings indicate that presence of peace facing a cancer diagnosis associated with neuroendocrine regulation, whereas drawing on one's faith, particularly among Hispanic patients, associated with neuroendocrine dysregulation during the first months after the diagnosis. Further investigations of psychobiobehavioral moderators and mediators for healthy neuroendocrine functioning among patients with cancer are warranted.

War and peace in public health education and training: a scoping review.

BACKGROUND: Armed conflict and war are public health disasters. Public health action has a crucial role in conflict-related emergencies and rehabilitation but also in war prevention and peace promotion. Translating this into public health training and competencies has just started to emerge, especially in Europe. METHODS: We conducted a Scoping Review to map and identify the role of public health education and training of public health workforce relating to the prevention of war and promoting peace, as reflected in the scientific literature. We searched in PubMed, CINAHL, PsycINFO, Embase, Web of Science Core Collections as well as the reference list of included material in English, German and Polish. Focusing initially on the European region, we later expanded the search outside of Europe. RESULTS: We included 7 publications from opinion pieces to an empirical assessment of curricula and training. The educational programs were predominantly short-term and extra-curricular in postgraduate courses addressing both public health professionals in conflict-affected countries as well as countries not directly affected by war. Publications focused on public health action in times of war, without specifying the context and type of war or armed conflict. Competencies taught focused on emergency response and multi-disciplinary collaboration during emergencies, frequently drawing on experience and examples from natural disaster and disease outbreak management. CONCLUSIONS: The scientific discourse on competences in public health education for times of war and for the promotion of peace, predominately focuses on immediate emergency response actions. The prevention of war and the promotion of peace are missing foci, that need to feature more prominently in public health training. Public Health Education and training should ensure that war prevention and peace promotion, as well as public health action in times of war, are included in their competencies for public health professionals.

Evaluation of the effect of death education based on the Peace of Mind Tea House: a randomized controlled trial of nursing trainees at Xiamen University, China.

BACKGROUND: There are few studies on death education models for nursing students in China. It is of great significance to construct a model of nursing students' death education combined with clinical practice. This study aims to evaluate the effect of death education on nursing students based on the Peace of Mind Tea House. METHODS: The randomized controlled trial commenced from February 7 to March 18, 2021,featuring a two-month intercession at a hospital situated in Xiamen, China. The research subjects were chosen using a convenient sampling approach with nursing students from the hospital's internship program. Ninety-two participants were enrolled, with 46 in each group. Thirteen participants were lost to follow-up, corresponding to 14% of the total study population. The samples were then allocated randomly into either the intervention group or the control group. In addition to their hospital internship, the intervention group participated in six death education courses that focused on cognitive, emotional, and motor skills as well as the "Peace of Mind Tea House" program. Control participants will undergo regular internships. Before and two weeks after the course, both groups were evaluated for death anxiety, attitude towards death, and the meaning of life to assess the intervention's effectiveness. RESULTS: In the fear of death item of the Death Attitude Scale and the meaning of life section, the post-test score minus the pre-test score of the intervention group were 2.50 ± 3.90 (p = 0.011), and 8.90 ± 11.07 (p = 0.035), respectively. During the communication and sharing session of the reassurance card activity, 41 participants (95.3%) found the activity meaningful. CONCLUSION: Our data analysis demonstrates that nursing students have accepted and acknowledged the Peace of Mind Tea House-based education on death, which positively impacted their attitudes towards deathand the meaning of life. The content of death education should be integrated with traditional culture, and a new model of death education should be constructed with the Heart to Heart cards as its core. This research presents proof of the efficacy of implementing appropriate death education for nursing students, and provides a successful intervention plan to alleviate their future death anxiety and develop a positive outlook on death. TRIAL REGISTRATION: This study was approved by the Ethical Committee of Xiamen University School of Medicine (No. XDYX202304K21)(Date:18/01/2021). Written consent to participate was obtained from all the students.

Differentiating Gliosarcoma from Glioblastoma: A Novel Approach Using PEACE and XGBoost to Deal with Datasets with Ultra-High Dimensional Confounders.

In this study, we used a recently developed causal methodology, called Probabilistic Easy Variational Causal Effect (PEACE), to distinguish gliosarcoma (GSM) from glioblastoma (GBM). Our approach uses a causal metric which combines Probabilistic Easy Variational Causal Effect (PEACE) with the XGBoost, or eXtreme Gradient Boosting, algorithm. Unlike prior research, which often relied on statistical models to reduce dataset dimensions before causal analysis, our approach uses the complete dataset with PEACE and the XGBoost algorithm. PEACE provides a comprehensive measurement of direct causal effects, applicable to both continuous and discrete variables. Our method provides both positive and negative versions of PEACE together with their averages to calculate the positive and negative causal effects of the radiomic features on the variable representing the type of tumor (GSM or GBM). In our model, PEACE and its variations are equipped with a degree d which varies from 0 to 1 and it reflects the importance of the rarity and frequency of the events. By using PEACE with XGBoost, we achieved a detailed and nuanced understanding of the causal relationships within the dataset features, facilitating accurate differentiation between GSM and GBM. To assess the XGBoost model, we used cross-validation and obtained a mean accuracy of 83% and an average model MSE of 0.130. This performance is notable given the high number of columns and low number of rows (code on GitHub).

Using the Preparation Phase of the Multiphase Optimization Strategy to Design an Antiextremism Program in Bahrain: Formative and Pilot Research.

BACKGROUND: Extremism continues to raise concerns about conflict and violent attacks that can lead to deaths, injuries, trauma, and stress. Adolescents are especially vulnerable to radicalization by extremists. Given its location in a region that often experiences extremism, Bahrain developed 4 peaceful coexistence lessons and 4 antiextremism lessons to be implemented as part of their Drug Abuse Resistance Education (D.A.R.E.) program. OBJECTIVE: The aim of this study is to report the results of the preparation phase of the multiphase optimization strategy (MOST) to develop a peaceful coexistence program and an antiextremism program implemented by D.A.R.E. officers in Bahrain. METHODS: We developed conceptual models for the peaceful coexistence and antiextremism programs, indicating which mediators each lesson should target, the proximal outcomes that should be shaped by these mediators, and the distal and ultimate outcomes that the intervention should change. We recruited 20 middle schools to pilot test our research protocol, survey measures, and the existing intervention lessons. A total of 854 seventh and ninth grade students completed a pretest survey, 4 peaceful coexistence intervention lessons, and an immediate posttest survey; and a total of 495 ninth grade students completed the pretest survey, 4 antiextremism lessons, and an immediate posttest survey. A series of 3-level models, nesting students within classrooms within schools, tested mean differences from pretest to posttest. RESULTS: Pilot test results indicated that most measures had adequate reliability and provided promising evidence that the existing lessons could change some of the targeted mediators and proximal outcomes. Specifically, students who completed the peaceful coexistence lessons reported significant changes in 5 targeted mediating variables (eg, injunctive norms about intolerance, P<.001) and 3 proximal outcomes [eg, social skills empathy (P=.008); tolerance beliefs (P=.041)]. Students who completed the antiextremism lessons reported significant changes in 3 targeted mediators [eg, self-efficacy to use resistance skills themselves (P<.001)], and 1 proximal outcome (ie, social skills empathy, P<.001). CONCLUSIONS: An effective antiextremism program has the potential to protect youth from radicalization and increase peaceful coexistence. We used the preparation phase of MOST to (1) develop a conceptual model, (2) identify the 4 lessons in each program as the components we will evaluate in the optimization phase of MOST, (3) pilot test the existing lessons, our newly developed measures, and research protocol, and (4) determine that our optimization objective will be all effective components. We will use these results to revise the existing lessons and conduct optimization trials to evaluate the efficacy of the individual lessons.

Addressing the needs of cisgender, heterosexual men and LGBTIQ+ survivors of sexual violence: a scoping review of service delivery and funding priorities among humanitarian organisations.

Sexual violence in humanitarian contexts is a global public health issue. Yet, evidence suggests that humanitarian organisations may not always be inclusive of cisgender, heterosexual men and LGBTIQ+ survivors in their responses. This scoping review examines the extent to which global organisations focusing on sexual and gender-based violence (SGBV) address the needs of cisgender, heterosexual men and LGBTIQ+ survivors in service delivery and funding priorities. We examined grey literature published from 2013-2023 on SGBV service delivery and funding priorities in humanitarian contexts. Forty-seven documents were included in the final analyses, which comprised content and thematic analyses. Many of the documents acknowledged cisgender, heterosexual men or LGBTIQ+ individuals as at-risk groups; however, there was a lack of comprehensive discussion of these groups. Documents on LGBTIQ+ individuals referred to the group as a monolith, making little distinction among the LGBTIQ+ experience and the need to tailor responses to meet intersectional needs. Documents on men emphasised their role as perpetrators and allies, while overlooking that they also experience sexual violence. Findings support the critical need to address gaps in humanitarian programme and donor priorities to better ensure inclusion of cisgender, heterosexual men and LGBTIQ+ individuals without ignoring the needs of women and girls.

Lifetime HIV testing among three samples of adults with histories of incarceration in Southern California.

ABSTRACTJustice-impacted persons may inconsistently access HIV testing. This cross-sectional secondary analysis investigates lifetime HIV testing prevalence among adults with prior histories of incarceration in Southern California, United States, participating in health-focused programming (n = 3 studies). Self-reported demographic and lifetime HIV testing data were collected between 2017-2023; descriptive analyses were conducted. Across the three samples, at least 74% of participants were male; Latino and African American individuals accounted for nearly two-thirds of participants. Lifetime HIV testing ranged from 72.8% to 84.2%. Males were significantly more likely than females to report never being tested in two samples and accounted for >95% of those never tested. No statistically significant differences in testing were observed by race/ethnicity. Single young adults (ages 18-26) were less likely than their partnered peers to report testing. HIV testing is critical for ensuring that individuals access prevention and treatment. HIV testing among justice-impacted adults in this study was higher than in the general population, potentially due to opt-out testing in correctional settings. Nevertheless, these findings underscore the importance of implementing targeted interventions to reduce structural (e.g., health insurance, access to self-testing kits) and social barriers (e.g., HIV stigma) to increase HIV testing among justice-impacted males and single young adults.

'Not a party to this crime': The reciprocal constitution of identity and morality by signatories of the Academics for Peace petition in Turkey.

In this paper, we examine how social identity, moral obligation and the relationship between the two shaped support for the 2016 Academics for Peace petition in Turkey. We examine the pre-trial statements of nine defendants charged for signing the petition and appearing in court on the same day in December 2018. We first conduct an inductive thematic analysis on one statement, and then, using the themes from this analysis, we conducted a deductive thematic analysis on the remaining eight statements. In line with the existing studies, we find considerable evidence that social identity and moral obligation are invoked as key reasons for signing in this highly repressive context. However, rather than these being separate factors, the two are reciprocally constitutive. That is, social identities define moral obligations and, at the same time, enacting moral obligations defines identity (both the position of the individual in the group and the nature of the group in the world). In discussion, we consider the broader implications of a moralized view of social identities for our understanding of both collective action and social identity processes more generally.

Developing culturally competent physicians: Empathy, inclusivity, moral distress training and ethical reflections during the Medicine Clerkship.

PURPOSE: We aimed to develop a tool that would allow assessment of ethics competency and moral distress during the Internal Medicine Clerkship and to introduce curricular changes that could empower students to better address ethical dilemmas and challenges encountered during the clerkship. MATERIALS AND METHODS: A structured ethics assignment was introduced where students could reflect on impactful stressful scenarios and address questions related to emotional responses, identified ethical issues, management themes, and professional obligations. A 4-tiered grading rubric and individual narrative feedback was provided for each assignment, and small-group debriefing sessions were introduced for reflective thought and future planning. De-identified assignments were analyzed and classified into subgroups according to 5 main ethical issue subgroups and 10 specific management themes. Assignments were also analyzed for the presence of moral distress. RESULTS: 357 students completed the reflective ethics activities. The most commonly identified ethical issues were related to Shared Medical Decision Making (>40%), Primary of Patient Welfare challenges, (>20%), and Social/Organizational dilemmas. Management themes often pertained to Patient Wishes/Legal Obligations, Professional Behaviors, and Limited Resources. 87% of assignments demonstrated moral distress. CONCLUSION: Medical school is a stressful time and challenges are augmented during clinical years. Our reflective activity demonstrated significant exposures to ethical dilemmas, reviewed earlier principles of ethics training, and provided a safe forum in which to discuss these important aspects of healthcare. We captured powerful images of challenging situations eliciting moral distress, and students greatly appreciated the activity. We encourage future investigations that support student well-being and enable smooth transitions into residency training.

Decolonization and antiracism: intersecting pathways to global health equity.

In this paper, as Black scholars, we address ways that interventions designed to promote equity in health can create pathways for coupling decolonization with antiracism by drawing on the intersection of the health of Africans and African Americans. To frame this intersection, we offer the Public Health Critical Race Praxis (PHCRP) and the PEN-3 Cultural Model as antiracism and decolonization tools that can jointly advance research on colonization and racism globally. We argue that racism is a global reality; PHCRP, an antiracism framework, and PEN-3, a decolonizing framework, can guide interventions to promote equity for Africans and African Americans.

A Letter to My Friend and Chaplain Colleague Imam Sohaib Sultan, Zichrono Livracha (of Blessed Memory).

I am a Jewish chaplain and I felt moved to write this letter to my esteemed colleague Imam Sohaib Sultan, of blessed memory. Sohaib and I each experienced our first unit of Clinical Pastoral Education together as part of the same cohort in the summer of 2008. Sohaib died tragically in 2021. Here, I reflect on how we might respond to the current Israel-Hamas War.

The Gigii-Bapiimin Study: resilience and the impacts of COVID-19 on health and wellbeing of Indigenous people living with HIV in Manitoba and Saskatchewan.

The Gigii-Bapiimin study explored the impacts of the COVID-19 pandemic on the health and wellbeing of First Nations, Inuit, and Métis people living with HIV in Manitoba and Saskatchewan, two provinces in Canada with alarmingly high rates of HIV infections. Participants (n = 28 in Manitoba and n = 23 in Saskatchewan) were recruited using various methods, including flyers, community organizations, peers, and social media. The qualitative interviews focused on the pandemic's impact on health, access to services, and ceremonies. The data were analyzed using inductive thematic analysis. The study identified three key themes: (a) resilience and coping; (b) negative impacts on health and substance use; (c) decreased access to health services, HIV care and harm reduction. The participants shared their experiences of social isolation and the loss of community support, which had deleterious effects on their mental health and substance use. The impacts on access to HIV care were exacerbated by poverty, homelessness, and distress over inadvertent disclosure of HIV status. Participants mitigated these impacts by relying on Indigenous knowledges, ceremonies, and resilience within their communities. Service providers must address the impacts of the COVID-19 pandemic on Indigenous people living with HIV and their access to HIV services and ceremonies.

Making Sense of "Ethics" of War: Just War, Just Peace, and Ethic of Care.

This paper reviews briefly the main approaches in the literature on ethics of war and suggests the need to move beyond an ethic of justice towards an ethic of care. The analysis problematizes dominant understandings of "just war" and "just peace" in the literature and highlights that incorporating elements of an ethic of care, our understanding of ethics of war and peace can be redefined, sharpened, and redeployed through an enlarged ethical lens. The author suggests that scholars and practitioners in different fields of study and domains of social and political life can make important contributions by defining, elucidating, and advocating why both perspectives, those of ethic of justice and care, together allow us to capture the prospects of a broader understanding and the practice of peace.

Janus faced: The co-evolution of war and peace in the human species.

The human species presents a paradox. No other species possesses the propensity to carry out coalitionary lethal attacks on adult conspecifics coupled with the inclination to establish peaceful relations with genetically unrelated groups. What explains this seemingly contradictory feature? Existing perspectives, the "deep roots" and "shallow roots" of war theses, fail to capture the plasticity of human intergroup behaviors, spanning from peaceful cooperation to warfare. By contrast, this article argues that peace and war have both deep roots, and they co-evolved through an incremental process over several million years. On the one hand, humans inherited the propensity for coalitionary lethal violence from their chimpanzee-like ancestor. Specifically, having first inherited the skills to engage in cooperative hunting, they gradually repurposed such capacity to execute coalitionary killings of adult conspecifics and subsequently enhanced it through tech`nological innovations like the use of weapons. On the other hand, they underwent a process of cumulative cultural evolution and, subsequently, of self-domestication which led to heightened cooperative communication and increased prosocial behavior within and between groups. The combination of these two biocultural evolutionary processes-coupled with feedback loop effects between self-domestication and Pleistocene environmental variability-considerably broadened the human intergroup behavioral repertoire, thereby producing the distinctive combination of conflictual and peaceful intergroup relations that characterizes our species. To substantiate this argument, the article synthesizes and integrates the findings from a variety of disciplines, leveraging evidence from evolutionary anthropology, primatology, archeology, paleo-genetics, and paleo-climatology.