[Climate change, floods and health intervention].

Climate change and variability are considered some of the biggest threats to human health in the 21st century. Extreme weather events such as floods and storms are examples of natural hazards resulting in highest number of disasters and with considerable mortality and morbidity among vulnerable communities. A coordinated, well-planned management of health interventions must be taken for timely action in the response, recovery, prevention and preparedness phases of disasters. Roles and responsibilities of international as well as national organizations and authorities are discussed.

Successful ageing: A study of the literature using citation network analysis.

BACKGROUND: Ageing is accompanied by an increased risk of disease and a loss of functioning on several bodily and mental domains and some argue that maintaining health and functioning is essential for a successful old age. Paradoxically, studies have shown that overall wellbeing follows a curvilinear pattern with the lowest point at middle age but increases thereafter up to very old age. OBJECTIVE: To shed further light on this paradox, we reviewed the existing literature on how scholars define successful ageing and how they weigh the contribution of health and functioning to define success. METHODS: We performed a novel, hypothesis-free and quantitative analysis of citation networks exploring the literature on successful ageing that exists in the Web of Science Core Collection Database using the CitNetExplorer software. Outcomes were visualized using timeline-based citation patterns. The clusters and sub-clusters of citation networks identified were starting points for in-depth qualitative analysis. RESULTS: Within the literature from 1902 through 2015, two distinct citation networks were identified. The first cluster had 1146 publications and 3946 citation links. It focused on successful ageing from the perspective of older persons themselves. Analysis of the various sub-clusters emphasized the importance of coping strategies, psycho-social engagement, and cultural differences. The second cluster had 609 publications and 1682 citation links and viewed successful ageing based on the objective measurements as determined by researchers. Subsequent sub-clustering analysis pointed to different domains of functioning and various ways of assessment. CONCLUSION: In the current literature two mutually exclusive concepts of successful ageing are circulating that depend on whether the individual himself or an outsider judges the situation. These different points of view help to explain the disability paradox, as successful ageing lies in the eyes of the beholder.

Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development.

BACKGROUND: Health policies are important instruments for improving population health. However, experience suggests that policies designed for the whole population do not always benefit the most vulnerable. Participation of vulnerable groups in the policy-making process provides an opportunity for them to influence decisions related to their health, and also to exercise their rights. This paper presents the findings from a study that explored how vulnerable groups and principles of human rights are incorporated into national sexual and reproductive health (SRH) policies of 4 selected countries (Spain, Scotland, Republic of Moldova, and Ukraine). It also aimed at discussing the involvement of vulnerable groups in SRH policy development from the perspective of policy-makers. METHODS: Literature review, health policy analysis and 5 semi-structured interviews with policy-makers were carried out in this study. Content analysis of SRH policies was performed using the EquiFrame analytical framework. RESULTS: The study revealed that vulnerable groups and core principles of human rights are differently addressed in SRH policies within 4 studied countries. The opinions of policy-makers on the importance of mentioning vulnerable groups in policy documents and the way they ought to be mentioned varied, but they agreed that a clear definition of vulnerability, practical examples, and evidences on health status of these groups have to be included. In addition, different approaches to vulnerable group's involvement in policy development were identified during the interviews and the range of obstacles to this process was discussed by respondents. CONCLUSION: Incorporation of vulnerable groups in the SRH policies and their involvement in policy development were found to be important in addressing SRH of these groups and providing an opportunity for them to advocate for equal access to healthcare and exercise their rights. Future research on this topic should include representatives of vulnerable communities which could help to build a dialogue and present the problem from multiple perspectives.

Non-communicable diseases in emergencies: a call to action.

Recent years have demonstrated the devastating health consequences of complex emergencies and natural disasters and thereby highlighted the importance of comprehensive and collaborative approaches to humanitarian responses and risk reduction. Simultaneously, noncommunicable diseases are now recognised as a real and growing threat to population health and development; a threat that is magnified by and during emergencies. Noncommunicable diseases, however, continue to receive little attention from humanitarian organisations in the acute phase of disaster and emergency response. This paper calls on all sectors to recognise and address the specific health challenges posed by noncommunicable diseases in emergencies and disaster situations. This publication aims to highlight the need for: • Increased research on morbidity and mortality patterns due to noncommunicable diseases during and following emergencies; • Raised awareness through greater advocacy for the issue and challenges of noncommunicable diseases during and following emergencies; • Incorporation of noncommunicable diseases into existing emergency-related policies, standards, and resources; • Development of technical guidelines on the clinical management of noncommunicable diseases in emergencies; • Greater integration and coordination in health service provision during and following emergencies; • Integrating noncommunicable diseases into practical and academic training of emergency workers and emergency-response coordinators.

The changing patterns of abortion among married women in China, 1984-2005.

OBJECTIVE: To identify changing levels and patterns of abortion in China among married women, and the determinants of these changes. STUDY DESIGN: Based on data from four nationwide surveys conducted by the Chinese National Population and Family Planning Commission in 1988, 1997, 2001 and 2006, this paper analyzed abortion rates by age, residence, and education. To minimize recall error, only the pregnancy history of the 5-10 years before the survey was used. RESULTS: Overall abortion levels in China fluctuated in the period 1970-1990, but declined markedly after 1991. The profile of women resorting to abortion has shifted from older, rural, less educated women, toward younger, urban, more educated women, at a rate beyond the change in composition of the population as a whole. Young, urban, educated women are also the demographic group more likely to employ "user controlled", short term methods. CONCLUSION: The findings are consistent with a gradual shift in the Chinese family planning programme, increasingly meeting the principles of the International Conference on Population and Development, which calls for making contraception accessible, and thereby helping women avoid recourse to abortion. Future reproductive health programmes should allow women more autonomy in socio-economic factors affecting their reproductive health.

Childbirth attendance strategies and their impact on maternal mortality and morbidity in low-income settings: a systematic review.

OBJECTIVE: To review quantitative evidence of the effect on maternal health of different childbirth attendance strategies in low-income settings. DESIGN: Systematic review. METHODS: Studies using quantitative methods, referring to the period 1987-2011, written in English and reporting the impact of childbirth attendance strategies on maternal mortality or morbidity in low-income settings were included. Guidelines developed by the Cochrane collaboration and the Centre for Review and Dissemination, University of York were followed. The included articles were read and sorted by category of strategy that emerged from the reading. RESULTS: The search criteria yielded 29 articles. The following three main categories of strategy emerged: (i) those primarily intended to improve quality of care; (ii) "centrifugal strategies," which sought to bring services to the women; and (iii) "centripetal strategies," which sought to bring the women to the services. Few of the studies had a design that provided strong evidence for the impact of the strategy concerned. CONCLUSIONS: The evidence emerging from the studies was difficult to compare, because concepts were not defined in a consistent manner (such as "skilled birth attendance") and many studies examined the impact of a package of interventions without ferreting out the impact of individual components. Yet, some studies described individual aspects with great promise (such as cost, transport, outreach-friendly drugs or targeted training). There is a need for clearer conceptual frameworks, including some which permit assessment of packages of interventions.

Gender and international crisis response: do we have the data, and does it matter?

For more than a decade the humanitarian community has been mandated to mainstream gender in its response to crises. One element of this mandate is a repeated call for sex-disaggregated data to help guide the response. This study examines available analyses, assessments and academic literature to gain insights into whether sex-disaggregated data are generated, accessible and utilised, and appraised what can be learned from existing data. It finds that there is a gap between policy and practice. Evaluations of humanitarian responses rarely refer to data by sex, and there seems to be little accountability to do so. Yet existing data yield important information, pointing at practical, locally-specific measures to reduce the vulnerability of both males and females. This complements population-level studies noting the tendency for higher female mortality. The study discusses some possible obstacles for the generation of data and hopes to spur debate on how to overcome them.

[Migration, climate and health]. / Migration, klima og sundhed.

Many tentative connections have been postulated between migration and climate. This article points to rural-urban migration, particularly into low elevation urban slums prone to flooding as an issue needing urgent attention by health professionals. It also notes the no-man's land in which environmental refugees find themselves and the consequences this may have. Finally, it points to the urgent need to reform health systems in both developing and developed countries to adapt to rapidly changing disease patterns and to become more responsive to them.