A negociação do novo Regulamento Sanitário Internacional (RSI) foi um processo complexo que durou dez anos e envolveu preocupações que extrapolam o campo da saúde pública. Este artigo, resultado final da pesquisa de Mestrado desenvolvida no âmbito do Programa de Pós-Graduação do Instituto de Relações Internacionais da Universidade de São Paulo (IRI/USP), busca demonstrar, por meio de vasta pesquisa documental, revisão de literatura e entrevistas com atores, que a agenda de segurança internacional influenciou as negociações do RSI em vigor, contribuindo para o avanço do processo de securitização da saúde pública. Temas de segurança internacional, notadamente o uso intencional ou acidental de agentes químicos, biológicos, radio-nucleares e a potencial ameaça de bioterrorismo foram determinantes tanto do avanço das negociações como da natureza do documento final aprovado, que promoveu mudanças substanciais na regulação internacional da saúde pública. / The negotiation of the new International Health Regulations (IHR) was a complex 10-year-long process and involved concerns which go beyond the public health field. This article, the final result of the Master\'s program at the Institute of International Relations of the University of Sao Paulo (IRI/USP), aims to demonstrate, through vast documental research, literature review and interview with actors, how the international security agenda influenced the IHR negotiations, advancing the securitization process of public health. International security issues, specially the intentional or accidental use of biological, chemical or radio-nuclear agents and the potential threat of bioterrorism were determinant both for the negotiation advancement and the character of the approved final document, which promoted substantial changes in the international public health regulation.

To learn how to address health issues specific to Hispanic cultures in an effort to address health disparities, learning from cultural aspects that affect health from the countries of origin would be most useful. Community programs built on rigorous and systematic research prove to be more powerful than ad-hoc programs. Qualitative research techniques offer powerful alternatives for public health professionals to develop adequate and directed programs at the community level, especially among underserved communities and those represented by oral/spoken traditions. The study was conducted among 132 working class single and married Mestizo women between the ages of 20-40 living in Panama City, Panama. This group of women has the highest incidence of HPV in Panama so are at the highest risk of cervical cancer. Using social construction as the theoretical framework, this study uses four different qualitative research techniques: free listing, pile sorting, individual semi-structured, and group interviews. Key findings include the importance of religion and family, women's understandings of the relationship between sexuality and health, influence of media, other women, and husbands help construct screening knowledge among women in the study. Culturally relevant health education interventions and programs delivered in a group format at the community level in a participatory mode would be most effective in reaching women in Panama and other Hispanic populations. Future quantitative studies and influences of social networks are suggested.

Given the importance placed on participation and empowerment in global health initiatives, the perspective of young people with disabilities has emerged as a vital field of study. This critical ethnographic study gained insight into the perspectives of adolescents with disabilities aged 12 to 18 years who were affiliated with a community-based rehabilitation program in the urban slums of North India. The purpose of this research was to highlight the collective voices of adolescents with disabilities about their rehabilitation challenges, to explore how the culture influenced the rehabilitation challenges faced by adolescents, and to support collaborative work among adolescents with and without disabilities that would inform organizational activities. Fieldwork was conducted from January to May 2005 and October 2006 to March 2007 with 21 adolescents with disabilities, 11 adolescents without disability, and 10 community-based rehabilitation team members. Multiple data collection methods were utilized to ensure that participants could comfortably express their views. A conceptual framework called the ‘Adolescent Group Empowerment Pyramid’ was developed that illustrates one process for empowering adolescents with disabilities and their peers without disabilities within a community setting. Group empowerment involves adolescents with disabilities working towards assuming greater ownership over their rehabilitation while collaborating with their peers. The ‘group’ concept provided the foundation for the framework because adolescents viewed the group setting as enjoyable and effective. Three areas associated with meaningful group empowerment included: group participation, group demonstration, and group recognition. Three external support factors and ten areas for nurturing the group empowerment process are also described. Participants promoted a more liberal approach to empowering adolescents that embraced the notion of collaboration (rather than competition), interdependence (rather than independence), shared benefits (rather than individual gain), and the interaction of community groups. This approach promotes a harmonious balance between empowerment and the community, rather than an aggressive approach to gaining power over or from other marginalized individuals. Group empowerment, achieved through enabling group-centered occupations, encourages adolescents to collectively work for social and occupational justice. To ensure the sustainability of community-based rehabilitation initiatives, programs must be aware of personally meaningful factors that empower and maintain the interest of the target population. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2009-08-05 15:30:32.786

abstract: Principle-based ethical frameworks, which commonly make use of codes of ethics, have come to be the popular approach in guiding ethical behavior within scientific research. In this thesis project, I investigate the benefits and shortcomings of this approach, ultimately to argue that codes of ethics are valuable as an exercise in developing a reconciled value profile for a given research community, and also function well as an internal and external proclamation of values and norms. However, this approach results in technical adherence, at best, and given the extent to which scientific research now irreversibly shapes our experience as human beings, I argue for the importance of cultivating ethical virtues in scientific research. In the interest of doing so I explore concepts from Aristotelian virtue ethics, to consider how to ameliorate the shortcomings of principle-based approaches. This project was inspired by a call to research and develop an ethical framework upon which to found a cooperative research network that would be aimed at combating the spread of emerging and re-emerging infectious diseases in resource-restricted countries, specifically throughout Latin America. The desire to found this network on an ethics-based framework is to move beyond technical compliance and cultivate a research community committed to integrity, therefore establishing and maintaining trust and communication that will allow for unprecedented productive collaboration and meaningful outcomes. I demonstrate in this thesis that this requires more than a code of ethics, and use this initiative as a case study to exhibit the merit of integrating concepts from virtue ethics. / Dissertation/Thesis / Masters Thesis Biology 2017

A negociação do novo Regulamento Sanitário Internacional (RSI) foi um processo complexo que durou dez anos e envolveu preocupações que extrapolam o campo da saúde pública. Este artigo, resultado final da pesquisa de Mestrado desenvolvida no âmbito do Programa de Pós-Graduação do Instituto de Relações Internacionais da Universidade de São Paulo (IRI/USP), busca demonstrar, por meio de vasta pesquisa documental, revisão de literatura e entrevistas com atores, que a agenda de segurança internacional influenciou as negociações do RSI em vigor, contribuindo para o avanço do processo de securitização da saúde pública. Temas de segurança internacional, notadamente o uso intencional ou acidental de agentes químicos, biológicos, radio-nucleares e a potencial ameaça de bioterrorismo foram determinantes tanto do avanço das negociações como da natureza do documento final aprovado, que promoveu mudanças substanciais na regulação internacional da saúde pública. / The negotiation of the new International Health Regulations (IHR) was a complex 10-year-long process and involved concerns which go beyond the public health field. This article, the final result of the Master\'s program at the Institute of International Relations of the University of Sao Paulo (IRI/USP), aims to demonstrate, through vast documental research, literature review and interview with actors, how the international security agenda influenced the IHR negotiations, advancing the securitization process of public health. International security issues, specially the intentional or accidental use of biological, chemical or radio-nuclear agents and the potential threat of bioterrorism were determinant both for the negotiation advancement and the character of the approved final document, which promoted substantial changes in the international public health regulation.

This thesis investigates the impact of international organizations on the making of international law by applying insights on how international organizations work—or fail to work—to the process of institutionalized treaty making. Specifically, I probe the relationship between the World Health Organization (“WHO”) and international infectious disease law, focusing in particular on the 2005 International Health Regulations (“2005 IHR”), which was negotiated, adopted, and is now being implemented under WHO’s auspices. The 2005 IHR is the most recent development in international infectious disease law, the history of which extends back to the beginning of international health cooperation in the mid-nineteenth century, before any international health organization was formed. Relying on secondary sources, WHO documents, archival materials, and personal interviews, I chronologically trace the evolution of international infectious disease law across changing institutional settings. I first examine the incremental growth of the older “barrier” approach to infectious disease regulation, initially developed in the absence of any international health organization and then with the aid of one of WHO’s predecessor organizations. I then analyze the decline of the barrier approach and the rise of the new “epidemiological” approach embodied by the 2005 IHR, with the aid of WHO. Based on my empirical analysis, I conclude that WHO has radically changed the process of making international infectious disease law as well as its content. On its own initiative and without member state demand, WHO’s permanent staff experimented with novel practices that subsequently became the basis for the 2005 IHR. WHO’s work reduced the length of formal negotiation needed to arrive at a new agreement and the uncertainty associated with adopting a novel regulatory system. Its influence also raises normative questions about the proper role of international organizations in making international law—questions that require further exploration.

Abstract: Social Determinants of Health in Belize Free Clinic Introduction: To determine the most appropriate ways to serve patients in rural Belize through medical mission work, it is important to assess social determinants of health (SDOH). It has long been agreed that a variety of factors affect health, including environment, community and social context, access to healthcare, stress, income, mental health, education, and transportation. Many people in Roaring Creek, Belize, a village with a population of approximately 2,000, use Body and Soul Ministries, a nonprofit that invites medical teams from all over to deliver medical care, as their primary source of healthcare. During one of these trips, a medical team from East Tennessee State University (ETSU) provided medical care and employed the TeamCare survey, already used in several clinics in east Tennessee to assess the SDOH needs of the patient population in Roaring Creek. The purpose of this study was to use a survey that assesses several SDOH to determine better ways to address health needs in the community of Roaring Creek as well as connect patients with resources to meet those needs. Methods: A team of ETSU medical students, a resident, and five physicians served in a free clinic in Roaring Creek, Belize in October 2017. The team saw approximately 500 patients. Some patients were randomly selected to take the TeamCare survey to assess for six SDOH, including literacy, financial needs, drug use, abuse, transportation, and mental health. Based on the results of the survey, patients were connected with their local community health worker to assist in locating resources for patients. Using SPSS, results from the survey were arranged for frequencies and measures of central tendency. Results: Overall, a total of 106 patients responded to the TeamCare survey. Based on the survey results, 83.2% of patients responded “yes” to at least one question regarding needs related to SDOH. In fact, 7.9% of patients answered “yes” to five questions. Of note, 53.5% of patients responded positively for financial need, 46.5% positive for mental health needs, 37.6% positive for environmental alcohol or drug abuse, and 32.7% positive for transportation needs. More women stated positively for physical or verbal abuse compared to men (-1.48, p=0.001). Discussion and Conclusion: Roaring Creek, Belize is a rural community that illustrates how SDOH can impact health outcomes. There has been a recent effort for clinicians to address SDOH, especially in rural areas, but perhaps not enough globally. One way this can be done is by surveying for SDOH at clinic visits and then linking patients with relevant community resources. However, resources are not always readily available in Roaring Creek, Belize. Many patients are positive for SDOH, but with an overall lack of resources, it is important to do more research to determine how global health efforts can best serve these populations. Perhaps the best way for SDOH needs to be addressed is for Body and Soul to collaborate with community health workers and mission teams to establish ongoing programs and longstanding resources for the community.

Exposure to violence and dysfunction in childhood is a major public health concern. The Adverse Childhood Experiences (ACEs) study demonstrated that childhood maltreatment and family dysfunction impact adult health, contributing to risk behaviors, infectious and chronic disease, and premature death. South Africa (SA) has one of the highest rates of violence and family dysfunction globally, and those living in townships are suspected to be disproportionately affected. Munsieville, the oldest undeveloped township in SA, has reported high rates of violence in the community. This study aimed evaluate the association between a history of childhood sexual abuse and various forms of risky sexual behavior. Data were collected by a team of researchers from the College of Public Health as part of a pilot study of ACEs in Munsieville. Self-report of sexual abuse before age 18 was used to compute the independent variable, which ranged from 0-1, with 0 implying the absence of any type of childhood sexual abuse and 1 implying one or more forms of childhood sexual abuse. Age and gender were deemed potential confounders. Two binary l outcomes representing forms of risky sexual behavior were considered, self-report of transactional sex and substance use before sexual activity. Descriptive analysis examined the frequency of childhood sexual abuse by each category of the study outcomes. Two multiple logistic regression models were individually constructed to examine the association between childhood sexual abuse and transactional sex, and substance use before sexual activity. Odds ratios and corresponding 95% confidence intervals were reported. Findings of the descriptive analysis indicated that 8.83% (43) of the sample reported participating in transactional sex, 22.4% (101) reported using either drugs or alcohol before sex. Moreover, 21.6% (103) reported experiencing one or more forms of childhood sexual abuse. A positive statistically significant association between self-reported childhood sexual abuse and transactional sex was identified (OR: 3.45; 95% CI: 1.71 – 6.98), illustrating that those who experienced any type of child sexual abuse had a 3.5 times as likely to report transactional sex compared to those who did not experience sexual abuse during childhood. Childhood sexual abuse was also significantly associated with substance use before sexual activity (OR: 1.93; 95% CI: 1.11 – 3.34). The study findings suggests a need for further research to understand the long term effects of child sexual abuse. Further, future public health interventions aimed at reducing sexual abuse and violence inflicted on South African children should be employed as means to improve their wellbeing in adulthood.

Infectious diseases attract a lot of mediatic, cultural and political attention. But are those diseases like Ebola, or ‘disease x’ actually what kills us? Since 1946, the WHO is the most authoritative figure in the fights against infectious disease outbreaks. So how does the WHO maintain this power and authority after tremendous budget cuts, competition for authority, and a shift to non-communicable disease epidemiology? This thesis uses a mixed-methods approach of quantitative analysis of ‘Disease Outbreak News’ reports, and qualitative analysis of key WHO literature, to develop the alternative narrative answering those questions. This thesis found that the WHO activities surrounding the collection and distribution of data create a political and institutional environment in which the WHO seems to be the only logical solution to prevent them. Additionally, the narrative put forth by the WHO prioritizes the ‘alert and response’ and operational capabilities of the organization to further expand authority in outbreak response. This study concludes that the WHO, through the collection and distribution of knowledge, and efforts to increase operational capability as seen through the Global Outbreak Alert and Response Network (GOARN), seeks to maintain normative authority and power as an international organization. / M.A. / Globalization of trade and travel has only increased the fear of infectious disease transmission. There is a great demand for a global health security system that is alert and capable. Based on this ‘threat’ the WHO justifies their role as global health leader. The Global Outbreak Alert and Response Network (GOARN) is the system that currently acts as the operational arm of the WHO, monitoring and coordinating response to infectious disease outbreaks globally. Despite the critical role of GOARN, its day-to-day endeavors remain unexplored by the public health field. This thesis analyzes how the WHO uses GOARN and its surveillance capabilities to collect and transform data as a method to maintain normative authority, and projects a powerful narrative as the leader of ‘alert and response’. In a competitive environment with limited financial resources, the WHO has adapted in terms of surveillance and operational capability to maintain its leadership and authority in the global public health field.

Malaria is caused by Plasmodium parasites, which are transmitted via the bite of infected female anopheles mosquitoes. There were 217 million cases of malaria worldwide, and about 435,000 malaria related deaths in 2017. WHO Africa region accounted for 92% and 93% of malaria cases and deaths worldwide. According to The Gambia National Malaria Strategic Plan 2013-2020, malaria is a leading cause of morbidity and mortality. The aim of this study was to identify factors influencing attitude towards the use of mosquito nets in households in The Gambia using Demographic and Health Survey (DHS) data. The current study is a secondary data analysis with a, cross-sectional study design. The source of the data for this study is the DHS, which was conducted by the United States Agency for International Development (USAID) together with the Gambia Bureau of Statistics (GBOS) in 2013. The study sample is representative of The Gambian population. The sample size for the study was 5276 subjects. Statistical Analysis System (SAS 9.3) was used for data analysis. Descriptive statistics were generated for the factors been tested. These included area of residence, presence of electricity, indoor residual spraying, highest level of education and wealth index. The outcome variable measured was household use of mosquito nets (Yes/No). Logistic regression analysis was done to determine whether area of residence, wealth index, education level, presence of electricity and indoor residual spraying influence attitude towards use of mosquito nets in households. Stepwise binary logistic regression was used to determine the final model with the most significant predictors. Odds ratios and corresponding confidence intervals were reported. Most of the study participants were poor (46%). Those with no education made up 45.5% of the study population and 58% of dwellings had no indoor residual spraying done in the past year. 76.6% and 59.1% of respondents lived in households that had at least one mosquito net and no electricity supply, respectively. 50.6% of the respondents resided in rural areas. Logistic regression analysis showed that wealth index, indoor residual spraying and area of residence were significant factors (p<0.05) influencing attitude towards use of mosquito nets in households. Indoor residual spraying (OR=2.00; 95% C.I. 1.71-2.36), primary school education (OR=1.1; 95% C.I. 0.94-1.32), middle class wealth index (OR=1.32; 95% C.I. 1.05-1.67) and rural residence (OR=1.29; 95% C.I. 1.01-1.64) are all independent factors that increased likelihood of mosquito net usage in households. Identifying factors that influence the usage of mosquito nets in households, can be useful in developing target interventions to further reduce malaria morbidity and mortality in The Gambia. Knowledge from this study can be used to further strengthen the national malaria strategic plan. To further establish causality and increase strength of association between factors and outcome, a case control or cohort study design will be needed, since that is one of the limitations of a cross sectional study.