Development and validation of a data quality index for forensic documentation of sexual and gender-based violence in Kenya.

INTRODUCTION: High-quality forensic documentation can improve justice outcomes for survivors of sexual and gender-based violence, but there are limited tools to assess documentation data quality. This study aimed to develop and validate a data quality assessment index to objectively assess clinician documentation across the 26 key elements of the standardized forensic evidence forms used in Kenya. METHODS: Informed by prior quality assessment tools, an initial draft of the index was developed. Feedback from Kenya- and U.S.-based clinicians and human rights experts was solicited and incorporated into the draft index in an iterative fashion. Two raters independently employed the finalized Physicians for Human Rights Data Quality Index to assess and score the quality of documentation across 31 clinician-completed forms. Inter-rater reliability was determined using Cohen kappa (к) coefficients. RESULTS: The Index was found to have substantial overall reliability. Of the 26 documentation items, the Index had a perfect (к = 1.0) and almost perfect (к = 0.81-0.99) level of inter-rater agreement across 17 (65.4%) and 5 (19.2%) items, respectively. On a low-to-high documentation quality scale of 0 to 2, the majority of items (n = 19, 73.1%) had a mean documentation quality score >1.5-2. CONCLUSION: Quality assurance of forensic documentation is an essential component of post-sexual assault care. To our knowledge, this is the first validated quality-assessment tool in the peer-reviewed literature for sexual assault documentation and may be a promising strategy to enhance the quality of sexual assault documentation in other settings, locally, regionally, and internationally.

Immigration Detention in the United States: Identifying Alternatives That Comply With Human Rights and Advance Public Health.

Under international law, the United States is obligated to uphold noncitizens' fundamental rights, including their rights to health. However, current US immigration laws-and their enforcement-not only fail to fulfill migrants' health rights but actively undermine their realization and worsen the pandemic's spread. Specifically, the US immigration system's reliance on detention, which precludes effective social distancing, increases risks of exposure and infection for detainees, staff, and their broader communities. International agreements clearly state that the prolonged, mandatory, or automatic detention of people solely because of their migration status is a human rights violation on its own. But in the context of COVID-19, the consequences for migrants' right to health are particularly acute. Effective alternatives exist: other countries demonstrate the feasibility of adopting and implementing immigration laws that establish far less restrictive, social services-based approaches to enforcement that respect human rights. To protect public health and realize its global commitments, the United States must shift away from detaining migrants as standard practice and adopt effective, humane alternatives-both amid COVID-19 and permanently.

Legal perspectives on liability for medical negligence and malpractices in Nigeria.

Medical practice usually involves different activities which if not professionally handled, may give rise to liabilities on the part of the medical practitioner. These liabilities may arise in tortious claims and in some other cases, may go beyond the realm of civil liabilities to criminal liabilities. This review focuses on liabilities that amount to negligence both under the civil and criminal laws in Nigeria, other instances of malpractices which may not amount to negligence but may suffice to give rise to a successful cause of action in other branches of substantive law including claims for breach of fundamental human rights; contract; and fiduciary relationship. The review concludes by emphasizing the need for caution and the need to ensure that justice is seen to be done not only to the victims but also to the medical practitioners who deserve all legal protection in the exercise of their professional duties.

Social suffering and the psychological impact of structural violence and economic oppression in an ongoing conflict setting: The Gaza Strip.

Structural violence and economic oppression (e.g. control over resources, politically engineered poverty and unemployment) are common features of warfare, yet there is a lack of research exploring the impact this has on civilian wellbeing in conflict-affected areas. This study, embedded within a human rights and community liberation psychology framework, aims to address this need by studying young Palestinian university graduates living under military blockade and occupation in the Gaza Strip. Semi-structured interviews were conducted. Thematic analysis indicated that economic and political domains adversely affected multiple aspects of civilian life and wellbeing. The findings revealed the deleterious effects of structural violence and economic oppression which created: human insecurity; poor psychological wellbeing and quality of life; existential, psychological and social suffering; humiliation; injuries to dignity; multiple losses; and led to life being experienced as 'on hold'. Local expressions and idioms to express distress were identified. The findings contributed to unique insights regarding how continual, systemic, and structural oppression can be potentially more psychologically detrimental than specific incidents of conflict and violence. The implications and the relevance of the findings to mental health and disaster relief are considered. Interventions providing human security and economic security should be prioritised.

Child marriage in Canada: A systematic review.

Child marriage, defined by the United Nations as marriage before the age of 18, is considered a violation of human rights with negative consequences for girls' health. We systematically reviewed existing academic literature and news media to learn what is known about the frequency of child marriage in Canada and its effects on health. Approximately 1% of 15-19-year-olds in Canada were married or in common law unions in 2016. News reports document cases of child marriage among religious minority communities but no nationwide estimates of the frequency of marriage before the age of 18 were identified. Sources consistently show girls are more likely to marry as teens than boys. Information on married teens between 15 and 19 years of age suggests similarities in marriage patterns among this age group in Canada and child marriage practices globally. Further research is needed to measure Canada's progress toward eliminating child marriage.

Is this a man's world? The effect of gender diversity and gender equality on firm innovativeness.

Gender diversity is known to have a positive effect on innovation in developed countries. However, it is unclear whether the benefits of gender diversity for innovation also apply to the particular context of developing countries, which is characterized by diverse and lower levels of gender equality. We propose that gender diversity positively impacts innovation in the developing countries participating in our study. In addition, we expect that this effect is moderated by country-specific levels of gender equality. In a cross-country study covering 18,547 firms in 15 developing countries, we find that gender diversity among a firm's owners and workforce as well as having a female top manager benefit innovation in developing countries. Yet, contradictory to our expectations, gender equality does not significantly moderate this relationship. As such, our results underline the importance of enabling and fostering gender diversity and have critical implications for firms and policy makers alike.

Evaluation of approaches to strengthen civil registration and vital statistics systems: A systematic review and synthesis of policies in 25 countries.

BACKGROUND: Civil registration and vital statistics (CRVS) systems play a key role in upholding human rights and generating data for health and good governance. They also can help monitor progress in achieving the United Nations Sustainable Development Goals. Although many countries have made substantial progress in strengthening their CRVS systems, most low- and middle-income countries still have underdeveloped systems. The objective of this systematic review is to identify national policies that can help countries strengthen their systems. METHODS AND FINDINGS: The ABI/INFORM, Embase, JSTOR, PubMed, and WHO Index Medicus databases were systematically searched for policies to improve birth and/or death registration on 24 January 2017. Global stakeholders were also contacted for relevant grey literature. For the purposes of this review, policies were categorised as supply, demand, incentive, penalty, or combination (i.e., at least two of the preceding policy approaches). Quantitative results on changes in vital event registration rates were presented for individual comparative articles. Qualitative systematic review methodology, including meta-ethnography, was used for qualitative syntheses on operational considerations encompassing acceptability to recipients and staff, human resource requirements, information technology or infrastructure requirements, costs to the health system, unintended effects, facilitators, and barriers. This study is registered with PROSPERO, number CRD42018085768. Thirty-five articles documenting experience in implementing policies to improve birth and/or death registration were identified. Although 25 countries representing all global regions (Africa, the Americas, Southeast Asia, the Western Pacific, Europe, and the Eastern Mediterranean) were reflected, there were limited countries from the Eastern Mediterranean and Europe regions. Twenty-four articles reported policy effects on birth and/or death registration. Twenty-one of the 24 articles found that the change in registration rate after the policy was positive, with two supply and one penalty articles being the exceptions. The qualitative syntheses identified 15 operational considerations across all policy categories. Human and financial resource requirements were not quantified. The primary limitation of this systematic review was the threat of publication bias wherein many countries may not have documented their experience; this threat is most concerning for policies that had neutral or negative effects. CONCLUSIONS: Our systematic review suggests that combination policy approaches, consisting of at least a supply and demand component, were consistently associated with improved registration rates in different geographical contexts. Operational considerations should be interpreted based on health system, governance, and sociocultural context. More evaluations and research are needed from the Eastern Mediterranean and Europe regions. Further research and evaluation are also needed to estimate the human and financial resource requirements required for different policies.

Gender and health social enterprises in Africa: a research agenda.

BACKGROUND: Health social enterprises in Africa working with community health workers (CHWs) are growing rapidly but understudied. In particular, gender equality issues related to their work has important public health and equity implications. METHODS: Particularly suited for generating timely findings from reviews at the intersection of overlapping disciplines, we utilized the rapid evidence assessment (REA) methodology to identify key unanswered research questions at the intersection of the fields of gender equality, social enterprises and community health workers. The REA used a series of structured Google Scholar searches, expert interviews and bibliography reviews to identify 57 articles in the academic and grey literatures that met the study inclusion criteria. Articles were thematically coded to identify answers to "What are the most important research questions about the influence of gender on CHWs working with health social enterprises in Africa?" RESULTS: The analysis identified six key unanswered research questions relating to 1) equitable systems and structures; 2) training; 3) leadership development and career enhancement; 4) payment and incentives; 5) partner, household and community support; and 6) performance. CONCLUSION: This is the first study of its kind to identify the key unanswered research questions relevant to gender equality in health social enterprises in Africa using community health workers. As such, it sets out a research agenda for this newly emerging but rapidly developing area of research and practice with important public health implications.

Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries.

CONTEXT: Although an association between gender equality and contraceptive use has been confirmed among adult samples, few studies have explored this relationship among adolescents. An examination of whether adolescents' contraceptive use is more prevalent in countries with higher levels of gender equality is needed to fill this gap. METHODS: Nationally representative data from 33 countries that participated in the 2013-2014 Health Behaviour in School-Aged Children study and country-level measures of gender equality-using the 2014 Global Gender Gap Index-were analyzed. Multilevel multinomial logistic regression analyses were employed to assess associations between gender equality and contraceptive use (condom only, pill only and dual methods) at last intercourse as reported by 4,071 females and 4,110 males aged 14-16. RESULTS: Increasing gender equality was positively associated with contraceptive use among both males and females. For every 0.1-point increase on the equality scale, the likelihood of condom use at last intercourse rose (odds ratio, 2.1 for females), as did the likelihood of pill use (6.5 and 9.6, respectively, for males and females) and dual method use (2.1 and 5.6, respectively). Associations with pill use and dual use remained significant after national wealth and income inequality were controlled for. Overall, associations were stronger for females than for males. CONCLUSIONS: More research is needed to identify potential causal pathways and mechanisms through which gender equality and adolescents' contraceptive use may influence one another.

Operationalization of patients' rights in Sudan: Quantifying nurses' knowledge.

BACKGROUND: Promoting patients' rights is essential for defining the standards of clinical services within a country. Given their responsibilities, nurses can be the primary target for research to investigate the issue of patients' rights within a healthcare system. As such, assessing the knowledge of nurses about patients' rights is an essential step toward improving the quality of healthcare in limited resource settings like Sudan. OBJECTIVES: We aimed to assess the level of knowledge about patients' rights among the nursing staff at Friendship Teaching Hospital in Sudan. METHODS: This hospital-based cross-sectional study was carried out at the Friendship Teaching Hospital in Sudan. We surveyed the totality of nurses (95) at the hospital using an amended survey. The data were analyzed in SPSS software using descriptive and inferential statistics. ETHICAL CONSIDERATION: The study was approved by the Research Unit of Khartoum Ministry of Health and the Hospital administration. All respondents gave verbal consent prior to participating in the study. RESULTS: Only 48.4% of the participants knew about the existence of the Sudanese Charter of patients' rights. Nonetheless, our analysis found that 65.8% of nurses had acceptable level of knowledge (scored more than 75% of the total knowledge score) of patients' rights, and none of the participant scored less than 50% of the total knowledge score. Finally, we found no statistical association between the knowledge score and demographic data, educational level, whether the participant knows about the existence of the Charter or not and a number of other factors. CONCLUSION: Nurses' lack of knowledge about the existence of the Sudanese Charter of patients' rights adopted in 2009 rights confirms the need for further efforts by Ministry of Health to promote the document. Furthermore, further research is needed to investigate the disconnect between nurses' lack of knowledge about the existence of the charter and their awareness of the rights within the charter as well as the actual implementation of rights.

Broadening understanding of accountability ecosystems in sexual and reproductive health and rights: A systematic review.

BACKGROUND: Accountability for ensuring sexual and reproductive health and rights is increasingly receiving global attention. Less attention has been paid to accountability mechanisms for sexual and reproductive health and rights at national and sub-national level, the focus of this systematic review. METHODS: We searched for peer-reviewed literature using accountability, sexual and reproductive health, human rights and accountability instrument search terms across three electronic databases, covering public health, social sciences and legal studies. The search yielded 1906 articles, 40 of which met the inclusion and exclusion criteria (articles on low and middle-income countries in English, Spanish, French and Portuguese published from 1994 and October 2016) defined by a peer reviewed protocol. RESULTS: Studies were analyzed thematically and through frequencies where appropriate. They were drawn from 41 low- and middle-income countries, with just over half of the publications from the public health literature, 13 from legal studies and the remaining six from social science literature. Accountability was discussed in five health areas: maternal, neonatal and child health services, HIV services, gender-based violence, lesbian/gay/bisexual/transgender access and access to reproductive health care in general. We identified three main groupings of accountability strategies: performance, social and legal accountability. CONCLUSION: The review identified an increasing trend in the publication of accountability initiatives in Sexual and Reproductive Health and Rights (SRHR). The review points towards a complex 'accountability ecosystem' with multiple actors with a range of roles, responsibilities and interactions across levels from the transnational to the local. These accountability strategies are not mutually exclusive, but they do change the terms of engagement between the actors involved. The publications provide little insight on the connections between these accountability strategies and on the contextual conditions for the successful implementation of the accountability interventions. Obtaining a more nuanced understanding of various underpinnings of a successful approach to accountability at national and sub national levels is essential.

Undocumented children in the Amsterdam region: an analysis of health, school, and living circumstances.

Undocumented migrants are people who do not have a valid residence permit. There are only estimates about how many undocumented migrants are living in the European Union; the number of children among them is unclear. Studies about undocumented children are scarce and little is known about their living situation and their access to health care. Therefore, we aimed to estimate the number of undocumented children in the population of visitors of our primary care clinic for undocumented patients. Moreover, we explored whether these children's rights with respect to health care, education, and living circumstances were met. All undocumented adult patients visiting the clinic between September 1, 2016 and December 31, 2016 received a questionnaire. In total, 267 undocumented adults responded; 30% of them had children, and 15% had one or more undocumented children living in the Netherlands. Eleven percent of those undocumented children did not attend school, 17% was not vaccinated, 83% did not have a general practitioner, and 30% did not have a permanent place of residence. CONCLUSION: There are probably a considerable number of undocumented children in the Netherlands; our study estimated a percentage of 17% of the undocumented population. Not all their basic human rights are met; more awareness among people involved with child and health policies is needed. What is Known: • There are only estimates of the number of undocumented migrants in the European Union, the number of children among them is not clear. • Studies about undocumented children are scarce and little is known about their living circumstances and access to health care. What is New: • A substantial number of undocumented children do not go to school, are not vaccinated, and do not have a general practitioner. • The hidden group of undocumented children, whose basic human rights are not met, need special attention when they or their caregivers present at a health care facility.

[International experience in the legal regulation of the circulation of medicines through the prism of the law of the world trade organization].

OBJECTIVE: Introduction: The development of international legal cooperation in the field of health has largely been driven by the trade interests of states. The aim: The article analyzes the legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization. PATIENTS AND METHODS: Materials and methods: Using the historical legal method has allowed to analyze the genesis of legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization. The dialectical method is widely used, in particular, when it comes to the issue of the ratio of market regulation of medicines circulation and public health protection, the formal logic method, in particular, in formulating the general principles, principles and methods of legal regulation in the field of medicines, as well as the systemic method, in particular, in defining the institutional component of legal regulation in the field of medicines. RESULTS: Review: The activities of the WTO include several areas related to health protection: international control over infectious diseases, international legal regulation of food safety (food security), tobacco control, environmental protection, international legal aspects of access and treatment of medicinal and pharmaceutical products, international legal regulation of medical services provision. CONCLUSION: Conclusions: It is proved that the right to health is a right to access to medicines. However, for many developing countries, it is problematic to obtain patents for the production of necessary medicines or to pay a license fee, which creates a barrier to the realization of the right to health.

Older and incarcerated: policy implications of aging prison populations.

Purpose The purpose of this paper is to explore the policy Implications of aging prison populations. Design/methodology/approach An examination of the worldwide aging trend in prison and its implications for correctional policy, including an examination of population aging in California prisons as a case example of needed reform. Findings Prison populations worldwide are aging at an unprecedented rate, and age-related medical costs have had serious consequences for jurisdictions struggling to respond to the changes. These trends are accompanied by a growing body of evidence that old age is strongly correlated with desistance from criminal behavior, suggesting an opportunity to at least partially address the challenges of an aging prison population through early release from prison for appropriate persons. Originality/value Some policies do exist that aim to reduce the number of older, chronically ill or disabled and dying people in prison, but they have not achieved that goal on a sufficient scale. An examination of the situation in California shows that recognizing how the healthcare needs of incarcerated people change as they age - and how aging and aging-related health changes often decrease an older person's likelihood of repeat offense - is critical to achieving effective and efficient policies and practices aimed at adequately caring for this population and reducing their numbers in prisons when appropriate.

What Is the Association between Absolute Child Poverty, Poor Governance, and Natural Disasters? A Global Comparison of Some of the Realities of Climate Change.

The paper explores the degree to which exposure to natural disasters and poor governance (quality of governance) is associated with absolute child poverty in sixty-seven middle- and low-income countries. The data is representative for about 2.8 billion of the world´s population. Institutionalist tend to argue that many of society's ills, including poverty, derive from fragile or inefficient institutions. However, our findings show that although increasing quality of government tends to be associated with less poverty, the negative effects of natural disasters on child poverty are independent of a country´s institutional efficiency. Increasing disaster victims (killed and affected) is associated with higher rates of child poverty. A child´s estimated odds ratio to be in a state of absolute poverty increases by about a factor of 5.7 [95% CI: 1.7 to 18.7] when the average yearly toll of disasters in the child´s country increases by one on a log-10 scale. Better governance correlates with less child poverty, but it does not modify the correlation between child poverty and natural disasters. The results are based on hierarchical regression models that partition the variance into three parts: child, household, and country. The models were cross-sectional and based on observational data from the Demographic Health Survey and the Multiple Indicator Cluster Survey, which were collected at the beginning of the twenty-first millennium. The Sustainable Development Goals are a principle declaration to halt climate change, but they lack a clear plan on how the burden of this change should be shared by the global community. Based on our results, we suggest that the development agencies should take this into account and to articulate more equitable global policies to protect the most vulnerable, specifically children.

Incommunicado detention and torture in Spain, Part II: Enhanced credibility assessment based on the Istanbul Protocol.

BACKGROUND: The Istanbul Protocol (IP) is the key instrument in the documentation of allegations of torture. However, few scientific studies have evaluated its effectiveness as a tool to assess credibility of allegations of ill-treatment or torture. OBJECTIVE: Present data on the credibility of allegations of torture in a sample of 45 Basque people held in short-term incommunicado detention between 1980 and 2012, using a modified version of the Standard Evaluation Form for Credibility Assessment (SEC), a new tool to assess credibility based on the IP. METHOD: Each case was evaluated by two psychiatrists, a psychologist and a physician through a layered system of simultaneous, independent assessments, blind audits and peer-review processes. Clinical interviews following the IP were contrasted with psychometric tests and external documentary evidence by independent experts. All available data were structured using the SEC and cases were accordingly classified as having Maximum consistency, Highly Consistent, Consistent or Inconsistent. FINDINGS: According to the SEC, 53% of allegations of torture were considered to have Maximum Consistency, 31% Highly consistent, 15% Consistent and 0% Inconsistent. The items that most contributed to the overall credibility assessment came from the psychological evaluation, including the description of alleged torture, emotional reactions, objective functional changes, changes in identity and worldviews and clinical diagnosis. There was little contribution from previous medical reports. INTERPRETATION: When applied competently, the IP is an essential tool in the documentation of torture. Our study shows: (a) evidence that allegations of ill-treatment and torture in the Basque Country are consistent and credible, being ascertained beyond reasonable doubt and aside from any political debate; (b) the wider use of the IP as a tool to assess credibility of allegations of ill-treatment and torture; and, (c) the usefulness of the SEC as a tool. The SEC can help as a tool for documenting torture in contexts where there are political differences and figures are distorted as a result of polarized political debates, and where legal documentation is needed for judicial purposes. Forensic science can help by providing an objective assessment of the credibility of allegations.

Representing Human Rights Violations in Darfur: Global Justice, National Distinctions.

This article examines how international judicial interventions in mass atrocity influence representations of violence. It relies on content analysis of 3,387 articles and opinion pieces in leading newspapers from eight Western countries, compiled into the Darfur Media Dataset, as well as in-depth interviews to assess how media frame violence in the Darfur region of Sudan. Overall, it finds that UN Security Council and International Criminal Court interventions increase representations of mass violence as crime in all countries under investigation, although each country applies the crime frame at a different level. Reporting suffering and categorizing the violence as genocide also varies across countries. Comparative case studies identify country specific structural and cultural forces that appear to account for these differences. Multilevel multivariate analyses confirm the explanatory power of cultural sensitivities and policy practices, while individual-and organization-level factors, such as reporters' gender and the newspapers' ideological orientation, also have explanatory power.

Frailty's Place in Ethics and Law: Some Thoughts on Equality and Autonomy and on Limits and Possibilities for Aging Citizens.

Consideration of ethical and legal themes relating to frailty must engage with the concern that frailty is a pejorative concept that validates and reinforces the disadvantage and vulnerability of aging adults. In this chapter, we consider whether a greater focus on frailty may indeed be part of the solution to the disadvantages that aging adults face in achieving equality and maintaining their autonomy within systems that have used their frailty to deny them equality and autonomy. First, by examining equality both as an ethical norm and as a requirement for protections against discrimination, we raise questions about the grounds on which health providers and health systems can be required to give equal concern and respect to the needs of frail older persons. Second, we explore autonomy and identify the tension between meaningful self-determination and prevailing ethical and legal norms associated with informed choice. Third, we argue that a proper understanding of frailty is essential within both of these themes; it respects equality by enabling health providers and systems to identify and address the distinct care needs of aging adults and helps to align informed choice theory with appropriate processes for decision-making about those needs.

Sex work and the claim for grassroots legislation.

The aim of this paper is to contribute to understanding of legal models that aim to control sex work, and the policy implications of these, by discussing the experience of developing a grassroots legislation bill proposal by organised sex workers in Córdoba, Argentina. The term 'grassroots legislation' here refers to a legal response that derives from the active involvement of local social movements and thus incorporates the experiential knowledge and claims of these particular social groupings in the proposal. The experience described in this paper excludes approaches that render sex workers as passive victims or as deviant perpetrators; instead, it conceives of sex workers in terms of their political subjectivity and of political subjectivity in its capacity to speak, to decide, to act and to propose. This means challenging current patterns of knowledge/power that give superiority to 'expert knowledge' above and beyond the claims, experiences, knowledge and needs of sex workers themselves as meaningful sources for law making.