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.

Explicit motives and personality characteristics in first year medical students: a multicentre quantitative study using McClellands motive disposition theory.

BACKGROUND: Despite the challenging curriculum, medicine is a popular study program. We propose McClelland's Motive Disposition Theory (MDT) as a possible theory for explaining medical students motivation. The theory describes how individuals differ in their behaviour due to their varying manifestations of certain motives. The three motives can thus influence the students behaviour and academic success. Using these motives, complimented with an altruism- and a freedom motive, this study was aimed at investigating young adults' explicit motives to study medicine. In addition, we also wanted to find out whether there are gender differences in motives and other variables such as empathy, emotional intelligence and academic self-concept. METHODS: Over 20 universities across Germany were contacted and asked to share the online study with their first semester medical students in the winter term 2022/23, which resulted in a final N = 535. We used validated and reliable measurements, including a self-created and piloted questionnaire covering medicine-specific explicit motives. RESULTS: Comparing the mean scores between motives, we found that the altruism motive was the strongest motive (M = 5.19), followed by freedom (M = 4.88), affiliation (M = 4.72) and achievement (M = 4.59). The power motive achieved the lowest score (M = 3.92). Male students scored significantly higher for power (M = 4.24) than females did (M = 3.80, p < .001), while female students found affiliation more important (M = 4.81) than male students did (M = 4.59, p = .016). Female participants scored significantly higher for emotional intelligence (p = .010) and several personality aspects, including empathy (p < .001), but showed a significantly lower academic self-concept (p = .033), compared to their male colleagues. Nonetheless, the effect sizes were mostly small to medium. CONCLUSIONS: Our findings suggest that first-year medical students are primarily motivated by humanitarian factors to study medicine, compared to motives related to money or power. This is mostly in line with earlier studies using qualitative approaches, showing that MDT can be applied to explain explicit motives in medical students. TRIAL REGISTRATION: The longitudinal project, which this study was part of, was registered via OSF ( https://archive.org/details/osf-registrations-mfhek-v1 ) on the 28th of September 2022 under the title "Transformation of emotion and motivation factors in medical students during the study progress: A multicenter longitudinal study".

Using artificial agents to nudge outgroup altruism and reduce ingroup favoritism in human-agent interaction.

Ingroup favoritism and intergroup discrimination can be mutually reinforcing during social interaction, threatening intergroup cooperation and the sustainability of societies. In two studies (N = 880), we investigated whether promoting prosocial outgroup altruism would weaken the ingroup favoritism cycle of influence. Using novel methods of human-agent interaction via a computer-mediated experimental platform, we introduced outgroup altruism by (i) nonadaptive artificial agents with preprogrammed outgroup altruistic behavior (Study 1; N = 400) and (ii) adaptive artificial agents whose altruistic behavior was informed by the prediction of a machine learning algorithm (Study 2; N = 480). A rating task ensured that the observed behavior did not result from the participant's awareness of the artificial agents. In Study 1, nonadaptive agents prompted ingroup members to withhold cooperation from ingroup agents and reinforced ingroup favoritism among humans. In Study 2, adaptive agents were able to weaken ingroup favoritism over time by maintaining a good reputation with both the ingroup and outgroup members, who perceived agents as being fairer than humans and rated agents as more human than humans. We conclude that a good reputation of the individual exhibiting outgroup altruism is necessary to weaken ingroup favoritism and improve intergroup cooperation. Thus, reputation is important for designing nudge agents.

Too few epidemiologists in humanitarian crises: a critical gap that needs addressing. A new course organised by the Italian Association of Epidemiology

The current humanitarian crises in Ukraine and Gaza, along with the chronic crises, and the climate-related disasters, have exposed the limitations of the humanitarian system. Within these contexts, humanitarian organisations frequently struggle with collecting, analysing, interpreting, and utilising health data, due to the challenging environments in which they operate and funding constraints. It is precisely in these contexts that field epidemiology plays a crucial, but often overlooked role.Field epidemiologists face unique challenges, including rapidly changing conditions, poor-quality data, and biases. Despite these difficulties, accurate epidemiological data are essential for needs assessment, guidance on interventions, and advocacy. Conventional methods often need adaptation for crisis settings, and there are still gaps in measurement.This article discusses the role of epidemiology in such contexts, noting a shortage of trained 'humanitarian epidemiologists' and specialised training as major issues.To address these needs, the Italian Association of Epidemiology organised a course in early 2024 to enhance the epidemiological skills of staff working in humanitarian crises and introduce traditional epidemiologists to crisis-specific challenges. The course covered key concepts and methods of field epidemiology, emphasising the use of secondary health data. Its positive reception underscored the demand for such specialised training.Improving public health information collection and use in humanitarian crises is an ethical and practical necessity. Indeed, investing in field epidemiology and recognising its importance can enhance humanitarian interventions and better serve vulnerable populations.

Applying process dissociation to self-sacrificial moral dilemmas: Extending the dual-process model.

There is considerable evidence linking cognitive reflection with utilitarian judgments in dilemmas that involve sacrificing someone else for the greater good. However, the evidence is mixed on the question of whether cognitive reflection is associated with utilitarian judgments in self-sacrificial dilemmas. We employed process dissociation to extract a self-sacrificial utilitarian (SU) parameter, an altruism (A) parameter, an other-sacrificial (OU) utilitarian parameter, and a deontology (D) parameter. In Study 1, the cognitive reflection test (CRT) positively correlated with both SU and OU (replicated in Studies 2 and 4, pre-registered). In Study 2, we found that instructing participants to rely on reason increased SU and OU (replicated in Study 4, pre-registered). In Study 3, we found that SU and OU positively correlated with giving in the single-game version of the public goods game (replicated in Study 4, pre-registered), which provides behavioral validation that they are genuine moral tendencies. Together, these studies constitute strong cumulative evidence that SU and OU are both valid measures that are associated with reliance on cognitive reflection.

Evaluating strategies to recruit health researchers to participate in online survey research.

BACKGROUND: Engaging researchers as research subjects is key to informing the development of effective and relevant research practices. It is important to understand how best to engage researchers as research subjects. METHODS: A 24 factorial experiment, as part of a Multiphase Optimization Strategy, was performed to evaluate effects of four recruitment strategy components on participant opening of an emailed survey link and survey completion. Participants were members of three US-based national health research consortia. A stratified simple random sample was used to assign potential survey participants to one of 16 recruitment scenarios. Recruitment strategy components were intended to address both intrinsic and extrinsic sources of motivation, including: $50 gift, $1,000 raffle, altruistic messaging, and egoistic messaging. Multivariable generalized linear regression analyses adjusting for consortium estimated component effects on outcomes. Potential interactions among components were tested. Results are reported as adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). RESULTS: Surveys were collected from June to December 2023. A total of 418 participants were included from the consortia, with final analytical sample of 400 eligible participants. Out of the final sample, 82% (341) opened the survey link and 35% (147) completed the survey. Altruistic messaging increased the odds of opening the survey (aOR 2.02, 95% CI: 1.35-2.69, p = 0.033), while egoistic messaging significantly reduced the odds of opening the survey (aOR 0.56, 95%CI 0.38-0.75, p = 0.08). The receipt of egoistic messaging increased the odds of completing the survey once opened (aOR 1.81, 95%CI: 1.39-2.23, p < 0.05). There was a significant negative interaction effect between the altruistic appeal and egoistic messaging strategies for survey completion outcome. Monetary incentives did not a have a significant impact on survey completion. CONCLUSION: Intrinsic motivation is likely to be a greater driver of health researcher participation in survey research than extrinsic motivation. Altruistic and egoistic messaging may differentially impact initial interest and survey completion and when combined may lead to improved rates of recruitment, but not survey completion. Further research is needed to determine how to best optimize message content and whether the effects observed are modified by survey burden.

Standardising job descriptions in the humanitarian supply chain: A text mining approach for recruitment process.

PURPOSE: Uncertainty and complexity have increased in recent decades, posing new challenges to humanitarian organisations. This study investigates whether using standard terminology in Human Resource Management processes can support the Humanitarian supply chain in attracting and maintaining highly skilled operators. METHODOLOGY: We exploit text mining to compare job vacancies on ReliefWeb, the reference platform for humanitarian job seekers, and ESCO, the European Classification of Skills, Competencies, and Occupations. We measure the level of alignment in these two resources, providing quantitative evidence about terminology standardisation in job descriptions for supporting HR operators in the Humanitarian field. FINDINGS: The most in-demand skills, besides languages, relate to resource management and economics and finance for capital management. Our results show that job vacancies for managerial and financial profiles are relatively more in line with the European database than those for technical profiles. However, the peculiarities of the humanitarian sector and the lack of standardisation are still a barrier to achieving the desired level of coherence with humanitarian policies.

Implementation of maternal and perinatal death surveillance and response and related death review interventions in humanitarian settings: A scoping review.

Background: The global population impacted by humanitarian crises continues to break records each year, leaving strained and fractured health systems reliant upon humanitarian assistance in more than 60 countries. Yet little is known about implementation of maternal and perinatal death surveillance and response (MPDSR) within crisis-affected contexts. This scoping review aimed to synthesise evidence on the implementation of MPDSR and related death review interventions in humanitarian settings. Methods: We searched for peer-reviewed and grey literature in English and French published in 2016-22 that reported on MPDSR and related death review interventions within humanitarian settings. We screened and reviewed 1405 records, among which we identified 25 peer-reviewed articles and 11 reports. We then used content and thematic analysis to understand the adoption, appropriateness, fidelity, penetration, and sustainability of these interventions. Results: Across the 36 records, 33 unique programmes reported on 37 interventions within humanitarian contexts in 27 countries, representing 69% of the countries with a 2023 United Nations humanitarian appeal. Most identified programmes focussed on maternal death interventions; were in the pilot or early-mid implementation phases (1-5 years); and had limited integration within health systems. While we identified substantive documentation of MPDSR and related death review interventions, extensive gaps in evidence remain pertaining to the adoption, fidelity, penetration, and sustainability of these interventions. Across humanitarian contexts, implementation was influenced by severe resource limitations, variable leadership, pervasive blame culture, and mistrust within communities. Conclusions: Emergent MPDSR implementation dynamics show a complex interplay between humanitarian actors, communities, and health systems, worthy of in-depth investigation. Future mixed methods research evaluating the gamut of identified MPDSR programmes in humanitarian contexts will greatly bolster the evidence base. Investment in comparative health systems research to understand how best to adapt MPDSR and related death review interventions to humanitarian contexts is a crucial next step.

By the numbers and in their own words: A mixed methods study of unmet needs and humanitarian inclusion of older Syrian refugees in Lebanon.

Older people constitute an overlooked vulnerable population in humanitarian crises. Lebanon is a small country that hosts the largest number of refugees per capita in the world. With exacerbating socioeconomic conditions, exclusionary policies against refugees, and a fragmented humanitarian system, the status of older Syrian refugees (OSRs) requires special attention. This study aimed to explore OSRs' unmet needs, coping strategies, available humanitarian services, and some indicators of the humanitarian inclusion standards focusing on the shelter, health, nutrition and food security, and water, sanitation and hygiene sectors. We conducted a convergent mixed-methods study between December 2021 and March 2022 in the North and Bekaa, including a cross-sectional survey with 461 participants and 14 semi-structured interviews. Results show that OSRs lived in inappropriate shelters (cold, leaking rainwater), especially in informal tented settlements. High rent prices pushed refugee households with elderly to prioritize paying rent at the expense of other needs such as food and medication, particularly when food cash transfer is the sole source of income, jeopardizing food security and intake. Access to dignifying and accessible bathing facilities was compromised in ITSs with shared facilities. Substantial medical costs hindered OSRs access to healthcare such as surgeries. Due to the crisis, chronic medications are not always available in dispensaries for subsidized cost, pushing OSRs to non-compliance and selling food assistance to buy medications. Soaring fuel prices hindered OSRs access to heating and transportation to receive healthcare. No efforts were reported in collecting data on OSRs' needs, targeting them with information on services, or soliciting feedback for programming, especially in the absence of any age-tailored interventions. Findings shed light on the precarious living conditions of OSRs in Lebanon and add to the body of evidence documenting their invisibility to the humanitarian response. An age-inclusive response is needed through holistic, tailored, and sustainable interventions.

Endogenous Opioids and Volunteering: On the Evolutionary Significance of Helping Others.

The human tendency to help others in need has been subject to trans-, inter-, and multidisciplinary studies (e.g., anthropology, neurobiology, evolutionary psychology, economy), within the frame of studying the mechanisms and adaptive significance of human prosocial behavior. Volunteering directed to unrelated and unfamiliar individuals is one common form of such helping behavior. Helping others may be adaptive for a species at a macro-level, which in turn is mediated by neurobiological mechanisms. A key target for analysis of the neurobiological underpinnings of volunteering is the endogenous opioid system (EOS). This chapter discusses EOS activity as a potential mediator of volunteering behavior. Evidence of the congruence between EOS involvement in social group behavior and social bonding and the role of these phenomena in volunteerism is reviewed. Models and empirical evidence of the mechanisms and adaptive value of helping unrelated others are discussed and integrated, including the mammalian caregiving system, the neurobiological model of prosocial behavior, synchrony promoting social bonding, and stress-driven motivation of prosocial action in immediate needs.

The effect of conversation on altruism: A comparative study with different media and generations.

Despite the overwhelming evidence of climate change and its effects on future generations, most individuals are still hesitant to make environmental changes that would especially benefit future generations. In this study, we investigate whether dialogue can influence people's altruistic behavior toward future generations of humans, and how it may be affected by participant age and the appearance of the conversation partner. We used a human, an android robot called Telenoid, and a speaker as representatives of future generations. Participants were split among an old age group and a young age group and were randomly assigned to converse with one of the aforementioned representatives. We asked the participants to play a round of the Dictator Game with the representative they were assigned, followed by an interactive conversation and another round of the Dictator Game in order to gauge their level of altruism. The results show that, on average, participants gave more money after having an interactive conversation, and that older adults tend to give more money than young adults. There were no significant differences between the three representatives. The results show that empathy might have been the most important factor in the increase in altruistic behavior for all participants.

Diasporas as a linchpin in local and international humanitarian action: a case study of the Chinese in Aceh following the 2004 tsunami.

Chinese humanitarian actors have worked frequently with the Chinese diaspora in disaster-affected areas, but little, if any, research has been conducted into the important role of the diaspora in disaster response and humanitarian assistance. This paper investigates what local knowledge the Chinese diaspora has offered to humanitarian actors from the People's Republic of China (PRC), and how this has contributed to their effectiveness. Based on a case study of the semi-autonomous Indonesian province of Aceh in the aftermath of the Indian Ocean tsunami of 2004, this paper argues that the diaspora can serve as a linchpin in local and international humanitarian action. It can do so by strengthening networks and bringing together local ethnic communities, local governments, and the PRC's humanitarian actors, while also offering local knowledge in the form of contextual memory. Such local knowledge may have to be fully utilised to address any underlying ethnic tensions in disaster-affected areas.

Local knowledge as the basis of disaster management and humanitarian assistance.

Recent policy discourse on the localisation of disaster management and humanitarian assistance lacks attention to the culture, history, and traditions of the Global South. This special issue of Disasters argues that it is imperative to recognise the dynamic, interactive, contested, and negotiated nature of local knowledge. Such local knowledge saves lives by enabling responders to situate ad hoc, one-off events such as disasters in the broader and deeper context of community relationships, thereby providing more appropriate and more effective aid. Through the cases of China, Japan, Indonesia, and the Philippines, this special issue examines such dynamic local knowledge using an analytical framework consisting of three manifestations of local knowledge, namely: social capital; contextual historical memories; and adaptation to new ideas. These three manifestations show the ways in which local knowledge creates local capacity, via which local, national, and international disaster respondents can centre their response coordination, and in turn, demonstrate how local capacity reformulates local knowledge.

Interpreting International Humanitarian Law to Guarantee Abortion and Other Sexual and Reproductive Health Services in Armed Conflict.

The provision of basic sexual and reproductive health services in humanitarian settings, including armed conflict, is extremely limited, causing preventable mortalities and morbidities and violating human rights. Over 50% of all maternal deaths occur in humanitarian and fragile settings. International humanitarian law falls short in guaranteeing access to the full range of sexual and reproductive health information and services for all persons. Guaranteeing access to sexual and reproductive health services under international humanitarian law can increase access to services, improving the health and well-being of civilians in conflict zones. This paper sets forth ways in which international human rights law on sexual and reproductive health and rights should be incorporated into the forthcoming International Committee of the Red Cross Commentary on Geneva Convention IV, regarding the protection of civilians, to ensure services in the context of armed conflict.

Transcranial electrical stimulation modulates emotional experience and metabolites in the prefrontal cortex in a donation task.

Understanding the neural, metabolic, and psychological mechanisms underlying human altruism and decision-making is a complex and important topic both for science and society. Here, we investigated whether transcranial Direct Current Stimulation (tDCS) applied to two prefrontal cortex regions, the ventromedial prefrontal cortex (vmPFC, anode) and the right dorsolateral prefrontal cortex (DLPFC, cathode) can induce changes in self-reported emotions and to modulate local metabolite concentrations. We employed in vivo quantitative MR Spectroscopy in healthy adult participants and quantified changes in GABA and Glx (glutamate + glutamine) before and after five sessions of tDCS delivered at 2 mA for 20 min (active group) and 1 min (sham group) while participants were engaged in a charitable donation task. In the active group, we observed increased levels of GABA in vmPFC. Glx levels decreased in both prefrontal regions and self-reported happiness increased significantly over time in the active group. Self-reported guiltiness in both active and sham groups tended to decrease. The results indicate that self-reported happiness can be modulated, possibly due to changes in Glx concentrations following repeated stimulation. Therefore, local changes may induce remote changes in the reward network through interactions with other metabolites, previously thought to be unreachable with noninvasive stimulation techniques.

Persistence in repeated games encourages the evolution of spite.

Social behavior is divided into four types: altruism, spite, mutualism, and selfishness. The former two are costly to the actor; therefore, from the perspective of natural selection, their existence can be regarded as mysterious. One potential setup which encourages the evolution of altruism and spite is repeated interaction. Players can behave conditionally based on their opponent's previous actions in the repeated interaction. On the one hand, the retaliatory strategy (who behaves altruistically when their opponent behaved altruistically and behaves non-altruistically when the opponent player behaved non-altruistically) is likely to evolve when players choose altruistic or selfish behavior in each round. On the other hand, the anti-retaliatory strategy (who is spiteful when the opponent was not spiteful and is not spiteful when the opponent player was spiteful) is likely to evolve when players opt for spiteful or mutualistic behavior in each round. These successful conditional behaviors can be favored by natural selection. Here, we notice that information on opponent players' actions is not always available. When there is no such information, players cannot determine their behavior according to their opponent's action. By investigating the case of altruism, a previous study (Kurokawa, 2017, Mathematical Biosciences, 286, 94-103) found that persistent altruistic strategies, which choose the same action as the own previous action, are favored by natural selection. How, then, should a spiteful conditional strategy behave when the player does not know what their opponent did? By studying the repeated game, we find that persistent spiteful strategies, which choose the same action as the own previous action, are favored by natural selection. Altruism and spite differ concerning whether retaliatory or anti-retaliatory strategies are favored by natural selection; however, they are identical concerning whether persistent strategies are favored by natural selection.

Doctor, Indian nationalist and humanitarian: Mukhtar Ahmad Ansari (1880-1936).

Mukhtar Ahmad Ansari was a doctor and remarkable political figure in the late 19th century and the first half of 20th century. After studying medicine in Edinburgh, he returned to his country and became interested in political issues. Not unlike other educated Indian Muslims, Ansari first expressed his concerns about the situation in the Ottoman empire and went to Istanbul as the head of the medical mission. Ansari, who became more interested in politics after his days in Istanbul, came to the forefront as one of the leading figures of the Indian independence movement. Along with Mahatma Gandhi (1869-1948), Ansari did not engage in violence but supported the unity of Muslims and Hindus and opposed communalism. Despite his active political life, Ansari continued his medical studies with great seriousness and played an active role in establishing the Delhi Medical Association in 1914. During this period, his most important aim was to graft animal testicles onto human beings.

Sexual and reproductive health implementation research in humanitarian contexts: a scoping review.

BACKGROUND: Meeting the health needs of crisis-affected populations is a growing challenge, with 339 million people globally in need of humanitarian assistance in 2023. Given one in four people living in humanitarian contexts are women and girls of reproductive age, sexual and reproductive health care is considered as essential health service and minimum standard for humanitarian response. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on appropriate methods and analytical frameworks is limited. METHODS: A scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Peer-reviewed papers published from 2013 to 2022 were identified through relevant systematic reviews and a literature search of Pubmed, Embase, PsycInfo, CINAHL and Global Health databases. Papers that presented primary quantitative or qualitative data pertaining to a sexual and reproductive health intervention in a humanitarian setting were included. RESULTS: Seven thousand thirty-six unique records were screened for inclusion, and 69 papers met inclusion criteria. Of these, six papers explicitly described the use of an implementation research framework, three citing use of the Consolidated Framework for Implementation Research. Three additional papers referenced other types of frameworks used in their evaluation. Factors cited across all included studies as helping the intervention in their presence or hindering in their absence were synthesized into the following Consolidated Framework for Implementation Research domains: Characteristics of Systems, Outer Setting, Inner Setting, Characteristics of Individuals, Intervention Characteristics, and Process. CONCLUSION: This review found a wide range of methodologies and only six of 69 studies using an implementation research framework, highlighting an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization. Three hundred thirty-nine million people globally were in need of humanitarian assistance in 2023, and meeting the health needs of crisis-affected populations is a growing challenge. One in four people living in humanitarian contexts are women and girls of reproductive age, and provision of sexual and reproductive health care is considered to be essential within a humanitarian response. Implementation research can help to better understand how real-world contexts affect health improvement efforts. Despite growing calls for increased investment in implementation research in humanitarian settings, guidance on how best to do so is limited. This scoping review was conducted to examine the extent to which implementation research frameworks have been used to evaluate sexual and reproductive health interventions in humanitarian settings. Of 69 papers that met inclusion criteria for the review, six of them explicitly described the use of an implementation research framework. Three used the Consolidated Framework for Implementation Research, a theory-based framework that can guide implementation research. Three additional papers referenced other types of frameworks used in their evaluation. This review summarizes how factors relevant to different aspects of implementation within the included papers could have been organized using the Consolidated Framework for Implementation Research. The findings from this review highlight an opportunity for standardization to better inform the evidence for and delivery of sexual and reproductive health interventions in humanitarian settings. Increased use of implementation research frameworks such as a modified Consolidated Framework for Implementation Research could work toward both expanding the evidence base and increasing standardization.