Governance of Transnational Global Health Research Consortia and Health Equity

Global health research partnerships are increasingly taking the form of consortia of institutions from high-income countries and low- and middle-income countries that undertake programs of research. These partnerships differ from collaborations that carry out single projects in the multiplicity of their goals, scope of their activities, and nature of their management. Although such consortia typically aim to reduce health disparities between and within countries, what is required for them to do so has not been clearly defined. This article takes a conceptual approach to explore how the governance of transnational global health research consortia should be structured to advance health equity. To do so, it applies an account called shared health governance to derive procedural and substantive guidance. A checklist based on this guidance is proposed to assist research consortia determine where their governance practices strongly promote equity and where they may fall short.     

Motivation to Pursue Genetic Testing in Individuals with a Personal or Family History of Cardiac Events or Sudden Cardiac Death

Genetic testing is becoming increasingly available for cardiac channelopathies, such as long QT syndrome and Brugada syndrome, which can lead to sudden cardiac death. Test results can be used to shape an individual’s medical management and to identify at-risk family members. In our qualitative study, all participants had a personal or family history of a diagnosed cardiac arrhythmia syndrome or sudden cardiac death. Open-ended interviews were conducted individually and in focus groups. Interviews were audio recorded, transcribed verbatim, and analyzed using a qualitative grounded-theory approach. Of 50 participants, 37 described their motivations for pursuing genetic testing for long QT syndrome or another cardiac channelopathy. Participants’ motivations included: to find an explanation for a family member’s sudden death, to relieve uncertainty regarding a diagnosis, to guide future medical management, to allay concern about children or other family members, and to comply with recommendations of physicians or family members. Perceived reasons not to pursue genetic testing included denial, fear, and lack of information. The genetic counseling and informed consent process can be enhanced by understanding and addressing an individual’s internal and external motivations either for or against pursuing genetic testing.     

Parent Perspectives of Support Received from Physicians and/or Genetic Counselors Following a Decision to Continue a Pregnancy with a Prenatal Diagnosis of Trisomy 13/18

Families that choose to continue a pregnancy with a prenatal diagnosis of Trisomy 13/18 are a minority that present unique challenges for those in charge of their care. This study investigated the extent to which these patients felt supported by their healthcare providers, and any differences in the perceived level of support experienced by those working with a physician versus those working with a genetic counselor. Two online support groups, SOFT and Hope for Trisomy, distributed an online survey to their members. Means, standard deviations and chi-square analysis were calculated to describe their responses. One-hundred fourteen surveys were included in the final analysis. Respondents were more likely to agree that genetic counselors provided unbiased information in a way that they understood, compared to physicians. Review of qualitative responses found that portrayal of Trisomy 13/18 by healthcare providers used directive language when describing the lethality, morbidity and burden of the condition. Language included terms such as “incompatible with life” and comments on burden to other family members. Healthcare providers can assist families that receive a prenatal diagnosis of Trisomy 13 or 18 by providing up-to-date written resources and connecting them with support groups for parents who have received a similar diagnosis. Our study found that involving genetic counselors in the prenatal care of these patients is likely beneficial.     

Institutional Betrayal in the Canadian Medical System: Reliability and Validity of a Self-Report Questionnaire

Institutional betrayal (IB), an institutional failure to either prevent or to respond supportively to a traumatic event, tends to cause trauma survivors further psychological distress. The medical system may exhibit significant levels of IB given the frequency of medical interactions and vulnerability of patients. The current study aimed to assess the reliability and validity of a new measure of IB in the medical system in a sample of 352 Canadian adults with chronic medical conditions. An exploratory factor analysis found 3 stable and reliable factors of IB: negative healthcare experiences, cognitive-affective reactions, and systemic responses to these experiences. Subsequent analyses found evidence supporting the validity of the IB questionnaire. As expected, IB predicted poorer mental health even after controlling for demographics, and traumatic experiences. Future studies should confirm that these factors hold in different populations, and should employ different experimental designs to better understand the causal factors of IB.     

A systematic literature review of the average IQ of sub-Saharan Africans

On the basis of several reviews of the literature, Lynn [Lynn, R., (2006). Race differences in intelligence: An evolutionary analysis. Augusta, GA: Washington Summit Publishers.] and Lynn and Vanhanen [Lynn, R., & Vanhanen, T., (2006). IQ and global inequality. Augusta, GA: Washington Summit Publishers.] concluded that the average IQ of the Black population of sub-Saharan Africa lies below 70. In this paper, the authors systematically review published empirical data on the performance of Africans on the following IQ tests: Draw-A-Man (DAM) test, Kaufman-Assessment Battery for Children (K-ABC), the Wechsler scales (WAIS & WISC), and several other IQ tests (but not the Raven's tests). Inclusion and exclusion criteria are explicitly discussed. Results show that average IQ of Africans on these tests is approximately 82 when compared to UK norms. We provide estimates of the average IQ per country and estimates on the basis of alternative inclusion criteria. Our estimate of average IQ converges with the finding that national IQs of sub-Saharan African countries as predicted from several international studies of student achievement are around 82. It is suggested that this estimate should be considered in light of the Flynn Effect. It is concluded that more psychometric studies are needed to address the issue of measurement bias of western IQ tests for Africans.     

When Cross‐Examination Offends: How Men and Women Assess Intrusive Questioning of Male and Female Expert Witnesses

Personally intrusive questioning during cross‐examination has become commonplace. The differential impact of this questioning on female vs. male experts was the focus in this study, thus these questions are referred to as gender‐intrusive questions. The results demonstrated that the female expert was rated as less confident, trustworthy, likable, believable, and credible than the male expert. The male and female experts were both rated as more credible, trustworthy, and believable when subjected to gender‐intrusive questions. Furthermore, the use of these questions left the jurors with a negative impression of the prosecuting attorney and his case. Jury members were more likely to believe that the evidence exhibited the most support for the defense's case when the witness was subjected to gender‐intrusive questioning.     

Virtue and Disagreement

One of the most prominent strands in contemporary work on the virtues consists in the attempt to develop a distinctive—and compelling—account of practical reason on the basis of Aristotle’s ethics. In response to this project, several eminent critics have argued that the Aristotelian account encourages a dismissive attitude toward moral disagreement. Given the importance of developing a mature response to disagreement, the criticism is devastating if true. I examine this line of criticism closely, first elucidating the features of the Aristotelian account that motivate it, and then identifying two further features of the account that the criticism overlooks. These further features show the criticism to be entirely unwarranted. Once these features are acknowledged, a more promising line of criticism suggests itself—namely, that the Aristotelian account does too little to help us to resolve disputes—but that line of objection will have to be carried out on quite different grounds.     

Resistance to Violence Prevention Interventions in Schools: Barriers and Solutions

Studies of the prevalence and impact of aggression among school-age children and adolescents document the pervasiveness of bully-victim problems and indicate clear linkages between bully-victim problems, psychological distress, and, in rare instances, lethal attacks on perceived tormentors or towards the self. Evidence is slowly accumulating to show how well-conceived school-based strategies can be effective in addressing bully-victim problems—if implemented and sustained. However, anecdotal evidence suggests many comprehensive school-based initiatives suffer from incomplete implementation, resulting in limited effectiveness. We propose that multiple factors nested within different levels of social ecological complexity (e.g., individual, school, community, and culture) limit the widespread use of schoolwide approaches to reducing bully–victim–bystander problems. Challenges arise at each of these levels and can potentially thwart efforts to produce meaningful changes in the problems of peer victimization in and around school. Drawing from efforts to implement and evaluate bully–victim–bystander programs, we describe a core set of potential barriers at each ecological level and offer possible strategies for action.     

Tolerant macaque species are less impulsive and reactive

Animal Cognition - Inhibitory control, the inhibition of impulsive behaviours, is believed to be key in navigating a complex social environment. Species characterised by higher social tolerance,...