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Humanitarian research with Syrian refugees can be difficult to conduct in-person, due to COVID-19 containment, security, and logistics issues We assessed whether the online implementation of a brief, culturally grounded resilience measure would yield reliable responses for use with children and adolescents in the Middle East region We implemented an online survey screening for socio-economic status, insecurity, prosocial behaviour, and resilience (using the Child Youth Resilience Measure, CYRM) with 119 Syrian refugees (14–18 years old;74 male, 45 female) living in Jordan Responses were compared with in-person data, available for a separate cohort of 324 Syrian refugees, previously sampled in Jordan with the same survey instruments The online CYRM produced reliable and valid responses, as shown by analyses of internal reliability, convergent and divergent validity, and 7-day test-retest consistency We reflect on logistic, ethical, and methodological challenges of online surveys, and suggest ways to plan and execute online research with hard-to-reach, crisis-affected communities [ABSTRACT FROM AUTHOR] Copyright of International Journal of Social Research Methodology is the property of Routledge and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

This article examines how notions of solidarity, social justice, and faith guide humanitarian work at the U.S.-Mexico border. Based on interviews and participant observation in three regions, it examines the narratives of lay and religious actors serving migrants, refugees, and asylum-seekers, to understand the moral and political resonance of their work in the context of border surveillance, migrant detentions, and mass deportation. Different notions of solidarity and justice jostle one another, espousing political and structural dimensions, whilst faith inspires the conviction that change can be enacted. A radical message for social action is, notably, fuelled by anger and courage, and used to confront pain and fear in the humanitarian and political sphere. This article contributes to a better understanding of how notions of human dignity, justice, and advocacy are articulated by humanitarian actors at the border, a site of striking civic and faith-based resistance to the criminalization of refugee and undocumented communities.

Purpose In situations of adversity, young people draw on individual, relational, and contextual (community and cultural) resources to foster their resilience. Recent literature defines resilience as a capacity that is underpinned by a network of interrelated resources. Although empirical studies show evidence of the value of a network approach, little is known regarding how different country contexts influence which resources are most critical within a resource network and how resources interact for adolescent resilience. Methods Network analysis was conducted with data from studies that had used the Child and Youth Resilience Measure. Regularized partial correlation networks of 17 resources were estimated for 14 countries (Botswana, Canada, China, Colombia, Equatorial Guinea, India, Indonesia, Italy, Jordan, New Zealand, the Philippines, Romania, South Africa, and Syrian refugees living in Jordan). The sample size was 18,914 (mean age = 15.70 years, 48.8% female). Results We observed mostly positive associations between the resources of interest. The salience and strength of associations between resources varied by country. The most central resource across countries was having supportive caregivers during stressful times because this resource had the most and strongest positive associations with other resources. Conclusions This study gives first empirical evidence from multiple countries that an interplay of social–ecological resources (such as individual skills, peer, caregiver and community support, and educational aspirations and opportunities) matter for adolescent resilience. Across countries, caregiver support appears to be most central for adolescent resilience. Future resilience interventions might apply this network approach to identify important, contextually relevant resources that likely foster additional resources.

Deployment in a crisis zone is a perilous undertaking. Little is known right now about how humanitarian workers relate social and professional goals to lived experiences of high-risk environments. In South Sudan, ranked as the most dangerous country globally for aid workers, 20 international humanitarian staff were interviewed to examine their sense of place, well-being, and vocation, using thematic and interpretative phenomenological analysis. Subjectivities of humanitarian space hinged upon negotiating physical hardships and social relationships: Juba, the capital, was described as a 'prison' and a 'party hotspot'. For expatriate staff, making sense of spatial, social, and professional transience was sharply gendered and rooted in the subjectivities of risk-taking, crisis management, and career-building. Two policy measures are highlighted here to address the implications of transience for human well-being and organisational effectiveness. Efforts to support teams and structure work environments, altering the humanitarian and vocational bubble, will help to develop resilience at the heart of humanitarian systems.الانتشار في مناطق الأزمات هو عمل محفوف بالمخاطر. وحتى الآن، لا يُعرف سوى القليل عن كيفية ربط العاملين في المجال الإنساني بين الأهداف الاجتماعية والمهنية بالتجارب المعيشية في البيئات عالية الخطورة. ففي جنوب السودان، المصنف على أنه أخطر دولة بالنسبة لعمال الإغاثة على مستوى العالم، أجرينا مقابلات مع موظفين دوليين في المجال الإنساني (عددهم = 20) لفحص باستخدام التحليل الموضوعي والتفسيري للظواهر وإحساسهم بالمكان والرفاهية والوظيفة. توقفت السمات الشخصية للمساحات الإنسانية على التفاوض بشأن الصعوبات الجسدية والعلاقات الاجتماعية حيث وُصفت جوبا بكونها "سجن" و "بقعة ساخنة للحفلات." بالنسبة للموظفين المغتربين، كان فهم الزوال المكاني والاجتماعي والمهني مرتبطًا بشكل حاد بالنوع الاجتماعي ومتحدرا في السمات الذاتية للمخاطرة وإدارة الأزمات وبناء المسار الوظيفي. نسلط الضوء على اثنين من تدابير السياسة لمعالجة الآثار المترتبة على الزوال لكلا من رفاهية الإنسان والكفاءة التنظيمية. ستساعد الجهود المبذولة لدعم الفرق وهيكلة بيئات العمل، وتغيير الفقاعة الإنسانية والمهنية على بناء المرونة في قلب الأنظمة الإنسانية.在危机地区部署是件危险的事情。迄今为止，关于人道主义工作者如何将社会和职业目标与高风险环境的生活经验联系起来，我们知之甚少。南苏丹被评为全球援助工作者最危险的国家，我们采访了20名国际人道主义工作人员，利用主题和解释性现象学分析来考察他们的地点感、幸福感和职业感。人道主义空间的主观性取决于对物质困难和社会关系的谈判:朱巴被描述为“监狱”和“派对热点。” 对于外派员工来说，对空间、社会和职业短暂性的理解有明显的性别差异，根植于冒险、危机管理和职业生涯建设等主观活动。我们强调了两项政策措施以解决短暂性对人类福祉和组织效率的影响。努力支持团队和构建工作环境，改变人道主义和职业泡沫，将帮助 人道主义系统的核心建立弹性。.

Background Evidence of ‘what works’ in humanitarian programming is important for addressing the disruptive consequences of conflict and forced displacement. However, collecting robust scientific evidence, and ensuring contextual relevance, is challenging. We measured the biological, psychosocial, and cognitive impacts of a structured psychosocial intervention, implemented by Mercy Corps with Syrian refugees and Jordanian host-community youth. In this paper, we present a case analysis of this evaluation study and reflect on the scientific contributions of the work, the challenges experienced in its delivery, and the strategies deployed to address them. Discussion We identified challenges with respect to study design, methods, and dissemination: these included the logistics and acceptability of implementing a randomized controlled trial in a humanitarian context, the selection and refinement of culturally-relevant research tools and community-based practices, and the dissemination of results to multiple stakeholders. We demonstrated beneficial and sustained impacts on self-reports of insecurity, stress, and mental health; developed a reliable and culturally-relevant measure of resilience; experimentally tested cognitive skills; and showed that levels of cortisol, a biomarker of chronic stress, reduced by one third in response to intervention. Using stress biomarkers offered proof-of-concept evidence, beyond self-reported data: interventions targeting mental health and psychosocial wellbeing can regulate physiological stress in the body as well as improve self-reported mental health and wellbeing. We built constructive dialogue between local communities, scholars, humanitarian practitioners, and policy-makers. Conclusions Our work shows the value of rigorous research in humanitarian settings, emphasizing relevance for local communities and meaningful ways to build research ownership. Findings encourage the adoption of cognitive measures and stress biomarkers alongside self-report surveys in evaluating programme impacts. High-quality scientific research with youth can be feasible, useful, and ethical in humanitarian settings.

The impacts of war and displacement on executive function (EF)-what we might call the cognitive signatures of minds under siege-are little known. We surveyed a gender-balanced sample of 12- to 18-year-old Syrian refugees (n = 240) and Jordanian non-refugees (n = 210) living in Jordan. We examined the relative contributions of poverty, trauma exposure, posttraumatic stress, and insecurity to variance in inhibitory control and working memory. We observed associations between poverty and WM, suggesting that, even in populations exposed to substantial violence and fear, poverty is a specific pathway to WM deficit. We did not, however, find associations between EFs and exposures to trauma. Careful distinction between childhood adversities may illuminate which neurocognitive pathways matter for measures of cognitive function. [ABSTRACT FROM AUTHOR]

Early childhood trauma can have profound and lifelong effects on adult mental health and psychosocial wellbeing. Nevertheless, responses to trauma are highly variable. Genetic variants may help explain variation in responses to trauma by identifying alleles that associate with changes in mental health measures. Protective factors, such as resilience, likely also play an important role in responses to trauma. The effects of genetic variants, in combination with protective factors, on psychosocial health are not well understood, particularly in non-Western contexts. In this study, we test the relative influence of genetic variants of monoamine oxidase A (MAOA, a gene proposed to influence the impact of childhood trauma on adult violence and antisocial behavior), levels of resilience, and exposure to traumatic events on psychosocial stress and mental health trajectories over time. We use data from a cohort of 12-18-year-old Syrian refugees who were forcibly displaced to neighboring Jordan (n = 399). DNA samples and survey data on trauma exposure, resilience (CYRM-12), and psychosocial stress were collected at three time points: baseline, ~13 weeks, and ~48 weeks. Using multilevel models, we identified an association of MAOA variant, in males only, with symptom scores of psychosocial stress on the Perceived Stress Scale (PSS) over time (p = 8.1 x 10-4). We also found that resilience is strongly associated with PSS (p = 7.9 x 10-9), underscoring the importance of protective factors in influencing levels of psychosocial stress. Furthermore, there was an additive effect wherein the sharpest reductions in perceived psychosocial stress are seen in low-activity MAOA males with low trauma exposure or high resilience levels. Our results highlight the value of studies that integrate genetic and psychosocial factors to better understand complex phenotypes, such as responses to trauma in contexts of high trauma exposure.

Why do humans heal one another? Evolutionary psychology has advanced our understanding of why humans suffer psychological distress and mental illness. However, to date, the evolutionary origins of what drives humans to alleviate the suffering of others has received limited attention. Therefore, we draw upon evolutionary theory to assess why humans psychologically support one another, focusing on the interpersonal regulation of emotions that shapes how humans heal and console one another when in psychosocial distress. To understand why we engage in psychological healing, we review the evolution of cooperation among social species and the roles of emotional contagion, empathy, and self-regulation. We discuss key aspects of human biocultural evolution that have contributed to healing behaviors: symbolic logic including language, complex social networks, and the long period of childhood that necessitates identifying and responding to others in distress. However, both biological and cultural evolution also have led to social context when empathy and consoling are impeded. Ultimately, by understanding the evolutionary processes shaping why humans psychologically do or do not heal one another, we can improve our current approaches in global mental health and uncover new opportunities to improve the treatment of mental illness across cultures and context around the world.

Validated measures are needed for assessing resilience in conflict settings. An Arabic version of the Child and Youth Resilience Measure (CYRM) was developed and tested in Jordan. Following qualitative work, surveys were implemented with male/female, refugee/nonrefugee samples (N = 603, 11–18 years). Confirmatory factor analyses tested three-factor structures for 28- and 12-item CYRMs and measurement equivalence across groups. CYRM-12 showed measurement reliability and face, content, construct (comparative fit index = .92–.98), and convergent validity. Gender-differentiated item loadings reflected resource access and social responsibilities. Resilience scores were inversely associated with mental health symptoms, and for Syrian refugees were unrelated to lifetime trauma exposure. In assessing individual, family, and community-level dimensions of resilience, the CYRM is a useful measure for research and practice with refugee and host-community youth.

Grandparents are often a key source of care provision for their grandchildren, yet they are sidelined in caregiving research and policy decisions. We conducted a global, systematic review of the literature to examine the scope and quality of studies to date (PROSPERO database CRD42019133894). We screened 12,699 abstracts across 7 databases, and identified 206 studies that examined how grandparents influence child health and development. Indicators of grandparent involvement were contact, caregiving behaviors, and financial support. Our review focused on two research questions: how do grandparents influence child health and development outcomes, and what range of child outcomes is reported globally? We examined study design, sample characteristics, key findings, and outcomes pertaining to grandchildren’s physical health, socio-emotional and behavioral health, and cognitive and educational development. Our search captured studies featuring grandparent custodial care (n = 35), multigenerational care (n = 154), and both types of care (n = 17). We found substantial heterogeneity in the data provided on co-residence, caregiving roles, resources invested, outcomes, and mechanisms through which “grandparent effects” are manifested. We identified two important issues, related to operationalizing indicators of grandparent involvement and conceptualizing potential mechanisms, leading to gaps in the evidence base. Currently, our understanding of the pathways through which grandparents exert their influence is constrained by limited data on what grandparents actually do and insufficient attention given to interpersonal and structural contexts. We present a conceptual framework to explicitly measure and theorize pathways of care, with a view to inform research design and policy implementation. We underscore the need for more robust data on three indicators of caregiver involvement—contact, behavior, and support—and for careful description of structural and interpersonal contexts in caregiving research.

We undertook a systematic search and review of individual, family, community, and societal risk and protective factors for mental health in children and adolescents who are forcibly displaced to high-income countries. Exposure to violence has been shown to be a key risk factor, whereas stable settlement and social support in the host country have a positive eff ect on the child’s psychological functioning. Further research is needed to identify the relevant processes, contexts, and interplay between the many predictor variables hitherto identifi ed as aff ecting mental health vulnerability and resilience. Research designs are needed that enable longitudinal investigation of individual, community, and societal contexts, rather than designs restricted to investigation of the associations between adverse exposures and psychological symptoms. We emphasise the need to develop comprehensive policies to ensure a rapid resolution of asylum claims and the eff ective integration of internally displaced and refugee children.

A critical health-related issue in war-affected areas is how people make sense of adversity and why they show resilience in a high-risk environment. In Afghanistan, the burden of poor mental health arises in contexts of pervasive poverty, social inequality, and persistent violence. In 2006, we conducted face-to-face interviews with 1011 children (age 11–16) and 1011 adult caregivers, randomly selected in a school-based survey in three northern and central areas. Participants narrated their experiences as part of a systematic health survey, including an open-ended questionnaire on major life stressors and solutions to mitigate them. Responses were analysed using an inductive thematic approach and categorised for quantitative presentation, producing a conceptual model. For adults, the primary concern is repairing their “broken economy,” the root of all miseries in social, educational, governance, and health domains. For students, frustrations focus on learning environments as well as poverty, as education is perceived as the gateway to upward social and economic mobility. Hope arises from a sense of moral and social order embodied in the expression of key cultural values: faith, family unity, service, effort, morals, and honour. These values form the bedrock of resilience, drive social aspirations, and underpin self-respect and dignity. However, economic impediments, social expectations, and cultural dictates also combine to create entrapment, as the ability to realise personal and social aspirations is frustrated by structural inequalities injurious to health and wellbeing. This study contributes to a small but growing body of work on resilience in public health and conflict settings. It demonstrates that culture functions both as an anchor for resilience and an anvil of pain, and highlights the relevance of ethnographic work in identifying what matters most in formulating social and public health policies to promote a hopeful future.

Foreword -Peter Piot Bringing Life into Relief: Comparative Ethnographies of Humanitarian Practice -Sharon Abramowitz and Catherine Panter-Brick PART I. INTIMATE INTERVENTIONS: HEALTH WORKER EXPERIENCES IN HUMANITARIAN CONTEXTS Chapter 1. Dignity Under Extreme Duress: The Moral and Emotional Landscape of Local Humanitarian Workers in the Afghan-Pakistan Border Areas -Patricia Omidian and Catherine Panter-Brick Chapter 2. Compassion and Care at the Limits of Privilege: Haitian Doctors amid the Influx of Foreign Humanitarian Volunteers -Laura Wagner Chapter 3. Trust and Caregiving During a UNICEF-Funded Relief Operation in the Somali Region of Ethiopia -Lauren Carruth PART II. THE ARCHITECTURE OF HUMANITARIAN KNOWLEDGE, ETHICS, AND IMPERATIVES Chapter 4. Evidence and Narratives: Recounting Ongoing Violence in Darfur, Sudan -Alex de Waal Chapter 5. Life Beyond the Bubbles: Cognitive Dissonance and Humanitarian Impunity in Northern Uganda -Tim Allen Chapter 6. Staging a "Medical Coup"? Medecins Sans Frontieres and the 2005 Food Crisis in Niger -Jean-Herve Jezequel PART III. STRONG STATES, WEAK STATES, AND CONTESTED HEALTH SOVEREIGNITIES Chapter 7. What Happens When MSF Leaves? Humanitarian Departure and Medical Sovereignty in Postconflict Liberia -Sharon Abramowitz Chapter 8. Humanitarianism and "Mobile Sovereignty" in Strong State Settings: Reflections on Medical Humanitarianism in Aceh, Indonesia -Byron J. Good, Jesse Hession Grayman, and Mary-Jo DelVecchio Good Chapter 9. The British Military Medical Services and Contested Humanitarianism -Stuart Gordon PART IV. THE AFTERLIVES OF INTERVENTION Chapter 10. Anthropology and Medical Humanitarianism in the Age of Global Health Education -Peter Locke Chapter 11. The Creation of Emergency and Afterlife of Intervention: Reflections on Guinea Worm Eradication in Ghana -Amy Moran-Thomas Chapter 12. Medical NGOs in Strong States: Working the Margins of the Israeli Medical Bureaucracy -Ilil Benjamin Conclusion. A Measured Good -Peter Redfield List of Contributors Index

Homeless and street children are commonly portrayed in the academic and welfare literature as a prime category of ‘children at risk’. They have attracted world‐wide attention due to rising numbers in cities of the Western and developing world coupled with a discourse of childhood that ascribes risk to poor urban children unaccompanied by adults on the streets. This paper presents a critique of views about homeless and street children that rest upon an unhelpful blanket generalization of risk and, more specifically, that adopt polemical or categorical statements about homelessness as the most salient risk factor for poor health. Current research is distancing itself from a discourse that sets global characteristics for a ‘street lifestyle’, aiming instead to contextualize research on street children. Many studies have also questioned the stereotypical expectation that homeless children are the most vulnerable in deprived environments, arguing that poverty, not homelessness per se, carries the most signific...

Culture and resilience prove to be slippery concepts unless deployed with care and attention. In this chapter, I demonstrate why a fine-grained approach to culture is important to the study of resilience, helping us avoid common pitfalls such as equating culture with society, religion, or ethnicity in ways that offer limited insights about people’s lives and local contexts. I advocate greater clarity of purpose with respect to concepts, methods, and evidence in resilience research, with a view to inform next steps for theory and practice. I illustrate mixed-methods approaches that operationalize vulnerability and resilience across cultures, as well as ethnographic approaches to resilience across cultures that uncover a political economy of health consonant with a quest for dignity, social justice, and respect. Resilience is driven by culturally specific, diverse, and often-changing goals: for youth, the relationship between culture and resilience is akin to bricolage, in the sense of navigating an array of pursuits, goals, and values. Thus resilience has important moral, social, and political dimensions, beyond the consideration of poor wellbeing or development.

In the spirit of critical reflection, we examine how the field of global health might surmount current challenges and prioritize its ethical mandate, namely to achieve, for all people, equity in health. We use the parlance of mastering deadly sins and striving for greater virtues in an effort to review what is needed to transform global health action. Global health falls prey to four main temptations: coveting silo gains, lusting for technological solutions, leaving broad promises largely unfulfilled, and boasting of narrow successes. This necessitates a change of heart: to keep faith with the promise it made, global health requires a realignment of core values and a sharper focus on the primacy of relationships with the communities it serves. Based on the literature to date, we highlight six steps to re-orienting global health action. Articulating a coherent global health agenda will come from principled action, enacted through courage and prudence in decision-making to foster people-centered systems of care over the entire lifespan. Keywords : equity; scale-up; leadership; health systems; global health; interventions (Published: 28 March 2014) Citation : Glob Health Action 2014, 7: 23411 - http://dx.doi.org/10.3402/gha.v7.23411

This study of two natural fertility Nepali groups, the Tamang and Kami, identifies biological and behavioral factors associated with population differences in fertility. Previous research had established that Tamang experience longer interbirth intervals than Kami despite similarly intense nursing practices, and bear considerably higher energy expenditure due to workload. This cross-sectional study of 71 breastfeeding women includes prolactin determinations on three blood spot samples collected 5, 30, and 50 minutes following a timed nursing bout, and data on maternal age, BMI, menstrual status, previous birth interval, parity, infant age, nursing bout length, and durations of supplementation and postpartum amenorrhea. The findings show that Tamang breastfeeding mothers have higher average prolactin levels than Kami for as long as 22 months postpartum. Tamang mothers sustain average prolactin levels above those of nonpregnant, nonlactating women for nearly 2 years postpartum, whereas prolactin levels among Kami breastfeeding mothers are the same as this latter group after 1 year postpartum. Furthermore, the findings indicate that Tamang mothers have higher average prolactin levels regardless of maternal age, physical status (BMI, weight, or height), or infant age, and the rate of decline in prolactin from 5 to 50 minutes after suckling is significantly greater for Kami than Tamang. Since factors associated with prolactin levels differ by group, the findings also emphasize that populations vary not only in the strength of effects that proximate determinants have on fertility regulation, but also in the pathways by which they exert their effects (direct physiological versus indirect behavioral). Am. J. Hum. Biol. 10:191-210, 1998. © 1998 Wiley-Liss, Inc.

Food shortages occur periodically and predictably in over- populated areas of the foothills of the Himalaya, leading to extensive outmigration and to indebtedness of farmers. A survey of four administrative areas and in-depth interviews of 120 households (a sample of diverse caste and ethnic groups, stratified by land area) was undertaken in two districts of western Nepal to document the severity of shortfall in local agricultural production and the range of household coping strategies. The duration of food shortages averaged 5 months of the year, but ranged enormously across households, with 4% of sample families being entirely landless. Out-migration, wage labor, petty trade, high-interest loans, and land mortgage were well-established coping strategies, beneficial for some families in generating income and the possibility for investment, but for others leading to progressively greater debt, economic marginalisation and impoverishment. This study highlights the importance of encouraging diversified strategies for subsistence farmers to ensure cash revenue, much of which is derived from debt and emigration, and reviews the geographical and socioeconomic factors influencing both constraints on household subsistence and responses to seasonal food deficits.

Resilience offers the promise of a paradigm shift in many fields of research, clinical practice, and policy. A lens on resilience shifts the focus of attention - from concerted efforts to appraise risk or vulnerability, towards concerted efforts to enhance strength or capability. It also shifts the focus of analysis - from asking relatively limited questions regarding health outcomes, such as what are the linkages between risk exposures and functional deficits, to asking more complex questions regarding wellbeing, such as when, how, why and for whom do resources truly matter. Thus we might ask when interventions are most effective, within the time frame of human development and evolutionary life history; and how do we best measure pathways of human experience, to uncover ways in which individuals and communities withstand adversity. To many, resilience is an intuitive, albeit opaque, concept - akin to fortitude in the face of adversity. We may have an intuitive grasp of what resilience means, but fall short of measuring it comprehensively and meaningfully (the same is true of risk). This Annual Research Review issue features ten articles from leaders in the field on how resilience can transform the field of child development. Each articulates important lessons on resilience some of which we editors wish to summarize at the outset. First, resilience is best understood as a process that unfolds over the course of development; consequently, we seek to understand human experience of adversity as pathways of risk and resilience. Second, research on resilience focuses attention on the biological and social trade-offs in human experience: issues of timing, process, and context to understand change or adaptability. Language: en

The impact of war on child and adolescent mental health is an issue that sits high on the global public health agenda, especially where it concerns young people living in low-income countries (Patel, Flisher, Hetrick, & McGorry, 2007) and conflict zones (Morris, van Ommeren, Belfer, Saxena, & Saraceno, 2007). One key debate in the literature on ‘conflict and child health’ focuses on the relative importance of exposure to different kinds of violence (Panter-Brick, Goodman, Tol, & Eggerman, 2011): are mental health outcomes primarily driven by war-related trauma, family-level violence and/or structural barriers taking the form of institutional, social and economic stressors? Of course, a protracted war exacerbates poverty, weakens social institutions, drives poor health and often increases social and economic inequalities. But such a macro-level view of the consequences of war does not necessarily help to understand the everyday experiences, emotional lives and social realities of children in conflict zones. It is essential for research to carefully assess the main drivers of child and adolescent mental health, in order to understand which cluster of childhood adversities has the greatest impact, to reach specific insights that have both local and global significance and to underscore which interventions might be most effective.

Research on the underlying causes of population variation in levels of natural fertility has recently been given new impetus with the development of endocrinological measures able to track biological variation in human fecundity. Birth seasonality was examined for a non-contracepting population with low fertility and seasonally heavy workloads in rural Nepal. Reproductive histories were collected from 1983 to 1993, totalling 1829 live births (1532 with known month of birth) to 521 women of average parity 3.5 (SD 1.5) births. The seasonal pattern of conceptions was examined in light of previously collected data on marriage patterns, climatic seasonality, subsistence workloads, energy balance, nursing patterns, lactational amenorrhoea, and endocrinological measures of prolactin and ovarian function. Both the frequency distribution of live births and a life-table analysis of women's exposure to the risk of conception show significant seasonality. The size of seasonal variation, with peak conception rates rai...

Children and adolescents who are forcibly displaced represent almost half the world's internally displaced and refugee populations. We undertook a two-part systematic search and review of the evidence-base for individual, family, community, and societal risk and protective factors for the mental health outcomes of children and adolescents. Here we review data for displacement to low-income and middle-income settings. We draw together the main findings from reports to identify important issues and establish recommendations for future work. We draw attention to exposure to violence as a well established risk factor for poor mental health. We note the paucity of research into predictor variables other than those in the individual domain and the neglect of other variables for the assessment of causal associations, including potential mediators and moderators identifiable in longitudinal work. We conclude with research and policy recommendations to guide the development and assessment of effective interventions. © 2012 Elsevier Ltd.

The authors report on their multidisciplinary and longitudinal studies of Afghan families that included paired interviews with adolescents and adult caregivers. The authors argue that cultural values are the “bedrock” of resilience: they underpin the meaning attributed to great suffering, hope for the future, and a sense of emotional, social, and moral order to ordinary and extraordinary aspects of life. Remarkably, they show that war-related trauma is not the principal driver of poor mental health: traumatic experiences are linked to fractured family relationships and a failure to achieve personal, social, and cultural milestones. Resilience, meanwhile, rests upon a demonstration of family unity. In the context of structural disadvantage that includes poverty, crowded living conditions, and exposure to violence, the authors also show that cultural dictates come to entrap Afghans in the pursuit of honor and respectability, a core facet of psychosocial resilience. The chapter highlights linkages between psychosocial and structural resilience, cautioning against a simplistic view of culture as a set of protective resources. The authors discuss the ramifications of social policies that raise not just hope, but undue expectations without sufficient resource provision.

The nursing behaviour of rural Nepali women, from two castes inhabiting the same village, is quantified on the basis of 2202 hr of continuous and direct day-time observation over 1 year. Feed duration, interval, total time and daily frequency are examined in relation to women's work, particularly the type of subsistence activity and seasonality. 'Opportunity' feeds are governed both by infant demands and maternal activity. Caste differences in birth intervals are also discussed.From 1982-1983, researchers observed working women from 2 castes (16 Tamang and 8 Kami) in Salme, Nepal for 11-13 hours/day to determine if breast feeding and working behaviors explain fertility differences between them. Work loads greatly increased for the agropastoralist Tamang women during the monsoon (p.0007), but not so for the low caste Kami women who worked mainly at home. Intervals between feeds and agricultural activities averaged 98 minutes while they averaged 47 minutes for husbandry activities (p.05). Neither affected feed duration. If Tamang women worked in a labor group rather than alone, they tended to provide shorter breast feeds only during the monsoon (p.05). Infant age greatly affected duration of breast feeds (p.0005), interval between feeds (p.004), and total frequency and nursing time (p.0001) among the Tamang. Seasonality did not affect these relationships, except for 3 year olds in which seasonality was significantly reduced during the monsoon. On the other hand, it did have a strong effect on interval (p.05), total frequency (p.01), and total time (p.001) for the Kami. Tamang women provided longer feeds for their infants than did the Kami women during the winter (p.0002), but differences between the 2 castes were minor during spring. Yet Tamang women breast feed their 2 year olds for shorter times than Kami women during the spring (p.01). Among the Kami, infant age did not affect duration, interval, total frequency, and total time. Therefore the 2 castes were not alike in how they planned feeds from day to day. In fact, the Kami women fed their children at very irregular intervals regardless of the child's age. As for Tamang women, intervals grew more irregular with increasing age of the child. Supplementary foods most likely accounted for the high variability between the 2 castes. No 3 year old Kami children were breast fed. The interval between feeds rose consistently with infant age for the Tamang but not for the Kami.

In-depth interviews of 36 Saudi families whose children suffered from neuro-metabolic disorders were conducted at a specialist hospital in Riyadh in order to examine parental understanding of disease and attitudes towards future births and consanguineous marriages. Parents had difficulty accepting a genetic explanation for diseases that did not affect all children at the time of birth; they also expressed religious or folk beliefs to account for illness. Coping behaviours included denial and resignation to the situation, divorce and remarriage. Some families adopted a cautious approach to cousin marriages and future births; this was significantly related to their education level, but not to previous infant deaths. Awareness of medical facts brought little emotional comfort to parents but allowed for preventive measures through screening adult carriers and identifying affected infants. This study presents new material from Saudi Arabia to strengthen current awareness that the range of religious beliefs, social attitudes and reproductive behaviours adopted by families in a society undergoing rapid change is of direct relevance to health care.

The purpose of this paper is to analyse household decision-making regarding resource allocation in the aftermath of a food crisis in rural Niger. International attention had resulted in humanitarian agencies launching emergency nutrition programmes to alleviate persistently high levels of acute child malnutrition. We conducted participant observation, 93 in-depth interviews, 15 focus groups, 44 feeding and illness histories for children under 5, and debriefing sessions with local humanitarian staff. The impetus for this study came from observations of marked intra-household differences in child growth and health status, despite the caregivers' ethos of treating children equally. Egalitarian input, however, does not always result in equal outcomes: vulnerable children become “victims of non-discrimination” through a form of benign neglect engendered by pervasive poverty. The ethos and practices of equal investment in children are rooted in a need to balance the perceived risks to children with the preservation of long-term livelihoods. We discuss the mismatch of views between external interventions, which focus on saving individual children's lives, and local priorities, aimed at spreading risk. This mismatch is rooted in the different ways in which humanitarian agencies and local communities weigh up risks and vulnerabilities in matters of child health.

As widespread social transformations have been paralleled by gains in health and life expectancy through public health and other improvements, a variety of other challenges to health have emerged, particularly in lifestyle related, behaviourally mediated changes in rates of chronic disease. Hormones, Health and Behavior looks at the relationship of human biology and human society at the intersection of behavior, hormones and health. There is both scientific interest and practical urgency behind the ideas and findings presented here, as the need for a socio-ecological view of function and well-being has become more apparent. This book documents an emerging understanding of how hormones create linkage between behavior or social life and health. It will inform graduate students and researchers interested in human sciences, human development, anthropology, epidemiology, public environmental and reproductive health.

New methods for monitoring ovarian function have allowed an extension of research venue beyond typical clinical settings to studies of human populations in their natural settings. Such studies have confirmed that patterns of variation in ovarian function with age and energetic factors are general features of human reproductive biology. Age patterns of ovarian function are extremely robust across populations of distinct genetic, ecological and cultural backgrounds. Comparable ovarian responses to energetic stresses are likewise observable in different populations where they arise as correlates of local ecologies rather than as correlates of voluntary patterns of diet or exercise. Maternal age and energetic factors also appear to interact with lactation in the modulation of postpartum, ovarian function. Average levels of ovarian function, however, differ considerably between populations, perhaps correlated with chronic environmental conditions that affect growth, development, and the establishment of adult set-points. Western populations appear to represent an extreme of the spectrum of variation in ovarian function, a fact which may relate to the epidemiology of breast and ovarian cancer.

Menstrual and hormonal disturbances have been reported in thin, dieting and exercising Western women, and also recently in rural African women. A study of salivary progesterone profiles was undertaken in a Nepali population to examine whether seasonal increases in workload and changes in energy balance influenced ovarian function. Women's energy expenditure levels were moderately heavy in the winter and very heavy in the monsoon, and body mass fluctuated by -2.8 to +4.8 kg. Samples were collected from 24 normally menstruating women in two seasons, each individual serving as her own control. Progesterone levels were significantly depressed in the monsoon relative to winter for women who lost weight, but not for women who gained weight, indicating that energy imbalance is associated with a loss of fecundity. No differences in body mass index were found between women who lost or gained weight. Progesterone levels were age-dependent, and the degree of hormonal disturbance between age-groups was related to weight loss. The study demonstrates seasonal changes in the fecundity of hard-working Nepali women and a direct link between ovarian function and weight loss (negative energy balance), which is independent of current nutritional status.In October-November 1990 and August-September 1991, anthropologists collected saliva samples from 24 17-46 year old nonpregnant, nonlactating, and normally menstruating Tamang women in a remote village in the foothills of the Himalayas in northwestern Nepal to measure progesterone levels (indicative of ovarian function). They used these levels to determine whether a very heavy workload during the monsoon season and changes in dietary intake affected ovarian function. Anthropometric measurements were also taken. The women served as their own controls. Seasonal changes in body mass ranged from -2.8 kg to 4.8 kg. Mean and mid-luteal progesterone levels fell 27% (104-76 pmol/l) and 38% (138-85 pmol/l), respectively, between the winter and monsoon (p .01). The levels of ovarian function were much lower than those of healthy, regularly menstruating Western women and of menstruating Lese women of the Ituri forest in Zaire (mean luteal phase progesterone levels, 104 pmol/l vs. 232 pmol/l for Boston women and 140 pmol/l for Lese women). Reduction in progesterone levels was most significant for 24-34 year old women. In fact, the reduction in mid-luteal progesterone levels was only significant in this age group (p .05). Body mass index did not influence progesterone levels, regardless of changes in weight or age. Reduced progesterone levels was only significant for women who lost weight between the winter and the monsoon seasons, suggesting that energy imbalance is linked to loss of fecundity. Younger women were more likely to gain weight than older women (.6 kg vs. -1.1 kg for middle aged women and -.2 for older women; p .05). The regression between changes in progesterone levels and degree of weight loss was also significant (p .01). Between the winter and the monsoon, the percentage of ovulatory cycles decreased from 71 to 38%. These findings showed seasonal changes in the fecundity of these women and a direct association between ovarian function and weight loss, regardless of current nutritional status.