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Gender-based violence (GBV) is an internationally widespread human rights and public health issue, known to be exacerbated and underreported in humanitarian settings and among conflict-affected populations. A combination of factors including increased vulnerability, lack of protection and marginalization are believed to increase the risk for GBV in settings such as displacement and refugee camps. An increased understanding of GBV in these populations is needed to inform and improve future policy changes and interventions. This qualitative study sought to explore women's perceptions and experiences of GBV in a refugee camp setting in Uganda to increase the understanding of the dynamics and risk contexts of GBV in the context of displacement and refugee camps. This was a qualitative study based on individual semi-structured interviews and content analysis. The interviews were conducted during October 2023 with women living in a refugee camp setting in Western Uganda. The participants (N = 13) included female refugees, residing in the refugee camp, above eighteen years of age and who were survivors of GBV. Findings showed no easy escape route from gender-based violence, with a high exposure to GBV throughout the refugee experience. The nature of GBV, the perpetrators and risk contexts however seemed to shift throughout the process from conflict to the refugee camp. Increased marginalization and lack of resources compounded by a shift in gender roles in the refugee camp where women seemed to assume the role of the primary provider increased the risk of violence in pursuit of basic needs. Women described extensive intimate partner violence (IPV) in the camp often connected to new gendered power dynamics and the control of resources. Faced with the struggles of migration, marginalization, and GBV, women displayed various coping mechanisms including rebuilding networks and support systems. Our study showed the complexity of GBV in settings such as refugee camps, where various structural and individual changes involved in migration and life in a refugee camp seemed to create new risk contexts for GBV both inside and outside of the household. Interventions across various dimensions including addressing underlying conditions of marginalization and gendered power dynamics are therefore warranted to address GBV in refugee camps. Further research is essential to better understand this complex issue, as well as the perception and effectiveness of services and interventions in place.

University students experience a distinct working environment in the context of completing their studies. In line with existing research into the connection between workplace environment and stress, it is rational to believe that such study environments can affect the level of stress that students experience. However, few instruments have been developed for measuring this. The aim of this study was to validate a modified instrument based on the Demand-Control-Support (DCS) model among students at a large university in southern Sweden to determine its utility for assessing the psychosocial properties of the study environment. Data from a survey performed at a Swedish university in 2019, which generated 8960 valid cases, was used. Of these cases, 5410 studied a course or programme at bachelor level, 3170 a course or programme at master level, and 366 a combination of courses and programmes on the two levels (14 missing). A 22-item DCS-instrument for students was used comprising four scales: Psychological workload (demand) with nine items, Decision latitude (control) with eight items, supervisor/lecturer support with four items, and colleague/student support with three items. Construct validity was examined using exploratory factor analysis (EFA) and internal consistency using Cronbach's alpha. The results of the exploratory factor analysis of the Demand-Control components support a 3-dimension solution with dimensions corresponding to psychological demands, skill discretion, and decision authority in the original DCS model. Cronbach's alpha coefficients were acceptable for Control (0.60) and Student Support (0.72) and very good for the Demand and Supervisor Support scales (0.81 and 0.84, respectively). The results suggest that the validated 22-item DCS-instrument is a reliable and valid tool for assessing Demand, Control, and Support elements of the psychosocial study environment among student populations. Further research is necessary to examine the predictive validity of this modified instrument.

Violence is a major public health concern with a significant impact on the health and well-being of individuals, families, and communities. Living in a new environment without parental control and experimenting with new lifestyles may increase the risk of violence among university students. Therefore, this study aimed to assess exposure to violence and its associated factors among university students in Ethiopia. A cross-sectional study was conducted among 2988 university students from six randomly selected universities in Ethiopia. A two-stage stratified sampling method was used to recruit the study participants. A self-administered questionnaire was utilized to collect information regarding exposure to emotional, physical, and sexual violence. Bivariable and multivariable logistic regression analyses were used to identify factors associated with violence exposure in the last 12 months. The prevalence of exposure to any type of violence in the last 12 months was 17.6% (n = 525) (17.9% among males, 16.5% among females). The adjusted odds ratio (AOR) of violence was 2.9 times higher (95% CI 1.6-5.0) among students older than 25 years than those aged 18-20 years. Those students who were in a relationship had 1.4 times higher odds of violence (95% CI 1.0-2.0) than those who were not in a relationship. In addition, those students who were from rural residences before coming to the university had 1.4 times higher odds of violence (95% CI 1.1-1.8) than those from urban residences. The odds of violence among those who consumed alcohol once a week or more in the past month were 2.2 times higher (95% CI 1.3-3.6) than those who did not consume alcohol. Furthermore, the likelihood of violence was 1.6 times higher (95% CI 1.0-2.4) among those who chewed khat and 2 times higher (95% CI 1.3-3.1) among those who used other drugs in the last 12 months. Exposure to violence is a challenge for both male and female university students in Ethiopia. Several socio-demographic and behavioral factors were significantly associated with exposure to violence. Therefore, it is crucial for universities and stakeholders to raise awareness about contributing factors to minimize violence, regardless of gender.

Sexual harassment in contexts of higher education is a well-documented problem with far reaching consequences for individuals and organizations. Questions remain about how sexual harassment is conceptualized and what implications these conceptualizations have for designing programmes to prevent and respond to sexual harassment in university settings. This study aimed to understand how students conceptualize sexual harassment, focussing on the influence of perceived norms and organizational structures as explanatory mechanisms. This grounded theory study utilized seven focus group discussions to collect data from students at Lund University, Sweden. The analysis yielded one core category, \"Aware but confused: conflicted between individual and collective responsibility\", supported by four categories reflecting different elements of conceptualizing and responding to sexual harassment. Sub-categories captured properties and dimensions of these categories along the continuum of individual to collective responsibility. The findings reflected an awareness among students of the occurrence of sexual harassment but confusion over definitions and assignment of responsibility. This confusion could have serious consequences for willingness to report cases of sexual harassment. Building trust in the university system requires establishing common understandings of sexual harassment, clear and accountable pathways for reporting, and transparency of outcome when reports are made.

Background Workplace sexual harassment remains a persistent issue in Sweden. Research about organisational antecedents has been criticised for being limited in scope, possibly overlooking contextual factors relevant for the occurrence of sexual harassment. This study examined two factors capturing aspects of organisational climate, perceived relational justice and authoritarian treatment, and their association to workplace sexual harassment in a Swedish university setting. Methods Cross-sectional data from a 2019 survey targeting all Lund University employees was used. Validated instruments were employed to measure relational justice, authoritarian treatment and sexual harassment. Bivariate and multivariable regression analyses, stratified by gender, were conducted using Poisson regression models and additive interaction analysis performed, calculating synergy index (SI) and relative excess risk due to interaction (RERI). Results The adjusted prevalence ratio (PR) of sexual harassment was statistically significantly higher among participants who perceived low relational justice (RJ), with a PR of 1.8 (95% CI 1.3–2.6) among women and PR 2.2 (95% CI 1.01–4.6) among men. A similar pattern was seen among participants who perceived high authoritarian treatment (AT), with a PR of 2.0 (95% CI 1.4–2.9) among women and PR 3.4 (95% CI 1.7–6.9) among men. Interaction analyses indicated that women and participants with a foreign background perceiving low relational justice or high authoritarian treatment have a higher probability of sexual harassment compared to men and participants with a Swedish background with the same perceptions. Furthermore, that participants with low or non-academic positions perceiving low relational justice have a lower probability of sexual harassment compared to those with high academic positions. Conclusion Our findings suggest that superiors’ unjust or authoritarian treatment of employees might be contextual factors contributing to workplace sexual harassment, disproportionally affecting women, employees with a foreign background or high academic positions. To ensure evidence-based interventions, researchers should incorporate organisational risk factors in the design and evaluation of workplace interventions aimed at reducing sexual harassing behaviours.

Although progress has been made to improve access to sexual and reproductive health services globally in the past two decades, in many low-income countries, improvements have been slow. Discrimination against vulnerable groups and failure to address health inequities openly and comprehensively play a role in this stagnation. Healthcare practitioners are important actors who, often alone, decide who accesses services and how. This study explores how health care practitioners perceive sexual and reproductive health and rights (SRHR) and how background factors influence them during service delivery. Participants were a purposefully selected sample of health practitioners from five low income countries attending a training in at Lund University, Sweden. Semi-structured interviews and qualitative content analysis were used. Three themes emerged. The first theme, \"one-size doesn't fit all' in SRHR\" reflects health practitioners' perception of SRHR. Although they perceived rights as fundamental to sexual and reproductive health, exercising of these rights was perceived to be context-specific. The second theme, \"aligning a pathway to service delivery\", illustrates a reflective balancing act between their personal values and societal norms in service delivery, while the third theme, \"health practitioners acting as gatekeepers\", describes how this balancing act oscillates between enabling and blocking behaviours. The findings suggest that, even though health care practitioners perceive SRHR as fundamental rights, their preparedness to ensure that these rights were upheld in service delivery is influenced by personal values and society norms. This could lead to actions that enable or block service delivery.

BackgroundUniversities can be understood as work-like environments for students, with similar risks and expectations regarding psychosocial environment. Limited research has examined this study environment from a Demand-Control-Support perspective with regard to sexual harassment. Understanding this environment is key to designing protective measures. This study aimed to examine the association between individual and psychosocial study environment characteristics and exposure to sexual harassment among students at Lund University, Sweden.MethodsThis cross-sectional study utilised data from an online survey conducted among students. Questions on background characteristics, exposure to sexual harassment while at university and psychosocial study environment as measured by a Demand-Control-Support-instrument were used. Bivariate, and multivariable logistic regressions were used, together with Population Attributable Fractions (PAF), and synergy indexes (SI).ResultsHigh demands and low control were independently associated with higher odds of being exposed to sexual harassment among both females and males (OR 1.41, OR 1.26 and OR 1.55, OR1.34, respectively). When adjusting for background characteristics, high study strain (combination of high demands and low control) was associated with exposure to sexual harassment among both female and male respondents (aOR 1.67 and 1.98 respectively) and could account for PAF of 14% and 15% of study environment sexual harassment for females and males, respectively. Low lecturer support was associated with higher odds for sexual harassment among females (aOR 1.19) but not males. Little evidence was found for a buffering effect of student support on high strain and sexual harassment (SI 0.7).ConclusionWorking to reduce situations of high strain study environments could be an effective strategy for reducing sexual harassment in university settings. Improving support from lecturers could also modify this relationship, but more research is required to identify causal pathways underlying this result.

Background Sexual violence is widespread in the eastern parts of the Democratic Republic of the Congo, including in the North Kivu province. Moreover, in this region survivors of sexual violence often have limited access to care and encounter a variety of barriers when seeking care and support. The aim of this study was to explore community perceptions about access to care, barriers, enablers and possible actions to improve access to care for survivors of sexual violence in North Kivu. A deeper understanding of community perceptions about access to care can guide ongoing efforts to overcome barriers and increase access to care for survivors of sexual violence. Methods The study utilised a qualitative design, based on focus group discussions with male and female adult community members in the study area. Previous experience of sexual violence was not a requirement. The transcripts from the discussions were analysed using manifest and latent qualitative content analysis. Results A total of 18 focus group discussions were carried out. The analysis resulted in three main themes; Knowledge and misconceptions around medical consequences crucial for care seeking, Community and family attitudes playing a dual role in care seeking behaviours and Care seeking dependent on optimised healthcare facilities and sensitive staff. Conclusions Lack of correct knowledge, harmful attitudes from community and healthcare staff, and poorly adapted healthcare services constitute barriers to accessing care. Improved awareness raising around sexual violence is needed to address both lack of knowledge and misconceptions. Efforts should be made to build upon the community support models and actively work to improve community attitudes towards survivors of sexual violence. In addition, there is a need for better adapted healthcare services with improved proximity, access for different groups of survivors and respectful and well-trained healthcare staff.

Refractory cardiogenic shock (CS) often requires veno-arterial extracorporeal membrane oxygenation (VA-ECMO) to sustain end-organ perfusion. Current animal models result in heterogenous cardiac injury and frequent episodes of refractory ventricular fibrillation. Thus, we aimed to develop an innovative, clinically relevant, and titratable model of severe cardiopulmonary failure. Six sheep (60 ± 6 kg) were anaesthetized and mechanically ventilated. VA-ECMO was commenced and CS was induced through intramyocardial injections of ethanol. Then, hypoxemic/hypercapnic pulmonary failure was achieved, through substantial decrease in ventilatory support. Echocardiography was used to compute left ventricular fractional area change (LVFAC) and cardiac Troponin I (cTnI) was quantified. After 5 h, the animals were euthanised and the heart was retrieved for histological evaluations. Ethanol (58 ± 23 mL) successfully induced CS in all animals. cTnI levels increased near 5000-fold. CS was confirmed by a drop in systolic blood pressure to 67 ± 14 mmHg, while lactate increased to 4.7 ± 0.9 mmol/L and LVFAC decreased to 16 ± 7%. Myocardial samples corroborated extensive cellular necrosis and inflammatory infiltrates. In conclusion, we present an innovative ovine model of severe cardiopulmonary failure in animals on VA-ECMO. This model could be essential to further characterize CS and develop future treatments.

Background: The total cholesterol concentration decreases with age in older people. The reasons for this phenomenon are controversial. This study investigated the hypothesis that poor health status is a determinant of the inverse association between age and cholesterol in older persons. Methods: Cross-sectional study of 2,486 (53% women) older medical patients (≧65 years) admitted at 35 centers of the Gruppo Italiano di Farmacovigilanza nell’Anziano (GIFA) study in Italy. Total cholesterol was measured on the first day after admission to the hospital. Disease burden and comorbidity were assessed by the Charlson index; low serum albumin and iron were considered markers of frailty and poor health. Results: In men there was a significant, inverse age-cholesterol relationship (–0.97 mg/dl per year, p < 0.001). In women the association was nonlinear and cholesterol significantly decreased after the age of 75 (–0.95 mg/dl per year, p < 0.005). In multiple linear regression analysis, indicators of poor health accounted for almost two thirds of the crude effect of age on the cholesterol level in both men and women (adjusted coefficients for age were: for men, –0.38 mg/dl per year, p = 0.044; for women after the age of 75, –0.37 mg/dl per year, p = 0.205). The unadjusted probability of having low cholesterol significantly increased with age among men (p for trend <0.005). In multiple logistic regression, indicators of poor health were strongly associated with low cholesterol in both men and women. After adjusting for indicators of poor health, the association between age and low cholesterol in men was no longer present. Conclusion: These findings suggest that the age-dependent reduction of cholesterol often observed in clinical and epidemiologic studies is substantially explained by the effect of poor health status. Low cholesterol in older persons may be a marker of poor health.