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ObjectivePrevious research suggests a significant relationship between intimate partner violence (IPV) and HIV infection in women and that the risk of IPV is heightened in women with disabilities. Women with disabilities, particularly those residing in low-income and middle-income countries, may experience additional burdens that increase their vulnerability to IPV. We aimed to examine the association between having disability and HIV infection and the risk of IPV among women in South Africa.DesignUsing the 2016 South Africa Demographic and Health Survey, we calculated the prevalence of IPV and conducted modified Poisson regressions to estimate the unadjusted and adjusted risk ratios of experiencing IPV by disability and HIV status.ParticipantsOur final analytical sample included 1269 ever-partnered women aged 18–49 years, who responded to the IPV module and received HIV testing.ResultsThe prevalence of IPV was twice as high in women with disabilities with HIV infection compared with women without disabilities without HIV infection (21.2% vs 50.1%). Our unadjusted regression analysis showed that compared with women without disabilities without HIV infection, women with disabilities with HIV infection had almost four times higher odds (OR 3.72, 95% CI 1.27 to 10.9, p<0.05) of experiencing IPV. It appeared that women with disabilities with HIV infection experience compounded disparity. The association was compounded, with the OR for the combination of disability status and HIV status equal to or more than the sum of each of the individual ORs.ConclusionsWomen with disabilities and HIV infection are at exceptionally high risk of IPV in South Africa. Given that HIV infection and disability magnify each other’s risks for IPV, targeted interventions to prevent IPV and to address the complex and varied needs of doubly marginalised populations of women with disabilities with HIV infection are critical.

BackgroundThe prognosis of lung cancer remains poor; only 20% of patients can undergo surgery. N2 non-small cell lung cancer (NSCLC) is a heterogeneous disease. We conducted a retrospective study to analyze the impact of N2 location on survival.MethodsThis study included 342 NSCLC with N2 involvement between 1988 and 2014. Patient-related data were collected through the CRB biobank and included demographic, therapeutic, and survival data. Survival was analyzed according to Kaplan-Maier method. Cox’s regression analysis and analysis of variance (ANOVA) were used to determine factors significantly associated with survival.ResultsThe population average age was 61.6 years; 82.2% were men, a majority were former smokers (87.1%), and 45.3% had adenocarcinoma. The main prognostic factors were male gender (p = 0.01), number of nodes (p < 0.0001), and tumor size (p < 0.0001). N2 disease had a poor survival (16 months) compared with N0 (32 months) and N1 (21.1 months) disease (p < 0.0001). The patients with involvement of station 4 (survival = 17.8 months) seemed to have a prognosis between those with station 7 (survival = 10.5 months) and N1 (survival = 22.6 months), p = 0.0005.ConclusionsN2 location has a prognostic impact in surgically NSCLC, and station 4 involvement has a better prognostic than station 7.

Violence against women with disabilities is pervasive, yet a paucity of research examines intimate partner violence (IPV) experienced by women with disabilities in low- and middle-income countries. The purpose of this study is to document the prevalence and consequences of IPV exposure among Ugandan women with disabilities. Cross sectional data from the 2011 and 2016 Uganda Demographic and Health Surveys (UDHS) were used to study married and/or partnered women aged 15–49 who answered specific questions about lifetime intimate partner violence (N = 8592). Univariate and multivariate logistic regression models were used to investigate the relationship between disability, IPV, and indicators of maternal and child health. Compared to women without disabilities, women with disabilities were more likely to experience lifetime physical violence (odds ratio (OR) 1.4, p < 0.01), sexual violence (OR = 1.7, p < 0.01), and emotional abuse (1.4, p < 0.01) after controlling for sociodemographic and household characteristics. Study findings suggest that women with disabilities in Uganda may experience increased risk for IPV compared to women without disabilities, with concomitant risks to their health and the survival of their infants. Further research examining the prevalence and correlates of IPV in low- and middle-income countries is needed to address the needs and rights of women with disabilities.

Individuals with disabilities may experience higher rates of opioid/substance use disorders (OUD/SUD) than other individuals and are likely vulnerable to unmet treatment needs. Peer support may be beneficial to these individuals, given the evidence of benefits in target populations with similar needs and the potential for overcoming barriers to treatment suggested in the available literature. The objective of this exploratory study was to specify essential considerations in adapting peer support for this population. Diverse key stakeholders (n = 16) were interviewed to explore the experiences, needs, and available supports for individuals with disabilities and OUD/SUD. A Peer Support Work Group including members with lived experience advised each component of the study. Semi-structured interview data were content analyzed and memos generated to summarize themes related to the research question. Participants reported extensive professional and personal experience in human services, disability, and recovery. Emergent themes included the importance of accessibility and model fit, the notion of “peerness” and peer match, and essential aspects of peer recruitment, training, and support. An accessible, acceptable, effective model of peer support requires particular attention to the needs of this diverse and varied population, and the contexts in which they are identified, referred, and engaged in services.

Objectives To conduct a systematic review of the epidemiological and health service utilization literature related to the Roma population between 2003 and 2012. Methods Systematic review of empirical research related to Roma health and health care utilization published between 2003 and 2012 identified through electronic databases (PsycInfo, Medline, Google Scholar). Methodological rigor was evaluated using a six-point set of design criteria. Results We found evidence for lower self-reported health and significantly higher mortality risk for Roma compared to non-Roma, and greater prevalence of health risk factors for Roma children, including environmental risks, low birth weight, and lower vaccination coverage. Studies of non-communicable and infectious disease remain insufficient to make firm conclusions on disparities. Barriers to care include lack of documentation and affordability of care, though more studies on health care utilization are needed. Conclusions Roma youth and adults are in need of programs that reduce health disparities and their increased mortality risk. Reducing exposure to risk factors such as smoking, obesity, and poor living conditions may be a target for interventions. More intervention studies and rigorous evaluations are needed.

The current opioid crisis has been described as the worst drug epidemic in US history. Existing research converges to show an epidemic increasingly likely to touch the lives of women -- particularly reproductive age women -- yet some researchers argue that the role of sex and gender in the ongoing epidemic has largely been overlooked. Many programs and policies directed at the epidemic have sought to limit the volume of opioids prescribed. However, dissemination of medication treatment for individuals with opioid use disorder (MOUD) is equally important. The effectiveness of efforts to limit opioid exposure while increasing access to MOUD depends on the ability to alter prescribing behavior. Sex and gender-based influences on prescribing are enormously important given differences observed in women’s risk of opioid exposure, co-occurring benzodiazepine use, consequences of substance use disorders and concerns about the potential for pregnancy. This dissertation utilized prescription data to examine the influence of patient sex on prescribing patterns in reproductive age women, guided by prescribing theory. Interrupted time series design with segmented regression was used to quantify the impact of the Food and Drug Administration’s black box warnings on extended-release and immediate-release opioids in reproductive age women aged 18-44 years compared to women aged 45-64 years and men aged 18-44 years. While the black box warnings were associated with a slowdown in the trend of opioid prescribing across patient sex and age, the findings suggest a limited effect of FDA’s action on prescribing patterns in reproductive age women. Logistic regression and survival analysis were used to examine the relationship between patient sex and treatment retention among initial buprenorphine treatment episodes, with particular attention paid to treatment retention in reproductive age women. Several sex and age-based differences were observed in both the presenting characteristics of individuals seeking buprenorphine pharmacotherapy and in the association between prescription-level characteristics and treatment retention. Attention paid to the relationship between sex, gender and opioid prescribing patterns has significant implications for the development of policies and interventions that seek to prevent opioid misuse and increase access to treatment for women with opioid use disorder. Results from this research may help to inform prescribing interventions by addressing gaps in our understanding of the association between risk communication and prescriber decision-making processes as well as the potential for sex differences in opioid prescribing and medication treatment for opioid use disorder.

Objectives: We assess whether posttraumatic stress disorder (PTSD) varies in prevalence, diagnostic criteria endorsement, and type and frequency of potentially traumatic events (PTEs) among a nationally representative US sample of 5071 non-Latino whites, 3264 Latinos, 2178 Asians, 4249 African Americans, and 1476 Afro-Caribbeans. Methods: PTSD and other psychiatric disorders were evaluated using the World Mental Health-Composite International Diagnostic Interview (WMH-CIDI) in a national household sample that oversampled ethnic/racial minorities (n = 16,238) but was weighted to produce results representative of the general population. Results: Asians have lower prevalence rates of probable lifetime PTSD, whereas African Americans have higher rates as compared with non-Latino whites, even after adjusting for type and number of exposures to traumatic events, and for sociodemographic, clinical, and social support factors. Afro-Caribbeans and Latinos seem to demonstrate similar risk to non-Latino whites, adjusting for these same covariates. Higher rates of probable PTSD exhibited by African Americans and lower rates for Asians, as compared with non-Latino whites, do not appear related to differential symptom endorsement, differences in risk or protective factors, or differences in types and frequencies of PTEs across groups. Conclusions: There appears to be marked differences in conditional risk of probable PTSD across ethnic/racial groups. Questions remain about what explains risk of probable PTSD. Several factors that might account for these differences are discussed, as well as the clinical implications of our findings. Uncertainty of the PTSD diagnostic assessment for Latinos and Asians requires further evaluation.

Bringing together Jacques Lacan and Friedrich Nietzsche, Tim Themi focuses on their conceptions of ethics and on their accounts of the history of ethical thinking in the Western tradition. Nietzsche blames Plato for setting in motion a degenerative process that turned ethics away from nature, the body, and its senses, and thus eventually against our capacities for reason, science, and a creative, flourishing life. Dismissing Plato's Supreme Good as a \"mirage,\" Lacan is very much in sympathy with Nietzsche's reading. Following this premise, Themi shows how Lacan's ethics might build on Nietzsche's work, thus contributing to our understanding of Nietzsche, and also how Nietzsche's critique can strengthen our understanding of Lacan.

Examines the political dimensions of Aristophanes' comic poetry.

BackgroundAn emerging body of evidence underscores the often-intensive perinatal healthcare needs of women with intellectual and developmental disabilities (IDD). However, population-based research examining postpartum experiences of US women with IDD is sparse. We examined emergency department (ED) use in the postpartum period among Massachusetts mothers with IDD.MethodsWe analysed 2002–2010 Massachusetts Pregnancy to Early Life Longitudinal data to compare any and ≥2 ED visits between mothers with and without IDD: within 1–42 days post partum, 1–90 days post partum and 1–365 days post partum. We also determined whether or not such ED use was non-urgent or primary-care sensitive.ResultsWe identified 776 births in women with IDD and 595 688 births in women without IDD. Across all three postpartum periods, women with IDD were vastly more likely to have any postpartum ED use, to have ≥2 ED visits and to have ED visits for mental health reasons. These findings persisted after controlling for numerous sociodemographic and clinical characteristics. Women with IDD were less likely to have non-urgent ED visits during the three postpartum periods and they were less likely to have primary-care sensitive ED visits during the postpartum period.ConclusionThese findings contribute to the emerging research on perinatal health and healthcare use among women with IDD. Further research examining potential mechanisms behind the observed ED visit use is warranted. High ED use for mental health reasons among women with IDD suggests that their mental health needs are not being adequately met.