Forced Sexual Relations Among Young Women in Developing Countries

Recent research in developing countries suggests that a considerable number of young women may experience forced sex within marriage, but most women may be inhibited from reporting these experiences due to shame, fear of reprisal or deep-rooted unequal gender norms.The consequences of domestic violence can be severe, and in fact, intimate partner violence is one of the leading causes of death among women 15-44 years of age.(1) Papers highlighting the nature and prevalence of coercion among married young women were presented at a global consultative meeting in New Delhi.Evidence comes from small-scale studies and large population-based surveys, such as Demographic and Health Surveys (DHS), from some developing countries. Many women may under report coercion by a partner within marriage, and there are variations in the framing of questions posed, methods of data collection and the reference period, making findings of small-scale studies difficult to compare. However, available data give an idea of the extent and nature of coercion that married young women experience. Studies reveal that sexual coercion within marriage includes deception, verbal threats or psychological intimidation to obtain sex, attempted rape and forced penetrative sex.(2)Forced marital sex can be accompanied by physical or emotional violence. Sexual coercion is observed in marital partnerships in diverse settings such as South Asia, Latin America, Africa and the Middle East. Although cultural settings and contexts condition the nature of coercion among married young women, there are striking similarities across different settings

Silver(i) complexes of bis- and tris-(pyrazolyl)azine derivatives - dimers, coordination polymers and a pentametallic assembly.

Silver(I) complexes of 2,4,6-tri(pyrazol-1-yl)pyridine (tpp), 2,4,6-tri(pyrazol-1-yl)pyrimidine (tpym), 2,4,6-tri(pyrazol-1-yl)-1,3,5-triazine (tpt) and 2,4-di(pyrazol-1-yl)-1,3,5-triazine (bpt) are reported. Dinuclear [Ag₂(μ-tpp)₂(MeCN)₂][BF₄]₂·2MeCN and [Ag₂(μ-tpym)₂(MeCN)₂][BF₄]₂ are formed from approximately planar [AgL(NCMe)]⁺ (L = tpp or bpym) centres, which dimerise via apical interactions to the pendant pyrazolyl donor on each ligand. Two polymeric solvatomorph phases [Ag₂(μ-tpp)₂][BF₄]₂·nMeNO₂ were obtained by crystallising AgBF₄ and tpp from nitromethane solution. One is composed of the same dimeric [Ag₂(μ-tpp)₂]²⁺ motif as the MeCN solvates, but with semibridging pyrazolyl substitutents replacing the solvent ligands. The other form has helicate [Ag₂(μ-tpp)₂]²⁺ dimers linked into chains by unsupported Ag⋯Ag interactions. In contrast, [Ag₅(μ₃-tpym)₄][BF₄]₅·2MeNO₂ contains discrete pentametallic assemblies, of a flattened [Ag₄(μ-tpym)₄]⁴⁺ molecular square centred by the fifth silver ion. Three helical or linear 1D coordination polymer topologies are described for [Ag(μ-tpt)]X (X¯ = BF₄¯ or ClO₄¯), where ditopic tpt ligands bind one silver ion in a [2 + 1] geometry and the other in bidentate, [1 + 1] or monodentate fashion. Finally, [Ag(bpt)]BF₄ is a polymer of square planar silver ions linked by bis-bidentate bpt ligands. Most of the tpt and bpt structures include short anion⋯π contacts to the ligand triazinyl rings. Electrospray mass spectra confirm the oligomeric nature of the Ag/tpym and tpt complexes in MeNO₂ solution

Heterometallic Coordination Polymer Gels Supported by 2,4,6-Tris(pyrazol-1-yl)-1,3,5-triazine

Complexes of type [M(tpt)2]X2 (M2+ = Fe2+, Co2+, Ni2+; tpt = 2,4,6-tri{pyrazol-1-yl}-1,3,5-triazine; X– = BF4– or ClO4–) crystallize in a cubic lattice, with the metal ion and ligand conformation showing unusual symmetry-imposed disorder. Addition of 1 equiv AgX to the corresponding preformed [M(tpt)2]X2 salt in concentrated MeNO2 solution affords thixotropic gels. Gelation was not observed in analogous reactions using [Mn(tpt)2][ClO4]2, or from reactions in other, more donating solvents. Scanning electron microscopy (SEM) images from dilute solutions of the reagents confirmed the fibrous microstructure of the gels and their homogeneous elemental composition. However, energy-dispersive X-ray data show a reduced Fe/Ag ratio compared to the Co/Ag and Ni/Ag gels, where a 1:1 ratio of metals is evident. More concentrated gels decomposed to silver nanoparticles during SEM sample preparation. Mass spectrometry and 1H NMR indicate that silver induces partial ligand displacement reactions in [Fe(tpt)2]2+ and [Co(tpt)2]2+, but not in [Ni(tpt)2]2+. Hence, the strength of the gels, which follows the order M = Mn (no gel) < Fe < Co < Ni, correlates with the stability of octahedral [M(tpt)2]2+ under gelation conditions. Iron(II) complexes of the related ligands 2,4,6-tri{pyrazol-1-yl}pyridine (tpp) and 2,4,6-tri{pyrazol-1-yl}pyrimidine (tpym) did not undergo gelation with silver salts under the above conditions. The unique properties of tpt as a gelator in this work may reflect the crystallographically observed ability of metal-coordinated tpt to chelate to exogenous silver ions, through its pendant pyrazolyl group and triazinyl N donors. In contrast, the pendant azolyl substituents in silver complexes of the nongelators tpp and tpym only bind exogenous silver in monodentate fashion

Lack of confidence among trainee doctors in the management of diabetes: the Trainees Own Perception of Delivery of Care (TOPDOC) Diabetes Study

Background: There is an increased prevalence of diabetes. Doctors in training, irrespective of specialty, will have patients with diabetes under their care

Culture change in elite sport performance teams: Examining and advancing effectiveness in the new era

Reflecting the importance of optimizing culture for elite teams, Fletcher and Arnold (2011) recently suggested the need for expertise in culture change. Acknowledging the dearth of literature on the specific process, however, the potential effectiveness of practitioners in this area is unknown. The present paper examines the activity's precise demands and the validity of understanding in sport psychology and organizational research to support its delivery. Recognizing that sport psychologists are being increasingly utilized by elite team management, initial evidence-based guidelines are presented. Finally, to stimulate the development of ecologically valid, practically meaningful knowledge, the paper identifies a number of future research directions

Change management: The case of the elite sport performance team

The effective and efficient implementation of change is often required for both successful performance and management survival across a host of contemporary domains. However, although of major theoretical and practical significance, research to date has overlooked the application of change management (hereafter CM) knowledge to the elite sport performance team environment. Considering that the success of ‘off-field’ sports businesses are largely dependent on the performances of their ‘on-field’ team, this article explores the application of current CM theorizing to this specific setting and the challenges facing its utility. Accordingly, we identify the need and importance of developing theory specific to this area, with practical application in both sport and business, through examination of current knowledge and identification of the domain's unique, dynamic and contested properties. Markers of successful change are then suggested to guide initial enquiry before the article concludes with proposed lines of research which may act to provide a valid and comprehensive theoretical account of CM to optimize the research and practice of those working in the field

Oral bisphosphonate compliance and persistence: a matter of choice?

Compliance to oral bisphosphonates is suboptimal, with negative consequences of increased healthcare utilization and less effective fracture risk reduction. Extending dose interval increased adherence only moderately. We used literature derived from multiple chronic conditions to examine the problem of noncompliance with osteoporosis medication. We reviewed the literature on adherence to osteoporosis medication as well as that across multiple chronic conditions to understand what is known about the cause of the poor adherence. Poor compliance to oral medications is due mostly, not to forgetfulness, but to deliberate choice. Gender differences and style of healthcare management also play a role. Preliminary data suggest psychobehavioral interventions may help to improve motivation. We need to understand better reasons for poor compliance before effective interventions can be developed. Forgetfulness is only a small part of poor compliance. Patient preferences must be considered in medication decision making

The Potential of Medical Abortion to Reduce Maternal Mortality in Africa: What Benefits for Tanzania and Ethiopia?

BACKGROUND: Unsafe abortion is estimated to account for 13% of maternal mortality globally. Medical abortion is a safe alternative. METHODS: By estimating mortality risks for unsafe and medical abortion and childbirth for Tanzania and Ethiopia, we modelled changes in maternal mortality that are achievable if unsafe abortion were replaced by medical abortion. We selected Ethiopia and Tanzania because of their high maternal mortality ratios (MMRatios) and contrasting situations regarding health care provision and abortion legislation. We focused on misoprostol-only regimens due to the drug's low cost and accessibility. We included the impact of medical abortion on women who would otherwise choose unsafe abortion and on women with unwanted/mistimed pregnancies who would otherwise carry to term. RESULTS: Thousands of lives could be saved each year in each country by implementing medical abortion using misoprostol (2122 in Tanzania and 2551 in Ethiopia assuming coverage equals family planning services levels: 56% for Tanzania, 31% for Ethiopia). Changes in MMRatios would be less pronounced because the intervention would also affect national birth rates. CONCLUSIONS: This is the first analysis of impact of medical abortion provision which takes into account additional potential users other than those currently using unsafe abortion. Thousands of women's lives could be saved, but this may not be reflected in as substantial changes in MMRatios because of medical abortion's demographic impact. Therefore policy makers must be aware of the inability of some traditional measures of maternal mortality to detect the real benefits offered by such an intervention

A prospective, double-blind, randomized, controlled clinical trial comparing standard wound care with adjunctive hyperbaric oxygen therapy (HBOT) to standard wound care only for the treatment of chronic, non-healing ulcers of the lower limb in patients with diabetes mellitus: a study protocol

<p>Abstract</p> <p>Background</p> <p>It has been suggested that the use of adjunctive hyperbaric oxygen therapy improves the healing of diabetic foot ulcers, and decreases the risk of lower extremity amputations. A limited number of studies have used a double blind approach to evaluate the efficacy of hyperbaric oxygen therapy in the treatment of diabetic ulcers. The primary aim of this study is to assess the efficacy of hyperbaric oxygen therapy plus standard wound care compared with standard wound care alone in preventing the need for major amputation in patients with diabetes mellitus and chronic ulcers of the lower limb.</p> <p>Methods/Design</p> <p>One hundred and eighteen (59 patients per arm) patients with non-healing diabetic ulcers of the lower limb, referred to the Judy Dan Research and Treatment Centre are being recruited if they are at least 18 years of age, have either Type 1 or 2 diabetes with a Wagner grading of foot lesions 2, 3 or 4 on lower limb not healing for at least 4 weeks. Patients receive hyperbaric oxygen therapy every day for 6 weeks during the treatment phase and are provided ongoing wound care and weekly assessments. Patients are required to return to the study centre every week for an additional 6 weeks of follow-up for wound evaluation and management. The primary outcome is freedom from having, or meeting the criteria for, a major amputation (below knee amputation, or metatarsal level) up to 12 weeks after randomization. The decision to amputate is made by a vascular surgeon. Other outcomes include wound healing, effectiveness, safety, healthcare resource utilization, quality of life, and cost-effectiveness. The study will run for a total of about 3 years.</p> <p>Discussion</p> <p>The results of this study will provide detailed information on the efficacy of hyperbaric oxygen therapy for the treatment of non-healing ulcers of the lower limb. This will be the first double-blind randomized controlled trial for this health technology which evaluates the efficacy of hyperbaric oxygen therapy in prevention of amputations in diabetic patients.</p> <p>Trial registration</p> <p>ClinicalTrials.gov Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00621608">NCT00621608</a></p