Gender-based violence and the need for evidence-based primary prevention in South Africa

Gender-based violence is a significant problem globally and in South Africa. The public and political discourse has been dominated by calls for increased penalties and convictions for perpetrators of various types of gender-based violence. However, these responses are unlikely to prevent such violence from occurring in the first place. Primary prevention strategies should address the underlying causes and drivers of gender-based violence in order to prevent violence and promote safer, respectful, happy relations between men and women. Through rigorous research, these factors have been identified and specific strategies based on these findings include: (a) building gender equality and challenging hegemonic masculinities; (b) challenging the widespread acceptance of violence; (c) improving conflict resolution and communication skills; (d) developing relationship-building skills; (e) reducing substance abuse; and (f) improved gun control. Each of these strategies and the evidence-base for the recommendations is discussed. Interventions that combine these strategies and are informed by research evidence during development are most likely to be effective in preventing gender-based violence on a large scale.Keywords: gender equality, masculinities, primary prevention, gender-based violence, South Afric

Health insurance mediation of the Mexican American non-Hispanic white disparity on early breast cancer diagnosis

We examined health insurance mediation of the Mexican American (MA) non-Hispanic white (NHW) disparity on early breast cancer diagnosis. Based on social capital and barrio advantage theories, we hypothesized a 3-way ethnicity by poverty by health insurance interaction, that is, that 2-way poverty by health insurance interaction effects would differ between ethnic groups. We secondarily analyzed registry data for 303 MA and 3,611 NHW women diagnosed with breast cancer between 1996 and 2000 who were originally followed until 2011. Predictors of early, node negative (NN) disease at diagnosis were analyzed. Socioeconomic data were obtained from the 2000 census to categorize neighborhood poverty: high (30% or more of the census tract households were poor), middle (5% to 29% poor) and low (less than 5% poor). Barrios were neighborhoods where 50% or more of the residents were MA. Primary health insurers were Medicaid, Medicare, private or none. MA women were 13% less likely to be diagnosed early with NN disease (RR = 0.87), but this MA-NHW disparity was completely mediated by the main and interacting effects of health insurance. Advantages of health insurance were largest in low poverty neighborhoods among NHW women (RR = 1.20) while among MA women they were, paradoxically, largest in high poverty, MA barrios (RR = 1.45). Advantages of being privately insured were observed for all. Medicare seemed additionally instrumental for NHW women and Medicaid for MA women. These findings are consistent with the theory that more facilitative social and economic capital is available to MA women in barrios and to NHW women in more affluent neighborhoods. It is there that each respective group of women is probably best able to absorb the indirect and direct, but uncovered, costs of breast cancer screening and diagnosis

Impact of Stepping Stones on incidence of HIV and HSV-2 and sexual behaviour in rural South Africa: cluster randomised controlled trial

Objective To assess the impact of Stepping Stones, a HIV prevention programme, on incidence of HIV and herpes simplex type 2 (HSV-2) and sexual behaviour

2-(4-Bromo­phen­yl)-2-oxoethyl anthracene-9-carboxyl­ate

In the title compound, C23H15BrO3, the anthracene ring system is essentially planar [maximum deviation = 0.29 (2) Å] and makes a dihedral angle of 5.74 (8)° with the mean plane of the bromo-substituted benzene ring. An intra­molecular C—H⋯O hydrogen bond generates an S(9) ring motif. In the crystal, mol­ecules are linked by C—H⋯O inter­actions, forming a two-dimensional network parallel to the ac plane. π–π stacking inter­actions are observed between benzene rings [centroid–centroid distances = 3.5949 (14) and 3.5960 (13) Å]

Disparities among Minority Women with Breast Cancer Living in Impoverished Areas of California

Background: Interaction effects of poverty and health care insurance coverage on overall survival rates of breast cancer among women of color and non-Hispanic white women were explored. Methods: We analyzed California registry data for 2,024 women of color (black, Hispanic, Asian, Pacific Islander, American Indian, or other ethnicity) and 4,276 non-Hispanic white women (Anglo-European ancestries and no Hispanic-Latin ethnic backgrounds) diagnosed with breast cancer between the years 1996 and 2000 who were then followed until 2011. The 2000 US census categorized rates of neighborhood poverty. Health care insurance coverage was either private, Medicare, Medicaid, or none. Cox regression was used to model rates of survival. Results: A 3-way interaction between ethnicity, health care insurance coverage, and poverty was observed. Women of color inadequately insured and living in poor or near-poor neighborhoods in California were the most disadvantaged. Women of color adequately insured and who lived in such neighborhoods in California were also disadvantaged. The incomes of such women of color were typically lower than the incomes of non-Hispanic white women. Conclusions: Women of color with or without insurance coverage are disadvantaged in poor and near-poor neighborhoods of California. Such women may be less able to bare the indirect, direct, or uncovered costs of health care for breast cancer treatment

4-(Morpholin-4-yl)-3-(trifluoro­meth­yl)­benzonitrile

In the title benzonitrile compound, C12H11F3N2O, an intra­molecular C—H⋯F hydrogen bond generates an S(7) ring motif. The trifluoro­methyl group is disordered over two orientations with a refined occupancy ratio of 0.549 (16):0.451 (16). The morpholine ring adopts a chair conformation. The benzene ring and mean plane of the morpholine ring make a dihedral angle of 58.04 (10)° with each other. In the crystal, mol­ecules are connected by inter­molecular C—H⋯F and C—H⋯O inter­actions to form R 2 2(8) ring motifs. These inter­actions also link the mol­ecules into chains parallel to the [10] direction

Potential of Grain Legume Fallows to Address Food Insecurity and Boost Household Incomes in Western Kenya

A pigeonpea fallow-maize crop rotation trial was carried out over a period of 4 seasons in western Kenya. The trial compared six high altitude long duration pigeonpea varieties i.e. ICEAP 00020, ICEAP 00040, ICEAP 00048, ICEAP 00053, ICP 9145 and ICP 13076 and a medium duration variety i.e. ICP 13211 for productivity, post fallow maize crop yield and financial returns indicators. Long duration pigeonpea varieties take 140-180 days to mature while medium duration varieties take >200 days to mature. Continuous maize cropping acted as a control. Depending on the variety, pigeonpea grain yield ranged between 1.3 and 1.9 t ha-1. Post fallow maize grain yield from each of pigeonpea variety plot was approximately 3 fold higher than yield from continuous maize plots. The medium duration pigeonpea plots yielded significantly higher maize grain than the long duration (ICEAP 00053, ICEAP 00040) pigeonpea variety plots. Relative to the control, incremental returns to land were highest for medium duration pigeonpea fallow plots (619 USD ha-1) and lowest for ICEAP 00040 fallow plots (305 USD ha-1). We estimated that by selecting an appropriate pigeonpea variety for a fallow-maize rotation system, a household could produce sufficient food for consumption and remain with a surplus of approximately 2.8 tons for sale. For widespread adoption of pigeonpea based technologies in western Kenya, there is a need for policy improvement on issues related to improved seed production systems, cost of fertilizers, extension services, and market for the end products

2-(4-Chloro­phen­yl)-2-oxoethyl 2-meth­oxy­benzoate

In the title compound, C16H13ClO4, the two benzene rings make a dihedral angle of 86.38 (8)°. In the crystal, inter­molecular C—H⋯O hydrogen bonds link the mol­ecules to form columns along the a axis. The mol­ecules are also stabilized by a π–π stacking inter­action, with a centroid–centroid distance of 3.7793 (10) Å between the inversion-related benzene rings

Effects of being uninsured or underinsured and living in high poverty neighborhoods on colon cancer care and survival in California: historical cohort analysis, 1996—2011

Background: We examined the mediating effects of health insurance on poverty-colon cancer care and survival relationships and the moderating effects of poverty on health insurance-colon cancer care and survival relationships among women and men in California. Methods: We analyzed registry data for 3,291 women and 3,009 men diagnosed with colon cancer between 1996 and 2000 and followed until 2011 on lymph node investigation, stage at diagnosis, surgery, chemotherapy, wait times and survival. We obtained socioeconomic data for individual residences from the 2000 census to categorize the following neighborhoods: high poverty (30% or more poor), middle poverty (5-29% poor) and low poverty (less than 5% poor). Primary health insurers were Medicaid, Medicare, private or none. Results: Evidence of mediation was observed for women, but not for men. For women, the apparent effect of poverty disappeared in the presence of payer, and the effects of all forms of health insurance seemed strengthened. All were advantaged on 6-year survival compared to the uninsured: Medicaid (RR = 1.83), Medicare (RR = 1.92) and private (RR = 1.83). Evidence of moderation was also only observed for women. The effects of all forms of health insurance were stronger for women in low poverty neighborhoods: Medicaid (RR = 2.90), Medicare (RR = 2.91) and private (RR = 2.60). For men, only main effects of poverty and payers were observed, the advantaging effect of private insurance being largest. Across colon cancer care processes, Medicare seemed most instrumental for women, private payers for men. Conclusions: Health insurance substantially mediates the quality of colon cancer care and poverty seems to make the effects of being uninsured or underinsured even worse, especially among women in the United States. These findings are consistent with the theory that more facilitative social and economic capital is available in more affluent neighborhoods, where women with colon cancer may be better able to absorb the indirect and direct, but uncovered, costs of care

Better Colon Cancer Care for Extremely Poor Canadian Women Compared with American Women

Extremely poor Canadian women were recently observed to be largely advantaged on most aspects of breast cancer care as compared with similarly poor, but much less adequately insured, women in the United States. This historical study systematically replicated the protective effects of single- versus multipayer health care by comparing colon cancer care among cohorts of extremely poor women in California and Ontario between 1996 and 2011. The Canadian women were again observed to have been largely advantaged. They were more likely to have received indicated surgery and chemotherapy, and their wait times for care were significantly shorter. Consequently, the Canadian women were much more likely to experience longer survival times. Regression analyses indicated that health insurance nearly completely explained the Canadian advantages. Implications for contemporary and future reforms of U.S. health care are discussed