Male perspectives on intimate partner violence: A qualitative analysis from South Africa

Background Intimate partner violence (IPV) affects one in four women globally and is more commonly enacted by men than women. Rates of IPV in South Africa exceed the global average. Exploring the background and context regarding why men use violence can help future efforts to prevent IPV. Methods We explored adult men’s perspectives of IPV, livelihoods, alcohol use, gender beliefs, and childhood exposure to abuse through a secondary analysis of qualitative interviews that were conducted in South Africa. The setting was a peri-urban township characterized by high unemployment, immigration from rural areas, and low service provision. We utilized thematic qualitative analysis that was guided by the social ecological framework. Results Of 30 participants, 20 were residents in the neighborhood, 7 were trained community members, and 3 were program staff. Men reported consumption of alcohol and lack of employment as being triggers for IPV and community violence in general. Multiple participants recounted childhood exposure to abuse. These themes, in addition to culturally prescribed gender norms and constructs of manhood, seemed to influence the use of violence. Conclusion Interventions aimed at reducing IPV should consider the cultural and social impact on men’s use of IPV in low-resource, high-IPV prevalence settings, such as peri-urban South Africa. This work highlights the persistent need for the implementation of effective primary prevention strategies that address contextual and economic factors in an effort to reduce IPV that is primarily utilized by men directed at women

Subcortical brain volumes in young infants exposed to antenatal maternal depression: Findings from a South African birth cohort.

BACKGROUND: Several studies have reported enlarged amygdala and smaller hippocampus volumes in children and adolescents exposed to maternal depression. It is unclear whether similar volumetric differences are detectable in the infants' first weeks of life, following exposure in utero. We investigated subcortical volumes in 2-to-6 week old infants exposed to antenatal maternal depression (AMD) from a South African birth cohort. METHODS: AMD was measured with the Beck Depression Inventory 2nd edition (BDI-II) at 28-32 weeks gestation. T2-weighted structural images were acquired during natural sleep on a 3T Siemens Allegra scanner. Subcortical regions were segmented based on the University of North Carolina neonatal brain atlas. Volumetric estimates were compared between AMD-exposed (BDI-II ⩾ 20) and unexposed (BDI-II < 14) infants, adjusted for age, sex and total intracranial volume using analysis of covariance. RESULTS: Larger volumes were observed in AMD-exposed (N = 49) compared to unexposed infants (N = 75) for the right amygdala (1.93% difference, p = 0.039) and bilateral caudate nucleus (left: 5.79% difference, p = 0.001; right: 6.09% difference, p < 0.001). A significant AMD-by-sex interaction was found for the hippocampus (left: F(1,118) = 4.80, p = 0.030; right: F(1,118) = 5.16, p = 0.025), reflecting greater volume in AMD-exposed females (left: 5.09% difference, p = 0.001, right: 3.54% difference, p = 0.010), but not males. CONCLUSIONS: Volumetric differences in subcortical regions can be detected in AMD-exposed infants soon after birth, suggesting structural changes may occur in utero. Female infants might exhibit volumetric changes that are not observed in male infants. The potential mechanisms underlying these early volumetric differences, and their significance for long-term child mental health, require further investigation

Cost effectiveness of potential ART adherence monitoring interventions in sub-saharan Africa

Background Interventions based around objective measurement of adherence to antiretroviral drugs for HIV have potential to improve adherence and to enable differentiation of care such that clinical visits are reduced in those with high adherence. It would be useful to understand the approximate upper limit of cost that could be considered for such interventions of a given effectiveness in order to be cost effective. Such information can guide whether to implement an intervention in the light of a trial showing a certain effectiveness and cost. Methods An individual-based model, calibrated to Zimbabwe, which incorporates effects of adherence and resistance to antiretroviral therapy, was used to model the potential impact of adherence monitoring-based interventions on viral suppression, death rates, disability adjusted life years and costs. Potential component effects of the intervention were: enhanced average adherence when on ART, reduced risk of ART discontinuation, and reduced risk of resistance acquisition. We considered a situation in which viral load monitoring is not available and one in which it is. In the former case, it was assumed that care would be differentiated based on the adherence level, with fewer clinic visits in those demonstrated to have high adherence. In the latter case, care was assumed to be primarily differentiated according to viral load level. The maximum intervention cost required to be cost effective was calculated based on a cost effectiveness threshold of $500 per DALY averted. Findings In the absence of viral load monitoring, an adherence monitoring-based intervention which results in a durable 6$50 per person-year on ART, mainly driven by the cost savings of differentiation of care. In the presence of viral load monitoring availability, an intervention with a similar effect on viral load suppression was cost-effective when costing $23-$32 per year, depending on whether the adherence intervention is used to reduce the level of need for viral load measurement. Conclusion The cost thresholds identified suggest that there is clear scope for adherence monitoringbased interventions to provide net population health gain, with potential cost-effective use in situations where viral load monitoring is or is not available. Our results guide the implementation of future adherence monitoring interventions found in randomized trials to have health benefit

Do interventions to improve adherence to antiretroviral therapy recognise diversity? A systematic review

People living with HIV (PLWH) are often culturally and linguistically diverse populations; these differences are associated with differing barriers to antiretroviral therapy (ART) adherence. Cultural competence measures the extent to which trial design recognises this diversity. This systematic review aimed to determine whether adherence trial participants represent the diversity of PLWH. Randomised Controlled Trials in Organisation for Economic Co-operation and Development countries to improve ART adherence were eligible. We searched MEDLINE, EMBASE, and Cochrane Database of Systematic Reviews. For all included trials, we searched for their development, testing and evaluation studies. We compared trial participant characteristics with nationally reported PLWH data. We appraised trial cultural competence against ten criteria; scoring each criterion as 0, 1 or 2 indicating cultural blindness, pre-competence or competence respectively. For 80 included trials, a further 13 studies presenting development/testing/evaluation data for the included trials were identified. Only one of the 80 included studies reported trial participants representative of the country's population of PLWH. The median (IQ) cultural competence score was 2.5 (1.0, 4.0) out of 20. HIV adherence trial participants are not reflective of the population with HIV, which may be due to limited adoption of culturally competent research methods

The Daily Relationship Between Food Insecurity and Medication Adherence Among People Living with HIV

Limited access to resources based on social position can significantly impact health behaviors. Previous research on food insecurity and HIV has focused on establishing the relationship between food insecurity and antiretroviral (ARV) medication non-adherence in a variety of social contexts (i.e. resource poor and resource rich environments). However, one main caveat of these studies is the level of analysis. Previous studies have used cross-sectional and longitudinal studies that concentrate on the individual level of analysis. However, these study designs do not allow for a true test of whether ARV medication non-adherence occurs on days with limited access to food. The current study utilized a prospective, observational design to test the daily relationship between food insecurity and medication non-adherence. Fifty-nine adults living with HIV were enrolled. They were followed for 45 days and completed daily assessments of food insecurity and alcohol use via two way text message surveys. Participants also used Wisepill devices to assess daily medication adherence. Results showed that severe food insecurity (i.e. hunger) significantly predicted missed doses of medication on a daily level. This relationship was moderated by alcohol use but not geospatial factors. Additionally, psychosocial factors did not mediate this relationship. There are several potential explanations for this daily relationship including competing resource demands and food requirements of prescriptions. Future research should tease apart these potential explanations in order to better understand the daily relationship between food insecurity and medication non-adherence and the ways that we can intervene

Just-in-Time Mobile Behavioral Self-Regulation Medication Adherence Counseling Intervention for People Living with HIV/AIDS: A Test of Concept

Sub-optimal antiretroviral adherence is a serious problem among people living with HIV (PLWH) that can lead to virologic rebound, resistance to medication regimens, and poor health outcomes. Emerging technologies allow for the detection of potential missed doses in real time as a possible point of intervention. Using these sensory technologies, this test of concept intervention trial was designed to target possible missed doses and initiate just-in-time self-regulation adherence counseling. The purpose of this study was to assess the acceptability, feasibility and potential efficacy of a just-in-time adherence counseling intervention using a Wisepill electronic pillbox device. Overall, there was trending evidence for greater medication adherence for those in the intervention condition (d=0.21). Additionally, the majority of participants found both the device and the intervention acceptable. However, the intervention had low feasibility. Only a small number (11.7%) of missed doses were able to be counseled. Thus, utilizing the Wisepill device for intervention initiation may not be the best way to use this device to increase medication adherence among PLWH. However, the opportunities that the Wisepill device and others like it afford have not yet been fully elucidated

Psychiatrischer Beitrag

&lt;jats:title&gt;Zusammenfassung&lt;/jats:title&gt;&lt;jats:p&gt;Wer zur Frage der Schuldfähigkeitsbeurteilung bei Intelligenzminderung in forensisch-psychiatrischen Lehrbüchern nachschlägt, findet vielfach und teils sehr anschaulich in schematischer Aufbereitung eine Beurteilungsmaßgabe, dass bei&lt;jats:italic&gt;schwerster und schwerer Intelligenzminderung die Einsichtsfähigkeit aufgehoben&lt;/jats:italic&gt;, bei&lt;jats:italic&gt;mittelgradiger Intelligenzminderung teils die Einsichts- und teils die Steuerungsfähigkeit aufgehoben&lt;/jats:italic&gt;und bei&lt;jats:italic&gt;leichter Intelligenzminderung entweder die Einsichtsfähigkeit oder die Steuerungsfähigkeit&lt;/jats:italic&gt;entweder&lt;jats:italic&gt;vermindert oder aufgehoben&lt;/jats:italic&gt;seien. Eine psychopathologische Fundierung dieser Leitsätze oder eine Darlegung möglicher Begründungswege von Fähigkeitsbeeinträchtigungen entsprechend den §§ 20, 21 StGB wird jedoch in aller Regel nicht geboten. Nachfolgend soll versucht werden, unter Bezugnahme auf aktuelle diagnostische Kriterien und Konzeptionen der Intelligenzminderung, die über die isolierte Bestimmung eines IQ-Werts hinausweisen, weitere Orientierung bei der Schuldfähigkeitsbeurteilung von Straftätern mit Intelligenzminderung zu bieten.&lt;/jats:p&gt