Intimate Partner Violence During COVID-19 Restrictions: A Study of 30 Countries From the I-SHARE Consortium

Intimate partner violence (IPV) causes substantial physical and psychological trauma. Restrictions introduced in response to the COVID-19 pandemic, including lockdowns and movement restrictions, may exacerbate IPV risk and reduce access to IPV support services. This cross-sectional study examines IPV during COVID-19 restrictions in 30 countries from the International Sexual HeAlth and REproductive Health (I-SHARE) study conducted from July 20th, 2020, to February, 15th, 2021. IPV was a primary outcome measure adapted from a World Health Organization multicountry survey. Mixed-effects modeling was used to determine IPV correlates among participants stratified by cohabitation status. The sample included 23,067 participants from 30 countries. A total of 1,070/15,336 (7.0%) participants stated that they experienced IPV during COVID-19 restrictions. A total of 1,486/15,336 (9.2%) participants stated that they had experienced either physical or sexual partner violence before the restrictions, which then decreased to 1,070 (7.0%) after the restrictions. In general, identifying as a sexual minority and experiencing greater economic vulnerability were associated with higher odds of experiencing IPV during COVID-19 restrictions, which were accentuated among participants who were living with their partners. Greater stringency of COVID-19 restrictions and living in urban or semi-urban areas were associated with lower odds of experiencing IPV in some settings. The I-SHARE data suggest a substantial burden of IPV during COVID-19 restrictions. However, the restrictions were correlated with reduced IPV in some settings. There is a need for investing in specific support systems for survivors of IPV during the implementation of restrictions designed to contain infectious disease outbreaks

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Female genital cutting and sexual function: in search of an alternate theoretical model

This article revisits the open debate regarding the link between Female Genital Cutting (FGC) and Female Sexual Function (FSF). In particular, it considers how the practice, both as an operative procedure involving the alteration of external female genitalia, and culturally sanctioned maturation ritual, affects subjects\u27 sexual function and capacity to self-actualise in matters pertaining to sexuality. The article questions the validity of prevailing discourses that infer a causative association between FGC and Female Sexual Dysfunction (FSD). Informed as they are by classical perspectives regarding the female sexual response cycle, the discourses attribute various dimensions of sexual dysfunction to the latter\u27s failure to function optimally. However, it is the position of this article that this paradigm, in spite of its apparent persuasiveness, has not lent itself to sufficient empirical substantiation. This article proceeds from the premise that sexual function is a highly complex phenomenon, the optimisation of which not only is dependent upon physiological and psychological processes of body and mind, but likewise is contingent upon a broader spectrum of factors, some of which are external to instinctual processes of body and mind. This is particularly true in the context of practising and mostly culturally conservative societies, where culture, as a value and custom system is almost certain to exert an overarching influence on human relational behaviour and, by extension, the practice and experience of sexuality. It is therefore inconceivable that a conclusive judgement regarding the imports of FGC relative to sexual function can be reached without a critical consideration of this latter dimension. Scholarly explorations in this direction are scarce. This article summarises the findings of a recent investigation regarding the theme. Using the Maasai community of East Africa serving as an illustrative case study, the study explores the nexus between culture, sexuality and sexual function, in which it attempts to determine which cultural vectors are involved in the intermediation of sexual function. Emerging insights are used as key inferences towards building a contextualised explanatory theory on the subject. The article is structured in three parts. It begins by interrogating prevailing discourses regarding FGC and FSF. The interrogation serves as a background to, and provides a rationale for, an empirical investigation regarding the study theme, the latter of which is further outlined in a subsequent section. The third and final section briefly outlines elements of the proffered theoretical model