Women with disabilities' experiences of gender-based violence in Cape Town, South Africa

Background: Little is known about violence against women with disabilities in South Africa. Given that South Africa has a high prevalence of gender-based violence (GBV), especially intimate partner violence (IPV), there is a need to highlight the violence experiences of women with disabilities within their communities, intimate partnerships, and other settings. Aims: The aim of the thesis was to investigate how South African women with disabilities experience GBV. In doing so, the study’s objectives were to highlight the nature and forms of violence they experience, the social constructions of women with disabilities’ intimate partner relationships, and the barriers and enablers to GBV support they may encounter. Methods: This thesis takes the form of a qualitative research study that was conducted with 30 women with physical and sensory disabilities, and 19 disability and GBV service providers in Cape Town, South Africa. Repeat in-depth interviews and focus groups followed a narrative approach that was used to elicit participants’ stories, perspectives and lived experiences. Thematic analysis was conducted on the data, and interpretation of the data used an intersectional framework, with an emphasis on social approaches to disability and resistance theories. Findings: Published or submitted papers included in the thesis reveal how women with disabilities in South Africa may experience additional layers of GBV because of their disability status, and consider how gender inequality, disability stigma, and disability-specific forms of abuse shape participants’ lives and experiences of violence (Paper 1). The thesis claims that, while women with disabilities are vulnerable to GBV, particularly IPV, some women have agency and are able to manage disability stigma and intimate partnerships to avoid acts of violence (Paper 2). The thesis finds that, while women with disabilities do seek help after IPV and sexual violence, they encounter unique barriers to GBV service-provision. Service providers and women with disabilities acknowledge various limitations to providing inclusive and accessible services to women with disabilities who experience violence (Paper 3). The thesis also makes a series of recommendations for undertaking ethical GBV research with women with disabilities, and argues for the need to review current ethical guidelines to facilitate future disability-inclusive GBV research (Paper 4). Conclusion: The thesis recommends that violence prevention efforts should address the role of disability stigma, facilitate economically empowering opportunities for women living with disabilities in the country, and provide a range of accessible mental health services and GBV care and support services to facilitate better intimate partnership outcomes. Strengthened pathways to violence prevention and post-violence care and support should be coordinated by both disability and GBV sectors. The thesis calls for population data to reveal the prevalence and adverse public-health outcomes of GBV against women with disabilities in South Africa and other low-middle income countries (LMICs). Future epidemiological research should include validated disability measures and measures of disability-specific forms of violence that may compound GBV. Understanding the magnitude of violence against women with disabilities is the first step in the public-health approach to GBV prevention and requires collaborative research and surveillance efforts

Psychosocial group interventions to improve psychological well-being in adults living with HIV.

Being diagnosed with human immunodeficiency virus (HIV), and labelled with a chronic, life-threatening, and often stigmatizing disease, can impact on a person's well-being. Psychosocial group interventions aim to improve life-functioning and coping as individuals adjust to the diagnosis. To examine the effectiveness of psychosocial group interventions for improving the psychological well-being of adults living with HIV/AIDS. We searched the following electronic databases up to 14 March 2016: the Cochrane Central Register of Controlled Trials (CENTRAL) published in the Cochrane Library (Issue 2, 2016), PubMed (MEDLINE) (1996 to 14 March 2016), Embase (1996 to 14 March 2016), and Clinical Trials.gov. Randomized controlled trials (RCTs) or quasi-RCTs that compared psychosocial group interventions with versus control (standard care or brief educational interventions), with at least three months follow-up post-intervention. We included trials that reported measures of depression, anxiety, stress, or coping using standardized scales. Two review authors independently screened abstracts, applied the inclusion criteria, and extracted data. We compared continuous outcomes using mean differences (MD) with 95% confidence intervals (95% CIs), and pooled data using a random-effects model. When the included trials used different measurement scales, we pooled data using standardized mean difference (SMD) values. We reported trials that we could not include in the meta analysis narratively in the text. We assessed the certainty of the evidence using the GRADE approach. We included 16 trials (19 articles) that enrolled 2520 adults living with HIV. All the interventions were multifaceted and included a mix of psychotherapy, relaxation, group support, and education. The included trials were conducted in the USA (12 trials), Canada (one trial), Switzerland (one trial), Uganda (one trial), and South Africa (one trial), and published between 1996 and 2016. Ten trials recruited men and women, four trials recruited homosexual men, and two trials recruited women only. Interventions were conducted with groups of four to 15 people, for 90 to 135 minutes, every week for up to 12 weeks. All interventions were conducted face-to-face except two, which were delivered by telephone. All were delivered by graduate or postgraduate trained health, psychology, or social care professionals except one that used a lay community health worker and two that used trained mindfulness practitioners.Group-based psychosocial interventions based on cognitive behavioural therapy (CBT) may have a small effect on measures of depression, and this effect may last for up to 15 months after participation in the group sessions (SMD -0.26, 95% CI -0.42 to -0.10; 1139 participants, 10 trials, low certainty evidence). Most trials used the Beck Depression Inventory (BDI), which has a maximum score of 63, and the mean score in the intervention groups was around 1.4 points lower at the end of follow-up. This small benefit was consistent across five trials where participants had a mean depression score in the normal range at baseline, but trials where the mean score was in the depression range at baseline effects were less consistent. Fewer trials reported measures of anxiety, where there may be little or no effect (four trials, 471 participants, low certainty evidence), stress, where there may be little or no effect (five trials, 507 participants, low certainty evidence), and coping (five trials, 697 participants, low certainty evidence).Group-based interventions based on mindfulness have not demonstrated effects on measures of depression (SMD -0.23, 95% CI -0.49 to 0.03; 233 participants, 2 trials, very low certainty evidence), anxiety (SMD -0.16, 95% CI -0.47 to 0.15; 62 participants, 2 trials, very low certainty evidence), or stress (MD -2.02, 95% CI -4.23 to 0.19; 137 participants, 2 trials, very low certainty evidence). No mindfulness based interventions included in the studies had any valid measurements of coping. Group-based psychosocial interventions may have a small effect on measures of depression, but the clinical importance of this is unclear. More high quality evidence is needed to assess whether group psychosocial intervention improve psychological well-being in HIV positive adults

Peer victimization and experiences of violence at school and at home among school age children with disabilities in Pakistan and Afghanistan

Background: Children with disabilities are more likely to experience violence or injury at school and at home, but there is little evidence from Central Asia. Objective: To describe the prevalence of disability and associations with peer violence perpetration and victimization, depression, corporal punishment, school performance and school attendance, among middle school children in Pakistan and Afghanistan. Method: This is a secondary analysis of data gathered in the course of evaluations of interventions to prevent peer violence conducted in Pakistan and Afghanistan as part of the \u27What Works to Prevent Violence against Women and Girls Global Programme\u27. In Pakistan, the research was conducted in 40 schools, and disability was assessed at midline in 1516 interviews with Grade 7s. In Afghanistan, the data were from the baseline study conducted in 11 schools with 770 children. Generalized Linear Mixed Modeling was used to assess associations with disability. Results: In Afghanistan, the prevalence of disability was much higher for girls (22.1%) than boys (12.9%), while in Pakistan 6.0% of boys and girls reported a disability. Peer violence victimization was strongly associated with disability in Afghanistan and marginally associated in Pakistan. In Pakistan, perpetration of peer violence was associated with disability. In both countries, disability was significantly associated with higher depression scores. Food insecurity was strongly associated with disability in Afghanistan. Conclusion: Disability is highly prevalent in Afghanistan and Pakistan schools and this is associated with a greater risk of experiencing and perpetrating peer violence. It is important to ensure that all children can benefit from school-based prevention interventions

Loss of p53 triggers Wnt-dependent systemic inflammation to drive breast cancer metastasis

Cancer-associated systemic inflammation is strongly linked to poor disease outcome in patients with cancer1,2. For most human epithelial tumour types, high systemic neutrophil-to-lymphocyte ratios are associated with poor overall survival3, and experimental studies have demonstrated a causal relationship between neutrophils and metastasis4,5. However, the cancer-cell-intrinsic mechanisms that dictate the substantial heterogeneity in systemic neutrophilic inflammation between tumour-bearing hosts are largely unresolved. Here, using a panel of 16 distinct genetically engineered mouse models for breast cancer, we uncover a role for cancer-cell-intrinsic p53 as a key regulator of pro-metastatic neutrophils. Mechanistically, loss of p53 in cancer cells induced the secretion of WNT ligands that stimulate tumour-associated macrophages to produce IL-1β, thus driving systemic inflammation. Pharmacological and genetic blockade of WNT secretion in p53-null cancer cells reverses macrophage production of IL-1β and subsequent neutrophilic inflammation, resulting in reduced metastasis formation. Collectively, we demonstrate a mechanistic link between the loss of p53 in cancer cells, secretion of WNT ligands and systemic neutrophilia that potentiates metastatic progression. These insights illustrate the importance of the genetic makeup of breast tumours in dictating pro-metastatic systemic inflammation, and set the stage for personalized immune intervention strategies for patients with cancer

Loss of p53 triggers Wnt-dependent systemic inflammation to drive breast cancer metastasis

Cancer-associated systemic inflammation is strongly linked to poor disease outcome in patients with cancer1,2. For most human epithelial tumour types, high systemic neutrophil-to-lymphocyte ratios are associated with poor overall survival3, and experimental studies have demonstrated a causal relationship between neutrophils and metastasis4,5. However, the cancer-cell-intrinsic mechanisms that dictate the substantial heterogeneity in systemic neutrophilic inflammation between tumour-bearing hosts are largely unresolved. Here, using a panel of 16 distinct genetically engineered mouse models for breast cancer, we uncover a role for cancer-cell-intrinsic p53 as a key regulator of pro-metastatic neutrophils. Mechanistically, loss of p53 in cancer cells induced the secretion of WNT ligands that stimulate tumour-associated macrophages to produce IL-1β, thus driving systemic inflammation. Pharmacological and genetic blockade of WNT secretion in p53-null cancer cells reverses macrophage production of IL-1β and subsequent neutrophilic inflammation, resulting in reduced metastasis formation. Collectively, we demonstrate a mechanistic link between the loss of p53 in cancer cells, secretion of WNT ligands and systemic neutrophilia that potentiates metastatic progression. These insights illustrate the importance of the genetic makeup of breast tumours in dictating pro-metastatic systemic inflammation, and set the stage for personalized immune intervention strategies for patients with cancer

The CHIP-Family study to improve the psychosocial wellbeing of young children with congenital heart disease and their families: design of a randomized controlled trial

Background: Children with congenital heart disease (CHD) are at increased risk for behavioral, emotional, and cognitive problems. They often have reduced exercise capacity and participate less in sports, which is associated with a lower quality of life. Starting school may present more challenges for children with CHD and their families than for families with healthy children. Moreover, parents of children with CHD are at risk for psychosocial problems. Therefore, a family-centered psychosocial intervention for children with CHD when starting school is needed. Until now, the 'Congenital Heart Disease Intervention Program (CHIP) - School' is the only evidence-based intervention in this field. However, CHIP-School targeted parents only and resulted in non-significant, though positive, effects as to child psychosocial wellbeing. Hence, we expanded CHIP by adding a specific child module and including siblings, creating the CHIP-Family intervention. The CHIP-Family study aims to (1) test the effects of CHIP-Family on parental mental health and psychosocial wellbeing of CHD-children and to (2) identify baseline psychosocial and medical predictors for the e

Predictive factors for new onset or progression of knee osteoarthritis one year after trauma: MRI follow-up in general practice

Objective: To prospectively evaluate prognostic factors for new onset or progression of degenerative change on follow-up MRI one year after knee trauma and the association with clinical outcome. Methods: Within a prospective observational cohort study in general practice, we studied a subgroup of 117 patients with acute knee trauma (mean age 41 years, 43% women). Degenerative change was scored on MRI at baseline and after one year follow-up. Multivariate logistic regression analysis was performed to evaluate prognostic factors for new onset or progressive degenerative change on follow-up MRI. Association between new or progressive degeneration and clinical outcome after one year was assessed. Results: On follow-up MRI 15% of patients with pre-existing knee osteoarthritis showed progression and 26% of patients demonstrated new degenerative change. The only statistically significant prognostic variable in the multivariate analysis was bone marrow oedema on initial MRI (OR 5.29 (95% CI 1.64-17.1), p∈=∈0.005). A significant association between new or progressive degenerative change and clinical outcome was found (p∈=∈0.003). Conclusion: Bone marrow oedema on MRI for acute knee injury is strongly predictive of new onset or progression of degenerative change of the femorotibial joint on follow-up MRI one year after trauma, which is reflected in clinical outcome

MRI follow-up of conservatively treated meniscal knee lesions in general practice

Objective: To evaluate meniscal status change on follow-up MRI after 1 year, prognostic factors and association with clinical outcome in patients with conservatively treated knee injury. Methods: We analysed 403 meniscal horns in 101 conservatively treated patients (59 male; mean age 40 years) in general practice who underwent initial knee MRI within 5 weeks of trauma. We performed ordinal logistic regression analysis to analyse prognostic factors for meniscal change on follow-up MRI after 1 year, and we assessed the association with clinical outcome. Results: On follow-up MRI 49 meniscal horns had deteriorated and 18 had improved. Age (odds ratio [OR] 1.3/decade), body weight (OR 1.2/10 kg), total anterior cruciate ligament (ACL) rupture on initial MRI (OR 2.4), location in the posterior horn of the medial meniscus (OR 3.0) and an initial meniscal lesion (OR 0.3) were statistically significant predictors of meniscal MRI appearance change after 1 year, which was not associated with clinical outcome. Conclusion: In conservatively treated patients, meniscal deterioration on follow-up MRI 1 year after trauma is predicted by higher age and body weight, initial total ACL rupture, and location in the medial posterior horn. Change in MRI appearance is not associated with clinical outcome

The BRCA1-Δ11q Alternative Splice Isoform Bypasses Germline Mutations and Promotes Therapeutic Resistance to PARP Inhibition and Cisplatin.

Breast and ovarian cancer patients harboring BRCA1/2 germline mutations have clinically benefitted from therapy with PARP inhibitor (PARPi) or platinum compounds, but acquired resistance limits clinical impact. In this study, we investigated the impact of mutations on BRCA1 isoform expression and therapeutic response. Cancer cell lines and tumors harboring mutations in exon 11 of BRCA1 express a BRCA1-Δ11q splice variant lacking the majority of exon 11. The introduction of frameshift mutations to exon 11 resulted in nonsense-mediated mRNA decay of full-length, but not the BRCA1-Δ11q isoform. CRISPR/Cas9 gene editing as well as overexpression experiments revealed that the BRCA1-Δ11q protein was capable of promoting partial PARPi and cisplatin resistance relative to full-length BRCA1, both in vitro and in vivo Furthermore, spliceosome inhibitors reduced BRCA1-Δ11q levels and sensitized cells carrying exon 11 mutations to PARPi treatment. Taken together, our results provided evidence that cancer cells employ a strategy to remove deleterious germline BRCA1 mutations through alternative mRNA splicing, giving rise to isoforms that retain residual activity and contribute to therapeutic resistance. Cancer Res; 76(9); 2778-90. ©2016 AACR

Women of Steel : articulations of empowerment and livelihood practices in the Dwars River Valley, Western Cape

Thesis (MA (Sociology and Social Anthropology))--Stellenbosch University, 2009.ENGLISH SUMMARY: Women’s livelihoods are not only experienced differently, but are articulated in different ways. This dissertation begins from the understanding that women’s livelihoods are processual, complex and contextual. They are embedded in multifarious processes, structures, discourses and everyday practices, which are locally defined and globally linked. This thesis interrogates women’s articulations of empowerment and agency that were central to their community and entrepreneurial activities. Women’s social actions and responses to constraints and transformation they encountered in the valley were sites of struggle. Informed by local women’s perspectives and articulations of empowerment, this ethnography focuses on how women practiced their livelihoods: how they manoeuvred, negotiated and performed their livelihood tactics in response to local, national and global constraints. The study narrates how women in a rural valley in the Winelands of the Western Cape (South Africa) spoke of how they felt ‘empowered’ despite constraints. They claimed that they exhibited productive moments and harnessed opportunities to rise above constraints. They felt that in general men in their communities were passive in their response to crisis in the valley. Women’s narratives of empowerment in the Dwars River Valley invoked ideas of ‘women of steel’ and ‘moments’ of agency. These helped to re-fashion local gender orders and rehabilitate notions of ‘appropriate’ women’s work.AFRIKAANSE OPSOMMING: Die bestaanswyses van vroue word nie slegs in die uitleef daarvan waargeneem nie, maar is dikwels ook ‘n fokus van gespreksvoering. Die uitgangspunt van hierdie tesis is dat vroue se bestaanswyses metodies, kompleks en kontekstueel is. Dit word begrond deur uiteenlopende prosesse, strukture, diskoerse, en alledaagse gebruike wat plaaslik gedefinieer word en globaal gebonde is. Hierdie tesis ondersoek vroue se artikulasie van bemagtiging en agentskap wat sentraal tot hul gemeenskap en entrepreneurskap aktiwiteite staan. Vroue se sosiale handelinge en reaksies tot struikelblokke en transformasie wat hulle in die vallei in die gesig gestaar het, is beduidend van ‘n plek van worsteling. Hierdie etnografie word toegelig deur plaaslike vroue se perspektiewe en artikulasie van bemagtiging en fokus op hoe hulle hul bestaanswyse beoefen het: hoe vroue bestaanswyse taktieke gemanipuleer, onderhandel en ook uitgevoer het as reaksie op plaaslike, nasionale en globale beperkinge. Hierdie studie vertel hoe vroue in ‘n landelike vallei van die Wynlande in die Wes-Kaap (Suid-Afrika) praat oor hoe hul ‘bemagtig’ voel, ten spyte van beperkinge. Hulle voer aan dat hul produktiewe oomblikke vertoon en gebruik maak van geleenthede om bo beperkinge uit te styg. Hulle voel dat mans oor die algemeen passief in hul reaksie op krisis is. Vroue se verhale van bemagtiging in die Dwars Rivier Vallei roep beelde op van ‘vroue van staal’ en ‘oomblikke’ van agentskap. Dit het bygedra tot die herskepping van plaaslike gender rolle en die hervestiging van idees oor ‘gepaste’ werk vir vroue