Global prevalence of non-partner sexual violence against women.

Sexual violence against women is a human rights violation and public health concern, with serious implications for women's physical and mental health. Reducing non-partner sexual violence, including rape, sexual assault and other forms of non-contact sexual abuse, is one of the main indicators of the sustainable development goals. World Health Organization estimates, based on available prevalence data from 137 countries between 2000 and 2018, showed that, globally, 6% of women aged 15-49 years reported experiencing sexual violence in their lifetime from someone other than an intimate partner, with prevalence rates varying across regions. However, the reporting, measurement and documentation of the global extent of non-partner sexual violence against women is methodologically challenging, resulting in a gross underestimation of its magnitude and impact. To prevent and respond to this issue, policy-makers must consider interventions on education, access to relevant health-care services, public awareness, and effective and comprehensive legislation. To better estimate the prevalence of both sexual violence overall and non-partner sexual violence, it is essential to continue to strengthen the measurement of non-partner sexual violence, including the types of acts asked about and the mode of interviewing. Further research is needed to understand the cumulative impact of different forms of sexual violence on the lives of women and girls, including sexual violence during childhood and its associated risk with further exposure. Funding is required for more research and implementation of interventions to prevent and reduce all forms of violence against women and girls, including sexual violence.

Les violences sexuelles à l'égard des femmes constituent une violation des droits humains et un problème de santé publique qui ont de graves répercussions sur la santé physique et mentale des femmes. La réduction des violences sexuelles qui ne sont pas le fait d'un(e) partenaire, y compris le viol, l'agression sexuelle et d'autres formes d'abus sexuels sans contact, est l'un des principaux indicateurs des objectifs de développement durable. Selon les estimations de l'Organisation mondiale de la santé, qui se fonde sur les données de prévalence disponibles dans 137 pays entre 2000 et 2018, 6% des femmes âgées de 15 à 49 ans dans le monde ont déclaré avoir subi des violences sexuelles au cours de leur vie de la part d'une personne autre qu'un(e) partenaire intime, les taux de prévalence variant d'une région à l'autre. Toutefois, la déclaration, la mesure et la documentation de l'ampleur mondiale des violences sexuelles à l'égard des femmes qui n'impliquent pas de partenaire sont difficilement réalisables sur le plan méthodologique, ce qui entraîne une sous-estimation flagrante de leur ampleur et de leur impact. Pour prévenir et pallier ce problème, les décideurs politiques doivent envisager des interventions dans les domaines de l'éducation, de l'accès à des soins de santé appropriés, de la sensibilisation du public et de l'adoption d'une législation efficace et complète. Afin de mieux estimer la prévalence des violences sexuelles en général et des violences sexuelles qui ne sont pas le fait d'un(e) partenaire en particulier, il est essentiel de continuer à renforcer la mesure de ce dernier type de violences sexuelles, notamment en ce qui concerne les types d'actes sur lesquels portent les questions et le mode d'interrogation. Des recherches supplémentaires s'imposent pour comprendre l'impact cumulatif des différentes formes de violences sexuelles sur la vie des femmes et des filles, y compris les violences sexuelles subies pendant l'enfance et les risques associés à une exposition ultérieure. La recherche sur les interventions visant à empêcher et à réduire toutes les formes de violences à l'égard des femmes et des filles, y compris les violences sexuelles, et leur mise en œuvre doivent être davantage financées.

La violencia sexual contra las mujeres es una violación de los derechos humanos y un problema de salud pública, con graves consecuencias para la salud física y mental de las mujeres. Reducir la violencia sexual fuera de la pareja, incluidas las violaciones, las agresiones sexuales y otras formas de abuso sexual sin contacto, es uno de los principales indicadores de los Objetivos de Desarrollo Sostenible. Las estimaciones de la Organización Mundial de la Salud, basadas en los datos de prevalencia disponibles de 137 países entre 2000 y 2018, mostraron que, a nivel mundial, el 6% de las mujeres de 15 a 49 años informaron haber sufrido violencia sexual en su vida por parte de alguien que no era su pareja, con tasas de prevalencia que varían según las regiones. Sin embargo, la presentación de informes, la medición y la documentación del alcance mundial de la violencia sexual contra las mujeres fuera de la pareja es metodológicamente difícil, lo que resulta en una gran subestimación de su magnitud e impacto. Para prevenir y responder a este problema, los responsables de formular las políticas deben considerar la posibilidad de intervenir en la educación, el acceso a los servicios sanitarios pertinentes, la concienciación pública y una legislación eficaz y exhaustiva. Para estimar mejor la prevalencia tanto de la violencia sexual en general como de la violencia sexual fuera de la pareja, es esencial seguir reforzando la medición de esta última, incluidos los tipos de actos sobre los que se pregunta y el modo de entrevista. Se requiere más investigación para comprender el impacto acumulativo de las diferentes formas de violencia sexual en la vida de las mujeres y las niñas, incluida la violencia sexual durante la infancia y su riesgo asociado con una mayor exposición. Se requiere financiación para investigar más e implementar intervenciones que prevengan y reduzcan todas las formas de violencia contra mujeres y niñas, incluida la violencia sexual.

First-Time Isotopic Characterization of Seleno-Compounds in Biota: A Pilot Study of Selenium Isotopic Composition in Top Predator Seabirds.

This study pioneers the reporting of Se isotopes in marine top predators and represents the most extensive Se isotopic characterization in animals to date. A methodology based on hydride generation─multicollector inductively coupled plasma mass spectrometry─was established for such samples. The study was conducted on various internal organs of giant petrels (Macronectes spp.), encompassing bulk tissues (δ82/78Sebulk), distinct Se-specific fractions such as selenoneine (δ82/78SeSEN), and HgSe nanoparticles (δ82/78SeNPs). The δ82/78Sebulk results (2.0-5.6‰) offer preliminary insights into the fate of Se in key internal organs of seabirds, including the liver, the kidneys, the muscle, and the brain. Notably, the liver of all individuals was enriched in heavier Se isotopes compared to other examined tissues. In nanoparticle fraction, δ82/78Se varies significantly across individuals (δ82/78SeNPs from 0.6 to 5.7‰, n = 8), whereas it exhibits remarkable consistency among tissues and individuals for selenoneine (δ82/78SeSEN, 1.7 ± 0.3‰, n = 8). Significantly, there was a positive correlation between the shift from δ82/78Sebulk to δ82/78SeSEN and the proportion of Se present as selenoneine in the internal organs. This pilot study proves that Se species-specific isotopic composition is a promising tool for a better understanding of Se species fate, sources, and dynamics in animals.

Is time of eating associated with BMI and obesity? A population-based study.

PURPOSE: Time-related eating patterns have been associated with metabolic and nutritional diseases such as obesity. However, there is a lack of representative studies on this subject. This study's aim was to assess the association between the timing of eating and obesity in a large and representative sample of the Brazilian adult population (POF 2008-2009 survey). METHODS: Two days of adults' food diary (n = 21,020) were used to estimate tertiles of first and last meal intake times, eating midpoint, caloric midpoint time, and calories consumed from 18:00 h onwards. BMI was estimated and its values, as well as excess weight (BMI ≥ 25 kg/m2) and obesity (BMI ≥ 30 kg/m2) were used as outcomes. Multiple linear and logistic regressions were performed. RESULTS: The first (ß = 0.65, 95% CI 0.37-0.93) and last food intake time (ß = 0.40, 95% CI 0.14-0.66), eating midpoint (ß = 0.61, 95% CI 0.34-0.88) and calories consumed after 21:00 h (ß = 0.74, 95% CI 0.32-1.16) and 22:00 h (ß = 0.75, 95% CI 0.18-1.32) were positively associated with BMI. The likelihood of having excess weight or obesity was significantly higher in the third tertile of the first food intake time (OR = 1.28, 95% CI 1.13-1.45 and OR = 1.34, 95% CI 1.13-1.58, respectively), last food intake time (OR = 1.16, 95% CI 1.03-1.32; and OR = 1.18, 95% CI 1.00-1.41, respectively), eating midpoint (OR = 1.28, 95% CI 1.13-1.45; and OR = 1.35, 95% CI 1.14-1.59, respectively) and energy consumption after 21:00 h (OR = 1.33, 95% CI 1.10-1.59). CONCLUSION: Chrononutrition meal patterns indicative of late meal intake were significantly associated with high BMI, excess weight and obesity in the Brazilian population.

Chagas Disease: A Silent Threat for Dogs and Humans.

Chagas disease (CD) is a vector-borne Neglected Zoonotic Disease (NZD) caused by a flagellate protozoan, Trypanosoma cruzi, that affects various mammalian species across America, including humans and domestic animals. However, due to an increase in population movements and new routes of transmission, T. cruzi infection is presently considered a worldwide health concern, no longer restricted to endemic countries. Dogs play a major role in the domestic cycle by acting very efficiently as reservoirs and allowing the perpetuation of parasite transmission in endemic areas. Despite the significant progress made in recent years, still there is no vaccine against human and animal disease, there are few drugs available for the treatment of human CD, and there is no standard protocol for the treatment of canine CD. In this review, we highlight human and canine Chagas Disease in its different dimensions and interconnections. Dogs, which are considered to be the most important peridomestic reservoir and sentinel for the transmission of T. cruzi infection in a community, develop CD that is clinically similar to human CD. Therefore, an integrative approach, based on the One Health concept, bringing together the advances in genomics, immunology, and epidemiology can lead to the effective development of vaccines, new treatments, and innovative control strategies to tackle CD.

Global, regional, and national prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018.

BACKGROUND: Intimate partner violence against women is a global public health problem with many short-term and long-term effects on the physical and mental health of women and their children. The Sustainable Development Goals (SDGs) call for its elimination in target 5.2. To monitor governments' progress towards SDG target 5.2, this study aimed to provide global, regional, and country baseline estimates of physical or sexual, or both, violence against women by male intimate partners. METHODS: This study developed global, regional, and country estimates, based on data from the WHO Global Database on Prevalence of Violence Against Women. These data were identified through a systematic literature review searching MEDLINE, Global Health, Embase, Social Policy, and Web of Science, and comprehensive searches of national statistics and other websites. A country consultation process identified additional studies. Included studies were conducted between 2000 and 2018, representative at the national or sub-national level, included women aged 15 years or older, and used act-based measures of physical or sexual, or both, intimate partner violence. Non-population-based data, including administrative data, studies not generalisable to the whole population, studies with outcomes that only provided the combined prevalence of physical or sexual, or both, intimate partner violence with other forms of violence, and studies with insufficient data to allow extrapolation or imputation were excluded. We developed a Bayesian multilevel model to jointly estimate lifetime and past year intimate partner violence by age, year, and country. This framework adjusted for heterogeneous age groups and differences in outcome definition, and weighted surveys depending on whether they were nationally or sub-nationally representative. This study is registered with PROSPERO (number CRD42017054100). FINDINGS: The database comprises 366 eligible studies, capturing the responses of 2 million women. Data were obtained from 161 countries and areas, covering 90% of the global population of women and girls (15 years or older). Globally, 27% (uncertainty interval [UI] 23-31%) of ever-partnered women aged 15-49 years are estimated to have experienced physical or sexual, or both, intimate partner violence in their lifetime, with 13% (10-16%) experiencing it in the past year before they were surveyed. This violence starts early, affecting adolescent girls and young women, with 24% (UI 21-28%) of women aged 15-19 years and 26% (23-30%) of women aged 19-24 years having already experienced this violence at least once since the age of 15 years. Regional variations exist, with low-income countries reporting higher lifetime and, even more pronouncedly, higher past year prevalence compared with high-income countries. INTERPRETATION: These findings show that intimate partner violence against women was already highly prevalent across the globe before the COVID-19 pandemic. Governments are not on track to meet the SDG targets on the elimination of violence against women and girls, despite robust evidence that intimate partner violence can be prevented. There is an urgent need to invest in effective multisectoral interventions, strengthen the public health response to intimate partner violence, and ensure it is addressed in post-COVID-19 reconstruction efforts. FUNDING: UK Department for International Development through the UN Women-WHO Joint Programme on Strengthening Violence against Women Data, and UNDP-UN Population Fund-UNICEF-WHO-World Bank Special Programme of Research, Development, and Research Training in Human Reproduction, a cosponsored programme executed by WHO.

A Comparative Analysis of Fibroblast Activation Protein-Targeted Small Molecule-Drug, Antibody-Drug, and Peptide-Drug Conjugates.

We present the first in vivo comparative evaluation of chemically defined antibody-drug conjugates (ADCs), small molecule-drug conjugates (SMDCs), and peptide-drug conjugates (PDCs) targeting and activated by fibroblast activation protein (FAP) in solid tumors. Both the SMDC (OncoFAP-Gly-Pro-MMAE) and the ADC (7NP2-Gly-Pro-MMAE) candidates delivered high amounts of active payload (i.e., MMAE) selectively at the tumor site, thus producing a potent antitumor activity in a preclinical cancer model.

Meal timing variability of rotating shift workers throughout a complete shift cycle and its effect on daily energy and macronutrient intake: a field study.

PURPOSE: To evaluate the meal timing variability of rotating shift workers throughout a complete shift schedule and its effect on daily energy and macronutrient intake. METHODS: Thirty male shift-workers from a mining company were evaluated in a complete rotation shift cycle over 240 consecutive hours (10 days; two days of morning shifts, two days of evening shifts, 24 h free, two days of night shifts and three days off). Food intake related variables [meal timing, energy (kcal) and macronutrient intake (%)] were assessed by 24 h recall by a trained nutritionist. Mixed models were used to analyze the variation in meal timing and energy and macronutrient intake throughout the shift cycle, as well as the interaction between shift and time ranges (00:00-03:59, 04:00-07:59, 08:00-11:59, 12:00-15:59, 16:00-19:59, 20:00-23:59). RESULTS: The first meal of the day was earlier on night shifts [D6 (3:44 ± 0:33) and D7 (5:52 ± 0:42)] compared to the other shifts (p < 0.001), except for D4 (evening shift; 5:51 ± 0:47) versus D7 (p = 0.999). Night shifts also showed a shorter night fasting (D5-D6, 9.3 h; D6-D7, 9.6 h) than most other nights (p < 0.05), except for the fasting between D1-D2 (11.3 h) and D3-D4 (11.2 h) (p > 0.05). There was no difference in 24 h energy intake throughout the shift cycle (p = 0.065). The analysis of interaction between shift and time ranges showed that night shift (D6) presented a higher intake of energy (441.5 ± 48.4 kcal), percentage of energy (D6: 17.8 ± 1.8%), fat (17.6 ± 2.0%), carbohydrate (17.0 ± 1.7%) and protein (16.4 ± 1.8%) between 00:00 and 03:59 compared with the other shift days (p < 0.05). CONCLUSION: Night shifts seem to contribute to a longer eating window than other shifts. Moreover, there is a higher energy and macronutrients intake during night shifts, which reduces the night fast period and could have implications for metabolic dysregulation.

A pilot study of multi-modal pain management for same-day discharge after minimally invasive repair of pectus excavatum (Nuss procedure) in children.

BACKGROUND: Despite advancements in minimally invasive repair of pectus excavatum (MIRPE), Nuss procedure, postoperative pain control remains challenging. This report covers a multimodal regimen using bilateral single-shot paravertebral block (PVB) and bilateral thoracoscopic intercostal nerve (T3-T7) cryoablation, leading to significant reduction in length of stay (LOS) and high rate of same-day discharge. METHODS: This is a comparative study of pain management protocols for patients undergoing the Nuss procedure at a single center from 2016 through 2020. All patients underwent the the same surgical technique for the treatment of pectus excavatum at a single center. Patients received bilateral PVB with continuous infusion (Group 1, n = 12), bilateral PVB with infusion and right-side cryoablation (Group 2, n = 9), or bilateral single-shot PVB and bilateral cryoablation (Group 3, n = 17). The primary outcome was LOS with focus on same-day discharge, and the secondary outcome was decreased opioid usage. RESULTS: Eleven of 17 patients in Group 3 (65%) (bilateral single-shot PVB and bilateral cryoablation) were discharged the same day as surgery. The remaining Group 3 patients were discharged the following day with no complications or interventions. Compared to Group 1 (no cryoablation), Group 3 had shorter LOS (median 4.4 days vs. 0.7 days, respectively, p < 0.001) and significantly decreased median opioid use on the day of surgery (0.92 mg/kg vs. 0.47 mg/kg, p = 0.006). CONCLUSION: Findings demonstrate the feasibility of multimodal pain management for same-day discharge after the Nuss procedure. Future multisite studies are needed to investigate the superiority of this approach to established methods. LEVEL OF EVIDENCE: III.

Engineering Symmetry-Selective Couplings of a Superconducting Artificial Molecule to Microwave Waveguides.

Tailoring the decay rate of structured quantum emitters into their environment opens new avenues for nonlinear quantum optics, collective phenomena, and quantum communications. Here, we demonstrate a novel coupling scheme between an artificial molecule comprising two identical, strongly coupled transmon qubits and two microwave waveguides. In our scheme, the coupling is engineered so that transitions between states of the same (opposite) symmetry, with respect to the permutation operator, are predominantly coupled to one (the other) waveguide. The symmetry-based coupling selectivity, as quantified by the ratio of the coupling strengths, exceeds a factor of 30 for both waveguides in our device. In addition, we implement a Raman process activated by simultaneously driving both waveguides, and show that it can be used to coherently couple states of different symmetry in the single-excitation manifold of the molecule. Using that process, we implement frequency conversion across the waveguides, mediated by the molecule, with efficiency of about 95%. Finally, we show that this coupling arrangement makes it possible to straightforwardly generate spatially separated Bell states propagating across the waveguides. We envisage further applications to quantum thermodynamics, microwave photodetection, and photon-photon gates.

Homogenization of terrestrial mammals in fragmented rainforests: the loss of species turnover and its landscape drivers.

Understanding the factors and mechanisms shaping differences in species composition across space and time (ß-diversity) in human-modified landscapes has key ecological and applied implications. This topic is, however, challenging because landscape disturbance can promote either decreases (biotic homogenization) or increases (biotic differentiation) in ß-diversity. We assessed temporal differences in intersite ß-diversity of medium-bodied and large-bodied mammals in the fragmented Lacandona rainforest, Mexico. We hypothesized that, given the relatively short history of land-use changes in the region, and the gain and loss of some species caused by landscape spatial changes, ß-diversity would increase through time, especially its nestedness component. We estimated ß-diversity between 24 forest sites (22 forest patches and two continuous forest sites) in 2011 and 2017 to assess whether ß-diversity is decreasing or increasing in the region, and calculated its turnover and nestedness components to understand the mechanisms responsible for changes in ß-diversity, separately assessing mammal groups with different body mass, feeding guild, and habitat specialization. We then related such temporal changes in ß-diversity to temporal changes in five landscape variables (forest cover, matrix openness, number of patches, edge density and interpatch distance) to identify the landscape drivers of ß-diversity. In contrast with our expectations, ß-diversity decreased over time, suggesting an ongoing biotic homogenization process. This pattern was mostly driven by a decrease in species turnover in all mammal groups, especially in landscapes with decreasing forest cover and increasing forested matrices. Although the nestedness component showed a three-fold increase through time, species turnover was 22 and six times higher than nestedness in 2011 and 2017, respectively. The decreased turnover appears to be driven by an increase in dispersal (i.e., spillover) of native species among patches. The prevalence of species turnover over nestedness indicates that different forest sites have a fairly distinct subset of species (i.e., high complementarity in species composition). Therefore, conserving all remaining forest patches and increasing forest cover is of utmost importance to effectively maintain ß-diversity and conserve the total diversity (γ) of mammal assemblages in this Mesoamerican biodiversity hotspot.

A framework to model global, regional, and national estimates of intimate partner violence.

BACKGROUND: Accurate and reliable estimates of violence against women form the backbone of global and regional monitoring efforts to eliminate this human right violation and public health problem. Estimating the prevalence of intimate partner violence (IPV) is challenging due to variations in case definition and recall period, surveyed populations, partner definition, level of age disaggregation, and survey representativeness, among others. In this paper, we aim to develop a sound and flexible statistical modeling framework for global, regional, and national IPV statistics. METHODS: We modeled IPV within a Bayesian multilevel modeling framework, accounting for heterogeneity of age groups using age-standardization, and age patterns and time trends using splines functions. Survey comparability is achieved using adjustment factors which are estimated using exact matching and their uncertainty accounted for. Both in-sample and out-of-sample comparisons are used for model validation, including posterior predictive checks. Post-processing of models' outputs is performed to aggregate estimates at different geographic levels and age groups. RESULTS: A total of 307 unique studies conducted between 2000-2018, from 154 countries/areas, and totaling nearly 1.8 million unique women responses informed lifetime IPV. Past year IPV had a similar number of studies (n = 332), countries/areas represented (n = 159), and individual responses (n = 1.8 million). Roughly half of IPV observations required some adjustments. Posterior predictive checks suggest good model fit to data and out-of-sample comparisons provided reassuring results with small median prediction errors and appropriate coverage of predictions' intervals. CONCLUSIONS: The proposed modeling framework can pool both national and sub-national surveys, account for heterogeneous age groups and age trends, accommodate different surveyed populations, adjust for differences in survey instruments, and efficiently propagate uncertainty to model outputs. Describing this model to reproducible levels of detail enables the accurate interpretation and responsible use of estimates to inform effective violence against women prevention policy and programs, and global monitoring of elimination efforts as part of the Sustainable Development Goals.

First Time Identification of Selenoneine in Seabirds and Its Potential Role in Mercury Detoxification.

Birds are principally exposed to selenium (Se) through their diet. In long-lived and top predator seabirds, such as the giant petrel, extremely high concentrations of Se are found. Selenium speciation in biota has aroused great interest in recent years; however, there is a lack of information about the chemical form of Se in (sea)birds. The majority of publications focus on the growth performance and antioxidant status in broilers in relation to Se dietary supplementation. The present work combines elemental and molecular mass spectrometry for the characterization of Se species in wild (sea)birds. A set of eight giant petrels (Macronectes sp.) with a broad age range from the Southern Ocean were studied. Selenoneine, a Se-analogue of ergothioneine, was identified for the first time in wild avian species. This novel Se-compound, previously reported in fish, constitutes the major Se species in the water-soluble fraction of all of the internal tissues and blood samples analyzed. The levels of selenoneine found in giant petrels are the highest reported in animal tissues until now, supporting the trophic transfer in the marine food web. The characterization of selenoneine in the brain, representing between 78 and 88% of the total Se, suggests a crucial role in the nervous system. The dramatic decrease of selenoneine (from 68 to 3%) with an increase of Hg concentrations in the liver strongly supports the hypothesis of its key role in Hg detoxification.

Impact of exposure time in awake prone positioning on clinical outcomes of patients with COVID-19-related acute respiratory failure treated with high-flow nasal oxygen: a multicenter cohort study.

BACKGROUND: In patients with COVID-19-related acute respiratory failure (ARF), awake prone positioning (AW-PP) reduces the need for intubation in patients treated with high-flow nasal oxygen (HFNO). However, the effects of different exposure times on clinical outcomes remain unclear. We evaluated the effect of AW-PP on the risk of endotracheal intubation and in-hospital mortality in patients with COVID-19-related ARF treated with HFNO and analyzed the effects of different exposure times to AW-PP. METHODS: This multicenter prospective cohort study in six ICUs of 6 centers in Argentine consecutively included patients > 18 years of age with confirmed COVID-19-related ARF requiring HFNO from June 2020 to January 2021. In the primary analysis, the main exposure was awake prone positioning for at least 6 h/day, compared to non-prone positioning (NON-PP). In the sensitivity analysis, exposure was based on the number of hours receiving AW-PP. Inverse probability weighting-propensity score (IPW-PS) was used to adjust the conditional probability of treatment assignment. The primary outcome was endotracheal intubation (ETI); and the secondary outcome was hospital mortality. RESULTS: During the study period, 580 patients were screened and 335 were included; 187 (56%) tolerated AW-PP for [median (p25-75)] 12 (9-16) h/day and 148 (44%) served as controls. The IPW-propensity analysis showed standardized differences < 0.1 in all the variables assessed. After adjusting for other confounders, the OR (95% CI) for ETI in the AW-PP group was 0.36 (0.2-0.7), with a progressive reduction in OR as the exposure to AW-PP increased. The adjusted OR (95% CI) for hospital mortality in the AW-PP group ≥ 6 h/day was 0.47 (0.19-1.31). The exposure to prone positioning ≥ 8 h/d resulted in a further reduction in OR [0.37 (0.17-0.8)]. CONCLUSION: In the study population, AW-PP for ≥ 6 h/day reduced the risk of endotracheal intubation, and exposure ≥ 8 h/d reduced the risk of hospital mortality.

Improving health system readiness to address violence against women and girls: a conceptual framework.

BACKGROUND: There is an increasing focus on readiness of health systems to respond to survivors of violence against women (VAW), a global human rights violation damaging women's health. Health system readiness focuses on how prepared healthcare systems and institutions, including providers and potential users, are to adopt changes brought about by the integration of VAW care into services. In VAW research, such assessment is often limited to individual provider readiness or facility-level factors that need to be strengthened, with less attention to health system dimensions. The paper presents a framework for health system readiness assessment to improve quality of care for intimate partner violence (IPV), which was tested in Brazil and Palestinian territories (oPT). METHODS: Data synthesis of primary data from 43 qualitative interviews with healthcare providers and health managers in Brazil and oPT to explore readiness in health systems. RESULTS: The application of the framework showed that it had significant added value in capturing system capabilities - beyond the availability of material and technical capacity - to encompass stakeholder values, confidence, motivation and connection with clients and communities. Our analysis highlighted two missing elements within the initial framework: client and community engagement and gender equality issues. Subsequently, the framework was finalised and organised around three levels of analysis: macro, meso and micro. The micro level highlighted the need to also consider how the system can sustainably involve and interact with clients (women) and communities to ensure and promote readiness for integrating (and participating in) change. Addressing cultural and gender norms around IPV and enhancing support and commitment from health managers was also shown to be necessary for a health system environment that enables the integration of IPV care. CONCLUSION: The proposed framework helps identify a) system capabilities and pre-conditions for system readiness; b) system changes required for delivering quality care for IPV; and c) connections between and across system levels and capabilities.

Quantum Biochemistry Screening and In Vitro Evaluation of Leishmania Metalloproteinase Inhibitors.

Leishmanolysin, also known as major promastigote protease (PSP) or gp63, is the most abundant surface glycoprotein of Leishmania spp., and has been extensively studied and recognized as the main parasite virulence factor. Characterized as a metalloprotease, gp63 can be powerfully inactivated in the presence of a metal chelator. In this study, we first used the structural parameters of a 7-hydroxycoumarin derivative, L1 compound, to evaluate the theoretical-computational experiments against gp63, comparing it with an available metal chelator already described. The methodology followed was (i) analysis of the three-dimensional structure of gp63 as well as its active site, and searching the literature and molecular databases for possible inhibitors; (ii) molecular docking simulations and investigation of the interactions in the generated protein-ligand complexes; and (iii) the individual energy of the gp63 amino acids that interacted most with the ligands of interest was quantified by ab initio calculations using Molecular Fraction with Conjugated Caps (MFCC). MFCC still allowed the final quantum balance calculations of the protein interaction to be obtained with each inhibitor candidate binder. L1 obtained the best energy quantum balance result with -2 eV, followed by DETC (-1.4 eV), doxycycline (-1.3 eV), and 4-terpineol (-0.6 eV), and showed evidence of covalent binding in the enzyme active site. In vitro experiments confirmed L1 as highly effective against L. amazonensis parasites. The compound also exhibited a low cytotoxicity profile against mammalian RAW and 3T3 cells lines, presenting a selective index of 149.19 and 380.64 µM, respectively. L1 induced promastigote forms' death by necrosis and the ultrastructural analysis revealed disruption in membrane integrity. Furthermore, leakage of the contents and destruction of the parasite were confirmed by Spectroscopy Dispersion analysis. These results together suggested L1 has a potential effect against L. amazonensis, the etiologic agent of diffuse leishmaniasis, and the only one that currently does not have a satisfactory treatment.

Pathways to and factors associated with rape stigma experienced by rape survivors in South Africa: Analysis of baseline data from a rape cohort.

Rape stigma, both external and self-stigmatization (self-blame), is associated with adverse health outcomes. Understanding its origins and resilience factors is critical for reducing and preventing it. We describe the prevalence of rape stigma, the characteristics of women experiencing it and the pathways to experiencing greater stigma. The Rape Impact Cohort Evaluation study enrolled 852 women aged 16-40 years who had been raped from post-rape care centres in Durban, South Africa. We present a descriptive analysis of the baseline data, a multinomial logistic regression model of factors associated with different levels of stigma and a structural equation model (SEM). Most women reported stigmatizing thoughts or experiences, with self-stigmatizing thoughts being more prevalent than external stigmatization. The multinomial model showed that experiences of childhood or other trauma, emotional intimate partner violence (IPV), having less gender equitable attitudes and food insecurity were significantly associated with medium or high versus low levels of stigma. Internal and external stigma were significantly associated with each other. Women who had been previously raped reported less stigma. The SEM showed a direct path between food insecurity and rape stigma, with poorer women experiencing more stigma. Indirect paths were mediated by more traditional gender attitudes and childhood trauma experience and other trauma exposure. Our findings confirm the intersectionality of rape stigma, with its structural drivers of food insecurity and gender inequality, as well as its strong association with prior trauma exposure. Rape survivors may benefit from gender-empowering psychological support that addresses blame and shame.

Eating Duration throughout a Rotating Shift Schedule: A Case Study.

OBJECTIVE: The impact of the rotation between different shifts and free days within a short period of time on the food consumption is poorly addressed in the literature. Our objective was to characterize the eating duration (ED) over 10 d of clockwise rotating and to associate it with the intake of energy and macronutrients. METHODS: Thirty male shift-workers from a mining company were evaluated over a complete rotation shift schedule of 10 consecutive days (2 d of morning shifts, 2 d of afternoon shifts, 24 h free-day, 2 d of night shifts, and three free days). ED was defined as the interval between the first meal after awaking and last meal before sleep onset. Sleep/wake periods and food intake were evaluated by actigraphy and 24 h recalls, respectively. Generalized models were used to analyze the variation in ED and its association with nutrient intake over the shift schedule. RESULTS: ED periods showed significant variations throughout shift rotation and were associated with energy intake. The highest energy intake (3410 ± 235 kcal) and longest ED (20.7 ± 1.2 h) were found on Day 5, the day between afternoon and night shifts, and a part of Day 6 (night shift), i.e., in the longest period of wakefulness and the shortest sleep duration (4.7 ± 0.3 h) (p < 0.05 for all). The lowest energy intake (1284 ± 125 kcal) and shortest ED (4.96 ± 0.7 h) (p < 0.05) occurred after the last night shift (Day 7). The balance between the percentage of macronutrients did not differ statistically between the ED periods. CONCLUSIONS: In general, longer periods of wakefulness showed greater energy intake, demonstrating the tendency of workers to eat around the clock during their shift. Even with the energy intake variation, the balance of macronutrients remained the same over the ED periods. Despite the need of confirmation in future studies, these results suggest that the management of ED period could be considered in the nutritional approach of shift workers.

Exogenous melatonin decreases circadian misalignment and body weight among early types.

Shift workers experience chronic circadian misalignment, which can manifest itself in reduced melatonin production, and has been associated with metabolic disorders. In addition, chronotype modulates the effect of night shift work, with early types presenting greater circadian misalignment when working night shift as compared to late types. Melatonin supplementation has shown positive results reducing weight gain in animal models, but the effect of exogenous melatonin in humans on body weight in the context of shift work remains inconsistent. The aim of this study was thus to evaluate the effects of exogenous melatonin on circadian misalignment and body weight among overweight night shift workers, according to chronotype, under real-life conditions. We conducted a double-blind, randomized, placebo-controlled, crossover trial where melatonin (3 mg) or placebo was administered on non-night shift nights for 12 weeks in 27 female nurses (37.1 yo, ±5.9 yo; BMI 29.9 kg/m2 , ±3.3 kg/m2 ). Melatonin (or placebo) was only taken on nights when the participants did not work night shifts, that is, on nights when they slept (between night shifts and on days off). Composite Phase Deviations (CPD) of actigraphy-based mid-sleep timing were calculated to measure circadian misalignment. The analyses were performed for the whole group and by chronotype. We found approximately 20% reduction in circadian misalignment after exogenous melatonin administration considering all chronotypes. Moreover, melatonin supplementation in those who presented high circadian misalignment, as observed in early chronotypes, reduced body weight, BMI, waist circumference, and hip circumference, without any change in the participants' calorie intake or physical activity levels.

Training healthcare providers to respond to intimate partner violence against women.

BACKGROUND: Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. IPV may result in substantial physical and mental health impacts for survivors. Women affected by IPV are more likely to have contact with healthcare providers (HCPs) (e.g. nurses, doctors, midwives), even though women often do not disclose the violence. Training HCPs on IPV, including how to respond to survivors of IPV, is an important intervention to improve HCPs' knowledge, attitudes and practice, and subsequently the care and health outcomes for IPV survivors. OBJECTIVES: To assess the effectiveness of training programmes that seek to improve HCPs' identification of and response to IPV against women, compared to no intervention, wait-list, placebo or training as usual. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase and seven other databases up to June 2020. We also searched two clinical trials registries and relevant websites. In addition, we contacted primary authors of included studies to ask if they knew of any relevant studies not identified in the search. We evaluated the reference lists of all included studies and systematic reviews for inclusion. We applied no restrictions by search dates or language. SELECTION CRITERIA: All randomised and quasi-randomised controlled trials comparing IPV training or educational programmes for HCPs compared with no training, wait-list, training as usual, placebo, or a sub-component of the intervention. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures outlined by Cochrane. Two review authors independently assessed studies for eligibility, undertook data extraction and assessed risks of bias. Where possible, we synthesised the effects of IPV training in a meta-analysis. Other analyses were synthesised in a narrative manner. We assessed evidence certainty using the GRADE approach. MAIN RESULTS: We included 19 trials involving 1662 participants. Three-quarters of all studies were conducted in the USA, with single studies from Australia, Iran, Mexico, Turkey and the Netherlands. Twelve trials compared IPV training versus no training, and seven trials compared the effects of IPV training to training as usual or a sub-component of the intervention in the comparison group, or both. Study participants included 618 medical staff/students, 460 nurses/students, 348 dentists/students, 161 counsellors or psychologists/students, 70 midwives and 5 social workers. Studies were heterogeneous and varied across training content delivered, pedagogy and time to follow-up (immediately post training to 24 months). The risk of bias assessment highlighted unclear reporting across many areas of bias. The GRADE assessment of the studies found that the certainty of the evidence for the primary outcomes was low to very low, with studies often reporting on perceived or self-reported outcomes rather than actual HCPs' practices or outcomes for women. Eleven of the 19 included studies received some form of research grant funding to complete the research. Within 12 months post-intervention, the evidence suggests that compared to no intervention, wait-list or placebo, IPV training: · may improve HCPs' attitudes towards IPV survivors (standardised mean difference (SMD) 0.71, 95% CI 0.39 to 1.03; 8 studies, 641 participants; low-certainty evidence); · may have a large effect on HCPs' self-perceived readiness to respond to IPV survivors, although the evidence was uncertain (SMD 2.44, 95% CI 1.51 to 3.37; 6 studies, 487 participants; very low-certainty evidence); · may have a large effect on HCPs' knowledge of IPV, although the evidence was uncertain (SMD 6.56, 95% CI 2.49 to 10.63; 3 studies, 239 participants; very low-certainty evidence); · may make little to no difference to HCPs' referral practices of women to support agencies, although this is based on only one study (with 49 clinics) assessed to be very low certainty; · has an uncertain effect on HCPs' response behaviours (based on two studies of very low certainty), with one trial (with 27 participants) reporting that trained HCPs were more likely to successfully provide advice on safety planning during their interactions with standardised patients, and the other study (with 49 clinics) reporting no clear impact on safety planning practices; · may improve identification of IPV at six months post-training (RR 4.54, 95% CI 2.5 to 8.09) as in one study (with 54 participants), although three studies (with 48 participants) reported little to no effects of training on identification or documentation of IPV, or both. No studies assessed the impact of training HCPs on the mental health of women survivors of IPV compared to no intervention, wait-list or placebo. When IPV training was compared to training as usual or a sub-component of the intervention, or both, no clear effects were seen on HCPs' attitudes/beliefs, safety planning, and referral to services or mental health outcomes for women. Inconsistent results were seen for HCPs' readiness to respond (improvements in two out of three studies) and HCPs' IPV knowledge (improved in two out of four studies). One study found that IPV training improved HCPs' validation responses. No adverse IPV-related events were reported in any of the studies identified in this review. AUTHORS' CONCLUSIONS: Overall, IPV training for HCPs may be effective for outcomes that are precursors to behaviour change. There is some, albeit weak evidence that IPV training may improve HCPs' attitudes towards IPV. Training may also improve IPV knowledge and HCPs' self-perceived readiness to respond to those affected by IPV, although we are not certain about this evidence. Although supportive evidence is weak and inconsistent, training may improve HCPs' actual responses, including the use of safety planning, identification and documentation of IPV in women's case histories. The sustained effect of training on these outcomes beyond 12 months is undetermined. Our confidence in these findings is reduced by the substantial level of heterogeneity across studies and the unclear risk of bias around randomisation and blinding of participants, as well as high risk of bias from attrition in many studies. Further research is needed that overcomes these limitations, as well as assesses the impacts of IPV training on HCPs' behavioral outcomes and the well-being of women survivors of IPV.

How the coronavirus disease 2019 pandemic is impacting sexual and reproductive health and rights and response: Results from a global survey of providers, researchers, and policy-makers.

INTRODUCTION: We aimed to give a global overview of trends in access to sexual and reproductive health and rights (SRHR) during the coronavirus disease 2019 (COVID-19) pandemic and what is being done to mitigate its impact. MATERIAL AND METHODS: We performed a descriptive analysis and content analysis based on an online survey among clinicians, researchers, and organizations. Our data were extracted from multiple-choice questions on access to SRHR services and risk of SRHR violations, and written responses to open-ended questions on threats to access and required response. RESULTS: The survey was answered by 51 people representing 29 countries. Eighty-six percent reported that access to contraceptive services was less or much less because of COVID-19, corresponding figures for surgical and medical abortion were 62% and 46%. The increased risk of gender-based and sexual violence was assessed as moderate or severe by 79%. Among countries with mildly restrictive abortion policies, 69% had implemented changes to facilitate access to abortion during the pandemic, compared with none among countries with severe restrictions (P < .001), 87.5% compared with 46% had implemented changes to facilitate access to contraception (P = .023). The content analysis showed that (a) prioritizations in health service delivery at the expense of SRHR, (b) lack of political will, (c) the detrimental effect of lockdown, and (d) the suspension of sexual education, were threats to SRHR access (theme 1). Requirements to mitigate these threats (theme 2) were (a) political will and support of universal access to SRH services, (b) the sensitization of providers, (c) free public transport, and (d) physical protective equipment. A contrasting third theme was the state of exception of the COVID-19 pandemic as a window of opportunity to push forward women's health and rights. CONCLUSIONS: Many countries have seen decreased access to and increased violations of SRHR during the COVID-19 pandemic. Countries with severe restrictions on abortion seem less likely to have implemented changes to SRHR delivery to mitigate this impact. Political will to support the advancement of SRHR is often lacking, which is fundamental to ensuring both continued access and, in a minority of cases, the solidification of gains made to SRHR during the pandemic.