A global perspective on intimate partner violence during pregnancy: An analysis of twelve developing countries

Violence against women has been recognized as a significant worldwide human rights issue and public health problem. Women of reproductive age may be particularly at risk, and pregnancy may trigger or escalate violence. Using data available from Demographic and Health Surveys on 271,103 women of reproductive age (15-49) from Bolivia, Cameroon, Colombia, Dominican Republic, Egypt, Haiti, India, Kenya, Nicaragua, Peru, South Africa, and Zambia, this study examined the nature of domestic violence during pregnancy in developing countries, including prevalence, demographic and risk factors, maternal and child health outcomes, perpetrators of violence, help-seeking behavior, and social support. In the majority of countries analyzed, violence during pregnancy consistently occurred at approximately one-third the rate at which domestic violence occurred overall. Younger women and women with more children were particularly at risk. Abuse during pregnancy was significantly associated with history of a terminated pregnancy and under-5 child mortality in most countries, and with neonatal and post-neonatal mortality in most Latin American countries. Women who were abused during pregnancy were most often abused by their current or former husband or boyfriend and most never attempted to seek help. In most countries that examined social support, women abused during pregnancy had significantly less contact with family and friends. Implications for practice and research are discussed. ^

The use of invasive myocardial revascularization procedures following myocardial infarction and the effectiveness of these procedures in the biethnic community of Nueces County, Texas, 1988--1991

High levels of poverty and unemployment, and low levels of health insurance coverage may pose barriers to obtaining cardiac care by Mexican Americans. We undertook this study to investigate differences in the use of invasive myocardial revascularization procedures received within the 4-month period following hospitalization for a myocardial infarction (MI) between Mexican Americans and non-Hispanic whites in the Corpus Christi Heart Project (CCHP). The CCHP is a population-based surveillance program for hospitalized MI, percutaneous transluminal coronary angioplasty (PTCA), and aortocoronary bypass surgery (ACBS). Medical record data were available for 1706 patients identified over a three-year period. Mexican Americans had significantly lower rates of receiving a PTCA following MI than non-Hispanic Whites (RR: 0.56, 95% CI: 0.44-0.70). No meaningful ethnic difference was seen in the rates of ACBS use. History of PTCA use appeared to interact with ethnicity. Among patients without a history of PTCA use, Mexican Americans were less likely to receive a PTCA than non-Hispanic whites (RR: 0.59; 95% CI: 0.46-0.76). Among patients with a history of PTCA use, however, Mexican Americans were more likely to receive a PTCA than non-Hispanic whites (RR: 1.47; 95% CI: 0.75-2.87).^ Differences in the effectiveness of a first-time PTCA and first-time ACBS between Mexican Americans and non-Hispanic whites in the CCHP were also investigated. Mexican Americans were more likely to receive a 2nd PTCA (RR: 1.56, 95% CI: 1.11-2.17) and suffer a subsequent MI (RR: 1.42, 95% CI: 1.03-1.96) following a first-time PTCA than non-Hispanic whites. No meaningful ethnic differences were found in the rates of death and rates of ACBS following a first-time PTCA. Also, no significant ethnic differences were found in the rates of any of the events following a first-time ACBS. After adjusting for potential demographic, socioeconomic, clinical and angiographic confounders using Cox regression analysis, Mexican Americans were still more likely to receive a 2nd PTCA (HR: 1.38; 95% CI: 0.99-1.93) following a first-time PTCA than non-Hispanic whites. A significant difference in the rates of a subsequent MI following a first-time PTCA persisted (HR: 1.39, 95% CI: 1.01-1.93). (Abstract shortened by UMI.) ^

Homogenization of Portuguese long-term temperature data series: Lisbon, Coimbra and Porto

Three long-term temperature data series measured in Portugal were studied to detect and correct non-climatic homogeneity breaks and are now available for future studies of climate variability. Series of monthly minimum (Tmin) and maximum (Tmax) temperatures measured in the three Portuguese meteorological stations of Lisbon (from 1856 to 2008), Coimbra (from 1865 to 2005) and Porto (from 1888 to 2001) were studied to detect and correct non-climatic homogeneity breaks. These series together with monthly series of average temperature (Taver) and temperature range (DTR) derived from them were tested in order to detect homogeneity breaks, using, firstly, metadata, secondly, a visual analysis and, thirdly, four widely used homogeneity tests: von Neumann ratio test, Buishand test, standard normal homogeneity test and Pettitt test. The homogeneity tests were used in absolute (using temperature series themselves) and relative (using sea-surface temperature anomalies series obtained from HadISST2 close to the Portuguese coast or already corrected temperature series as reference series) modes. We considered the Tmin, Tmax and DTR series as most informative for the detection of homogeneity breaks due to the fact that Tmin and Tmax could respond differently to changes in position of a thermometer or other changes in the instrument's environment; Taver series have been used, mainly, as control. The homogeneity tests show strong inhomogeneity of the original data series, which could have both internal climatic and non-climatic origins. Homogeneity breaks which have been identified by the last three mentioned homogeneity tests were compared with available metadata containing data, such as instrument changes, changes in station location and environment, observing procedures, etc. Significant homogeneity breaks (significance 95% or more) that coincide with known dates of instrumental changes have been corrected using standard procedures. It was also noted that some significant homogeneity breaks, which could not be connected to the known dates of any changes in the park of instruments or stations location and environment, could be caused by large volcanic eruptions. The corrected series were again tested for homogeneity: the corrected series were considered free of non-climatic breaks when the tests of most of monthly series showed no significant (significance 95% or more) homogeneity breaks that coincide with dates of known instrument changes. Corrected series are now available in the frame of ERA-CLIM FP7 project for future studies of climate variability.

Securing Medical Personnel: Case Studies of Two Source Countries and Two Destination Countries

A shortage of medical personnel has become a critical problem for developing countries attempting to expand the provision of medical services for the poor. In order to highlight the driving forces determining the international allocation of medical personnel, the cases of four countries, namely the Philippines and South Africa as source countries and Saudi Arabia and the United Kingdom as destination countries, are examined. The paper concludes that changes in demand generated in major destination countries determine the international allocation of medical personnel at least in the short run. Major destination countries often alter their policies on how many medical staff they can accept, and from where, while source countries are required to make appropriate responses to the changes in demand.