A Systematic Review of the Correlates of Violence Against Sex Workers

We conducted a systematic review in June 2012 (updated September 2013) to examine the prevalence and factors shaping sexual or physical violence against sex workers globally.We identified 1536 (update = 340) unique articles. We included 28 studies, with 14 more contributing to violence prevalence estimates. Lifetime prevalence of any or combined workplace violence ranged from 45% to 75% and over the past year, 32% to 55%. Growing research links contextual factors with violence against sex workers, alongside known interpersonal and individual risks.This high burden of violence against sex workers globally and large gaps in epidemiological data support the need for research and structural interventions to better document and respond to the contextual factors shaping this violence. Measurement and methodological innovation, in partnership with sex work communities, are critical.Frequent reports of incidents of widespread violence against sex workers continue to emerge globally,1–3 including media reports of abuse, human rights violations, and murder.4–7 Despite increasing recognition of violence in the general population as a public health and human rights priority by policymakers, researchers, and international bodies,8–10 violence against sex workers that occurs within and outside the context of sex work is frequently overlooked in international agendas to prevent violence. Although increasing research has explored the prevalence, determinants, and correlates of violence against women,8,11–14 comparable research specifically among sex workers is lacking. There remains limited review of the magnitude, severity, or type of violence experienced by sex workers globally. This paucity of data on prevalence and incidence of violence against sex workers has been highlighted in a review on the magnitude and scope of violence globally.15Negative health effects of intimate partner violence in the general population include poor health overall, physical and sexual injury, and mental health problems including depression, anxiety, and posttraumatic stress disorder.16–21 Intimate partner violence faced by women in the general population has also been linked to unwanted pregnancy, abortion, and increased risk for HIV and other sexually transmitted infections (STIs), through different direct and indirect mechanisms.22–26 Victims of violence in early childhood are also more likely to have increased risk for HIV and other STIs.27 However, the role of violence, both workplace violence and violence by intimate or other nonpaying partners, in influencing negative health outcomes among sex workers, who are highly stigmatized and often criminalized, has received comparably less attention.The legal status of sex work can be a critical factor in shaping patterns of violence against sex workers.1,28 In many settings, the criminalized or quasicriminalized nature of sex work means that violence that occurs in the context of sex work (i.e., as a workplace harm and abuse) is not monitored by any formal bodies, with few to no legal protections afforded to sex workers by police and judicial systems.1,28 Violence against sex workers is often not registered as an offense by the police and in some cases is perpetrated by police.29,30 Physical and sexual violence, and verbal abuse or threats of abuse from police, can prevent sex workers from reporting violence to the police or accessing other public agencies (e.g., health or social services), exacerbating their trauma and health risks.1,29,30 These risks include the risk for HIV and other STIs, and in some settings, threats of arrest for possession of condoms as evidence of engaging in sex work can deter sex workers from carrying condoms.30–32 This can create a climate of tolerance of violence and thereby perpetuate violence against sex workers.We conducted a systematic review to examine the documented magnitude of violence against sex workers and to review the factors that shape risk for violence against sex workers. In our review we were guided by theoretical frameworks that implicate structural factors in shaping vulnerabilities experienced by vulnerable populations.33–35 Within the interrelated physical, social, economic, and policy environments, factors operate to create different levels of susceptibility and risk.33–35 The current review provides an evidence base pertaining to violence against sex workers from which to better inform the development of public health and social interventions to reduce violence and ameliorate its impacts on sex workers.     

Determinants of interest rates on tax-exempt hospital bonds

The aim of this paper is to examine the determinants of interest rates on tax-exempt hospital bonds. The results highlight the potential and actual roles of Federal and state policy in the determination of these rates. The shift to a Prospective Payment System under Medicare has subsidized the borrowing costs of some hospitals at the expense of others. The selection of underwriters by negotiation rather than by competitive bidding results in higher interest rates. The Federal tax act of 1986 raised the cost of hospital debt by encouraging bond issues to contain call features.     

AMALGAMATION OF HEALTH SERVICES IN SOUTH‐WEST VICTORIA: REINVENTION OR SURVIVAL?

ABSTRACT: In Australia 'the hospital' has long been considered the cornerstone of small, rural health services. However, this premise has been altered significantly by the introduction of casemix loading and diagnostic-related groups that promote a rationalised output-based model of management. In the light of these changes, many rural health services have struggled to reinvent themselves by establishing a range of service models such as Multi-purpose Service (MPS) and Health Streams, while maintaining traditional models (i.e. bush nursing centres, nursing homes and aged-care facilities). These changes are about survival. This paper analyses one such case in south-west Victoria, the Macarthur and District Community Outreach Service, and compares the outcomes with other similar Victorian rural health research projects. Particular attention is paid to the nature of the health services, the management of change and the proposed health outcomes for the local rural communities. In conclusion, it is argued that this study adds to the body of knowledge surrounding the construction of models of community health and development programming, These models impact upon future rural and remote area initiatives throughout Australia.     

Why doctors choose small towns: A developmental model of rural physician recruitment and retention

Shortages of health care professionals have plagued rural areas of the USA for more than a century. Programs to alleviate them have met with limited success. These programs generally focus on factors that affect recruitment and retention, with the supposition that poor recruitment drives most shortages. The strongest known influence on rural physician recruitment is a “rural upbringing,” but little is known about how this childhood experience promotes a return to rural areas, or how non-rural physicians choose rural practice without such an upbringing. Less is known about how rural upbringing affects retention. Through twenty-two in-depth, semi-structured interviews with both rural- and urban-raised physicians in northeastern California and northwestern Nevada, this study investigates practice location choice over the life course, describing a progression of events and experiences important to rural practice choice and retention in both groups.     

Long-term outcome of phase II trial evaluating chemotherapy,chemoradiotherapy, and surgery for locoregionally advanced esophageal cancer

PURPOSE: To evaluate the long-term outcome of chemotherapy, chemoradiotherapy, and surgery for patients with locoregionally advanced esophageal cancer. METHODS AND MATERIALS: Thirty-eight patients with locoregionally advanced esophageal cancer were entered into a Phase II study between November 1996 and October 1998 at the University of Texas M. D. Anderson Cancer Center. Patients initially received two cycles of chemotherapy with paclitaxel (200 mg/m(2)), 5-fluorouracil (750 mg/m(2)/d for 5 days), and cisplatin (15 mg/m(2)/d for 5 days), followed by chemoradiotherapy, consisting of radiation (45 Gy during 5 weeks) with 5-fluorouracil (300 mg/m(2)/d during radiation) and cisplatin (15 mg/m(2)/d for 5 days). Surgical resection was performed 4-6 weeks after the completion of the chemoradiotherapy. RESULTS: Most patients had adenocarcinoma (n = 32; 84%). Pretreatment endoscopic ultrasonography revealed T3 tumors in 33 patients (87%) and N1 disease in 25 patients (66%). Thirty-seven patients (97%) completed the planned chemotherapy and chemoradiotherapy, and 35 patients (92%) underwent surgery, with a 30-day mortality rate of 6% (2 of 35 patients). A pathologic complete response or microscopic residual carcinoma (<10% viable) was found in 25 (71%) of 35 patients and was associated with a disease-free survival rate of 72% at 3 years and 51% at 5 years. On the basis of an intention-to-treat analysis and a median potential follow-up of 58 months, the 3- and 5-year overall survival rate for all 38 patients was 63% and 39%, respectively. CONCLUSION: The long-term results of this study suggest that the strategy of induction chemotherapy followed by chemoradiotherapy and surgery is safe and warrants further evaluation in the treatment of patients with locoregionally advanced esophageal cancer.     

A randomized prospective comparison of oral versus intraperitoneal ofloxacin as the primary treatment of CAPD peritonitis

Summary: Oral ofloxacin has been successfully used in our centres for the primary treatment of peritonitis complicating continous ambulatory peritoneal dialysis (CAPD). In view of the progressive rise in the resistance rate to ofloxacin among peritoneal bacterial isolates, a study was conducted to determine if oral ofloxacin remains a viable first line treatment for CAPD peritonitis in our centres and if the result can be improved by changing from an oral to an intraperitoneal (i.p.) route. In patients on three 2 L daily CAPD exchanges, ofloxacin given at the i.p. dosage of 200 mg loading followed by 25 mg/L of peritoneal dialysate achieved overnight trough peritoneal levels which are at least four times the minimal 90% inhibitory concentration (MIC90) of most bacterial pathogens without significant accumulation in the systemic circulation. This i.p. dosage was therefore chosen for the clinical study and the result was compared to that using ofloxacin given in the oral dosage of 400 mg loading followed by 300 mg once daily as maintenance. of all the recruited episodes, 35 were eligible for analysis. the overall primary cure rate including primary failures and relapses was 55.6% (10/18) in the oral treatment group and 70.6% (12/17) in the i.p. treatment group. the corresponding figures for gram positive bacterial (g +) infections were 36.4% and 50%, for gram negative bacterial (g -) infections were 66.7 and 80% and for culture negative infections were 75 and 80%. In culture positive cases, all treatment failures were due to resistant infections which were observed in 42.3% of all bacterial isolates, 47.1% of g + isolates and 33.3% of g - isolates. Due to the high background level of bacterial resistance among our CAPD population, ofloxacin monotherapy given either by the oral or the i.p. route can no longer be recommended for the primary treatment of CAPD peritonitis.     

Mapping and gene order of U1 small nuclear RNA,endogenous viralenv sequence,amylase, and alcohol dehydrogenase-3 on mouse chromosome 3

Linkage was established between a number of genes that map on chromosome 3 by studying the distribution patterns of DNA polymorphisms and protein electrophoretic mobility polymorphisms in recombinant inbred (RI) strains of mice. This analysis resulted in the following suggested gene order between the newly assigned genes and previously mapped genes: -fibrinogen(Fgg), Xmmv-22 of mink cell focus-inducing (MCF) virus, Ulb small nuclear RNA gene cluster(Rnu-1b), amylase(Amy-1,2), cadmium resistance (cdm), alcohol dehydrogenase-3(Adh-3), alcohol dehydrogenase-1(Adh-1). In situ hybridization to chromosome spreads confirmed the assignment of the Ulb small nuclear RNA (snRNA) gene cluster and the -fibrinogen gene to the center of chromosome 3.