The relationship between stigma and a rehabilitation framework [international classification of functioning, disability and health (ICF)]: three case studies of women living with HIV in Lusaka, Zambia.

PURPOSE: To explore how the International Classification of Functioning, Disability and Health, a rehabilitation framework, can provide a holistic understanding of stigma experiences of three women living with human immunodeficiency virus in Lusaka, Zambia. METHODS: A secondary analysis of three cases by drawing on interview transcripts collected as part of a larger longitudinal study with eighteen women living with the virus. The interview tool used the rehabilitation framework to ask questions about the impact of the virus on the body, daily activities, social participation and the future. Vignettes were produced for each of the eighteen women including information on stigma and the rehabilitation framework. Three case studies were developed from women who provided comprehensive accounts of stigma and the International Classification of Functioning, Disability and Health. RESULTS: Stigma experiences aligned well with three dimensions of the International Classification of Functioning, Disability and Health: participation restrictions, environmental and personal factors. These domains were used to understand stigma in three forms (i.e. enacted, self and structural stigma) as experienced by these women. CONCLUSIONS: More research is needed to ascertain how stigma and rehabilitation are related in other environments and populations and to explore how to mitigate stigma within the rehabilitation context.IMPLICATIONS FOR REHABILITATIONRehabilitation professionals deal with aspects of stigma and discrimination in their clinical work and this analysis offers a way to consider HIV-related stigma within rehabilitation in an organized and theoretically-informed way.The insights from this study are important for the field of HIV and for advancing understanding of the complexities of stigma in the context of rehabilitation more broadly.This analysis offers guidance to rehabilitation providers about the nuanced and multi-faceted ways that stigma can occur in the context of rehabilitation, including within their own clinical practice.

The conceptualization of stigma within a rehabilitation framework using HIV as an example.

Stigma theory is concerned with inclusion and opportunities that influence well-being. Rehabilitation is also concerned with social inclusion and well-being. This is a central concern in one of the leading rehabilitation theories, the World Health Organization's International Classification of Functioning, Disability and Health. Despite these shared concerns, the relationship between the fields of stigma and rehabilitation has not been well theorized to date. Using human immunodeficiency virus (HIV) as an example, this article presents an analysis of three ways that stigma may be conceptualized within the context of the International Classification of Functioning, Disability and Health. Three broad spheres of stigma are described: enacted, self, and structural stigma. These three forms of stigma are then aligned in unique ways with three particular constructs of the International Classification of Functioning, Disability and Health: participation restrictions, environmental, and personal contextual factors. This conceptualization illustrates how rehabilitation professionals and other practitioners, policy makers and researchers can better understand the dynamic and nuanced forms of stigma and how they relate to rehabilitation. Implications for rehabilitation This article enables rehabilitation professionals to better understand stigma as it relates to rehabilitation and human immunodeficiency virus. Rehabilitation professionals have the important job of allies and advocates for persons experiencing restrictions in these domains as a result of stigma.

Undescended ovary and fallopian tube presenting as appendiceal mucocele.

Undescended ovary is a rare congenital gynecologic condition, frequently associated with urogenital malformations including unicornuate uterus and ectopic kidneys or renal agenesis. Although ectopic ovaries are mostly found during an infertility work up, its role in infertility is still unknown. We report a 38-year-old patient presenting with pain in the right lower quadrant. Explorative laparoscopy reveals a unicornuate uterus and a malpositioning of the right ovary and distal ending of the right fallopian tube. Through this report, we try to provide hints for guiding the diagnostic management of similar patients in terms of fertility, renal function and tumour formation.

Awake tracheal intubation in anticipated difficult airways: LMA Fastrach vs flexible bronchoscope: A pilot study.

STUDY OBJECTIVE: To compare the use of LMA Fastrach intubating laryngeal mask airway (ILMA) to flexible bronchoscopy (FB) for awake intubation in patients with difficult airways. DESIGN: Randomized prospective study. SETTING: Large academic medical center. PATIENTS: Forty adult patients, American Society of Anesthesiologists I-IV, meeting the criteria for awake intubation based on history and physical examination. INTERVENTIONS: After sedation and airway topicalization, patients were randomized to either FB group, n=19, or ILMA group, n=21. All intubations were performed by or under the supervision of an attending anesthesiologists, with variable participation of residents or certified registered nurse anesthetists. A maximum of three attempts were permitted with the assigned technique, to be followed by the alternative method in case of failure. MEASUREMENTS: Times to carbon dioxide (end-tidal carbon dioxide) detection, endotracheal tube placement, number of attempts, training level of operator, and adverse events were recorded. Blood pressure, oxygen saturation, and heart rate were measured. Patients were interviewed the following day regarding their experience and satisfaction. MAIN RESULTS: Overall intubation success rate within three attempts was 95% for both groups. However, successful intubation on the first attempt occurred at a significantly higher rate with ILMA vs FB (95% vs 58%; P=.0028). Total mean time to endotracheal tube placement was also significantly shorter in the ILMA group vs FB (92 vs 246 seconds; P=.0001). There were no adverse events in either group, and patient satisfaction was not significantly different. CONCLUSION: Awake intubation can be performed successfully and expeditiously with the use of LMA Fastrach in patients with a difficult airway and no contraindication to a blind technique. It compared favorably to the use of the fiberoptic bronchoscope in the patient cohort presented in this study.

Research on rehabilitation interventions for adults living with HIV: a scoping review.

The aim of this paper is to use a scoping review to investigate the extent, range, and nature of research on rehabilitation interventions for adults living with HIV. Electronic databases (MEDLINE, EMBASE, CINAHL, AMED, and PsychINFO) and reference lists of the included articles were searched. Authors were emailed when possible for unavailable articles. A total of 897 titles and abstracts were retrieved. Thirty-three articles were included. There were 27 different rehabilitation interventions delivered by 18 professions. The studies were completed in four different countries. Most studies were published in 2008. A randomized-controlled trial was the most used method. The nature of the studies was analyzed according to the three-core concepts of the International Classification of Functioning, Disability and Health: 28 studies addressed impairments; six studies addressed activity limitations; and 14 studies addressed participation restrictions. This scoping study advances the knowledge of research on rehabilitation interventions for adults living with HIV. More research on rehabilitation interventions is needed in sub-Saharan Africa and other low-income and middle-income countries to ensure that these individuals are receiving the best possible care. There is a need for the HIV field to recognize the important contribution of rehabilitation toward the HIV care continuum.

Perceptions of HIV-related health services in Zambia for people with disabilities who are HIV-positive.

INTRODUCTION: Despite the emerging body of literature on increased vulnerability to HIV among people with disabilities (PWDs), there is a dearth of evidence related to experiences of PWDs who have become HIV-positive. This priority was identified by a disability advocacy organization in Lusaka, Zambia, where the prevalence of HIV and of disability is each approximately 15%. The purpose of this study was to explore perceptions and experiences of HIV-related health services for PWDs who are also living with HIV in Lusaka, Zambia. METHODS: This qualitative, interpretive study involved in-depth, semi-structured, one-on-one interviews with two groups of participants in Lusaka, Zambia: 21 PWDs who had become HIV-positive, and 11 people working in HIV and/or disability. PWDs had physical, hearing, visual and/or intellectual impairments. Interviews were conducted in English, Nyanja, Bemba or Zambian sign language. Descriptive and thematic analyses were conducted by a multidisciplinary, international research team. RESULTS: Participants described their experiences with HIV-related health services in terms of the challenges they faced. In particular, they encountered three main challenges while seeking care and treatment: (1) disability-related discrimination heightened when seeking HIV services, (2) communication barriers and related concerns with confidentiality, and (3) movement and mobility challenges related to seeking care and collecting antiretroviral therapy. These experiences were further shaped by participants' profound concerns about poverty and unmet basic needs. DISCUSSION: This study demonstrates how PWDs who are HIV-positive have the same HIV care, treatment and support needs as able-bodied counterparts, but face avoidable barriers to care. Many challenges mirror concerns identified with HIV prevention, suggesting that efforts to promote inclusion and reduce stigma could have widespread benefits. CONCLUSIONS: Despite the growing body of literature on increased risk of exposure to HIV among HIV-negative PWDs, this is the first published study to examine perceptions of testing, treatment and other HIV services for PWDs who have become HIV-positive. Findings reveal far-reaching opportunities for improving the quality of care for this population.

Rehabilitation interventions for children living with HIV: a scoping review.

PURPOSE: To report the extent (how many), range (variation) and nature (qualities) of rehabilitation interventions for children living with HIV. METHOD: Electronic databases, reference lists of included articles, and grey literature were searched. Title and abstract and full text review were completed independently by two reviewers. Each study's location, research methodology, interventions, the age of the participants, whether participants were receiving antiretroviral therapy (ART), the health professions delivering the interventions, when the study was conducted and the composition of the research team were documented. The nature of the intervention goals was organized into qualitative categories. RESULTS: The 17 included studies were conducted in seven countries. Seven rehabilitation professions were involved with the interventions. The age of the participants ranged from 3 months to 24 years. The year in which the study was conducted and whether children were receiving ART were rarely specified. Studies focused on impairments. There were no studies on activity limitations and only two studies on participation restrictions. Alternative and complementary therapies were the most common interventions. CONCLUSIONS: Research in this area is limited. More rehabilitation research is needed especially in areas where the burden of the disease is highest and for those children receiving ART. Implications for Rehabilitation Many low-and-middle-income countries (LMICs) struggle with an undersupply of trained rehabilitation professionals. Due to the large number of children living with HIV in LMICs, and as more continue to receive life-saving treatment, the need will grow for more rehabilitation professionals to work with this population to address HIV-related disability. This scoping review indicates that there is a dearth of research on interventions provided by allied health professionals, including physiotherapists, occupational therapists and speech language pathologists for children living with HIV. There is a moderate literature base supporting the use of alternative and complementary therapies for children living with HIV.

International research partnerships in occupational therapy: a Canadian-Zambian case study.

The country of Zambia's Sixth National Development Plan includes many objectives related to participation and health that align with values underlying occupational therapy. Given this link, occupational therapy research has the potential to advance the Sixth National Development Plan and thereby enhance the participation and health of Zambians. However, there is neither a school of occupational therapy nor many occupational therapists working in Zambia. Using an example of a global research partnership between Canadian occupational therapy researchers and Zambian researchers, this paper examines the partnership using four criteria for global health research in order to derive lessons for future occupational therapy research partnerships. Implications for future occupational therapy research partnerships include the need for partners to combine their complementary skills and knowledge so that they may collaborate in mutually beneficial ways to address global health challenges and expand the reach of occupational therapy perspectives.

Buprenorphine enhances and prolongs the postoperative analgesic effect of bupivacaine in patients receiving infragluteal sciatic nerve block.

BACKGROUND: Results from previous studies have shown favorable effects from the addition of buprenorphine to local anesthetics used for interscalene or axillary perivascular brachial plexus blocks. The main objective of the current study was to determine whether addition of buprenorphine could enhance bupivacaine analgesia after infragluteal sciatic nerve block. METHODS: One hundred and three consenting adult patients for elective foot and ankle outpatient surgeries were prospectively assigned randomly, in double-blind fashion, to one of three groups. Group 1 received 0.5% bupivacaine with epinephrine 1:200,000 for infragluteal sciatic block plus 1 ml normal saline intramuscularly. Group 2 received bupivacaine sciatic block along with intramuscular buprenorphine (0.3 mg). Group 3 received bupivacaine plus buprenorphine for infragluteal sciatic block and 1 ml normal saline intramuscularly. RESULTS: Although patients receiving buprenorphine either for sciatic block or intramuscularly had less pain in the postanesthesia care unit compared with patients receiving only bupivacaine, the individual pair-wise comparison of the analysis of variance model showed no statistical difference. However, only buprenorphine added to bupivacaine for sciatic block prolonged postoperative analgesia. Patients receiving a combination of buprenorphine and bupivacaine for sciatic block had lower numeric rating pain scores and received less opioid medication at home than patients in the other two groups. CONCLUSIONS: The results show that buprenorphine may enhance and prolong the analgesic effect of bupivacaine when used for sciatic nerve blocks in patients undergoing foot and ankle surgery under general anesthesia but does not do so to the extent shown in previous studies using brachial plexus models with mepivacaine and tetracaine.

The effect of propofol/remifentanil rapid-induction technique without muscle relaxants on intraocular pressure.

STUDY OBJECTIVE: To evaluate the effect of propofol (two mg/kg)/remifentanil (4 µg/kg) on intraocular pressure (IOP) when used for rapid-sequence induction. DESIGN: Randomized, double-blinded trial. SETTING: Ambulatory surgery center. PATIENTS: 47 adult, ASA physical status I and II patients (ages 18-75 yrs), undergoing outpatient, elective, nonophthalmologic surgery. INTERVENTIONS: After premedication with midazolam (two mg) and glycopyrrolate (0.2 mg), standard monitors and a bispectral index (BIS) monitor were applied. Patients underwent rapid-sequence induction with intravenous (IV) propofol two mg/kg and either remifentanil 4 µg/kg IV or succinylcholine 1.5 mg/kg IV. An experienced anesthesiologist, blinded to patient group assignment, performed intubation after 60 seconds. MEASUREMENTS: IOP, heart rate (HR), blood pressure, BIS scores, intubating conditions, and response to intubation (coughing or moving) were recorded at baseline, immediately after completion of induction, one minute after intubation, and three minutes after intubation. Time to return of spontaneous ventilation was also measured. MAIN RESULTS: Remifentanil produced a 39% decrease in IOP immediately after induction, which remained unchanged by laryngoscopy and intubation (P < 0.001). IOP remained below baseline even in patients who coughed or moved in response to intubation. Remifentanil caused a significant decrease in mean arterial pressure of 24% to 31% but no significant change in HR, and it blocked the hemodynamic response to laryngoscopy and intubation while providing intubating conditions comparable to those of succinylcholine. CONCLUSIONS: Propofol/remifentanil induction provides adequate intubating conditions, prevents an increase in IOP, and controls the hemodynamic stress response to laryngoscopy and intubation.

Altered gene expression in human hepatoma HepG2 cells exposed to low-level 2,4-dichlorophenoxyacetic acid and potassium nitrate.

2,4-dichlorophenoxyacetic acid (2,4-D) and nitrate are agricultural contaminants found in rural ground water. It is not known whether levels found in groundwater pose a human or environmental health risk, nor is the mechanism of toxicity at the molecular/cellular level understood. This study focused on determining whether 2,4-D or nitrate at environmentally realistic levels elicit gene expression changes in exposed cells. cDNA microarray technology was used to determine the impact of 2,4-D and nitrate in an in vitro model of exposure. Human hepatoma HepG2 cells were incubated with 2,4-D or nitrate alone for 24 h. Cell viability (neutral red assay) and proliferation (BrdU incorporation) were assessed following exposure. Total RNA from treated and control cells were isolated, reverse transcribed and reciprocal labelled with Cy3 or Cy5 dyes, and hybridized to a human cDNA microarray. The hybridized microarray chips were scanned, quantified and analyzed to identify genes affected by 2,4-D or nitrate exposure based on a two-fold increase or decrease in gene expression and reproducibility (affected in three or more treatments). Following filtering, normalization and hierarchical clustering initial data indicate that numerous genes were found to be commonly expressed in at least three or more treatments of 2,4-D or nitrate tested. The affected genes indicate that HepG2 cells respond to environmental, low-level exposure and produce a cellular response that is associated with alterations in the expression of many genes. The affected genes were characterized as stress response, cell cycle control, immunological and DNA repair genes. These findings serve to highlight new pathway(s) in which to further probe the effects of environmental levels of 2,4-D and nitrate.