Neonatal necrotizing enterocolitis due to COVID-19. A case report.

Digestive symptoms have been reported in an important proportion of children with COVID-19, and the clinical expression of critical patients with COVID-19 is thought to result from progressive increase of inflammation and an unusual trend of hypercoagulation. We report a newborn received with abdominal distension, green vomiting and imaging suggestive for enterocolitis. He had a close contact with COVID-19 and the PCR for SARS-CoV-2 came back positive. Despite the supportive measures, his condition deteriorated and a surgery was decided. The surgical exploration found an ischemic bowel. The therapeutic measures were ineffective as the child passed away a few hours after surgery despite the resuscitation treatment performed. The confirmed enterocolitis happening within the period of acute infection by SARS-CoV-2, the NEC was likely a manifestation of COVID-19.

Fluid mechanics of facial masks as personal protection equipment (PPE) of COVID-19 virus.

A fluid mechanics model of inhaled air gases, nitrogen (N2) and oxygen (O2) gases, and exhaled gas components (CO2 and water vapor particles) through a facial mask (membrane) to shield the COVID-19 virus is established. The model was developed based on several gas flux contributions that normally take place through membranes. Semiempirical solutions of the mathematical model were predicted for the N95 facial mask accounting on several parameters, such as a range of porosity size (i.e., 1-30 nm), void fraction (i.e., 10-3%-0.3%), and thickness of the membrane (i.e., 10-40 µm) in comparison to the size of the COVID-19 virus. A unitless number (Nr) was introduced for the first time to describe semiempirical solutions of O2, N2, and CO2 gases through the porous membrane. An optimum Nr of expressing the flow of the inhaled air gases, O2 and N2, through the porous membrane was determined (NO2 = NN2 = -4.4) when an N95 facial mask of specifications of a = 20 nm, l = 30 µm, and ε = 30% was used as a personal protection equipment (PPE). The concept of the optimum number Nr can be standardized not only for testing commercially available facial masks as PPEs but also for designing new masks for protecting humans from the COVID-19 virus.

Factors Affecting Implant Stability Quotients at Immediately and Conventionally Loaded Implants in the Posterior Maxilla: A Split-Mouth Randomized Controlled Trial.

PURPOSE: To assess primary and secondary stability of variable-thread tapered implants in the posterior maxilla and analyze the impact of various factors on implant stability quotients (ISQs). MATERIALS AND METHODS: Twenty-six subjects received 3-4 adjacent implants in the maxillary premolar-molar sextants to replace bilateral tooth loss. The implants on one side were immediately loaded with a provisional fixed prosthesis regardless of their primary stability. The contralateral control implants were conventionally loaded. Bone quality was subjectively recorded and primary stability was assessed by means of insertion torque values (ITVs) and ISQs in 4 directions. Secondary stability was measured by ISQ at definitive prosthesis delivery (3-3.5 months postoperatively), and 12 months after definitive loading. The impact of measurement direction, loading protocol, time, site-related (bone quality, implant position, crestal buccal bone thickness, apical cortical anchorage), and implant-related (implant dimensions, abutment height) variables on ISQs was assessed. RESULTS: For logistic reasons, ISQs were obtained for only 18 patients with 60 test and 60 control implants. Most of the implants (82%) at baseline had their lowest ISQ on the buccal aspect. There were no significant differences between ISQs measured in the buccal and palatal directions, or between ISQs in the mesial and distal directions. The mean of buccal and palatal ISQs was significantly lower than the mean of the 2 interproximal measurements at all evaluation periods. ISQs were not significantly different between the 2 loading groups at any time point. All implants showed a time-dependent increase in ISQs. Baseline ISQ correlated weakly with bone quality and ITV. None of the variables had a significant impact on baseline ISQs, except for implants in second molar sites which showed poorer primary stability than first premolars. CONCLUSION: Measurement direction and time are the most significant parameters affecting ISQs of variable-thread tapered implants in the posterior maxilla.

Immediate versus conventional loading of variable-thread tapered implants supporting three- to four-unit fixed partial dentures in the posterior maxilla: 3-year results of a split-mouth randomised controlled trial.

PURPOSE: To compare the 3-year outcomes of immediately loaded and one-stage conventionally loaded variable-thread tapered implants in the posterior maxilla. MATERIALS AND METHODS: This study was designed as a split-mouth randomised controlled trial. Twenty-six patients attending the postgraduate Periodontics Department at the Lebanese University, and missing teeth bilaterally in the posterior maxilla were randomised. All patients received three to four implants in each of the posterior sextants. The implants on one side were immediately loaded with a provisional resin fixed partial denture on definitive multi-unit abutments regardless of their primary stability. The implants in the contralateral side received definitive multi-unit abutments according to the one-stage unloaded protocol. Three to 3.5 months following implant placement, the implants were restored with metal-ceramic fixed prostheses. Outcome measures were implant and prosthesis failure rates, complications, and peri-implant bone level changes up to 3 years following delivery of the definitive prosthesis. The clinical outcomes and radiographic measurements were performed by a single outcome assessor blinded to the type of interventions. RESULTS: Two patients dropped out prior to the delivery of definitive prostheses. The results were analysed using a per-protocol analysis and included 24 patients. Four implants supporting a four-unit immediately loaded prosthesis failed in one patient, 3 months following definitive prosthesis. In the same patient, the three contralateral conventionally loaded implants failed 14 months after definitive prosthesis. There were no significant differences in the proportions of implant and prosthesis failures at 3 years (difference = 0%; 95% CI 0.0% to 14.2%; P = 0.999). Peri-implantitis was diagnosed at two adjacent conventionally loaded implants in one patient at the 3-year examination. In the immediately loaded group, four early minor prosthetic complications occurred during the provisionalisation phase. Following delivery of the definitive prostheses, one minor ceramic fracture was observed in each of the implant groups. The difference in the rate of complications between the two interventions was not statistically significant at 3 years (difference = 13%; 95% CI 3.4% to 27.7%; P = 0.453). The 3-year peri-implant marginal bone level changes were evaluated in 23 patients (77 immediately loaded and 76 conventionally loaded implants). On average, patients lost 0.79 (0.62) mm at the immediately loaded and 0.91 (0.82) mm at the conventionally loaded implants, the difference being statistically not significant (difference = 0.12 mm; 95% CI -0.31 to 0.55 mm; P = 0.590). The 3-year marginal bone level changes were not significantly different between smokers (n = 12) and non-smokers (n = 11) (difference = 0.19 mm; 95% CI -0.24 to 0.62 mm; P = 0.382). CONCLUSIONS: Immediate loading of three- to four-unit fixed partial prostheses supported by variable-thread implants in the posterior maxilla can achieve similar 3-year results to one-stage conventionally loaded implants.

Insertion Torque of Variable-Thread Tapered Implants in the Posterior Maxilla: A Clinical Study.

PURPOSE: Primary stability is a key factor for successful implant osseointegration, especially in poor bone quality and early/immediate loading. In the immediate loading protocol, insertion torque values (ITVs) have been suggested to be the most valid prognostic factor for osseointegration of maxillary implants. The objectives of this study were to: (1) evaluate ITVs achieved by a variable-thread tapered implant in the posterior maxilla; and (2) assess the impact of bone quality, implant dimensions, bicortical anchorage, and implant location on ITVs. MATERIALS AND METHODS: Twenty-six adult, systemically healthy patients received 173 variable-thread tapered implants in maxillary premolar and molar healed edentulous sites with a minimum subsinus height of 8 mm. Implant sites were prepared using the bone-quality adjusted drilling sequence according to manufacturer's recommendations. Bone quality was recorded subjectively during drilling based on Misch criteria (D1-D4), and ITVs were measured with a manual torque wrench. Univariate and multivariate analyses were performed at the 0.05 significance level. RESULTS: First and second molar sites accounted for 46.8% of all implants. D4 bone was encountered in 61.3% of the sites. Most of the implants were 4.3 mm in diameter (59.5%), and lengths of 11.5 and 13 mm were most commonly used (75.2%). Approximately half of the implants were associated with apical cortical anchorage (51.4%). The overall mean ITV was 44.5 ± 23.0 Ncm, with 65.5 ± 15.6 Ncm, 55.5 ± 19.6 Ncm, and 36.6 ± 21.7 Ncm for D2, D3, and D4 bone, respectively. Bone quality and implant location significantly affected ITVs, while implant dimensions and apical cortical anchorage did not. CONCLUSIONS: ITVs of variable-thread implants were significantly influenced by variations in bone quality and implant position in the posterior maxilla. Despite the influence of bone quality on primary stability, the mean ITVs attained with variable-thread tapered implants in poor bone quality were within the recommended range for immediate loading.

Audit of Laparoscopic Cholecystectomy: Impact of Procedure Recording on Clinical Practice.

Recorded videos of laparoscopic surgery can be used to audit surgical practice with a view to improve clinical practice and surgical outcomes. The objective was to audit our own practice by reviewing video recordings of laparoscopic cholecystectomies to improve our dissection in Calot's triangle and to prevent gall bladder perforation. We used recorded videos of laparoscopic cholecystectomy. In this study initially one hundred consecutive videos were reviewed for: a) establishment of critical view of safety, b) optimization of critical view of safety by division of cystic artery before cystic duct, c) perforation of gall bladder and d) use of diathermy for cystic artery. This prospective interventional audit was performed in a Civil Hospital, Karachi and Hamdard University Hospital, Karachi, Pakistan from January 2008 to March 2010. Recommendations were made according to published literature to change the practice in these steps of procedures. These recommendations were implemented in practice and the following 100 videos were reviewed for the same criteria to see the impact on clinical practice. In the first group, critical view of safety was established in 91 patients compared with 99 patients in 2nd group (p=0.009), optimization of view was done in 54 and 83 patients respectively (p<001), perforation occurred in 32 and 19 patients respectively (p=0.035) and use of diathermy for cystic artery, which was the routine, was stopped completely in the 2nd group. Audit of recorded videos of laparoscopic cholecystectomy can be used as an effective tool to improve surgical practice for safer and better outcome.

Cystic Lymph Node: Caution of Safety in Calot's Triangle Dissection.

Different landmarks are described in laparoscopic cholecystectomy for correct identification and orientation of structures to make the procedure as safe as possible. Among these one of the important landmarks is cystic lymphnode which always lies lateral to the biliary tree and forms the medial end point of dissection. This study was done to determine frequency of identification of cystic lymph node in our population. This retrospective descriptive study was conducted on 217 patients who underwent laparoscopic cholecystectomy for cholelithiasis from January 2012 to December 2013 over a period of two years in Jamal Noor Hospital and Hamdard University Hospital Karachi. All procedures were recorded and reviewed. Frequency of identification of cystic lymph node was documented in different levels of difficulty and whether it was possible to keep the dissection lateral to lymph node. Difficulty was assessed per-operatively by Cuschieri's scale. During dissection cystic lymph node was identified in 170(78.34%) cases. In majority of patients i.e. 165(97.05%), it was related to cystic artery. In 78(45.88%) patient dissection was possible lateral to lymph node. Cystic lymph node can be identified in majority of patients undergoing laparoscopic cholecystectomy and this identification helps in safe dissection of Calot's triangle. Efforts should be made to remain lateral to lymph node to avoid injuries to hepatic pedicle.

An angiotensin-converting enzyme (ACE) polymorphism may mitigate the effects of angiotensin-pathway medications on posttraumatic stress symptoms.

Angiotensin, which regulates blood pressure may also act within the brain to mediate stress and fear responses. Common antihypertensive medication classes of angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) have been associated with lower PTSD symptoms. Here we examine the rs4311 SNP in the ACE gene, previously implicated in panic attacks, in the relationship between ACE-I/ARB medications and PTSD symptoms. Participants were recruited from outpatient wait rooms between 2006 and March 2014 (n= 803). We examined the interaction between rs4311 genotype and the presence of blood pressure medication on PTSD symptoms and diagnosis. PTSD symptoms were lower in individuals taking ACE-Is or ARBs (N = 776). The rs4311 was associated with PTSD symptoms and diagnosis (N = 3803), as the T-carriers at the rs4311 SNP had significantly greater likelihood of a PTSD diagnosis. Lastly, the rs4311 genotype modified the effect of ACE-Is or ARBs on PTSD symptoms (N = 443; F1,443 = 4.41, P < 0.05). Individuals with the CC rs4311 genotype showed lower PTSD symptoms in the presence of ACE-Is or ARBs. In contrast, T- carriers showed the opposite, such that the presence of ACE-Is or ARBs was associated with higher PTSD symptoms. These data suggest that the renin-angiotensin system may be important in PTSD, as ACE-I/ARB usage associates with lower symptoms. Furthermore, we provide genetic evidence that some individuals are comparatively more benefitted by ACE-Is/ARBs in PTSD treatment. Future research should examine the mechanisms by which ACE-Is/ARBs affect PTSD symptoms such that pharmaco-genetically informed interventions may be used to treat PTSD.

Hernioplasty for ventral hernias: correlation of wound morbidity with body mass index.

To determine the correlation of wound morbidity especially serum drain output in on lay mesh hernioplasty with Body Mass Index (BMI). This prospective descriptive study was conducted at Hamdard University Hospital and Jamal Noor Hospital from January 2010 to December 2011. A total of 42 females with ventral hernias were included. According to BMI, patients were divided in two groups. Group 1(G-1) included patients with BMI ≤29.9 and Group 2(G-2) included patients with BMI ≥30. All patients underwent hernioplasty by conventional open method (on lay technique). Wound was closed over a vaccum drain (16 Fr). Total drain output, the number of days drain kept, clinical seroma formation & need of aspiration after removal of drain, discharge from the wound and wound infection were recorded and analyzed on SPSS version 15 by using sample 't' test. A total of 42 female patients, 21 in each group, were included with the mean age of 46.95 years. Size of hernial defect was 4.80cm in G-1 and 4.61cm in G-2. Mean drain out- put in G-1 was 134.05ml while in G-2 it was 244.29ml (p=0.008). Duration of drainage in G-1 was 3.71 days and in G-2 was 5.24 days (p=0.028). Seroma formation and serous discharge from the wound occurred in 2(4.76%) patients, both were from Group-1 and they required aspiration once only. Wound infection occurred in 4(9.52%) patients, and all were in Group 2. Post operative drain output in on lay mesh hernioplasty is directly proportional to the Body Mass Index (BMI) and these are the patients who require a longer period of drainage therefore this fact should be explained to obese patients in pre operative informed consent.

Tuberculosis among household contacts of multidrug-resistant tuberculosis patients in Delhi, India.

SETTING: Lala Ram Sarup Institute of Tuberculosis and Respiratory Diseases (LRS), a tertiary level tuberculosis (TB) institute in Delhi, India. OBJECTIVE: To study the profile of TB among household contacts of multidrug-resistant TB (MDR-TB) patients. DESIGN: In a cross-sectional study, contacts of MDRTB patients were traced and clinical, radiological, bacteriological and pulmonary function tests were performed for evidence of TB infection and active disease. RESULTS: Between January 2005 and December 2008, 58 of 92 index MDR-TB patients could be traced. Of 302 contacts who could be studied, 16 (5.29%) developed TB: nine had pulmonary and seven had extra- pulmonary disease; two (0.66%) had MDR-TB. Of the 302 contacts, 137 reported to the LRS Institute and were investigated. The most common symptoms observed were cough, chest pain and fever. The tuberculin skin test was positive in 109 of 135 (80.7%) contacts; among these, bacille Calmette-Guérin scar was present in 86. Pulmonary function tests revealed obstruction, restriction and mixed abnormalities. CONCLUSION: The majority of contacts of MDR-TB patients had drug-susceptible TB and the rate of MDRTB was very low. Evaluation of contacts of MDR-TB cases may lead to early diagnosis and prevention of TB.

Iatrogenic gall bladder perforations in laparoscopic cholecystectomy: an audit of 200 cases.

This study was done to evaluate the frequency of iatrogenic gall bladder perforation (IGBP) in laparoscopic cholecystectomy and to determine its association with gender, adhesions in right upper quadrant and types of gall bladder. This retrospective descriptive study included 200 patients who underwent laparoscopic cholecystectomy for symptomatic cholelithiasis at Jamal Noor Hospital and Hamdard University Hospital, Karachi from January 2007 to January 2009. Video recording of all 200 laparoscopic cholecystectomies were analyzed for the IGBP. The different factors; sex of the patient, type of gall bladder, presence of adhesions in the right upper quadrant, timing of perforation, site of perforation, cause of perforation and spillage of stones were recorded. Data was entered and analyzed on SPSS 15. Pearson Chi Square test was applied to check the significance of these factors in IGBP where applicable. In this study there were 173 females and 27 male patients. IGBP occurred in 51 patients (25.5%) and among them 40(23.12%) were females and 11(40.74%) males. Statistical analysis failed to prove male gender a significant factor in the IGBP (p=0.051). Spillage of stones occurred in 23 patients (11.5% in total study population). In 32(18.49%) patients with chronic calculus cholecystitis IGBP occured while in other cluster of 27 patients suffering from acute cholecystitis, empyema & mucocele, 19(70.37%) had IGBP. Hence the condition of gall bladder (acute cholecystitis, empyema and mucocele) was proved statistically a significant factor in IGBP (p=0.000). Adhesiolysis in right upper quadrant was required in 109 patients in whom 31 patients (28.44%) had IGBP while in 91 patients in whom no adhesiolysis was required, 20 patients (21.98%) had IGBP. Statistically no significant difference was present regarding this factor (p=0.296). In total of 51 patients of IGBP, fundus of gall bladder was the commonest site of perforation in 21(41.18%), followed by body of gall bladder in 18(35.29%) and Hartman's pouch in 12(23.53%) patients. In 27(52.94%) patients, diathermy hook was the cause of perforation followed by grasping forceps in 24(47.06%) patients. In 33(64.71%) patients perforations occurred during dissection of gall bladder from liver bed, in 2(3.92%) during adhesiolysis and in 16(31.37%) during retraction maneuvers. Perforation of gall bladder occurred in 25.5% of patients during laparoscopic cholecystectomy and acutely inflamed and over distended gall bladders were proved significant factor for this intraoperative event.

Factors identified for negative appendicectomies.

The study was done, to determine the factors for negative appendicectomies. This prospective descriptive study includes patients managed at four non teaching and a teaching hospital of Karachi from March 2006 to February 2008. One hundred and sixty eight patients underwent appendicectomy during the study period. Details of clinical presentations, investigations, operative findings and histopathology were entered and analyzed. Literature search was aimed to see the negative appendicectomy rate (NAR) in last ten years despite using diagnostic tools (clinical scoring, diagnostic imaging and laparoscopy). In this study a total number of 168 patients under went appendicectomy. Normal appendices were found in 31 patients (negative appendicectomy rate was 18.45%) and associated pathology was seen in 13 patients, an incidental finding of Meckel's diverticulum in 5 patients and no other pathology was seen in 13 patients. The different factors which we identified for negative appendicectomies in our practice were non teaching hospitals where diagnostic scoring system was difficult to apply, female gender, selective use of imaging modality, other pathologies presenting with pain in right lower quadrant (RLQ) and requiring surgical intervention, and non-availability of CT scan and laparoscopy. Despite many advances in diagnostic system, acute appendicitis is still a diagnostic dilemma at times. Although there is no substitute for clinical judgment but in sub groups of patients in whom the possibility of negative appendicectomy is high, diagnostic modalities should be used judiciously to decrease the negative exploration.

[Modern algorithm for treating pudendal neuralgia: 212 cases and 104 decompressions]. / La prise en charge moderne des névralgies pudendales. A partir d'une série de 212 patientes et 104 interventions de décompression.

Clinical signs and symptoms of the pudendal neuralgia are very rich, with a great individual variability. The clinical diagnosis is difficult. It is confirmed or invalidated by the electrophysiologicals tests. Since October 1998 patient selection has been possible using a diagnosis score. Over a four-year period, the diagnosis of pudendal neuralgia was confirmed by electrophysiological investigations in 212 subjects. We rejected 12 patients because of a radiculo-medullary organic etiology. We only describe here cases of women with a peripheral pudendal nerve injury (200 patients). Thirty-eight neuropathies free of canal symptoms (obstetrical, post-traumatic...) were treated by infiltration therapy. The study of a total of 162 canal syndromes showed prevalent injury at the sacro-spino-tuberal ligamental grip which was observed in 68% of the cases, compared to the Alcock canal which was present in only 20% of the cases. One hundred four of these patients underwent surgical decompression via a trans-ischio-rectal approach after negative results of the infiltration therapy. We report here the surgical methodology, the post-op follow-up and the results, which appear quite successful: after one year 86% of the subjects are symptom-free or with a significant reduction of pain.

The use and abuse of female domestic workers from Sri Lanka in Lebanon.

PIP: Women who migrate from Sri Lanka to become domestic workers in Lebanon face gender, class, and race discrimination that often results in abuse, yet the predicament of these women is largely ignored by local and international humanitarian and human rights agencies. Public consciousness about the plight of Asian domestic workers in the Persian Gulf region was raised in 1990 when domestic workers were repatriated in the wake of the Gulf War. In Lebanon, nearly half of the work permits granted to foreigners in 1997 were to women from Sri Lanka. This migration began in the 1970s and is sanctioned by the Sri Lanka government because of the economic benefits accruing from wages sent home by these women. Lebanese families procure domestic positions through an employment agency that arranges transportation and entry for the Sri Lankan women. These women, especially minors, often have to bribe Sri Lankan government agents to falsify travel documents. Upon arrival in Lebanon, the women have no support systems or job security. Most employment contracts last 3 years and pay $100/month with no benefits or protection from local labor laws. Domestic workers are made vulnerable by employers who withhold salaries or travel documents. Upon return to Sri Lanka, former domestic workers face social disapproval and marital problems. To redress this situation, the governments of sending and receiving countries must take action to protect female migrant workers, and nongovernmental organizations must publicize the plight of these women and take action to address the abuses they face.^ieng

Climb every mountain.

PIP: In Egypt, the Association of Garbage Collectors for Community Development (AGCCD), created and administered with government support by Zabballeen (low-income people who have collected, sorted, and recycled Cairo's mountains of garbage since 1970), serves an urban settlement of 16,000 where entire households supplement their living from scavenging by raising pigs, chickens, and rabbits. The AGCCD employs 44 women in a primary health care and credit program for women that involves home visits, provision of primary health care, disease prevention, immunization, and reproductive health care (RHC). The low status of the women has meant that the birth of a girl is rarely registered, so that Zabballeen girls can not enjoy the benefits of citizenship. The main goal of the AGCCD has been to increase the role of women in RHC decision-making in their families. Many women have been successful in convincing their husbands of the need for permanent contraception and have resisted efforts to have daughters married at an early age. Recently, RHC discussions have been conducted with men. Women have also begun to actively oppose female genital mutilation. Future challenges for AGCCD include gender training, increasing the birth registration of girls, forming new groups of girls and women to promote women's health by improving gender relations, and providing legal advice and assistance to women, especially those whose births were not registered.^ieng

Making it happen: the programme. Breaking the isolation.

PIP: Terrorism in Algeria has made women a primary target; this has only served to make the women there more determined to change their status, a process that began with independence in 1960. During preparations for the Fourth UN Conference in Beijing, Algerian women began networking with women from Tunisia and Morocco. Since then, Nadia Ait Zai, a lawyer and a member of the Collectif, at the invitation of the Oxfam Beirut Office, met with her Lebanese counterparts; the women shared experiences and developed strategies for working together. Nadia met with Sukaynah Salameh, the director of the Vocational Training Association centers in refugee camps in Beirut (which she visited); a group of grassroots women organized by the Youth Social League; and a group of disabled women. The meeting at the National Association for the Rights of Disabled Persons focused on family laws, which rule the lives of women. Nadia described efforts by the Collectif to bring about an egalitarian civil law.^ieng

Interview: Sukaynah Salameh, director of the Vocational Development Association (VDSA), Lebanon.

PIP: In this interview, Sukaynah Salameh, director of the nongovernmental Vocational Development Association (VDA) of Lebanon, states that the VDA was created to provide Palestinian and Lebanese youth with employment skills appropriate for local market conditions. The young men and women served by the VDA have had their education curtailed by 15 years of civil war and deteriorating economic conditions in their country. The situation is particularly difficult for Palestinian refugee women who face employment opportunities limited by scarce jobs, laws regulating the employment of refugees, competition by cheaper migrant labor, and women's unequal status. Most training programs provide refugee women with skills that do little but enhance their housekeeping skills. The VDA offers 6-9 month training courses using its own curricula. In addition, the VDA keeps a roster of its graduates to evaluate the usefulness of its training. This record-keeping allowed the VDA to determine that the market was being saturated with the skills they were offering. Therefore, the VDA conducted a market analysis that focused on the socioeconomic status of refugee women. This research revealed that the number of refugee girls enrolled in primary and intermediate school has gradually declined, although most young women 15-25 years old want to learn skills in order to find jobs. In order to increase the level of female enrollment in its vocational courses, the VDA decided to provide women who already have basic education skills with additional training in subjects the market is demanding, like architecture and design and computer studies. In addition, the VDA has begun an individual outreach program to promote the idea of female education and employment and has developed a network to help women find jobs.^ieng

"Women and disability don't mix]" Double discrimination and disabled women's rights.

PIP: Oxfam's experience with groups of disabled people has revealed that gender affects how disabled people are treated in various cultures. This experience runs counter to the often voiced (even by a consultant hired by Oxfam) assumption that gender analysis serves only to confuse any analysis undertaken of disability-based circumstances. This assumption is echoed in the disability movement itself where activists fear fragmentation through the introduction of gender analysis. Thus, gender is not yet understood as a factor which affects every aspect of life including race, class, ethnicity, caste, and disability. Because 75% of the 250 million disabled women in the world live in developing countries, development programs must consider the specific needs and rights of disabled women who suffer from double discrimination and are more likely than disabled men to live impoverished and isolated lives which lead to depression and despair. In many societies, disabled women, but not disabled men, lose their rights to marriage, family life, education, and health care. Mothers of disabled children are stigmatized, and fathers tend to "blame" defective genes on the mothers and to ignore their disabled offspring. These factors combine to make it difficult to improve the status and livelihoods of disabled women through development work. Disabled women activists have also voiced complaints about their lack of access to the preparatory meetings for the Fourth UN Women's Conference, but disabled women intend to use the Conference to lobby for their rights and to call for scrutiny of health policies which discriminate against the disabled.^ieng