RESUMO
The infectious spread of COVID-19 has been accompanied by stigma in both global and local contexts, sparking concern about its negative effect on individuals, communities, and public health responses. The changing epidemiological context of the COVID-19 epidemic and evolving public health responses during the first year of the pandemic (2020) in Vietnam serve as a case study to qualitatively explore the fluidity of stigma. We conducted in-depth interviews with 38 individuals, (13 cases, 9 close contacts, and 16 community members) from areas affected by local outbreaks. Thematic analysis was conducted iteratively. Our analysis indicates that the extent and impacts of COVID-19-related stigma were uneven. Adapting the clinical term 'viral load' as a metaphor, we describe this variation through the wide range of 'stigma load' noted in participants' experiences. Individuals encountering more acute stigma, i.e. the highest 'stigma load', were those associated with COVID-19 at the start of the local outbreaks. These intensively negative social responses were driven by a social meaning-making process that misappropriated an inaccurate understanding of epidemiological logic. Specifically, contact tracing was presumed within the public consciousness to indicate linear blame, with individuals falsely considered to have engaged in 'transgressive mobility', with onward transmission perceived as being intentional. In contrast, as case numbers grew within an outbreak the imagined linearity of the infection chain was disrupted and lower levels of stigma were experienced, with COVID-19 transmission and association reframed as reflecting an environmental rather than behavioural risk. Our findings demonstrate the role of public health policies in unintentionally creating conditions for stigma to flourish. However, this is fluid. The social perceptions of infection risk shifted from being individualised to environmental, suggesting that stigma can be modified and mitigated through attending to the productive social lives of public health approaches and policies.
RESUMO
OBJECTIVES: Delivery riders have been front-line workers throughout the pandemic but little is known about their own health and safety during this time. This study explores the health and safety issues facing delivery riders in Ho Chi Minh City, Vietnam, during the Covid-19 pandemic, in particular during the second lockdown (May-October 2021). METHOD: A web-based survey of more than 800 riders was conducted in August-September 2021. Following descriptive statistics, four logit models were fitted to examine the factors associated with (a) sanitizing one's hands, (b) using a face shield, (c) contracting a new health issue, and (d) engaging in riskier traffic behaviors during the lockdown. RESULTS: The riders who were less consistent in adopting health and safety measures tended to be male, older, less-educated, and vaccinated. Also, they were under greater financial pressure and had suffered a larger loss of income during the pandemic. To recover the loss, they worked longer hours and felt under more intense pressure at work. The job pressure, long working hours, and financial burdens led many drivers to adopt risky traffic behaviors, such as speeding. Conversely, where the companies and co-workers were more supportive, riders tended to adopt health prevention measures more often. Fear of Covid-19 also acted as a facilitator. Job and financial pressure combined with the fear of contracting the virus contributed to the occurrence of new heath issues during the pandemic. Again, support from the company and co-workers helped to reduce the risk of new health problems emerging. CONCLUSION: In Ho Chi Minh City and other Global South megacities that employ tens of thousands of riders, ensuring their health and safety is important to support both private businesses and public health. Overall, companies should assume a much larger responsibility here.
RESUMO
OBJECTIVES: The object of this study was to describe the experience of combining awake craniotomy techniques with high-field (1.5 T) intraoperative MRI (iMRI) for tumors adjacent to eloquent cortex. METHODS: From a prospective database the authors obtained and evaluated the records of all patients who had undergone awake craniotomy procedures with cortical and subcortical mapping in the iMRI suite. The integration of these two modalities was assessed with respect to safety, operative times, workflow, extent of resection (EOR), and neurological outcome. RESULTS: Between February 2010 and December 2011, 42 awake craniotomy procedures using iMRI were performed in 41 patients for the removal of intraaxial tumors. There were 31 left-sided and 11 right-sided tumors. In half of the cases (21 [50%] of 42), the patient was kept awake for both motor and speech mapping. The mean duration of surgery overall was 7.3 hours (range 4.0-13.9 hours). The median EOR overall was 90%, and gross-total resection (EOR ≥ 95%) was achieved in 17 cases (40.5%). After viewing the first MR images after initial resection, further resection was performed in 17 cases (40.5%); the mean EOR in these cases increased from 56% to 67% after further resection. No deficits were observed preoperatively in 33 cases (78.5%), and worsening neurological deficits were noted immediately after surgery in 11 cases (26.2%). At 1 month after surgery, however, worsened neurological function was observed in only 1 case (2.3%). CONCLUSIONS: There was a learning curve with regard to patient positioning and setup times, although it did not adversely affect patient outcomes. Awake craniotomy can be safely performed in a high-field (1.5 T) iMRI suite to maximize tumor resection in eloquent brain areas with an acceptable morbidity profile at 1 month.
