-
Frontiers in Global Women's Health 2023Abortion stigma has been shown to influence provider attitudes around abortion and may decrease provider willingness to participate in abortion care, or lead some to...
BACKGROUND
Abortion stigma has been shown to influence provider attitudes around abortion and may decrease provider willingness to participate in abortion care, or lead some to obstruct care. However, this link remains understudied.
METHODS
The present study uses baseline data collected through a cluster-randomized controlled trial in 16 public sector health facilities in South Africa in 2020. A total of 279 clinical and non-clinical health facility workers were surveyed. Primary outcome measures included: 1) willingness to facilitate abortion care in eight hypothetical scenarios, 2) facilitation of abortion care in the last 30 days, and 3) obstruction of abortion care in the last 30 days. Logistic regression models were used to assess the association between level of stigma as measured through the Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS) and the primary outcomes.
RESULTS
Overall, 50% of respondents in the sample were willing to facilitate abortion care in each of the eight scenarios, with differences in willingness based on the abortion client's age and personal situation in each scenario. Over 90% reported facilitating abortion care in the last 30 days, but 31% also reported having obstructed abortion care in the last 30 days. Stigma was significantly associated with willingness to facilitate abortion care and actual obstruction of abortion care in the last 30 days. Controlling for covariates, odds of willingness to facilitate abortion care in every scenario decreased with every one-point increase in SABAS score (reflecting more stigmatizing attitudes), and odds of obstructing abortion care increased with every one-point increase in SABAS score.
CONCLUSIONS
Lower abortion stigma on the part of health facility workers was associated with willingness to facilitate abortion access but not actual facilitation of abortion services. Higher abortion stigma was associated with actual obstruction of an abortion service in the last 30 days. Interventions to reduce stigma towards women seeking abortion, and particularly negative stereotyping, among health facility staff is key to ensuring equitable and non-discriminatory access to abortion.
TRIAL REGISTRATION
Retrospectively registered on clinicaltrials.gov (ID: NCT04290832) on February 27, 2020.
PLAIN ENGLISH SUMMARY
The link between stigma against women seeking abortion and decisions around whether to provide, abstain, or obstruct abortion care remains understudied. This paper assesses how stigmatizing beliefs and attitudes towards women seeking abortion in South Africa affects willingness to facilitate abortion care and actual facilitation or obstruction of abortion care in practice. A total of 279 clinical and non-clinical health facility workers were surveyed between February and March 2020. Overall, half of respondents in the sample were willing to facilitate abortion care in each of the eight scenarios, with important differences in willingness by scenario. Almost all respondents reported facilitating an abortion procedure in the last 30 days, but one in three also reported having obstructed abortion care in the last 30 days. More stigmatizing attitudes corresponded to decreased willingness to provide abortion care and increased odds of obstructing abortion care. Results show that stigmatizing attitudes, beliefs, and actions toward women who seek abortion shape how clinical and non-clinical staff in South Africa feel about their participation in abortion services and whether they obstruct this care. Facility staff hold great power in determining whose abortions are facilitated and whose are obstructed, resulting in stigma and discrimination being openly perpetuated. Continuous work to reduce stigma towards women seeking abortion among health workers is key to ensuring equitable and non-discriminatory access to abortion for all.
PubMed: 37396569
DOI: 10.3389/fgwh.2023.1142638 -
BMJ Case Reports Aug 2017A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following... (Review)
Review
A relatively young healthy man (barring obesity and distant gouty arthritis) was admitted with severe acute kidney injury (serum creatinine, 15.9 mg/dL) following acute gastroenteritis and occasional use of diclofenac. Abdominal ultrasound revealed mild left hydronephrosis due to staghorn stone and normal right kidney. Soon after, complete anuria necessitating haemodialysis developed without pain or evidence of infection. CT imaging revealed stones obstructing the right ureter. Following urological surgery, postobstructive diuresis developed and the serum creatinine came down to near normal. The stones were identified as uric acid stones.Anuria has a relatively narrow differential and painless (partially non-dilated) bilateral ureteral obstruction is a distinctly unusual cause. A review of the literature to cover all reported causes of bilateral ureteral obstruction is presented. Only a minority of cases were not associated with an underlying malignant disease or its treatment. The multifactorial aetiology of the patient's acute kidney injury (volume depletion, diclofenac and obstructive uropathy) is presented and discussed.
Topics: Acute Kidney Injury; Adult; Anuria; Creatinine; Humans; Hydronephrosis; Male; Staghorn Calculi; Ureter; Ureteral Calculi; Ureteral Obstruction
PubMed: 28784872
DOI: 10.1136/bcr-2016-218173 -
International Journal of Chronic... 2013Chronic obstructive pulmonary disease (COPD) is characterized by incompletely reversible airflow obstruction. Direct measurement of airways resistance using invasive... (Review)
Review
Chronic obstructive pulmonary disease (COPD) is characterized by incompletely reversible airflow obstruction. Direct measurement of airways resistance using invasive techniques has revealed that the site of obstruction is located in the small conducting airways, ie, bronchioles with a diameter < 2 mm. Anatomical changes in these airways include structural abnormalities of the conducting airways (eg, peribronchiolar fibrosis, mucus plugging) and loss of alveolar attachments due to emphysema, which result in destabilization of these airways related to reduced elastic recoil. The relative contribution of structural abnormalities in small conducting airways and emphysema has been a matter of much debate. The present article reviews anatomical changes and inflammatory mechanisms in small conducting airways and in the adjacent lung parenchyma, with a special focus on recent anatomical and imaging data suggesting that the initial event takes place in the small conducting airways and results in a dramatic reduction in the number of airways, together with a reduction in the cross-sectional area of remaining airways. Implications of these findings for the development of novel therapies are briefly discussed.
Topics: Airway Obstruction; Airway Remodeling; Airway Resistance; Bronchioles; Epithelial Cells; Fibrosis; Forced Expiratory Volume; Humans; Inflammation; Pulmonary Alveoli; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema
PubMed: 23319856
DOI: 10.2147/COPD.S28290 -
Respiratory Care Jun 2006For over 70 years, helium-oxygen mixture (heliox) has been promoted as adjunctive therapy to overcome airflow-obstructive disorders and lesions. In the past 2 decades... (Review)
Review
For over 70 years, helium-oxygen mixture (heliox) has been promoted as adjunctive therapy to overcome airflow-obstructive disorders and lesions. In the past 2 decades heliox has gained widespread support in many pediatric emergency departments and intensive care units, in treatment of infants and children with both upper and lower airway obstruction. Because heliox is less dense than air or oxygen, it provides more laminar flow in obstructed airways, and it is purported to reduce work of breathing, respiratory distress, and postextubation stridor. Clinical evidence of the effectiveness of heliox in pediatric patients with airflow obstruction is relatively sparse and appears in the literature primarily as case presentations, case series, and small, uncontrolled studies. This article reviews the rationale and methods for heliox treatment of children with asthma, airway obstruction, bronchiolitis, and croup.
Topics: Aerosols; Airway Obstruction; Asthma; Bronchiolitis; Child; Croup; Drug Delivery Systems; Equipment Design; Helium; Humans; Hypoxia; Oxygen; Work of Breathing
PubMed: 16723039
DOI: No ID Found -
International Journal of Chronic... 2020Obstructive ventilatory disturbances occur in both chronic obstructive pulmonary disease (COPD), a typical disease representative of peripheral airway obstruction, and...
BACKGROUND
Obstructive ventilatory disturbances occur in both chronic obstructive pulmonary disease (COPD), a typical disease representative of peripheral airway obstruction, and central airway obstruction (CAO). Pulmonary function tests (PFTs), which depend on patient effort, are traditionally used to evaluate lung function. The forced oscillation technique (FOT) is an effort-independent method for examining lung function during tidal breathing. The FOT is used universally to assess respiratory function in patients with COPD. Several studies have measured FOT to assess ventilatory disturbances in CAO. The results showed that FOT measurements in patients with CAO were similar to those reported in patients with COPD. However, no studies have compared FOT measurements directly between CAO and COPD. The aim of this study was to identify differences in ventilatory disturbances between peripheral and central airway obstructions in COPD and CAO, before patients received pharmacological therapy or bronchoscopic interventions, respectively.
PATIENTS AND METHODS
We retrospectively included 16 patients with CAO (10 cases of tracheal obstruction and 6 cases of bronchial obstruction) and 75 treatment-naïve patients with COPD (60 cases in Global Initiative for Chronic Obstructive Lung Disease [GOLD] stage II and 15 cases in GOLD stage III) that were admitted from December 2013 to May 2017. Prior to treatment, patients were examined with the FOT and PFTs.
RESULTS
All parameters measured with the FOT in the inspiratory phase were significantly worse in patients with CAO than in patients with COPD. The PFTs showed that the CAO group had a significantly lower peak expiratory flow rate. In the airway wall thickening phenotype of COPD, a difference between the inspiratory and expiratory phases of the resonance frequency (ΔFres) was the best indicator for distinguishing between peripheral and central airway obstructions.
CONCLUSION
This study compared differences between CAO and COPD (mainly GOLD stage II). We found that the FOT measurement, ΔFres, was the optimal indicator of the difference between the airway wall thickening COPD phenotype and CAO. Thus, the difference might be due to mechanical changes that occur in COPD with airway wall thickening.
Topics: Airway Obstruction; Airway Resistance; Forced Expiratory Volume; Humans; Oscillometry; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Retrospective Studies
PubMed: 32606651
DOI: 10.2147/COPD.S246126 -
Cureus Feb 2022We report a surprising case of intraoperatively detected worm obstruction of a hepaticojejunostomy anastomosis. The patient presented with acute cholangitis including...
We report a surprising case of intraoperatively detected worm obstruction of a hepaticojejunostomy anastomosis. The patient presented with acute cholangitis including fever, abdominal pain, obstructive jaundice and sepsis. Six years earlier, she had undergone open cholecystectomy with a right subcostal incision. Ultrasonography that night depicted the absence of the gall bladder and the presence of apparent stones in the common hepatic and common bile ducts. The patient was posted for laparoscopic exploration of common bile duct. Intraoperatively, worm obstruction was found in the hepaticojejunostomy anastomosis created during the previous operation. The obstruction was managed laparoscopically, and the patient recovered without any complications and was monitored for two years. In a search of PubMed and Google Scholar, we found reports of laparoscopy-assisted endoscopic retrograde cholangiopancreatography as an established method of relieving hepaticojejunostomy obstruction; however, we found no case of laparoscopic extraction of obstructing worms. Laparoscopic exploration of a hepaticojejunostomy anastomosis through the afferent Roux loop is a feasible and safe alternative to other advanced methods of endoscopic retrograde cholangiopancreatography, for which special technique, logistics, and training are required but may not be available in many parts of the world.
PubMed: 35282540
DOI: 10.7759/cureus.21968 -
Sleep & Breathing = Schlaf & Atmung Mar 2022Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue...
PURPOSE
Selective hypoglossal nerve stimulation (sHNS) constitutes an effective surgical alternative for patients with obstructive sleep apnea (OSA). sHNS results in tongue protrusion and consecutive alleviation of obstructions at the tongue base level (lower obstructions). Furthermore, obstructions at the soft palate level (upper obstructions) may be prevented through palatoglossal coupling as seen on sleep endoscopy. However, it has not been studied if the distribution of obstruction level during a whole night measurement is a relevant factor for the treatment outcome.
METHODS
Obstruction levels were measured with a manometry system during a whole night of sleep in 26 patients with OSA (f = 1, m = 25; age 59.4 ± 11.3; BMI = 29.6 ± 3.6) either before (n = 9) or after sHNS implantation (n = 12). Five patients received a measurement before and after implantation. Obstructions were categorized into velar (soft palate and above), infravelar (below soft palate), and multilevel obstructions. An association between obstruction level and treatment outcome was calculated.
RESULTS
The mean distribution of preoperative obstruction level could be divided into the following: 38% velar, 46% multilevel, and 16% infravelar obstructions. Patients with a good treatment response (defined as AHI < 15/h and AHI reduction of 50%) had fewer preoperative velar obstructions compared to non-responder (17% vs. 54%, p-value = 0.006). In patients measured after sHNS implantation, a significantly higher rate of multilevel obstructions per hour was measured in non-responders (p-value = 0.012).
CONCLUSIONS
Selective hypoglossal nerve stimulation was more effective in patients with fewer obstructions at the soft palate level. Manometry may be a complementary diagnostic procedure for the selection of patients for HNS.
Topics: Adult; Aged; Electric Stimulation Therapy; Female; Humans; Hypoglossal Nerve; Male; Middle Aged; Sleep Apnea, Obstructive; Treatment Outcome
PubMed: 34091793
DOI: 10.1007/s11325-021-02396-y -
International Journal of Surgery... Mar 2016Bowel obstruction is associated with a reduction in quality of life and survival among cancer patients, and the entity is traditionally treated by general surgeons...
INTRODUCTION
Bowel obstruction is associated with a reduction in quality of life and survival among cancer patients, and the entity is traditionally treated by general surgeons without dedication to the different malignancies that cause bowel obstruction or to palliation. This study aims to identify and improve outcome of bowel obstruction in women with a history of a gynaecologic cancer.
METHODS
Women operated for bowel obstruction were screened for a history of gynaecologic cancer and their records were reviewed.
RESULTS
Bowel obstruction followed cancer treatment by a median of 18.4 months (range 2.3-277) in 59 women. A malignant cause was identified in 53% and recurrence of cancer in 61%. The cause of malignant bowel obstruction was peritoneal carcinomatosis (19%), obstructing tumour and carcinomatosis (31%) and solitary tumour (3%). Ovarian cancer (OR: 6.29, 95% CI 1.95-20.21), residual tumour during initial surgery (R2-stage) (OR: 18.7, 96% CI: 4.35-80.46) and chemotherapy (OR: 7.19, 95% CI: 2.28-22.67) were all associated with malignant bowel obstruction. Surgery solved 84% of malignant bowel obstructions, but median survival was brief (2.5 months, 95% CI: 1.4-3.6) when compared to benign bowel obstruction (95.3 months, 64.7-125.9) (p < 0.001). Readmission for bowel obstruction occurred after a median of 4.3 months (95% CI: 3.1-5.5) in surviving patients with malignant bowel obstruction and after a median of 84.5 months (95% CI: 73.6-95.3) with adhesive obstruction (p < 0.001).
CONCLUSIONS
Increased awareness of the aetiology to bowel obstruction may improve treatment strategy in these women. Women with malignant bowel obstruction should be carefully identified and differentiated in order to improve quality of life rather than pursuing emergency surgical procedures.
Topics: Adult; Aged; Aged, 80 and over; Carcinoma; Cohort Studies; Female; Genital Neoplasms, Female; Humans; Intestinal Obstruction; Middle Aged; Peritoneal Neoplasms; Quality of Life; Treatment Outcome
PubMed: 26853847
DOI: 10.1016/j.ijsu.2016.02.002 -
Animals : An Open Access Journal From... May 2017Horses engaged in strenuous exercise display physiological responses that approach the upper functional limits of key organ systems, in particular their... (Review)
Review
Horses engaged in strenuous exercise display physiological responses that approach the upper functional limits of key organ systems, in particular their cardiorespiratory systems. Maximum athletic performance is therefore vulnerable to factors that diminish these functional capacities, and such impairment might also lead to horses experiencing unpleasant respiratory sensations, i.e., breathlessness. The aim of this review is to use existing literature on equine cardiorespiratory physiology and athletic performance to evaluate the potential for various types of breathlessness to occur in exercising horses. In addition, we investigate the influence of management factors such as rein and bit use and of respiratory pathology on the likelihood and intensity of equine breathlessness occurring during exercise. In ridden horses, rein use that reduces the jowl angle, sometimes markedly, and conditions that partially obstruct the nasopharynx and/or larynx, impair airflow in the upper respiratory tract and lead to increased flow resistance. The associated upper airway pressure changes, transmitted to the lower airways, may have pathophysiological sequelae in the alveolae, which, in their turn, may increase airflow resistance in the lower airways and impede respiratory gas exchange. Other sequelae include decreases in respiratory minute volume and worsening of the hypoxaemia, hypercapnia and acidaemia commonly observed in healthy horses during strenuous exercise. These and other factors are implicated in the potential for ridden horses to experience three forms of breathlessness-"unpleasant respiratory effort", "air hunger" and "chest tightness"-which arise when there is a mismatch between a heightened ventilatory drive and the adequacy of the respiratory response. It is not known to what extent, if at all, such mismatches would occur in strenuously exercising horses unhampered by low jowl angles or by pathophysiological changes at any level of the respiratory tract. However, different combinations of the three types of breathlessness seem much more likely to occur when pathophysiological conditions significantly reduce maximal athletic performance. Finally, most horses exhibit clear behavioural evidence of aversion to a bit in their mouths, varying from the bit being a mild irritant to very painful. This in itself is a significant animal welfare issue that should be addressed. A further major point is the potential for bits to disrupt the maintenance of negative pressure in the oropharynx, which apparently acts to prevent the soft palate from rising and obstructing the nasopharynx. The untoward respiratory outcomes and poor athletic performance due to this and other obstructions are well established, and suggest the potential for affected animals to experience significant intensities of breathlessness. Bitless bridle use may reduce or eliminate such effects. However, direct comparisons of the cardiorespiratory dynamics and the extent of any respiratory pathophysiology in horses wearing bitted and bitless bridles have not been conducted. Such studies would be helpful in confirming, or otherwise, the claimed potential benefits of bitless bridle use.
PubMed: 28587125
DOI: 10.3390/ani7060041 -
International Journal of Chronic... 2021Depression is a prevalent comorbidity of chronic obstructive pulmonary disease (COPD) that, along with COPD, has been associated with inflammation. An association...
RATIONALE
Depression is a prevalent comorbidity of chronic obstructive pulmonary disease (COPD) that, along with COPD, has been associated with inflammation. An association between inflammation and depression in COPD has not been validated in a large COPD cohort.
METHODS
Individuals from the University of Pittsburgh SCCOR cohort and the COPDGene cohort with tobacco use history and airway obstruction (FEV/FVC <0.7) were evaluated using the Beck Depression Inventory II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS), respectively. Participants completed symptom-related questionnaires and plasma IL-6 measurements. -test, Fisher's Exact tests and logistic regression were used for statistical analysis.
RESULTS
The SCCOR cohort included 220 obstructed participants: 44% female and 21.4% with elevated depressive symptoms. GOLD staging distribution was predominantly stage I and II. The COPDGene cohort included 745 obstructed participants: 44% female and 13.0% with elevated depressive symptoms. GOLD distribution was predominantly stage II and III. In the SCCOR cohort, correlation between IL-6 and depressive symptoms trended toward significance (p= 0.08). Multivariable modeling adjusted for FEV, age, gender and medical comorbidities showed a significant association (OR = 1.70, 95% CI = 1.08-2.69). IL-6 was significantly associated with elevated depressive symptoms in COPDGene in both univariate (p=0.001) and multivariable modeling (OR = 1.52, 95% CI =1.13-2.04).
CONCLUSION
Elevated plasma IL-6 levels are associated with depressive symptoms in individuals with COPD independent of airflow limitation and comorbid risk factors for depression. Our results suggest that systemic inflammation may play a significant and possibly bidirectional role in depression associated with COPD.
Topics: Cohort Studies; Comorbidity; Depression; Female; Humans; Inflammation; Male; Pulmonary Disease, Chronic Obstructive
PubMed: 34511896
DOI: 10.2147/COPD.S322144