Social accountability as a strategy to promote sexual and reproductive health entitlements for stigmatized issues and populations

Social accountability is often put forward as a strategy to promote health rights, but we lack a programmatic evidence base on if, when, and how social accountability strategies can be used to promote access to quality Sexual and Reproductive Health (SRH) care for stigmatized populations and/or stigmatized issues. In this Commentary, we discuss the potential advantages and disadvantages of social accountability strategies in promoting the availability of a full range of SRH services for excluded and historically oppressed populations. We accomplish this by describing four programs that sought to promote access to quality SRH care for stigmatized populations and/or stigmatized services. Program implementers faced similar challenges, including stigma and harmful gender norms among providers and communities, and lack of clear guidance, authority, and knowledge of Sexual and Reproductive Health and Rights (SRHR) entitlements at local level. To overcome these challenges, the programs employed several strategies, including linking their strategies to legal accountability, budgetary expenditures, or other institutionalized processes; taking steps to ensure inclusion, including through consultation with excluded or stigmatized groups throughout the program design and implementation process; specific outreach and support to integrating marginalized groups into program activities; and the creation of separate spaces to ensure confidentiality and safety. The program experiences described here suggest some general principles for ensuring that social accountability efforts are inclusive both in terms of populations and issues addressed. Further empirical research can test and further flesh out these principles, and deepen our understanding of context.

Human rights-based accountability for sexual and reproductive health and rights in humanitarian settings: Findings from a pilot study in northern Uganda

Ensuring accountability for the realization of sexual and reproductive health and rights is a human rights obligation and central tenet of strategies to improve health systems and outcomes in humanitarian settings. This pilot study explored the feasibility and acceptability of deploying human rights strategies, specifically through a participatory community-led complaints mechanism, to hold humanitarian health systems to account for the sexual and reproductive health and rights of refugee and host community women and girls in northern Uganda. Over a fifteen-month period we conducted a multi-methods exploratory study with refugee and host community rights-holders and duty-bearers using longitudinal in-depth interviews, focus groups, and secondary data document review. Deductive and inductive coding techniques were used to analyze data iteratively for content and themes. 107 sexual and reproductive health and rights related complaints and feedback were collected through the community complaints mechanism. Complaints concerned experiences of disrespect and abuse by health care workers; lack of adolescent access to sexual and reproductive health services and information; sexual and gender-based violence; and lack of access to acceptable and quality health goods and services. Participants reported an increased understanding and claiming of human rights through the intervention, acceptability of rights-based accountability strategies among humanitarian health system actors, and improved access to remedies when sexual and reproductive health rights are not respected. Findings demonstrate integrating rights-based social accountability mechanisms at the level of humanitarian response as a promising approach for strengthening and holding humanitarian health systems accountable for the sexual and reproductive health and rights of women and girls affected by humanitarian situations.

Environmental complexity positively impacts affective states of broiler chickens

Affective state can bias an animal's judgement. Animals in positive affective states can interpret ambiguous cues more positively ("optimistically") than animals in negative affective states. Thus, judgement bias tests can determine an animal's affective state through their responses to ambiguous cues. We tested the effects of environmental complexity and stocking density on affective states of broiler chickens through a multimodal judgement bias test. Broilers were trained to approach reinforced locations signaled by one color and not to approach unreinforced locations signaled by a different color. Trained birds were tested for latencies to approach three ambiguous cues of intermediate color and location. Broilers discriminated between cues, with shorter latencies to approach ambiguous cues closest to the reinforced cue than cues closest to the unreinforced cue, validating the use of the test in this context. Broilers housed in high-complexity pens approached ambiguous cues faster than birds in low-complexity pens-an optimistic judgement bias, suggesting the former were in a more positive affective state. Broilers from high-density pens tended to approach all cues faster than birds from low-density pens, possibly because resource competition in their home pen increased food motivation. Overall, our study suggests that environmental complexity improves broilers' affective states, implying animal welfare benefits of environmental enrichment.

Evaluation of rumen temperature as a novel indicator of meat quality: Rumen temperature and haematological indicators of stress during the pre-slaughter period as predictors of instrumental meat quality in bulls

The use of new technologies such as rumen temperature boluses, together with the collective assessment of an animal stress responses may have the potential to act as an indicator of meat quality. Therefore, the objective of this study was to evaluate rumen temperature as a novel indicator of meat quality, by investigating its relationship with welfare measures and instrumental meat quality. The study involved 42 Holstein bulls (15.8 ± 0.08 months of age), which were transported 42 km to a commercial abattoir. Mean rumen temperature rose by 0.511 °C (P < .001) during the pre-slaughter phase; peaking during lairage. In addition, cortisol, creatine kinase (CK) and lactate dehydrogenase (LDH) were significantly (P < .001) elevated at slaughter. Bulls with a greater rumen temperature during the pre-slaughter phase produced meat with significantly higher pH_ult. Pre-slaughter rumen temperature was positively associated with slaughter CK, slaughter cortisol, pH_ult, L* and a*. Thus, rumen temperature demonstrates the potential to be used both as a novel welfare indicator and predictor of meat quality.

"It is just like having a period with back pain": exploring women's experiences with community-based distribution of misoprostol for early abortion on the Thailand-Burma border

INTRODUCTION

The lack of economic development and longstanding conflict in Burma have led to mass population displacement. Unintended pregnancy and unsafe abortion are common and contribute to maternal death and disability. In 2011, stakeholders operating along the Thailand-Burma border established a community-based distribution program of misoprostol for early abortion, with the aim of providing safe and free abortion care in this low-resource and legally restricted setting.

METHODS

We conducted 16 in-depth, in-person interviews with women from Burma residing on both sides of the border who accessed misoprostol through the community-based distribution initiative. We analyzed interviews for content and themes using deductive and inductive methods.

RESULTS

Overall, women felt positively about their abortion experiences and the initiative. Previous abortion experiences and the recommendations of others shaped women's access. All participants, including those who remained pregnant after taking the misoprostol, would recommend the initiative to others.

CONCLUSION

Community-based distribution of misoprostol is an effective and culturally appropriate method of improving safe abortion care on the Thailand-Burma border. Supporting efforts to expand the harm reduction program to more communities and provide regular reproductive health and safe abortion trainings appears warranted.

IMPLICATIONS

In recent years, a number of organizations have launched programs dedicated to misoprostol-alone for early abortion. However, few have documented the experiences and perspectives of women. Our findings indicate providing misoprostol through lay provision in a legally restricted context is not only safe and effective but also culturally resonant.

To be, or not to be, referred: A qualitative study of women from Burma's access to legal abortion care in Thailand

Background

Reproductive health outcomes among women from Burma who live along the Thailand-Burma border demonstrate an unmet need for access to safe abortion services. In 2014, a multi-national team launched a collaborative three-year initiative to expand a program that refers eligible women for safe and legal abortion care to government Thai hospitals in Tak province, Thailand.

Methods

Over a six-month period we conducted 14 in-depth open-ended interviews with women from Burma who were referred through the program or denied a wanted abortion after being deemed ineligible for referral by staff at the participating clinic. We analyzed the interviews for content and themes using both deductive and inductive techniques.

Results

Women’s experiences accessing legal abortion care were positive and facilitated by appropriate options counseling, logistical support, and financial coverage. Five of the ineligible women we interviewed used traditional methods accessed on both sides of the border to self-induce an abortion and/or visited an untrained and unregulated provider.

Discussion

Our findings highlight the need to redouble efforts to expand access to safe and legal abortion care for women from Burma residing in northern Thailand. Ensuring that women who are denied a safe and legal abortion receive harm reduction interventions and resources is critical.

Exploring Legal Restrictions, Regulatory Reform, and Geographic Disparities in Abortion Access in Thailand

Despite decades of advocacy among Thai governmental and nongovernmental actors to remove abortion from the country's 1957 Criminal Code, this medically necessary service remains significantly legally restricted. In 2005, in the most recent regulatory reform to date, the Thai Medical Council established regulatory measures to allow a degree of physician interpretation within the confines of the existing law. Drawing on findings from a review of institutional policies and legislative materials, key informant interviews, and informal discussions with health service providers, government representatives, and nonprofit stakeholders, this article explores how legal reforms and health policies have shaped the abortion landscape in Thailand and influenced geographic disparities in availability and accessibility. Notwithstanding a strong medical community and the recent introduction of mifepristone for medication abortion (also known as medical abortion), the narrow interpretation of the regulatory criteria by physicians further entrenches these disparities. This article examines the causes of subnational disparities, focusing on the northern provinces and the western periphery of Thailand, and explores strategies to improve access to abortion in this legally restricted setting.

Assessing abortion coverage in nurse practitioner programs in Canada: a national survey of program directors

OBJECTIVES

Although nurse practitioners (NPs) play a critical role in the delivery of reproductive health services in Canada, there is a paucity of published information regarding the reproductive health education provided in their training programs. Our study aimed to understand better the didactic and curricular coverage of abortion in Canadian NP programs.

STUDY DESIGN

In 2014, we conducted a 3-contact, bilingual (English-French) mailed survey to assess the coverage of, time dedicated to and barriers to inclusion of 17 different areas of reproductive health, including abortion. We also asked respondents to speculate on whether or not mifepristone would be incorporated into the curriculum if approved by Health Canada for early abortion. We analyzed our results with descriptive statistics and used inductive techniques to analyze the open-ended questions for content and themes.

RESULTS

Sixteen of 23 (70%) program directors or their designees returned our survey. In general, abortion-related topics received less coverage than contraception, ectopic pregnancy management and miscarriage management. Fifty-six percent of respondents reported that their program did not offer information about first-trimester abortion procedures and/or post-abortion care in the didactic curriculum. Respondents expressed interest in incorporating mifepristone/misoprostol into NP education and training.

CONCLUSION

Reproductive health issues receive uneven and often inadequate curricular coverage in Canadian NP programs. Identifying avenues to expand education and training on abortion appears warranted. Embarking on curricular reform efforts is especially important given the upcoming introduction of mifepristone into the Canadian health system for early abortion.

IMPLICATIONS

Our findings draw attention to the need to integrate abortion-related content into NP education and training programs. The approval of Mifegymiso® may provide a window of opportunity to engage in curriculum reform efforts across the health professions in Canada.

No Exceptions: Documenting the Abortion Experiences of US Peace Corps Volunteers

Since 1979, US federal appropriations bills have prohibited the use of federal funds from covering abortion care for Peace Corps volunteers. There are no exceptions; unlike other groups that receive health care through US federal funding streams, including Medicaid recipients, federal employees, and women in federal prisons, abortion care is not covered for volunteers even in cases of life endangerment, rape, or incest. We interviewed 433 returned Peace Corps volunteers to document opinions of, perceptions about, and experiences with obtaining abortion care. Our results regarding the abortion experiences of Peace Corps volunteers, especially those who were raped, bear witness to a profound inequity and show that the time has come to lift the "no exceptions" funding ban on abortion coverage.

Board invited review: The importance of the gestation period for welfare of calves: maternal stressors and difficult births

The prenatal period is of critical importance in defining how individuals respond to their environment throughout life. Stress experienced by pregnant females has been shown to have detrimental effects on offspring biology in humans and a variety of other species. It also is becoming increasingly apparent that prenatal events can have important consequences for the behavior, health, and productivity of offspring in farmed species. Pregnant cattle may experience many potentially important stressors, for instance, relating to their social environment, housing system and physical environment, interactions with humans and husbandry procedures, and their state of health. We examined the available literature to provide a review of the implications of prenatal stress for offspring welfare in cattle. The long-term effects of dystocia on cattle offspring also are reviewed. To ensure a transparent and repeatable selection process, a systematic review approach was adopted. The research literature clearly demonstrates that prenatal stress and difficult births in beef and dairy cattle both have implications for offspring welfare and performance. Common husbandry practices, such as transport, were shown to influence offspring biology and the importance of environmental variables, including thermal stress and drought, also were highlighted. Maternal disease during pregnancy was shown to negatively impact offspring welfare. Moreover, dystocia-affected calves suffer increased mortality and morbidity, decreased transfer of passive immunity, and important physiological and behavioral changes. This review also identified considerable gaps in our knowledge and understanding of the effects of prenatal stress in cattle.

Developmental expression of parvalbumin by rat lower cervical spinal cord neurones and the effect of early lesions to the motor cortex

Expression of calcium binding proteins (CaBPs), increasing neuronal activity and phases of synapse elimination are widely believed to be linked during development. We have employed immunocytochemistry to study the expression of the CaBP parvalbumin (PV) during the postnatal development of the lower cervical spinal cord and investigated how early lesions to the motor cortex, at the onset of corticospinal synaptogenesis, perturb the normal pattern of PV expression. This study confirms previous observations that in normal rats PV-like immunoreactivity is confined to large sensory afferents for at least 10 days postnatally (P10) and that the adult pattern of expression emerges from about P18 and involves mainly dorsal horn neurones. However, the study has also demonstrated a transient wave of expression in ventral horn neurones which reaches a maximum between P14-18 and declines thereafter. Unilateral lesions made at P7 to the forelimb motor cortex, which sends an almost completely crossed projection to the spinal cord, resulted in reduced neuronal expression of PV in the lower cervical spinal cord contralaterally at a range of ages (P14-31). The median ratio of PV positive neurones contralateral/ipsilateral to the lesion in spinal cord segments C7 and C8 was significantly lower (p < 0.01) at 56.0% (34.5-76.8 95% confidence limits, n = 14) than in sham operated controls (99.7%, range 93.7-113.6, n = 5). The lesion affected the transient wave of expression seen in ventral horn neurones during the third postnatal week as well as dorsal horn expression at older ages. We conclude that there is considerable plasticity in PV immunoreactivity during spinal cord development. PV is transiently expressed by ventral horn neurones at an age when movement control is functionally maturing. Early cortical lesions disrupt this transient phase of expression but also alter mature patterns of PV localisation. This suggests a critical role for corticospinal pathways in guiding maturation of segmental spinal cord circuitry.

[Refsum's disease. Ophthalmologic symptomatology dominated by tight bilateral miosis]

A case of Refsum's disease in a 62-year-old man, with an ophthalmologic symptomatology dominated by a tight bilateral miosis, is reported. The miosis mechanism in this disease is discussed. The clinical evolution has been stabilized by a diet poor in phytanic acid.

[Panmedullary ependymoma. A case report]

Panmedullary ependymoma is an unusual disease last reported by Fuentes in 1986. The present case is the first to have been studied by magnetic resonance, using gadolinium. The findings indicated a panmedullary lesion rather than a tumour. Histopathological investigation confirmed the hypothesis.

[Fisher's one-and-one half syndrome. Involvement of the 6th cranial nerve nucleus and association with paralytic pontine exotropia]

Total lateral paralysis in a case of "One and half" Fisher's syndrome accompanied by paralytic pontine exotropia is described. Oculographic investigation indicates involvement of the nucleus of the VIth cranial nerve. Paralytic pontine exotropia, may therefore be encountered where the VIth nucleus is involved.

False positive-false negative CT scan in late epileptic seizure: a meningioma-glioblastoma association

A false-negative finding on initial CT is reported in a case of supratentorial glioma. This observation was peculiar because the first CT revealed a meningioma which might initially have been related to the clinical symptoms. The term false positive-false negative CT is proposed. The reasons for such CT failures are discussed. The accuracy of clues as to the localization of the glioma provided by EEG is emphasized.

[Femoral neuropathy with deafferentation pain. Complications of a hematoma during anticoagulant treatment]

A case of femoral palsy associated with chronic pain sensible to Carbamazepine, secondary to iliacus haematoma during anticoagulant therapy is reported. Late femoral nerve decompression followed by transcutaneous neurostimulation permit the normalization of the sensory nerve conduction and a complete clinical recovery. The localizations of hemorrhage and nervous compression are discussed. The necessity of a nerve decompression when features of nervous conduction persist is emphasized. Clinical symptomatology, Carbamazepine and transcutaneous neurostimulation efficacity, electrophysiological features are correlated with a central deafferentation state caused by an incomplete and heterogeneous lesion of the sensory nerve conduction pathways.

Management of cavernous sinus meningiomas

The management of intracavernous meningiomas remains controversial. The variety of methods of treatment reflects the difficulty of treating primary meningiomas of the cavernous sinus. Twelve personal cases and a review of the literature permit a choice between a direct surgical approach with or without radiotherapy, only radiation therapy or with no therapy. We think therefore that meningiomas of the cavernous sinus should nowadays be the subject of a surgical biopsy followed by radiotherapy according to their grading.

Acute spinal epidural abscess

An anterolateral cervical epidural abscess occurred in the course of a septicaemia caused by Staphylococcus aureus. Early diagnosis, before permanent neurological signs developed, was provided by CT scan without myelography. Total recovery occurred with antibiotic therapy alone.

Anti-PHF antibodies: an immunohistochemical marker of the lesions of the Alzheimer's disease. Characterization and comparison with Bodian's silver impregnation

An immune serum raised against paired helical filaments (PHF) was able to stain senils plaques (SP) and neurofibrillary tangles (NFT) specifically, the two characteristic lesions of the dementia of Alzheimer-type. This polyclonal antibody against PHF was characterized by immunochemistry and also compared with the classical Bodian silver staining. NFT and SP were observed where they were expected: in the fronto-temporal neo-cortex and hippocampus of Alzheimer-type patients, and also in hippocampus of non-demented elderly subjects. The pattern of SP visualized by the two methods was identical whereas NFT were not detected specifically by silver salts, specially in the nervous tissue where NFT were in discrete quantities. Since the preparation of the antigen is very easy and the resulting antibodies are specific, we conclude that this technique will be of considerable interest for routine neuropathological diagnosis. Finally, the properties of our anti-PHF antibody are compared with those reported in the literature. This antibody will probably be a good tool for the identification of the chemical nature of PHF components.

[Paravertebral ganglioneuroma in an adult. Discovery during a spinal attack revealing multiple sclerosis]

A paravertebral ganglioneuroma was discovered in a 25 year-old woman presenting a transverse spinal syndrome at the same level. Exeresis necessitated sacrifice of the ninth left intercostal artery, but paraplegia regressed completely under corticotherapy. Additional exploration and subsequent clinical evolution revealed multiple sclerosis, of which the pavaplegia had been a manifestation. The authors discuss ganglioneuroma in the adult, a rare tumour, and the possibility of a link with multiple sclerosis. The association seems fortuitous despite the fact that the tumour and the transverse myelitis occurred at the same level.

[Medullary compression due to vertebral angioma in pregnancy. A case treated by embolization]

A previously healthy 24 year old woman presented a progressive paraplegia during the third trimester of her second pregnancy. Partial improvement occurred after caesarian. The neuroradiological study revealed spinal cord compression by an extensive corporeo-pedicular angioma of the T2 vertebrae. Almost total recovery occurred after selective embolization. The occurrence of neurological complications of vertebral angiomas during pregnancy is rarely reported in the literature. Mechanisms of the spinal cord compression and their relations with the pregnancy are discussed and difficulties for diagnosis and treatment are emphasized. When technically possible, the embolization appears to be the most adapted treatment, especially for these extensive types of vertebral angioma.