Industrial and Agricultural Toxicants.

This article provides an overview of several agricultural and industrial toxicants that are most likely to be encountered by horses. Overviews include brief backgrounds of the agents in question, potential sources of intoxication, mechanisms of action, clinical signs, lesions, diagnostic considerations, and treatment options.

Provider Knowledge and Attitudes About Female Genital Mutilation/Cutting in Philadelphia.

BACKGROUND: Due to an increase in immigration from African countries, U.S. healthcare professionals are encountering women affected by Female Genital Mutilation/Cutting (FGM/C). Little formal education exists in medical, nursing or midwifery schools. Additionally, very few studies assess attitudes and knowledge of U.S. providers to care for these women. In order to eventually offer FGM/C-affected women informed and culturally competent care, assessments of provider readiness and attitudes must guide future educational efforts. METHODS: A voluntary survey was administered to healthcare providers prior to thirteen separate education sessions on FGM/C at Philadelphia institutions. RESULTS: Of the 229 surveys distributed, 227 were returned > 50% complete. 61.2% reported encountering FGM/C at least once in the past 5 years, yet 13.7% of participants reported receiving formal training in FGM/C; 77.5% felt unprepared and 47.1% uncomfortable serving patients with FGM/C. 34.1% of participants knew the matriarchal influence on the custom. The majority of providers accurately identified the short and long-term clinical consequences of FGM/C, but 67.7% of participants denied familiarity with laws regarding FGM/C. Attitude assessment revealed beliefs that all types of FGM/C are harmful and a practice rooted in tradition. DISCUSSION: While most providers reported encountering patients with FGM/C, lack of formal training leaves them unprepared and uncomfortable serving them. Results demonstrate misunderstanding of the tradition and motives of FGM/C. Our findings support the need for expansion of provider education to provide culturally competent care for women affected by FGM/C.

Implementing Couple's Human Immunodeficiency Virus Testing and Counseling in the Antenatal Care Setting.

OBJECTIVE: To describe a pilot implementation of couple's human immunodeficiency virus (HIV) testing and counseling in an antenatal care clinic in the United States. METHODS: We used a cross-sectional study design. Couples were recruited from an antenatal care clinic of a large, urban, tertiary medical center, and were eligible if both partners agreed to receive HIV test results together and reported no coercion to participate in testing and counseling and no intimate partner violence. We assessed relationship characteristics, HIV risk-related behaviors and concordance of couples' sexual agreement (ie, mutual agreement about sexual risk behaviors that are permissible within or outside of their relationship). Acceptability of couple's HIV testing and counseling (ie, format, quality of the sessions, ability to meet their needs) was assessed after completing the session. Barriers and facilitators to couple's HIV testing and counseling were assessed at the individual-level among decliners and participants and at the clinic-level among members of the care team. RESULTS: Dyadic data were collected from 82 individuals (41 couples). Most partners (n=56, 68%) did not have a sexual agreement or had differing expectations about their sexual agreement. Partners with a concordant sexual agreement (n=26) felt more confident working with their partners on condom use when having sex outside of their relationship (P=.008) and were more likely to agree with their partner to get tested regularly for HIV or sexually transmitted infections (P=.015). Acceptability was high, with a rating of 93 or more (out of 100) among all items. Individual-level barriers to couple's HIV testing and counseling included difficulty bringing the male partner for counseling and a perception by either member of the couple that they were at low-risk for HIV. At the clinic level, need for training, staff turnover, and integration of couple's HIV testing and counseling in the clinic flow presented as barriers, whereas commitment by the clinic leadership facilitated the couple's HIV testing and counseling program. CONCLUSION: Despite barriers, couple's HIV testing and counseling can be implemented in antenatal clinics and is a highly acceptable method of HIV testing.

Protocol for evaluating women with female genital mutilation seeking asylum.

Rapid immigration from countries that practice female genital mutilation/cutting (FGM/C) has introduced new populations requiring culturally sensitive health care. Clinicians play an important role in providing documentation and expert testimony for women seeking asylum on the basis on FGM/C. The intent of this paper is to provide instruction to providers aiming to evaluate an individual seeking asylum based on FGM/C. This document provides guidance about the three primary parts of evaluation: the interview, exam, and report. Other goals of investigation include preventing and ending suffering, compensation, and psychological or physical rehabilitation.