Centering disability visibility in reproductive health care: Dismantling barriers to achieve reproductive equity.

Access to comprehensive and culturally competent reproductive health care is essential for individuals and communities to realize and achieve health and well-being, as one prefers. The disability community represents a diverse group of individuals with a wide spectrum of functional, physical, sensory, and/or neurodivergent abilities. Existing barriers to reproductive health care are a consequence of environmental and attitudinal barriers, not from the disabilities themselves. People with disabilities are also not frequently centered or included in discussions surrounding reproductive rights. This article reviews the intersection of the Disability Justice Movement and the history of discrimination in the United States against people with disabilities with a particular focus on reproductive oppression. We discuss the mechanisms of inequity and barriers to health care, including financial barriers, inaccessible medical facilities, provider discrimination and competency, and guardianship; as well as the importance of open access to contraception, menstrual health, and abortion for people with disabilities. Finally, we explore the intersection of the Disability Justice Movement and the Reproductive Justice Movement to better promote reproductive autonomy.

Speech Perception Ability in Noise is Correlated with Auditory Brainstem Response Wave I Amplitude.

BACKGROUND: Difficulty understanding speech in background noise is a common complaint of individuals with sensorineural hearing loss. Recent animal studies suggest this difficulty may be due, in part, to spiral ganglion cell degeneration related to aging or noise exposure. Although auditory brainstem response (ABR) thresholds and standard clinical audiometric tests are minimally affected by neuronal degeneration, the amplitude of wave I of the ABR is correlated to spiral ganglion cell density. PURPOSE: This study hypothesized that wave I amplitude was correlated to speech-in-noise performance. To test this, the relationships between wave I amplitude, age, and speech perception ability were analyzed in human participants. RESEARCH DESIGN: This is a correlational study. STUDY SAMPLE: A total of 101 ears from 57 adults ranging in age from 19 to 90 yr with a pure-tone average of 45 dB HL or better were examined in this study. Only individuals with no history of neurological disease and ears without any evidence of conductive involvement were included. DATA COLLECTION AND ANALYSIS: Speech perception was measured in quiet using NU-6 word lists and in background noise using the QuickSIN. Ear canal electrodes were used to obtain ABR waveforms from each ear and the amplitude of wave I was measured as the absolute difference in voltage between the peak of the wave and the following trough. Speech perception performance in quiet and in background noise were both modeled using a linear mixed model with the covariates age, four-frequency pure-tone average (4fPTA), wave I amplitude, and the interaction between 4fPTA and wave I amplitude. ABR wave I amplitudes were modeled using a linear mixed model with age and 4fPTA as the covariates. The correlation between the right and left ears of the same participant were modeled using random effects. RESULTS: The results indicate that reduced ABR wave I amplitudes are (1) related to increased age, (2) associated with decreased speech-in-noise performance, with the greatest effects in individuals with poorer pure-tone thresholds, and (3) not correlated to speech perception in quiet. CONCLUSIONS: Reduced ABR wave I amplitude, an indicator of cochlear neuronal degeneration, is associated with decreased speech perception ability in noise, with a more pronounced effect in ears with poorer pure-tone thresholds, but does not appear to contribute to decreased speech perception in quiet.

Endoscopic sublabial transmaxillary approach to the rostral middle fossa.

OBJECTIVE: The rostral middle fossa faces the temporal pole and is the endocranial anterosuperior aspect of the greater wing of the sphenoid. Standard approaches to this region, such as the subtemporal, pterional, or orbitozygomatic approaches, require significant brain retraction or manipulation of the temporalis muscle. We report an endoscopic sublabial transmaxillary approach to this cranial base region that avoids the aforementioned pitfalls. METHODS: Ten adult cadaveric half heads were used to develop the endoscopic approach and to identify the salient surgical landmarks. RESULTS: The approach was divided into three stages: entry into the maxillary sinus, entry into the infratemporal fossa, and entry into the middle fossa. A craniotomy of greater than 20 mm in diameter can be safely created in the rostral middle fossa. When coupled with image guidance, the approach provides the flexibility to tailor the size and location of the middle fossa craniotomy. CONCLUSION: Although endonasal endoscopic approaches are increasing in popularity, the middle fossa has not been adequately accessed with these techniques. The endoscopic sublabial transmaxillary approach provides safe and direct access to the rostral middle fossa, eliminating the need for brain retraction, temporalis muscle manipulation, or an external incision. The approach also permits early devascularization of cranial- or dural-based lesions.