The rate of HIV infection among African Americans is disproportionately higher than for other racial groups in the United States. Previous research suggests that low level of health literacy (HL) is an underlying factor to explain racial disparities in the prevalence and incidence of HIV/AIDS. The present research describes a community and university project to develop a culturally tailored HIV/AIDS HL toolkit in the African American community. Paulo Freire's pedagogical philosophy and problem-posing methodology served as the guiding framework throughout the development process. Developing the HIV/AIDS HL toolkit occurred in a two-stage process. In Stage 1, a nonprofit organization and research team established a collaborative partnership to develop a culturally tailored HIV/AIDS HL toolkit. In Stage 2, African American community members participated in focus groups conducted as Freirian cultural circles to further refine the HIV/AIDS HL toolkit. In both stages, problem posing engaged participants' knowledge, experiences, and concerns to evaluate a working draft toolkit. The discussion and implications highlight how Freire's pedagogical philosophy and methodology enhances the development of culturally tailored health information.
Review of the English orthopaedic literature reveals no prior report of endoscopic repair of rectus abdominis tears and/or prepubic aponeurosis detachment. This technical report describes endoscopic reattachment of an avulsed prepubic aponeurosis and endoscopic repair of a vertical rectus abdominis tear immediately after endoscopic pubic symphysectomy for coexistent recalcitrant osteitis pubis as a single-stage outpatient surgery. Endoscopic rectus abdominis repair and prepubic aponeurosis repair are feasible surgeries that complement endoscopic pubic symphysectomy for patients with concurrent osteitis pubis and expand the less invasive options for patients with athletic pubalgia.O steitis pubis is a form of athletic pubalgia, and a recent study found a high prevalence in professional football players. 1 It is associated with femoroacetabular impingement and may be caused by transfer stress from constrained range of motion in one or both hips. 2 Endoscopic pubic symphysectomy has been found to be a safe and promising, less-invasive option to open pubic symphysis curettage. 3 Athletic pubalgia may also involve tears of the adductor and/or rectus abdominis tendons. Although open repair has been done, to our knowledge there is no previously published case of endoscopic repairs of the rectus tendon and the prepubic aponeurosis. The purpose of this technical report is to describe the endoscopic techniques used to perform endoscopic rectus abdominis and prepubic aponeurosis repairs after concurrent endoscopic pubic symphysectomy. TechniqueWe describe our techniques for endoscopic pubic aponeurosis reattachment and rectus abdominis repair after endoscopic pubic symphysectomy for the treatment of recalcitrant osteitis pubis and athletic pubalgia. Preoperative radiographs revealed sclerotic bony hypertrophy at the pubic symphysis and a healed right pubic stress fracture (Fig 1), and magnetic resonance imaging revealed detachment of the prepubic aponeurosis from the pubic tubercle (Fig 2) and a tear of the rectus abdominis (Fig 3).The patient was placed in a supine lithotomy position using gynecologic stirrups without traction (Figs 4 and 5). A Foley catheter was used to decompress the adjacent bladder. Endoscopic pubic symphysectomy was performed using our previously described technique, 4,5 first localizing the pubic symphysis under AP pelvic fluoroscopic guidance and marking the midpoint with a 22-gauge needle. The anterior portal was established as the initial viewing portal with the 30 standard arthroscope at a low pump pressure of 40 mm Hg. The suprapubic portal was established and a switching stick was used to locate the previously placed 22-guage needle tip in the pubic symphysis (Fig 6). The overlying bursal tissue was resected with a motorized shaver and radiofrequency ablator (Arthrocare; Smith & Nephew, Andover, MA) followed by incremental resection of the pubic symphysis beginning from anterosuperior to posteroinferior. Initial resection was performed with a 5.5-mm round burr, followed by deeper res...
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