Oral health in an urban slum, Nigeria: residents' perceptions, practices and care-seeking experiences.

BACKGROUND/INTRODUCTION: One of the key recommendations for the new WHO global strategy for oral health is inclusion of disadvantaged populations and their engagement in policy dialogues such that their needs and views are addressed in policy decisions. OBJECTIVES: This study explored oral health perceptions, practices and care-seeking experiences of slum residents in Ibadan, Nigeria. METHOD: Focus group discussions (FGD) were conducted with family health-decision makers in an urban slum site. Oral health perceptions, practices, and care-seeking experiences were discussed. FGDs were recorded, transcribed, and translated. ATLAS.ti qualitative research software was deployed for analysis using thematic analysis. RESULTS: Six FGD sessions, divided by gender and age, were conducted between September-October 2019, (N = total 58 participants, aged 25 to 59 years). Common dental ailments mentioned were dental pain, tooth sensitivity, bleeding gums, tooth decay, mouth odor, gum disease, and tooth fracture. Perceived causes of dental conditions included poor dental hygiene and habits, sugary diets, ignorance, and supernatural forces. Mouth cleaning was mostly done once daily using toothbrush and paste. Other cleaning tools were ground glass, wood ash, charcoal, "epa Ijebu" (a dentrifice), and "orin ata" (a type of chewing stick). Remedies for relieving dental pain included over-the-counter medicines, warm salted water, gin, tobacco (snuff/powdered), cow urine/dung, battery fluid, and various mixtures/ concoctions. Visits to the dentists were mentioned by a few but this was usually as last resort. Main barriers to accessing care from dental care facilities were unaffordability of service charges and fear of extreme treatment measures (extraction). Suggested measures to improve timely access to dental health care included reducing/subsidizing costs of treatments and medications, offering non-extraction treatment options, and oral health education programmes. CONCLUSION: The slum residents experience various forms of dental ailments mostly pain-related. The residents perceived formal dental clinics as unaffordable, thereby engaging in self-care remedies and harmful oral health practices before seeking professional help. Policymakers and decision-makers may leverage this empirical evidence for the people's education on early dental care and address challenges to affordable, available, and acceptable oral healthcare services among slum residents to improve access to care facilities.

Secondhand smoke exposure and dyslipidemia among non-smoking adults in the United States.

Dyslipidemia is a major public health challenge worldwide and whether secondhand smoke exposure (SHSE) is associated with dyslipidemia is yet to be understood. This study evaluated the relationship between SHSE and odds of dyslipidemia among adults in the United States. We identified 3064 adults who had never smoked in the 2015-2016 National Health and Nutrition Examination Survey and estimated the odds ratio and 95% confidence interval for the relationship between SHSE and odds of dyslipidemia using a multivariable adjusted-logistic regression at a two-sided p < 0.05. Overall, the mean age of respondents was 46.4 ± 18.0 years, 59.6% had dyslipidemia and 36.2% had SHSE. The odds of dyslipidemia among individuals with SHSE were 1.148 (1.147, 1.149) in the overall sample, 1.214 (1.214, 1.215) among women and 1.165 (1.163, 1.167) among men. The odds trended similarly independent of age groups: 1.130 (1.129, 1.131) for young adults (<60 years) and 1.304 (1.300, 1.308) for old adults (≥60 years). SHSE was associated with higher odds of dyslipidemia with higher odds among women and old adults. Primary intervention(s) targeted at reducing SHSE may show benefits in reducing the odds of dyslipidemia, and longitudinal studies would be necessary to clarify the association between SHSE and dyslipidemia.

Household air pollution, ultrasound measurement, fetal biometric parameters and intrauterine growth restriction.

BACKGROUND: Low birthweight, intrauterine growth restriction (IUGR) and perinatal mortality have been associated with air pollution. However, intervention studies that use ultrasound measurements to assess the effects of household air pollution (HAP) on fetal biometric parameters (FBP) are rare. We investigated the effect of a cookstove intervention on FBP and IUGR in a randomized controlled trial (RCT) cohort of HAP-exposed pregnant Nigerian women. METHODS: We recruited 324 women early in the second trimester of pregnancy. Between 16 and 18 weeks, we randomized them to either continue cooking with firewood/kerosene (control group) or receive a CleanCook stove and ethanol fuel (intervention group). We measured fetal biparietal diameter (BPD), head circumference (HC), femur length (FL), abdominal circumference (AC) and ultrasound-estimated fetal weight (U-EFW) in the second and third trimesters. The women were clinically followed up at six regular time points during their pregnancies. Once during the women's second trimester and once during the third, we made 72-h continuous measurements of their personal exposures to particulate matter having aerodynamic diameter < 2.5 µm (PM2.5). We adopted a modified intent-to-treat approach for the analysis. Differences between the intervention and control groups on impact of HAP on fetal growth trajectories were analyzed using mixed effects regression models. RESULTS: There were no significant differences in fetal growth trajectories between the intervention and control groups. CONCLUSIONS: Larger studies in a setting of low ambient air pollution are required to further investigate the effect of transitioning to a cleaner fuel such as ethanol on intrauterine growth. TRIAL REGISTRATION: ClinicalTrials.gov NCT02394574 ; September 2012.

Parenting styles and socio-demographic dynamics associated with mental health of in-school adolescents in Ibadan, south-west Nigeria.

Background: Positive parenting and enabling socio-demography, engenders good conduct in adolescence. Balanced parental demandingness and emotional responsiveness, deployed by authoritative parents, supports adolescents' mental health. Parental emotional responsiveness deters peer-pressured risky behaviours; while parental negligence, permissiveness, or demandingness encourages mental health problems. This is especially in the context of unfavourable socio-demographic setting. Aim: We aimed to evaluate parenting styles and socio-demographic factors associated with adolescents' mental health. Method: A cross-sectional multistage study was conducted with 286 in-school adolescents in Ibadan, Nigeria. Data were collected with questionnaires. The questionnaires evaluated socio-demography, mental health, and perceived parenting styles using the Strength and Difficulty Questionnaire (SDQ) and Scale of Parenting Styles (SPS) questionnaires. Data analysis was conducted using SPSS 21. Results: Some of the adolescents in this study, experienced peer problems (4.9%), conduct problems (9.4%), hyperactivity problems (0.7%), emotional problems (14.3%), and they lacked pro-social behaviours (11.1%). In comparison to adolescents who perceived fathers as authoritative, adolescents who perceived fathers as less demanding experienced emotional (p = 0.01) and peer (p = 0.02) problems. Perceived maternal negligence and authoritarian parenting was associated with more peer problems (1.5±2.3 and 1.3±2.2) in comparison to perceived maternal authoritative style (0.6±1.5). Most adolescents from lower social class experienced conduct (88.8%; p = 0.07) and emotional problems (73.2%; p = 0.20). Conclusion: Competent parenting style and socio-economic resources supports resilience to mental health problems in adolescents.

Breast Cancer Genetics Knowledge and Testing Intentions among Nigerian Professional Women.

Genetic testing services for breast cancer are well established in developed countries compared to African populations that bear a disproportionate burden of breast cancer (BC). The objective of this study is to examine the knowledge of professional Nigerian women about BC genetics and their intentions to utilize genetic testing services when it is made available in Nigeria. In this study, 165 lecturers and 189 bankers were recruited and studied using a validated self-administered questionnaire. The respondents' mean age was 34.9 years (SD = 10.9), 6.5% had family history of BC, and 84.7% had limited knowledge of breast cancer genetics. The proportion of women with genetic testing intentions for breast cancer was 87.3%. Health care access (OR = 2.35, 95% CI, 1.07-5.13), religion (OR = 3.51, 95% CI, 1.03-11.92), and perceived personal risk if a close relative had breast cancer (OR = 2.31, 95% CI, 1.05-5.08) independently predicted testing intentions. The genetic testing intentions for BC were high despite limited knowledge about breast cancer genetics. Promotion of BC genetics education as well as efforts to make BC genetic testing services available in Nigeria at reduced cost remains essential.

Anthropometric Analysis of the Nigerian Face: Any Conformity to the Neoclassical Canons?

This study defines the facial anthropometric and aesthetic measurements in young Nigerians. This is a prospective cohort study involving facial anthropometric measurement in young adults without craniofacial abnormalities. Ten anthropometric measurements (upper facial height (tr-n), mid-facial height (n-sn), lower facial height (sn-gn), height of auricle (sa-sba) bilaterally, intercanthal width (en-en), palpebral fissure width (en-ex) bilaterally, face width (zy-zy), nose width (al-al), mouth width (ch-ch) and the interincisal distance) were determined. Proportions were compared with neoclassic cannons, published North American and Asian norms 151 individuals consisting of 50 males and 51 females with age range from 16 to 31 (23.9 + 2.49) were enrolled. Only 1% of the study population had equal facial thirds, the midface was the shortest of the facial thirds and the male gender generally had larger mean values of the facial dimensions than the female gender. About half of the participants had the lower third > upper third > middle third, the intercanthal width was equal to the nasal width in only about a tenth of the participants and less than the nasal width in majority (88.1%) of the participants and the mean interincisal distance was 51.1 (SD ±â€Š6.997). The anthropometric measurements from this Nigerian study do not conform to the neoclassical cannons. Racially sensitive facial canons and measurements are advocated during reconstructive and aesthetic interventions in the craniofacial region.

Perception and Practice of HIV/AIDS Counseling and Testing Among Secondary School Adolescents in Ogun Waterside Local Government Area, Ogun State, Southwest Nigeria.

A large proportion of Nigerian adolescents are sexually active and the country has one of the highest HIV prevalence among youths globally. This study was done to assess the perception and practice of HIV/AIDS counseling and testing (HCT) among secondary school adolescents in a rural community in Southwest Nigeria. A cross-sectional descriptive study was carried out using multistage sampling method. The results showed that despite high level of HCT awareness, majority of the adolescents (62.9%) had negative attitude toward it. The practice of HCT was poor among majority of the respondents as less than 15% of the adolescents had ever done HCT. This study recommends that adolescents should be better informed on the locations of the health centers within the community and services rendered by them. Peer education on HCT should also be intensified in schools to promote positive healthy sexual lifestyles among adolescents.

Influence of Knowledge of Spousal Fertility Cycles on Male Reproductive Health Participation in Ibadan Metropolis, Nigeria.

In spite of the established roles and influence of men on women's uptake and utilization of reproductive health care interventions, the degree of involvement with intimate issues within the household which could help to understand male involvement and support remains an under-researched topic. The aim of this study was to investigate the degree of involvement at the family level of men within sub-urban communities of Ibadan in South-West Nigeria. A cross sectional survey design was conducted among 380 men selected from sub-urban communities in Ibadan, Oyo State using multi-stage sampling. Data was obtained using pre-tested, semi-structured, interviewer administered questionnaires. Data were analysed using descriptive statistics, bivariate analysis and logistic regression with level of significance set at 5%. Mean age of respondents was 41.1 ± 7.6 years. Men who were knowledgeable of spouse's menstrual cycles and ovulation dates were significantly more likely to have supported some form of public health intervention before (p <0.001). Age over 30, above secondary education, and men aware of menstrual dates of spouse were significant predictors of reproductive health interventions. Men who were aware of menstrual cycles of spouse were 96.6% more likely to be supportive or involved in reproductive health matters compared to those who were not (OR =0.034; 95% CI = 0.02 - 0.07; p <0.001). Involvement of men at family level as demonstrated in this study serves to influence and explain the level of involvement with reproductive health. Further research investigating other proximal factors that influence male participation is recommended.

Comparative assessment of determinants of health-related quality of life in hypertensive patients and normal population in south-west Nigeria.

OBJECTIVE: Health-related quality of life (HRQOL) in hypertensive patients may be influenced by the presence and the knowledge of disease, beliefs associated with the disease, blood pressure (BP) control, and drug utilization. The impact of hypertension on HRQOL in hypertensive patients compared to the normal population has not been assessed in Nigeria, the most populous country in sub-Saharan Africa. This study compares HRQOL in hypertensive patients and the normal population; the effect of BP control and medication on HRQOL of hypertensive patients is also assessed. MATERIALS AND METHODS: A prospective cross-sectional study of 713 individuals, 606 were hypertensive patients attending the University College Hospital in Oyo State, Nigeria, while 107 were normal persons residing in Ibadan. Data on sociodemographic status, clinical variables, and drug utilization were collected. World health organization-quality of life short version (WHO-QOL-BREF) questionnaires were used to assess HRQOL of participants. RESULTS: Hypertensive patients had poorer HRQOL compared with normal individuals in the physical health (p<0.05), psychological (p<0.01), and total quality of life domains. Blood pressure control had no effect on HRQOL in domain (p>0.05). Drug use significantly worsened HRQOL of hypertensive patients in the psychological (p˂0.01), social relationship (p<0.01), and the total quality of life domains (p<0.01). Multiple regression analysis showed that while income per month was positively predictive of physical, psychological, and total quality of life domains (r2=1.988, p=0.001; r2=3.710, p<0.001; r2=2.748, p<0.001), symptom count was negatively predictive of the same (r2=-0.746, p=0.005; r2=1.869, p<0.001; and r2=-1.094; p<0.001), respectively. Reduced symptoms and higher income improved quality of life in hypertensive patients. CONCLUSION: The presence of hypertension and antihypertensive medication reduced HRQOL of hypertensive patients, although BP control surprisingly did not impact HRQOL. However, lower symptom count and higher income improved quality of life.

Perception of Genetic Testing for Deafness and Factors Associated with Interest in Genetic Testing Among Deaf People in a Selected Population in Sub-Saharan Africa.

Understanding the perceptions of genetic testing by members of the deaf community may help in planning deafness genetics research, especially so in the context of strong adherence to cultural values as found among native Africans. Among Yorubas in Nigeria, deafness is perceived to be caused by some offensive actions of the mother during pregnancy, spiritual attack, and childhood infections. We studied attitudes towards, and acceptance of genetic testing by the deaf community in Nigeria. Structured questionnaires were administered to individuals sampled from the Vocational Training Centre for the Deaf, the religious Community, and government schools, among others. The main survey items elicited information about the community in which the deaf people participate, their awareness of genetic testing, whether or not they view genetic testing as acceptable, and their understanding of the purpose of genetic testing. There were 150 deaf participants (61.3 % males, 38.7 % females) with mean age of 26.7 years ±9.8. A majority of survey respondents indicated they relate only with other members of the deaf community (78 %) and reported believing genetic testing does more good than harm (79.3 %); 57 % expressed interest in genetic testing. Interest in genetic testing for deafness or in genetic testing in pregnancy was not related to whether respondents relate primarily to the deaf or to the hearing community. However, a significantly higher number of male respondents and respondents with low education reported interest in genetic testing.

Willingness of reproductive-aged women in a Nigerian community to accept human papillomavirus vaccination for their children.

AIM: The aim of this study was to determine the willingness of reproductive-aged women in a Nigerian community to allow human papillomavirus (HPV) vaccination in their children and the associated factors with this decision. MATERIAL AND METHODS: A multistage household survey of 1002 women who participated in the HPV Vaccine and Cervical Cancer Prevention Survey from 26 August to 29 September 2012 at Ibadan North Local Government Area, Mokola Ibadan, Nigeria. Descriptive, bivariate and multivariable analyses were performed, and statistical significance was set at 95% confidence level (CI). RESULTS: There was high willingness (88.6%) to vaccinate, and this attitude was associated with previous history of genital discharge or sores (adjusted odds ratio, 1.91; 95%CI, 1.05-3.45), and knowledge that cervical cancer is preventable (adjusted odds ratio, 1.67; 95%CI, 1.07-2.59). On the likely acceptability of Nigerian HPV vaccine policy, about two-thirds strongly agreed to its incorporation into the routine immunization program (66.9%), it being free (66.7%) and mandatory (64.3%), amongst other factors. The commonest concerns raised were cost/expenses (10.2%), that it might encourage promiscuity (9.9%), or stimulate early sexual debut (6.7%), and fear of infertility (6.3%). CONCLUSION: This study found that the majority of Nigerian women are willing to vaccinate their children against HPV infection and would prefer free universal HPV vaccination with regulation to ensure better uptake. The concerns expressed would need to be addressed by policy-makers to increase its acceptability.

Transcranial Doppler ultrasonography in children with sickle cell anemia: Clinical and laboratory correlates for elevated blood flow velocities.

BACKGROUND: Transcranial Doppler (TCD) sonography of major cerebral arteries is now recommended for routine screening for stroke risk in children with sickle cell disease (SCD). METHODS: We performed TCD studies on children with sickle cell anemia (SCA) seen at the pediatric hematology clinic over a period of 2 years. TCD scans were repeated yearly in children with normal flow velocities and every 3 months in children with elevated velocities. Findings were correlated with clinical variables, hematologic indices, and arterial oxygen saturation. Predictors of elevated velocities were identified by multiple linear regressions. RESULTS: We enrolled 237 children and performed a total of 526 TCD examinations. Highest time-averaged maximum flow velocities were ≥170 cm/s in 72 (30.3%) cases and ≥200 cm/s in 20 (8.4%). Young age, low hematocrit, low hemoglobin, and arterial oxygen desaturation <95% showed significant correlations with presence of increased cerebral flow velocities. CONCLUSIONS: Low hematocrit, low hemoglobin concentration, young age, and low arterial oxygen desaturation predicted elevated cerebral blood flow velocities and, invariably, increased stroke risk, in children with SCA. Children who exhibit these features should be given high priority for TCD examination in the setting of limited resources.

The impact of a mental health teaching programme on rural and urban secondary school students' perceptions of mental illness in southwest Nigeria.

OBJECTIVE: Available evidence suggests that children hold negative views about mental illness. Studies show that it is possible for schools and mental health services to jointly undertake child and adolescent mental health promotion. This study aimed to assess the impact of a school based mental health awareness programme aimed at increasing mental health literacy and reducing negative views about persons with mental illness. METHODS: A total of 154 secondary school students in Ibadan, southwest Nigeria, were allocated into an intervention and a control group. Students in the intervention group received a three-hour mental health awareness session. All students completed a pre-, immediate post, and six month post-intervention questionnaire on their views about mental health and illness. RESULTS: There was a significant difference in the mean knowledge scores between the intervention and the control group post-intervention, but no significant differences in attitude and social distance scores. CONCLUSION: Brief training workshops appear able to produce small but positive changes in the mental health knowledge of young Nigerians.

Re-telling the story of aminoglycoside ototoxicity: tales from sub-Saharan Africa.

Background: Aminoglycosides, such as Streptomycin, are cheap, potent antibiotics widely used Sub-Saharan Africa. However, aminoglycosides are the commonest cause of ototoxicity. The limited prospective epidemiological studies on aminoglycoside ototoxicity from Sub-Saharan Africa motivated this study to provide epidemiological information on Streptomycin-induced ototoxicity, identify risk factors and predictors of ototoxicity. Method: A longitudinal study of 153 adults receiving Streptomycin-based anti-tuberculous drugs was done. All participants underwent extended frequency audiometry and had normal hearing thresholds at baseline. Hearing thresholds were assessed weekly for 2 months, then monthly for the subsequent 6 months. Ototoxicity was determined using the ASHA criteria. Descriptive statistics were used to analyze socio-demographic variables. Ototoxicity incidence rate was calculated, and Kaplan-Meier estimate used to determine cumulative probability of ototoxicity. Chi-square test was done to determine parameters associated with ototoxicity and Cox regression models were used to choose the predictors of ototoxicity. Results: Age of participants was 41.43 ± 12.66 years, with a male-to-female ratio of 1:0.6. Ototoxicity was found in 34.6% of the participants, giving an incidence of 17.26 per 1,000-person-week. The mean onset time to ototoxicity was 28.0 ± 0.47 weeks. By 28th week, risk of developing ototoxicity for respondents below 40 years of age was 0.29, and for those above 40 years was 0.77. At the end of the follow-up period, the overall probability of developing ototoxicity in the study population was 0.74. A significant difference in onset of ototoxicity was found between the age groups: the longest onset was seen in <40 years, followed by 40-49 years, and shortest onset in ≥50 years. Hazard of ototoxicity was significantly higher in participants aged ≥50 years compared to participants aged ≤40 years (HR = 3.76, 95% CI = 1.84-7.65). The probability of ototoxicity at 40 g, 60 g and 80 g cumulative dose of Streptomycin was 0.08, 0.43 and 2.34, respectively. Age and cumulative dose were significant predictors of ototoxicity. Conclusion: The mean onset time to Streptomycin-induced ototoxicity was 28 weeks after commencement of therapy. Age and cumulative dose can reliably predict the onset of Streptomycin-induced ototoxicity. Medium to long term monitoring of hearing is advised for patients on aminoglycoside therapy.

Implementing genetic testing in diabetes: Knowledge, perceptions of healthcare professionals, and barriers in a developing country.

INTRODUCTION: Maturity-Onset Diabetes of the Young (MODY) is an unusual type of diabetes often missed in clinical practice, especially in Africa. Treatment decisions for MODY depend on a precise diagnosis, only made by genetic testing. We aimed to determine MODY knowledge among Nigerian healthcare professionals (HCPs), their perceptions, and barriers to the implementation of genetic testing in diabetes patients. METHODS: A cross-sectional survey was conducted among doctors and nurses in three levels of public and private healthcare institutions in Ibadan, Nigeria, from December 2018 to June 2019. In all, 70% and 30% of a total 415 participants were recruited from public and private centers, respectively. HCPs were recruited in a 60:40% ratio, respectively. A 51-item instrument was used to assess MODY knowledge, perceptions of HCPs, and barriers to the implementation of genetic testing in diabetes patients. RESULTS: In the survey, 43.4% self-rated their current MODY knowledge to be at least moderate. About 68%, 73% and 86%, respectively, correctly answered 3 of 5 questions on basic genetics' knowledge. However, only 1 of 7 MODY-specific questions was answered correctly by 72.7% of the respondents. The mean basic genetics and MODY-specific knowledge scores were 2.6/5 (SD=1.0) and 1.8/9 (SD=1.3), respectively. Multiple linear regression showed higher mean scores among those aged 30-49 years, those with degrees and fellowships (except PhD), and general practitioners; 360 (80.0%) perceived that genetic testing plays a central role in diabetes care. Barriers to genetic testing were lack of access to testing facilities, guidance on the use of and updates/educational materials on genetic testing (82.7%, 62.1% and 50.3%, respectively). CONCLUSIONS: The level of MODY awareness and knowledge among Nigerian HCPs is unacceptably low with a lack of access to genetic testing facilities. These can hinder the implementation of precision diabetes medicine. Increased awareness, provision of decision support aids, and genetic testing facilities are urgently needed.

Level of awareness of mammography among women attending outpatient clinics in a teaching hospital in Ibadan, South-West Nigeria.

BACKGROUND: Mammography has been used in developed countries with considerable success but very little is known about this imaging modality in low resource settings. This study examined the level of awareness of mammography and determined factors influencing the level of awareness. METHODS: We conducted a hospital based cross sectional study to investigate the level of awareness of mammography among 818 randomly selected women attending the General Outpatient clinics (GOP) of the University College Hospital (UCH), Ibadan, Nigeria. Independent predictors of level of awareness of mammography were identified using multiple logistic regression analysis. RESULTS: The proportion of women who ever heard of mammography was 5%, and they demonstrated poor knowledge of the procedure. Those with primary or secondary levels of education were about three times less likely to be aware of mammography when compared with those with tertiary level of education (OR = 0.3, 95% CI, 0.12 - 0.73). Also, participation in community breast cancer prevention activities (OR = 3.4, 95% CI, 1.39 - 8.36), and previous clinical breast examination (OR = 2.34, 95% CI, 1.10 - 4.96) independently predicted mammography awareness. Newspapers and magazines appeared to be the most important sources of information about mammography screening. CONCLUSION: The level of awareness of mammography is poor among women attending outpatient clinics in the studied population. Interventions promoting awareness of this screening procedure should give particular attention to the illiterate and older women while clinicians performing breast examinations should utilize the opportunity to inform women about the mammography procedure. Promotion of educational articles on breast cancer and its screening methods via media remains vital for the literate.

Knowledge of the human papilloma virus vaccines, and opinions of gynaecologists on its implementation in Nigeria.

The objective of this study was to determine the knowledge and perception of Nigerian Obstetricians and Gynaecologists towards human papilloma virus vaccine use in Nigeria. A cross sectional study was conducted amongst participants that attended the 42nd Society of Gynaecology and Obstetrics of Nigeria. The findings revealed that 44.5% knew the correct HPV vaccine schedule. Regarding implementation in Nigeria, 87.4% suggested its incorporation into the national immunization program and about a third agreed that it should be a precondition for school enrolment. Regression analysis showed that senior residents were more likely to have adequate knowledge of the vaccine compared to junior residents (AOR 7.181 95% CI OR = 1.792 - 28.782). We conclude that the knowledge of eligibility and schedule is poor. It is recommended that adequate information should be provided to this group of health workers because of their strategic position in its implementation in Nigeria.

Breastfeeding and Mammographic Breast Density: A Cross-sectional Study.

Breastfeeding is inversely associated with breast cancer risk but the associations of breastfeeding with mammographic breast density (MBD) are not clear. We investigated the association between breastfeeding and volumetric measures of MBD [volumetric percent density (VPD), dense volume (DV), and non-dense volume (NDV)] and evaluated whether it differs by race, menopausal status, and body mass index (BMI). The study population was comprised of 964 women (67% non-Hispanic White, 29% non-Hispanic Black) who had screening mammography at Washington University School of Medicine, St. Louis, MO. VPD, DV and NDV were log10 transformed. We performed multivariable linear regression models adjusted for age, BMI, family history of breast cancer, race, and age at menarche among all participants and exclusively in parous women. Mean age was 50.7 years. VPD was 12% lower among women who breastfed 0-6 months, [10ß = 0.88, 95% confidence interval (CI; 0.79-0.98)] compared with nulliparous women. Breastfeeding was not associated with VPD among women who breastfed >7 months. Breastfeeding was inversely associated with DV [parous never breastfed: 10ß = 0.93; 95% CI (0.83-1.04), breastfed 0-6 months: 10ß = 0.91, 95% CI (0.79-1.05), breastfed 7-12 months: 10ß = 0.94; 95% CI (0.81-1.10), breastfed >12 months: 10ß = 0.87, 95% CI (0.78-0.98), Ptrend = 0.03]. BMI modified the association between breastfeeding and VPD. Women who breastfed for 0-6 months and had a BMI < 25 kg/m2 had lower VPD compared with nulliparous women, but among women with a BMI ≥ 25 kg/m2 there was no association (Pinteraction = 0.04). In this diverse study population, the association of breastfeeding with VPD appears to be modified by BMI, but not by race or menopausal status. Future research exploring the associations of breastfeeding with other mammographic features are needed. PREVENTION RELEVANCE: Breastfeeding for up to 6 months may be associated with lower VPD among women with a BMI < 25 kg/m2. The potential role of MBD in mediating the associations of breastfeeding with breast cancer risk in a select group of women deserves further evaluation. See related Spotlight, p. 309.

Unawareness of breast cancer family history among African women.

Introduction: comprehensive cancer risk assessment services are lacking in most sub-Saharan African countries and the use of accurate family history (FH) information could serve as a cheap strategy for risk evaluation. The aim of this study is to determine the proportion of women unaware of family history of cancer among female relatives and associated socio-demographic characteristics. Methods: using case-control data on breast cancer among 4294 women in Nigeria, Uganda and Cameroon, we investigated the proportion of women unaware of family history of cancer among their female relatives. The association between participants' response to their awareness of female relatives' cancer history and socio-demographic characteristics was analysed according to case-control status, family side and distance of relation. Results: the proportion of women unaware if any relative had cancer was 33%, and was significantly higher among controls (43.2%) compared to 23.9% among cases (p<0.001) (Adjusted Odds Ratio (OR) = 2.51, 95% CI = 2.14 - 2.95). Age, education and marital status remained significantly associated with being unaware of FH among controls on multiple regression. Conclusion: about a third of women interviewed did not know about cancer history in at least one of their female relatives. Efforts aimed at improving cancer awareness in sub-Saharan Africa (SSA) are needed. Our findings could be useful for future studies of cancer risk assessment in SSA.

Incidence of CD19-negative relapse after CD19-targeted immunotherapy in R/R BCP acute lymphoblastic leukemia: a review.

There are inconsistencies in the reporting of CD19 antigen status following treatment with CD19-targeted therapies. A majority of evidence comes from studies reporting small sample sizes. In this review, we systematically summarize published studies that have reported rates of CD19-negative relapse after treatment with either blinatumomab or CD19-directed CAR T-cell therapy and report the rates of CD19-negative relapse when evaluated in a standardized way across trials. CD19-negative relapse appears to occur more commonly in relapses following CAR T-cell therapy compared with blinatumomab, whether proportions are calculated among all treated patients (8.7% vs 4.5%) or among patients who relapse (30% vs 22.5%). The median (range) duration of follow-up was 29.3 (17.4-50.8) and 20.4 (6.9-49.0) months for publications on blinatumomab (n = 10) and CAR T-cell therapies (n = 23), respectively. There is a need for standardized reporting of CD19 antigen status in the setting of relapse following novel immunotherapies to inform clinical practice.