What can be done to encourage women from Black, Asian and minority ethnic backgrounds to attend breast screening? A qualitative synthesis of barriers and facilitators.

OBJECTIVE: The objective of the study is to identify the barriers to UK Black, Asian and Minority Ethnic (BAME) women attending breast screening and subsequently, support the growing evidence base providing solutions to the public health problem of ethnic variation within screening attendance. STUDY DESIGN: A systematic review and thematic analysis of UK-based, qualitative studies concerning BAME women. METHODS: The methodology of this review is based on Cochrane guidelines. A search strategy was applied to Embase, PubMed and Medline. Predefined inclusion and exclusion criteria yielded 8 final articles which were appraised and thematically analysed. RESULTS: The main findings of the review revealed three overarching themes: knowledge-related, access-related and cultural-related factors. The emphasis of the importance of knowledge was highlighted by all studies identifying a lack of knowledge as a key barrier to screening attendance. CONCLUSIONS: BAME women have disproportionally lower breast screening attendance and a lack of knowledge is an essential barrier to overcome when addressing this health inequality.

The benefits of dual-consultant operating in complex breast reconstruction: A retrospective cohort comparison study.

BACKGROUND: Dual-consultant operating (DCO) has been introduced in a multitude of surgical specialities. This retrospective cohort comparison study seeks to delineate any benefits DCO may confer on list utilisation, patient safety and training opportunities. METHODS: A retrospective cohort comparison of all free-flap breast reconstruction cases conducted at a single centre by five consultant plastic surgeons in the period May 2016-May 2020. RESULTS: A total of 281 patient records were used for analysis; 146 cases were dual consultants compared with 135 single consultants, representing 186 and 158 free flaps, respectively. Patient demographics were near identical in terms of patient age, BMI and ASA grade. Operating times were significantly reduced for both unilateral (mean reduction 59.49 min) and bilateral cases (mean reduction 38.14 min) with the presence of dual consultants. The mean length of stay for dual-consultant cases was on average 0.35 days less than for single consultant cases (p = 0.04). Dual-consultant case complications were less severe than those of single consultant cases (mean Clavien-Dindo severity 1.35 vs 0.96, p = 0.05). The rates of trainee one-to-one consultant training were increased in dual-consultant cases when preparing vessels (0.08 vs 0.35, p=<0.01) and performing anastomosis (0.63 vs 0.77, p = 0.03). CONCLUSIONS: DCO for complex breast reconstruction confers significant benefits to operating time, list utility and patient safety whilst protecting training opportunities for trainees. Plastic surgery departments looking to redesign services in the post-SARS-CoV-19 era should consider its adoption into their enhanced recovery protocols.

Partial repigmentation of a vitiliginous nipple areolar complex following therapeutic mammoplasty.

We discuss the unusual repigmentation of a vitiliginous region of a nipple areolar complex following a therapeutic mammoplasty. We consider the autoimmune mechanisms behind the pathogenesis of vitiligo and their potential interplay with the immunological pathways involved in this patient's breast cancer and ultimately in the postoperative recovery period. This case highlights the potential interconnecting thread of immunological disruptions, which may provide a springboard for further discussion around the treatment for vitiligo. It also provides a useful point of note when counselling darker skin patients around scarring when undergoing surgical interventions.

An unusual "venous circle" of the internal mammary vein encountered during microvascular anastomosis and implications for practice.

The internal mammary vessels are commonly used for anastomosis in breast reconstruction. The anatomy when using the 2nd ICS has been shown to be predictable and hence preferentially used by the senior author. We present an unusual case of internal mammary vein bifurcation and immediate confluence forming a 'venous circle'.

Spontaneous regression of subcutaneous in-transit malignant melanoma deposits of the lower leg after treatment with the carbon dioxide laser.

Primary malignant melanoma (MM) is one of the few cancers that can show spontaneous regression, and although this is well described, the mechanisms behind this are unclear. Spontaneous regression of secondary metastatic deposits of melanoma is rare and there are only a handful of case reports supporting this phenomenon. We report a patient with in-transit MM metastatic disease of the leg, who underwent carbon dioxide (CO(2)) laser ablation, and subsequently developed remission of untreated deposits. We discuss the possible immunological mechanism for this phenomenon.

The ideal intercostal space for internal mammary vessel exposure during total rib-sparing microvascular breast reconstruction: A critical evaluation.

BACKGROUND: Total rib-preserving free flap breast reconstruction (RP-FFBR) using internal mammary vessel (IMV) recipients usually involves vessel exposure in the second or third intercostal spaces (ICS). Although the third one is more commonly used, no direct comparisons between the two have hitherto been performed. OBJECTIVES: To compare the in-vivo topography and vascular anatomy of second and third ICSs in patients undergoing FFBR using the rib-preservation technique of IMV exposure. METHODS: An analysis of prospectively collected data on intercostal space distance (ISD), number and arrangement of IMVs, location of venous confluence, and vessel exposure time was conducted on a single surgeon's consecutive RP-FFBRs. RESULTS: A total of 296 RP-FFBRs were performed in 246 consecutive patients. The second, third, or both second and third spaces were utilized in 282, 28, and 22 cases, respectively. The ISDs were 20.6 mm ±â€¯3.52 for the second ICS and 14.0 mm ± 4.35 for the third ICS (p<0.0001, CI = 5.17-7.97, t-test). The second versus third ICS vein content was as follows: single 81.4% vs. 74%, dual 18.6% vs. 26%, and confluence 3.7% vs. 13%. The second ICS single vein was medial to the artery in 92.6%. The third ICS single vein was medial to the artery in 88.2% Vessel exposure times for second (47.2 mins ±â€¯26.7) and third (46.5 mins ±â€¯31.4) spaces were similar (p = 0.93). The overall intraoperative anastomotic revision rate was 9.1%, and the postoperative flap re-exploration rate was 4.0%, with 99.7% overall flap success. DISCUSSION AND CONCLUSION: Preferential use of the second ICS is supported by its more predictable vascular anatomy, a broader space for performing the microanastomoses and a higher frequency of a single postconfluence (and thus larger) vein facilitating the microsurgery.

Spectrophotometric intracutaneous analysis for the assessment of burn wounds: A service evaluation of its clinical application in 50 burn wounds.

INTRODUCTION: The assessment of burn depth can be challenging even to the experienced burn clinician. Clinical assessment is most widely used to determine burn depth. Because of this subjective nature, various imaging modalities have been invented. The use of photospectometry as a novel technique in burn wound depth analysis has been previously described but the literature is very limited. METHODOLOGY: We carried out a single blinded non-randomized comparative study of healing potential of 50 burn wounds between tissue spectrophotometry analysis versus clinical evaluation. RESULTS: ScanOSkin™ technology has an overall sensitivity of 75% and specificity of 86% in predicting healing potential of wounds. Analysis of Inter Rater Agreement (IRA) using Kappa calculations showed strengths of agreement varied from fair to moderate in perfusion and burn depth. IRA for assessing pigmentation however, was poor and this was reflected in user feedback. CONCLUSION: There is a potential role for ScanOSkin™ tissue spectrophotometric analysis in burn depth assessment. Future studies comparing several imaging modalities with ScanOSkin®, taking into account costs comparison may be useful for future health resources planning.

'Leopard skin' as a rapid diagnostic index for estimating the endemicity of African onchocerciasis.

A study was made in five rural districts of Kwara State, Nigeria to assess the possible use of 'leopard skin' (Ls) as a rapid diagnostic technique for estimating the endemicity of African onchocerciasis. The findings revealed that there is a positive association between the percentage of subjects with skin microfilariae (mf) and the percentage with Ls. The prevalence of Ls less than 1% suggests communities with sporadic infection, 1-6% suggests hypoendemic communities and greater than 6% suggests meso- or hyperendemic communities, using mf rates of less than 10%, 10-39%, 40-69% and 70% or greater as the standard to classify sporadic, hypoendemic, mesoendemic and hyperendemic levels of the infection, respectively. The unique merits of Ls as a potential onchocercal index are presented.

The incidence and risk factors of ventilator-associated pneumonia in a Riyadh hospital.

We report the incidence of, and risk factors for, ventilator-associated pneumonia (VAP) at the King Fahad National Guard Hospital. Of the 202 patients studied, 41 (25.2%) had VAP. The incidence density was 16.8/1,000 person-days of ventilation. Variables significantly associated with VAP were serious injury from motor-vehicle accident, enteral feeding, and length of ventilation. The avoidance of unnecessary enteral nutrition could help to reduce VAP.

Impact of antibiotic prophylaxis on wound infection after cesarean section in a situation of expected higher risk.

BACKGROUND: To measure rates of incisional surgical site infection (ISSI) after cesarean section (CS) and to assess risks for infection. METHODS: Prospective surveillance for ISSI at a 540-bed hospital in Saudi Arabia by using Centers for Disease Control and Prevention definitions for infection and the National Nosocomial Infections Surveillance (NNIS) system risk index. RESULTS: Seven hundred thirty-five CSs were studied from September 1998 to July 1999; 72% were emergency procedures, despite a 95% rate of antenatal care. The overall ISSI rate was 2.8% (95% confidence interval [CI], 1.7%-4.3%). The rate for NNIS risk category 0 was 2.4% (95% CI, 1.3%-4.2%; n = 536) and for category 1 was 4.1% (95% CI, 1.8%-8.6%; n = 170). In the multivariate analysis, the only independent risks for ISSI were duration of surgery (OR = 1.01; 95% CI, 1.00-1.03; P =.02) and no antibiotic prophylaxis (OR = 3.09; 95% CI, 1.10-9.11; P =.04). Antibiotic prophylaxis was inconsistently administered among both emergency and elective CS. Infection control procedures were inadequate in the obstetric suite operating room. CONCLUSIONS: Despite deficient infection control practices in the setting described, ISSI rates after CS were judged "acceptable" compared with NNIS benchmark rates. This was attributed to prescribing antibiotic prophylaxis for patients at low risk as well as high risk of infection.

A randomized clinical trial to compare the effects of a heat and moisture exchanger with a heated humidifying system on the occurrence rate of ventilator-associated pneumonia.

BACKGROUND: The purpose of this study was to compare the performance of heat and moisture exchanger filters with heated humidifying systems in the mechanical ventilator circuit on the incidence of ventilator-associated pneumonia (VAP) and bacterial colonization. METHOD: Two hundred and forty-three consecutive patients who required mechanical ventilation for 48 hours or more in the adult intensive care unit were randomized to either a heat and moisture exchanger (HME) or a heated humidifying breathing circuit. RESULTS: The VAP rate among the group with HME was 11.4%; the rate among the group with heated humidifying system (HHS) was 15.8%. The difference was not statistically significant. Approximately 68% of the patients in the HME group had no pathogen isolated compared with 50% of the patients in the HHS group. This difference was statistically significant (P =.006). However, the distribution of the pathogens among those patients who had the isolated pathogens was mostly identical in the 2 groups. CONCLUSION: Even though the study did not find HME to be significantly advantageous over the HHS, in as much as VAP rate is concerned, other advantages such as reduced nurses workload, reduced financial cost, and better safety made HME a more favorable device for use in our adult intensive care unit.

Babana Parasitic Diseases Project. I. The study area and a preliminary assessment of onchocercal endemicity based on the prevalence of "leopard skin".

A prevalence survey of "leopard skin" (LS) was carried out in 24 villages to assess the distribution of onchocerciasis in the Babana District of Nigeria. The findings suggested that onchocerciasis is highly endemic in this community. Of 1,310 adults examined for the presence of the characteristic onchocercal depigmentation, 26.4% were found affected. LS occurred more frequently among the cattle Fulani people than among other local ethnic groups (P less than 0.001) and was significantly more commonly associated with the left than with the right leg (P less than 0.001). A background of the study area is given.

Prevalence and pattern of substance use among undergraduates in a Nigerian University.

The prevalence and pattern of substance use was investigated among undergraduate students of the University of Ilorin, Kwara State, Nigeria in June 1988. Six hundred and forty-nine students completed a 117-item self-report questionnaire 636 of which were analysed. Mean age and S.D. of respondents was 23 +/- 3.7 years; 69% were males. The most commonly used substances with their 'lifetime' prevalence rates were as follows: salicylate analgesics, 95.2%; alcohol, 77%; stimulants, 69.2%; antibiotics, 63.3%; hypno-sedatives, 49.4% and cigarettes, 37.4%. The corresponding 'current use' rates were relatively lower. Low use was recorded for cannabis, organic solvents, hallucinogens, cocaine and narcotic analgesics. Majority of the 'current users' use the substances on an occasional basis except for cigarettes where more than half reported weekly or daily use. Males were significantly more of 'current' users of cigarettes and alcohol while females tend to use stimulants more. The use of most of the substances started in primary school. The need for a comprehensive demand-reduction programme in Nigeria based on this and other local findings was advocated. Continuous monitoring, particularly of hard drug use, appears imperative.

Psychosocial correlates of alcohol, tobacco and cannabis use: findings from a Nigerian university.

The possible correlates of alcohol, tobacco and cannabis use were investigated in a survey conducted among undergraduate students of the University of Ilorin, Nigeria. Factors that emerged as common correlates to the three substances investigated were peer influence, self-reported poor mental health, religiousity, parental/guardian supervision, perceived availability and perceived harmfulness. In addition, drinking and smoking were found to be commoner among the male sex and among respondents who reported study difficulty. There was also a significant positive relationship between cannabis use and a polygamous family background and belonging to an older age group. Although the data used in the analysis is limited due to its cross-sectional nature, the observations made are useful enough for the formulation of primary prevention strategies. A further and more elaborate longitudinal study is, however, suggested.

Breastfeeding: its relationship with postpartum amenorrhea and postpartum sexual abstinence in a Nigerian community.

Breastfeeding, together with its two related postpartum variables--amenorrhea and abstinence--govern both the tempo and quantum of fertility in traditional African societies. Decline in breastfeeding also implies decline in postpartum amenorrhea and abstinence practice. Changes in breastfeeding practices in tropical Africa, therefore, has fertility implications and consequences. This paper examines how breastfeeding is functionally related to postpartum amenorrhea and abstinence in Ilorin, an urban community in Nigeria. Results indicated that the effect of breastfeeding on fertility, through its relationship with postpartum abstinence, might be more important than its effect through lactational amenorrhea in this society. This is more true among women with little or no education than among women with secondary or higher education. The population or family planning implications of these relationships are discussed.

Child mortality in a Nigerian city: its levels and socioeconomic differentials.

Using the 'indirect' demographic estimation technique, levels of child mortality for some selected socioeconomic characteristics of mothers in Ilorin, an urban community in Nigeria, were derived. The adjusted effects of these variables on child mortality were assessed. The variables found to exert significant independent effects on child mortality included the husbands education, area of residence in the town, the parity of the mother, her use of modern contraception, availability of indoor pipe-borne water and the use of a refrigerator by the household. Reliable or useful information on child mortality in this part of Nigeria is hard to come by, hence, the estimates provided here can serve as useful baseline data for evaluating the impacts of child survival activities that are currently going on in that part of the country.

Sociodemographic and clinical factors affecting recognition of childhood diarrhea by mothers in Kwara State, Nigeria.

Early diagnosis of infant and child diarrhea by family members is the key to timely treatment. Factors that influence the caregiver's recognition of diarrhea have not been systematically studied, but may include characteristics of the caregiver, the child, or the illness itself. This paper examines the relationships between the caregivers' diagnoses of diarrhea during the previous 24 hr and the reported frequency and consistency of their children's bowel movements during the same period of time, using information from a representative sample of 2655 children less than 3 years of age in Kwara State, Nigeria. Diarrheal point prevalence based on maternal diagnosis (10.0%) was about half that based on the clinical criteria of three or more liquid or semi-liquid stools (18.8%). Only 36% of the mothers recognized a recent episode of diarrhea defined by the clinical criteria. Mothers were more likely to recognize diarrhea when a greater number of stools of watery consistency were excreted or when the stools contained blood or mucus. Mothers were least likely to recognize diarrhea when the child was a girl or less than 2 months of age. These results suggest that cross-cultural comparisons of diarrheal rates should use consistent, objective evidence of illness to compare rates rather than maternal diagnosis alone. Also, diarrheal disease control programs should explore those factors affecting recognition of illness in local contexts to assure that treatment recommendations can be applied in a timely fashion.

Evaluation of a face-to-face weaning food intervention in Kwara State, Nigeria: knowledge, trial, and adoption of a home-prepared weaning food.

This paper reports on the evaluation of a pilot intervention which used nutrition education techniques to introduce a fortified, home-prepared weaning food (eko ilera, or 'pap for health') in 12 communities in Kwara State, Nigeria, from June to August, 1988. The recipe added toasted cowpea flour, red palm oil, and sugar to increase the energy and protein density of the traditional maize or sorghum starch porridge used for weaning from 38 to 85 kcal and 0.8 to 2.0 g protein per 100 g. A stratified, random sample of participating (n = 295) and non-participating (n = 301) mothers from the same communities were interviewed from 2 to 8 weeks following the completion of the intervention, and their rates of knowledge, trail, and adoption of eko ilera were evaluated. Of the participating mothers, 57% (95% CI: 51%, 63%) knew the modified recipe, 48% (43%, 54%) tried it, and 17% (12%, 21%) adopted it with the intention of using it in the future. Only 2% (1%, 7%) of non-participating mothers knew about the recipe. Multivariate analyses indicated that the mothers' level of education and their perception of the cost and length of preparation time of the recipe were significantly associated with its adoption. The intervention was successful in using face-to-face nutrition education methods to introduce eko ilera to mothers in this region of Nigeria and to encourage its trial and adoption.

Development of a nutritionally adequate and culturally appropriate weaning food in Kwara State, Nigeria: an interdisciplinary approach.

A nutrition education program was undertaken in Kwara State, Nigeria to improve infant feeding practices and nutritional status of weaning-aged children. A series of ethnographic, market survey, epidemiological, dietary, clinical, and communications research studies were implemented to develop a culturally acceptable, yet nutritionally adequate, weaning food. A premise of the project was that the development and introduction of any new weaning food should be based upon ingredients available in the community and to households, at a low cost and with minimum preparation time, and that would be culturally acceptable by mothers for feeding young children. Initially, research was conducted to define the problem in both nutritional and anthropological terms. Data was collected to describe: (1) present patterns of infant feeding and their determinants; and (2) dietary intake and nutritional status of infants in the intervention area. This paper focuses on the process of defining the problem and developing an intervention from an interdisciplinary perspective. The development of the new weaning food, Eko-Ilera, a fortified pap based on the traditional weaning food, is described.

Rapid ethnographic assessment: applications in a diarrhea management program.

This paper reports on a rapid ethnographic assessment methodology (REA) that was developed as an essential component of the dietary management of diarrhea (DMD) program. The DMD program is an interdisciplinary research project that has been developed to design intervention programs to reduce or eliminate the nutritional complications of diarrhea in Peru and Nigeria. Anthropological data gathering was an important component of the intervention design, but time and budgetary constraints required a rapid methodological approach. This paper outlines the REA methodology, describes the advantages and disadvantages of the approach, and discusses future applications for international primary health care interventions.