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.

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.

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.

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.

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.

Cancer Genetic Services in a Low- to Middle-Income Country: Cross-Sectional Survey Assessing Willingness to Undergo and Pay for Germline Genetic Testing.

PURPOSE: Cancer genetic testing (CGT), a pathway to personalized medicine, is also being embraced in Nigeria. However, little is known about the influence of demographics and perceptions on individuals' willingness to access and pay for CGT. This study assessed patients' willingness to undergo CGT in southwest Nigeria as a catalyst for sustainable Cancer Risk Management Program. METHODS: This was a cross-sectional study using semistructured questionnaire to interview 362 patients with cancer and 10 referred first-degree relatives between July 2018 and February 2020. Participants from three Nigerian teaching hospitals-University College Hospital, Ibadan, Lagos State University Teaching Hospital, Lagos, and Lagos University Teaching Hospital, Lagos, received genetic counseling and had subsequent CGT. Primary outcomes were willingness to undergo CGT in determining cancer risk and the willingness to pay for it. Ethical approval was from appropriate ethics committees of participating hospitals. Data were analyzed with SPSS version 22. Univariate comparison of categorical variables was performed by χ2 test, multivariate analysis by logistic regression. RESULTS: The participants from University College Hospital (56.2%), Lagos State University Teaching Hospital (26.3%), and Lagos University Teaching Hospital (17.5%) were mostly female (98.4%). Mean age was 48.8 years ± 11.79. Three hundred twenty-two (86.6%) patients and first-degree relatives were willing to take the test, of whom 231 (71.1%) were willing to pay for it. more than half (53.6%) of the participants were willing to pay between N10,000 and N30,000, which is less than $100 US dollars. Sociodemographic variables and willingness to test showed no association (P > .05). Education and ethnicity were found to be associated with their willingness to pay for CGT (P ≤ .05). CONCLUSION: Learning clinically relevant details toward cancer prevention informs health-related decisions in patients and relatives, a motivator for willingness to pay for genetic testing in low- and middle-income countries. Increased awareness may influence outcomes of cancer risk management.

Heart failure in Nigeria: protocol for a systematic review and meta-analysis.

Background: Heart failure is now a significant contributor to the burden of non-communicable diseases in developing countries like Nigeria which is experiencing epidemiologic and demographic transition. The epidemiology of heart failure in this country is poorly characterized. The aim of the review is to determine the prevalence of heart failure, the associated risk factors, the aetiology, management, and outcomes of the condition in the country. Methods: Relevant databases such as PubMed /Medline, EMBASE, Web of Science, Google Scholar, African Index Medicus, and African journal online would be searched for articles published in English from January 2000 to December 2021. The analysis will include observational studies conducted among Nigerian adults aged 12 years and above. Article selection shall be conducted by pairs of independent reviewers. Data extraction shall be done by 2 independent reviewers. Results: The primary outcome would be the pooled prevalence of heart failure while the secondary outcomes would be to identify the risk factors and management of heart failure in Nigeria. Conclusion: This will be the first systematic review and meta-analysis of heart failure epidemiology in Nigeria which will hopefully identify gaps for future research and guidance for policy interventions.

Factors associated with breast disorders detected by clinical breast examination during pregnancy and six months postpartum in Ibadan, South-western Nigeria.

Background: Breast disorders (BD) during pregnancy and postpartum cause anxiety and reduce women's quality of life. The study examined BD risk factors during pregnancy and six months after delivery. Methods: Women attending antenatal clinics at 26 weeks gestation were recruited. 1248 pregnant women were followed six months postpartum. During recruitment, a validated questionnaire was used to collect participant characteristics and risk factors. Palpable lumps, inflammation, persistent pain, and abnormal nipple discharge were classified breast disorders. Statistical analysis used multiple logistic and cox regression models at p<0.05. Results: Women with benign breast disease were more likely to develop BD (aOR = 2.63, 95% CI = 1.50-4.88). One pregnancy increases the risk of BD more than three times (aOR=0.52, 95%CI: 0.29-0.95). History of breast trauma (aHR=3.59, 95%CI: 1.40-9.17) and 3 miscarriages vs. none (aHR=2.23, 95%CI: 1.04-4.23) were also risk factors for BD. The second quartile of physical activity was associated with a lower risk of BD (aHR=0.35, 95%CI: 0.15-0.78). Conclusion: Women with breast trauma and miscarriage are more likely to develop breast disorders during pregnancy and six months after delivery. Our findings highlight the need for additional longitudinal research to validate these findings and plans for prevention and control. Keywords: Breast disorders, pregnancy, postpartum, predictors, longitudinal study.

Impact of prenatal maternal psychological distress on fetal biometric parameters in household air pollution-exposed Nigerian women.

RATIONALE: Studies identify prenatal household air pollution (HAP) exposure and maternal psychological distress (PMPD) as independent factors contributing to gestational ill-health and adverse birth outcomes. OBJECTIVE: We investigated the impact of PMPD on fetal biometric parameters (FBP) in HAP-exposed pregnant Nigerian women. METHODS: The randomized controlled trial (RCT; ClinicalTrials.gov NCT02394574) investigated effects of HAP exposure in pregnant Nigerian women (n = 324), who customarily cooked with polluting fuels (firewood or kerosene). Half of the women (intervention group) were given CleanCook ethanol stoves to use for 156 days during the study. Once a month, all women were administered an abridged version of the SF-12v2TM health-related quality of life questionnaire to assess psychological distress. Using mixed effects linear regression models, adjusted for relevant covariates, we analyzed associations between the women's exposure to PM2·5 (particulate matter with an aerodynamic diameter<2·5 microns) from HAP, their PMPD scores, and FBP (ultrasound estimated fetal weight [UEFW], head circumference [HC], abdominal circumference [AC], femur length [FL], biparietal diameter [BPD], estimated gestational age [GA] and intrauterine growth restriction [IUGR]), and birth anthropometric measures (birth weight [BW] and birth length [BL]). RESULTS: PMPD negatively impacted UEFW, HC, FL, BPD and BL (p<0·05). Controls (kerosene/firewood users) experienced significantly higher PMPD compared with ethanol-stove users (p<0·05). The mediation analysis revealed that the proportion of the outcome (fetal biometrics, birth anthropometrics, IUGR and GA), which can be explained via PMPD by groups (intervention vs. control) after adjusting for confounding variables was 6·2% (0·062). No significant correlation was observed between levels of PM2.5 exposure and PMPD scores. CONCLUSIONS: PMPD was an independent mediator of adverse fetal biometric parameters in pregnant women, who were exposed to HAP from burning of firewood/kerosene. Formulating preventative measures to alleviate maternal distress during pregnancy and reducing exposure to HAP is important from public health perspectives.

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.

Cross-ancestry GWAS meta-analysis identifies six breast cancer loci in African and European ancestry women.

Our study describes breast cancer risk loci using a cross-ancestry GWAS approach. We first identify variants that are associated with breast cancer at P < 0.05 from African ancestry GWAS meta-analysis (9241 cases and 10193 controls), then meta-analyze with European ancestry GWAS data (122977 cases and 105974 controls) from the Breast Cancer Association Consortium. The approach identifies four loci for overall breast cancer risk [1p13.3, 5q31.1, 15q24 (two independent signals), and 15q26.3] and two loci for estrogen receptor-negative disease (1q41 and 7q11.23) at genome-wide significance. Four of the index single nucleotide polymorphisms (SNPs) lie within introns of genes (KCNK2, C5orf56, SCAMP2, and SIN3A) and the other index SNPs are located close to GSTM4, AMPD2, CASTOR2, and RP11-168G16.2. Here we present risk loci with consistent direction of associations in African and European descendants. The study suggests that replication across multiple ancestry populations can help improve the understanding of breast cancer genetics and identify causal variants.

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.

Evaluating Polygenic Risk Scores for Breast Cancer in Women of African Ancestry.

BACKGROUND: Polygenic risk scores (PRSs) have been demonstrated to identify women of European, Asian, and Latino ancestry at elevated risk of developing breast cancer (BC). We evaluated the performance of existing PRSs trained in European ancestry populations among women of African ancestry. METHODS: We assembled genotype data for women of African ancestry, including 9241 case subjects and 10 193 control subjects. We evaluated associations of 179- and 313-variant PRSs with overall and subtype-specific BC risk. PRS discriminatory accuracy was assessed using area under the receiver operating characteristic curve. We also evaluated a recalibrated PRS, replacing the index variant with variants in each region that better captured risk in women of African ancestry and estimated lifetime absolute risk of BC in African Americans by PRS category. RESULTS: For overall BC, the odds ratio per SD of the 313-variant PRS (PRS313) was 1.27 (95% confidence interval [CI] = 1.23 to 1.31), with an area under the receiver operating characteristic curve of 0.571 (95% CI = 0.562 to 0.579). Compared with women with average risk (40th-60th PRS percentile), women in the top decile of PRS313 had a 1.54-fold increased risk (95% CI = 1.38-fold to 1.72-fold). By age 85 years, the absolute risk of overall BC was 19.6% for African American women in the top 1% of PRS313 and 6.7% for those in the lowest 1%. The recalibrated PRS did not improve BC risk prediction. CONCLUSION: The PRSs stratify BC risk in women of African ancestry, with attenuated performance compared with that reported in European, Asian, and Latina populations. Future work is needed to improve BC risk stratification for women of African ancestry.

Passive smoking exposure and the risk of hypertension among non-smoking adults: the 2015-2016 NHANES data.

BACKGROUND: Hypertension is a major public health problem and a prominent risk factor for cardiovascular diseases. However, whether passive smoking exposure (PSE) is associated with the risk of hypertension is scarcely understood. This study assessed the association between PSE and the risk of hypertension among adults (≥18 years) in the United States of America. METHODS: Three thousand and sixty-seven adults were identified from the 2015-2016 National Health and Nutrition Examination Survey and the association between PSE and hypertension (adjusting for relevant confounders) was examined using multivariable adjusted-logistic regression analysis at P < 0.05. RESULTS: Mean age of respondents was 46.5 ± 17.9 years. Overall, 23.7% of respondents reported PSE and 32.6% were hypertensives (of which only 14.3% were aware of their hypertensive state) Also, adjusted odds of hypertension for participants with PSE was 1.038 (1.037, 1.040), P < 0.0001, in the overall population. Also, PSE aggravated odds of hypertension among young adults - < 60 years (aOR: 1.095, 95CI%: 1.094 to 1.097), P < 0.0001, and old adults - ≥60 years (aOR: 1.110, 95% CI: 1.108 to 1.113), P < 0.0001. Similarly, PSE was associated with increased odds of hypertension among women (aOR: 1.240, 95% CI: 1.238 to 1.242), P < 0.0001 but not among men (aOR: 0.755, 95% CI: 0.754 to 0.757), P < 0.0001. CONCLUSIONS: PSE was independently associated with the risk of hypertension particularly among women, young and old adults. A multi-ethnic longitudinal cohort may help ascertain causality and provide more evidence for appropriate interventions.

Impact of prenatal and postnatal household air pollution exposure on lung function of 2-year old Nigerian children by oscillometry.

RATIONALE: Lung function is adversely affected by exposure to household air pollution (HAP). Studies investigating the impact of prenatal and postnatal HAP exposure on early childhood lung development are limited, especially from Sub-Saharan Africa. OBJECTIVE: We used oscillometry to investigate the impact on lung function of prenatal and postnatal HAP exposure of children born to Nigerian women who participated in a randomized controlled cookstove intervention trial. METHODS: We performed oscillometric measurements (R: airway resistance; X: airway reactance; Fres: resonant frequency; AX: reactance area) in 223 children starting at age of 2 years (ethanol stove, n = 113; firewood/kerosene, n = 110). Personal exposure monitoring assessed mothers' prenatal exposure to particulate matter less than 2.5 µm in aerodynamic diameter (PM2.5). Postnatal HAP exposure was measured by determining household PM2.5 levels. We employed linear regression analysis to examine the association of prenatal and postnatal HAP exposures with children's lung function. Models were adjusted for age, gender, weight, height, group (intervention or control), birthweight and gestational age. RESULTS: Mean age of the children was 2.9 years (standard deviation = 0.3); 120 were boys (53.8%) and 103 were girls (46.2%). Higher postnatal PM2.5 exposures were significantly associated with higher airway reactance at 5 Hz (X5 Hz; p = 0.04) in adjusted models. There were no significant associations between prenatal or postnatal PM2.5 exposure levels and other oscillometry parameters in adjusted regression analysis. CONCLUSIONS: This is the first study to use oscillometry to explore the relationship between HAP exposure and lung function in children as young as 2 years. The findings provide some evidence that increased postnatal HAP exposure may result in poorer lung function in children, although larger studies are needed to confirm observed results. This study indicates that oscillometry is a low-cost and effective method to determine lung function in early childhood.

Case-control study on ocular changes and ophthalmic Doppler velocimetric indices among preeclamptic and normotensive pregnant women in Ibadan, Nigeria.

OBJECTIVE: To compare the ocular changes and Doppler velocimetric indices in preeclamptic and normotensive pregnant women. METHODS AND ANALYSIS: This was a case-control study of 71 preeclamptic women and 72 parity-matched normotensive pregnant women conducted at the University College Hospital, Ibadan, Nigeria. Demographic data were obtained using questionnaires. All participants had visual acuity assessment, funduscopy, intraocular pressure measurement and orbital Doppler ultrasonography. The differences in parameters between the two groups were tested using Student's t-test for quantitative variables and χ2 tests for categorical variables. RESULTS: There were no significant differences between cases and controls with respect to sociodemographic variables. The mean pulsatility index was 1.35±0.46 in cases and 2.1±0.4 in controls (p<0.001); the resistivity index was 0.7±0.18 in cases and 0.83±0.27 among the controls (p=0.01). A similar pattern was observed in the peak systolic velocity (p<0.001) and the peak ratio (p<0.001). There was no significant difference between the groups concerning end-diastolic velocity (p=0.535). Three preeclampsia patients (5.2%) had abnormalities on funduscopy compared with none of the controls. Preeclamptic women had significantly higher intraocular pressures in both eyes at baseline and at 24 hours post delivery. CONCLUSION: This study demonstrated lower Doppler velocimetry and impedance parameters and higher intraocular pressure among preeclampsia cases compared with controls. Abnormal funduscopic findings were observed in a few preeclamptic women and none among the controls. Ophthalmic artery Doppler parameters could be useful in identifying those women who are likely to suffer preeclampsia and its complications.

Perceptions of the psychological experiences surrounding female genital mutilation/cutting (FGM/C) among the Izzi in Southeast Nigeria.

Evidence about psychological experiences surrounding female genital mutilation/cutting (FGM/C) remains weak and inconclusive. This article is the first of a series that deploys qualitative methods to ascertain the psychological experiences associated with FGM/C through the lifecycle of women. Using the free listing method, 103 girls and women, aged 12 to 68 years from rural and urban Izzi communities in Southeastern Nigeria, produced narratives to articulate their perceptions of FGM/C. Sixty-one of them had undergone FGM/C while 42 had not. Data was analysed using thematic analysis and the emerging themes were related to experiences and disabilities in the psychological, physical, and social health domains. While physical experiences were mostly negative, psychological experiences emerged as both positive and negative. Positive experiences such as happiness, hopefulness, and improved self-esteem were commonly described in response to a rise in social status following FGM/C and relief from the stigma of not having undergone FGM/C. Less commonly reported were negative psychological experiences, e.g., shame when not cut, anxiety in anticipation of the procedure, and regret, sadness, and anger when complications arose from FGM/C. Some participants listed disruption of daily activities, chronic pain, and sleep and sexual difficulties occurring in the aftermath of FGM/C. Most participants did not list FGM/C as having a significant effect on their daily living activities. In light of the association of FGM/C with both positive and negative psychological experiences in the Izzi community, more in-depth study is required to enable policy makers and those campaigning for its complete eradication to rethink strategies and improve interventions.

Prevalence of Inherited Mutations in Breast Cancer Predisposition Genes among Women in Uganda and Cameroon.

BACKGROUND: Sub-Saharan Africa (SSA) has a high proportion of premenopausal hormone receptor negative breast cancer. Previous studies reported a strikingly high prevalence of germline mutations in BRCA1 and BRCA2 among Nigerian patients with breast cancer. It is unknown if this exists in other SSA countries. METHODS: Breast cancer cases, unselected for age at diagnosis and family history, were recruited from tertiary hospitals in Kampala, Uganda and Yaoundé, Cameroon. Controls were women without breast cancer recruited from the same hospitals and age-matched to cases. A multigene sequencing panel was used to test for germline mutations. RESULTS: There were 196 cases and 185 controls with a mean age of 46.2 and 46.6 years for cases and controls, respectively. Among cases, 15.8% carried a pathogenic or likely pathogenic mutation in a breast cancer susceptibility gene: 5.6% in BRCA1, 5.6% in BRCA2, 1.5% in ATM, 1% in PALB2, 0.5% in BARD1, 0.5% in CDH1, and 0.5% in TP53. Among controls, 1.6% carried a mutation in one of these genes. Cases were 11-fold more likely to carry a mutation compared with controls (OR = 11.34; 95% confidence interval, 3.44-59.06; P < 0.001). The mean age of cases with BRCA1 mutations was 38.3 years compared with 46.7 years among other cases without such mutations (P = 0.03). CONCLUSIONS: Our findings replicate the earlier report of a high proportion of mutations in BRCA1/2 among patients with symptomatic breast cancer in SSA. IMPACT: Given the high burden of inherited breast cancer in SSA countries, genetic risk assessment could be integrated into national cancer control plans.

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.

Race, the microbiome and colorectal cancer.

In the past decade, more cancer researchers have begun to understand the significance of cancer prevention, which has prompted a shift in the increasing body of scientific literature. An area of fascination and great potential is the human microbiome. Recent studies suggest that the gut microbiota has significant roles in an individual's ability to avoid cancer, with considerable focus on the gut microbiome and colorectal cancer. That in mind, racial disparities with regard to colorectal cancer treatment and prevention are generally understudied despite higher incidence and mortality rates among Non-Hispanic Blacks compared to other racial and ethnic groups in the United States. A comprehension of ethnic differences with relation to colorectal cancer, dietary habits and the microbiome is a meritorious area of investigation. This review highlights literature that identifies and bridges the gap in understanding the role of the human microbiome in racial disparities across colorectal cancer. Herein, we explore the differences in the gut microbiota, common short chain fatty acids produced in abundance by microbes, and their association with racial differences in cancer acquisition.