Physicians used either an autonomy-supportive or a controlling interpersonal style to counsel smokers based on National Cancer Institute guidelines. Physician autonomy support was rated from audiotapes, and patients' perceived competence and autonomous motivation for quitting were self-reported on questionnaires. Validated point prevalences for 6, 12, and 30 months and for continuous cessation were examined. The intervention did not have a direct effect on quit rates; however, structural equation modeling supported the self-determination process model of smoking cessation. The model indicated that the autonomy-supportive intervention was rated as more autonomy supportive, that rated autonomy support predicted autonomous motivation, and that autonomous motivation predicted cessation at all points in time. Perceived competence contributed independent variance to cessation only at 6 months.

Tubular or nipple breasts are descriptive of an unusual deformity in which a hypoplastic mammary gland is situated under a stretched out areola, giving the breast a tubular shape. Six patients, age 17 to 21 years, have undergone surgical correction of this deformity. The one-stage procedure involves excision of excess areola, augmentation through the areolar incision, correction of asymmetry by means of asymmetric implants, and cruciate incisions on the posterior aspect of the breast to improve the contoural defect. The complication rate has been no greater than that of routine augmentation, and patient satisfaction has been good.

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Treatment of very low birth weight infants in a neonatal intensive care unit (NICU) can be expensive, particularly in rural areas, but may potentially reduce long-term treatment costs and improve short- and long-term health outcomes. Few studies look at this trade-off. We employed an instrumental variables approach (fuzzy discontinuity) based on changes in practice for the treatment of very low birth weight infants in a perinatal referral center's NICU in 2000-2001. The strategy of keeping infants in a NICU longer reduced the likelihood of discharge with an apnea/cardio monitor. The primary instrumental variables specification estimated that every additional 100 g of discharge weight reduced the likelihood of discharge with an apnea/cardio monitor by 4.8%. Extending an infant's length of stay (LOS) thus has important benefits. Greater expenses on days in the NICU are partially compensated by reduced monitoring post discharge. In contexts where postdischarge monitoring is particularly difficult or expensive, extending LOS may be cost effective and potentially improve outcomes.

Kimura disease (KD) is a chronic, inflammatory, benign disorder endemic to Asia that typically manifests as a triad of painless masses in the head and neck region, elevated eosinophils and serum immunoglobulin. It usually affects young men in their second and third decades of life and is rarely seen outside of the orient. This is a report of a case of KD in a young man of African descent who presented with a cheek mass. KD was not included in our differential diagnosis, and this report highlights the need to consider this entity, which can be easily missed due to its rarity in the Western world. There is no cure for the disease, and management includes medical and surgical modalities, but local recurrence or relapse is not uncommon.

Granular cell tumours of the scalp are rare. Malignant transformation of these tumours is even more uncommon, making the diagnosis exceedingly difficult. The recommended treatment of surgical excision with negative margins is not easily achieved in this location, given the anatomy of the scalp.

Motor vehicle accidents are a major public health problem in Jamaica, representing the leading cause of death in adolescents and young adults and consuming a large part of the health care budget, as surviving victims usually require surgical intervention and prolonged hospital stays. Patients with mid-third compound tibial fractures present a particularly difficult surgical challenge due to the difficulty in achieving soft-tissue coverage of the bone in this area, hence the need for extended hospitalization in order to prevent infection. We have used a Hemi-Soleus Muscle Flap to achieve coverage of these difficult wounds, thereby eliminating the risk of osteomyelitis, reducing hospital stays and returning patients to productive lives in a much shorter period.

No abstract