BackgroundIn most resource constrained settings like Nigeria, breast self-examination self-breast examination (BSE) is culturally acceptable, religious friendly and attracts no cost. Women's knowledge and beliefs about breast cancer and its management may contribute significantly to medical help-seeking behaviours. This study aimed to assess knowledge and beliefs of BSE among market women.MethodsA descriptive cross-sectional study was conducted among 603 market women in Ibadan, Nigeria. Data was collected using semi-structured interviews and analyzed using descriptive and analytic statistical methods.ResultsThe mean age of the respondents was 34.6±9.3 years with 40% of the women aged between 30-39years. The proportion of married women was 339 (68.5%) with 425 (70.8%) respondents reporting that they do not know how to perform BSE. However, 372 (61.7%) women strongly agreed that BSE is a method of screening for breast cancer. Highest proportion 219 (36.3%) reported that the best time for a woman to perform BSE was ‘anytime’. Most of the respondents believed breast cancer is a dangerous disease that kills fast and requires a lot of money for treatment.ConclusionMore efforts are needed in creating awareness and advocacy campaigns in the grassroots in order to detect early breast cancer and enhance prevention strategies that would reduce the burden of breast cancer in Nigeria.
Background: The highest burden of hepatitis C virus (HCV) infection is seen in patients with psychiatric disorders who have been excluded from traditional treatments with Interferon due to treatment-emergent neuropsychiatric adverse effects. The goal of this study is to determine the tolerability, treatment retention, and efficacy of direct-acting antivirals with psychiatric disorders and comorbid substance use disorders in real-life settings. Methods: This is a retrospective cohort observational study of HCV patients treated with direct-acting antivirals between January 2016 and December 2018. Patients were stratified and sub-stratified based on their psychiatric diagnosis and substance use. The primary assessment was the sustained virologic response at 12 weeks post-treatment (SVR12). Results: Among the 291 patients analyzed, patients with psychiatric diagnosis and non-psychiatric patients made up 51.2% (n = 149) and 48.8% (n = 142) respectively. Majority of the patients included in the study were African-Americans (68.7%, n = 200). Overall, 95.3% (142/149) and 94.4% (134/142) of psychiatric and nonpsychiatric patients, respectively, achieved SVR12 and treatment response was similar between the groups (p = 0.72). Among psychiatric patients, only the prior treatment status was identified as a predictor of treatment response (OR 0.153, 95% CI 0.03-0.79; p = 0.05). No statistical difference was observed among the patients with SVR12 based on their primary psychiatric diagnoses or by comorbid substance abuse. Conclusion: The results of our study show that directacting antiviral treatments are well tolerated in psychiatric patients, and an overwhelming majority of patients achieved SVR12. Our study highlights the need to integrate HCV screening with treatment linkage in psychiatry and primary care practice.
Background: Emerging evidence suggests a definite neuropsychiatric sequela of the SARS-CoV-2 infection possibly from a direct effect of the virus on the central nervous system. Although the pathophysiology of the virus and the epidemiology of its impact are only just being unraveled, clinical characteristics, and outcomes specifically among patients with primary psychiatric disorders who are hospitalized with COVID-19 remain unclear and unreported. Methods: This is a retrospective cohort study of all patients with psychiatric diagnoses who were hospitalized patients with severe SARS-CoV-2 infection in a community hospital in New York City. Results: More than 80% of the cohort are African Americans. Hypertension (61.2%), morbid obesity (41.8%) and diabetes (27.6%) were the most prevalent co-morbid medical conditions. Schizophrenia (32.7%) and Major Depressive disorder (29.6%) were the most common psychiatric diagnoses reported. At triage, the most common presentations were fever (57.1%), cough (55.1%), myalgia (32.7%), fatigue (25.5%), and altered mental status (19.4%). Distinctly high infectionrelated inflammatory markers and cytokines were also reported with median values including CRP (85.5 mg/ml), D-dimer (2061 ng/ml), procalcitonin (1.1 ng/ml) and IL-6 (65.5 pg/ml). Conclusion: Results from this study strengthen preliminary data that show an overrepresented COVID-19 burden in the African American community. This further suggests that the same holds true among a cohort of patients with psychiatric conditions hospitalized with severe COVID-19 infection. Having comorbid mental illness and older age were observed as independent factors of morbidity and mortality. The finding of elevated inflammatory markers in this cohort may account for the prolonged hospitalization and hospital course, morbidity and mortality among COVID patients with comorbid psychiatric diagnoses and requires further investigation.
The core symptomatology of the Olfactory Reference Syndrome (ORS) is characterized by a preoccupation with the belief that one emits an offensive odor, albeit not perceived by others. The present case is that of a 75-year-old African American woman, with an unclear past psychiatric history, who was brought into our Emergency Room after a suicide attempt. The patient reported a three-year history of a “rotten” smell from her vagina. She adamantly believes that she smells despite being told otherwise by people. The patient reported a trial of several feminine products to get rid of this smell and multiple visits to specialists but her symptoms persisted. Her symptoms involved a significant depressed mood and deterioration in her social functioning, interpersonal relationships, and self-care. She was constantly in the shower and had stopped leaving her apartment due to worries that people might smell her vagina. The culmination of her distress was the suicidal attempt, for which she was brought to the hospital. She was admitted to the inpatient psychiatric unit and started on Pimozide and Fluvoxamine. The patient made remarkable progress within a few days on admission and in the course of her hospitalization. Follow-up in our outpatient clinic shows that the patient remains completely asymptomatic with significant progress in her social functioning.
Coprophagia is a rare and distressing disorder characterized by symptoms of compulsive consumption of feces. Several attempts have been made in literature to explore the pathophysiology, management, and outcomes of this disorder. However, critical questions remain, related to characterizing effective management, features of associated comorbidities, time to recovery of symptoms, sustainability of recovery, and the determinants of outcomes. Unfortunately, there is a dearth of available literature addressing these questions. We present two cases of patients with coprophagia in seeking to address these questions. Common symptoms of thought content disorder related to coprophagic behavior are noted in both cases. A shorter time to resolution of coprophagia is noted in one of the patients compared to previously reported studies. Recent and pertinent literature was reviewed and the implications for diagnosis and management of coprophagia are discussed.
Background: The application of the structural vulnerability construct in medicine addresses social structures as the source of health inequities. Evidence demonstrates structural vulnerability as the meta-problem that underlie health disparities faced by underrepresented minorities who are less likely to access care and face stigma for substance use disorders (SUDs). Objective: The objective of this study is to assess perceived vulnerability at the structural and interpersonal levels depicted by barriers to care, treatment-related stigma and anticipated discrimination among African Americans with SUDs. Methods: Participants were 58 consecutive African American patients receiving treatment at an acute inpatient substance use service of a teaching hospital from September to November 2019. Structural vulnerability, barriers to care and anticipated discrimination were assessed using the structural vulnerability assessment tool, Barriers to Access Care Evaluation (BACE) and the Questionnaire on Anticipated Discrimination (QUAD) surveys, respectively. Results: The total mean scores for the BACE-3, BACE-3 stigma subscale and QUAD were 1.0, 1.15 and 1.51, respectively. No statistically significant differences are found in the stigma subscale based on gender and psychiatric diagnosis ( p > .05). Furthermore, there were also no gender, age or differences based on psychiatric diagnosis across both the BACE and QUAD scales. Conclusion: Structural and interpersonal factors remain sources of vulnerability, stigma and anticipated discrimination for African Americans with SUDs and comorbid mental illness.
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