Cemetery hoodoo: Culture, ritual crime and forensic archaeology.

In 2012 and 2014 the author was a consultant to law enforcement regarding crime scenes of a ritualistic nature in the American Southeast. These ritual activities were expressions of folk magic spells linked to certain West African traditions. These spells were used for magico-religious, curative, and 'justice' (i.e. revenge) practices known as hoodoo, conjure or rootwork. The ritual activities were conducted at gravesites in a public cemetery. When standard investigative police procedures failed to produce anything substantive with which to solve, prevent, or even understand the motive beyond one of 'vandalism,' or 'kids fooling around,' the author was approached to contribute forensic archaeological and anthropological insights that had thus far proved elusive. This article is an examination of how cultural anthropological understanding and a forensic archaeological "eye" to an outdoor crime scene can re-define crime scene investigative methodology and interpretation.

Ductal carcinoma in situ of the breast: can biomarkers improve current management?

BACKGROUND: Screening for invasive cancer has led to a marked increase in the detection of ductal carcinoma in situ (DCIS). DCIS is, if appropriately managed, a low-risk disease which has a small chance of impacting on patient life expectancy. However, despite significant advances in prognostic marker development in invasive breast cancer, there are no validated diagnostic assays to inform treatment choice for women with DCIS. Therefore we are unable to target effective treatment strategies to women at high risk and avoid over-treatment of women at low risk of progression to invasive breast cancer. Paradoxically, one effect of this uncertainty is undertreatment of some women. CONTENT: We review current practice and research in the field to identify key challenges in the management of DCIS. The impact of clinical research, particularly on the over and undertreatment of women with DCIS is assessed. We note slow progress toward development of diagnostic biomarkers and highlight key opportunities to accelerate advances in this area. SUMMARY: DCIS is a low-risk disease, its incidence is increasing, and current treatment is effective. However, many women are either over- or undertreated. Despite repeated calls for development of diagnostic biomarkers, progress in this area has been slow, reflecting a relative lack of investment of research effort and funding. Given the low event rate in treated patients and the lateness of recurrences, many previous studies have only limited power to identify independent prognostic and predictive biomarkers. However, the potential for such biomarkers to personalize treatment for DCIS is extremely high.

Impact of boost radiation in the treatment of ductal carcinoma in situ: a population-based analysis.

PURPOSE: To report the outcomes of a population of women with ductal carcinoma in situ (DCIS) treated with breast-conserving surgery and radiation and to evaluate the independent effect of boost radiation on the development of local recurrence. METHODS AND MATERIALS: All women diagnosed with DCIS and treated with breast-conserving surgery and radiation therapy in Ontario from 1994 to 2003 were identified. Treatments and outcomes were identified through administrative databases and validated by chart review. The impact of boost radiation on the development of local recurrence was determined using survival analyses. RESULTS: We identified 1895 cases of DCIS that were treated by breast-conserving surgery and radiation therapy; 561 patients received boost radiation. The cumulative 10-year rate of local recurrence was 13% for women who received boost radiation and 12% for those who did not (P=.3). The 10-year local recurrence-free survival (LRFS) rate among women who did and who did not receive boost radiation was 88% and 87%, respectively (P=.27), 94% and 93% for invasive LRFS (P=.58), and was 95% and 93% for DCIS LRFS (P=.31). On multivariable analyses, boost radiation was not associated with a lower risk of local recurrence (hazard ratio = 0.82, 95% confidence interval 0.59-1.15) (P=.25). CONCLUSIONS: Among a population of women treated with breast-conserving surgery and radiation for DCIS, additional (boost) radiation was not associated with a lower risk of local or invasive recurrence.

Asian women's use of specialist Contraception, Sexual and Reproductive Health Services in Leicester, UK.

BACKGROUND: There is evidence to suggest that Asian women in the UK have specific contraceptive and sexual health needs. It has been reported that Asian women may use less reliable contraceptive methods and that cultural influences can affect access to sexual health services. As part of a wider needs assessment project we compared Asian women's usage of our specialist Contraception, Sexual and Reproductive Health Services to that of non-Asian women. METHODS: An anonymous questionnaire was offered to all service users between October and December 2007. Data were analysed separately for Asian and non-Asian women. RESULTS: The response rate was low for Asian women with only 26% completing questionnaires. There were no significant differences between the groups for proportions of women attending for each contraceptive method. A smaller proportion of Asian women were using the service for contraception and a greater proportion were attending for other sexual health reasons compared to non-Asian women. Confidentiality, female staff and not wanting to see their general practitioner were stated more often as reasons for using our service by Asian women. CONCLUSIONS: The National Strategy for Sexual Health and HIV emphasises the need for services targeted at ethnic minorities. Asian women use our clinics for a variety of their sexual health needs. Our service is used by some in preference to general practice, which may reflect ease of access and the perceived confidentiality that a dedicated Contraception and Sexual Health Service offers. These preferences should be considered by primary care trusts when commissioning services.

A community-based vasectomy service in Leicestershire and Rutland - The patients' perspective.

OBJECTIVES: To evaluate the community-based vasectomy service from the patients' perspective and consider service provision in terms of access, process, quality and outcome. METHOD: A prospective questionnaire was handed to 150 consecutive men attending for vasectomy from February to June 2007, for completion two weeks after surgery. Postal reminders were sent at four and eight weeks. RESULTS: The response rate was 73%, with 93% (n = 102) of the respondents considering the vasectomy unit to be of high quality. The comprehension of written information (93%) and the approachability of staff (83%) were both considered highly satisfactory. Most men were equivocal regarding proposed 'holistic' changes to the service. Men under 40 were more likely to be neutral or agree that vasectomy was embarrassing and preferred a male surgeon. The occurrence of complications did not affect satisfaction but increased the mean number of disturbed nights sleep and days taking analgesia. Suggestions for improvement pertained to the pre-operative information and the use of skin sutures. CONCLUSIONS: The patients' evaluation of our vasectomy unit identified areas for improvement and reinforced good clinical practice. More research is needed to clarify the impact of age, ethnicity and other factors on the accessibility, acceptability and experience of vasectomy.

Usage of Long Acting Reversible Contraceptive Methods (LARC) in couples attending for vasectomy counselling.

OBJECTIVE: Vasectomy is a safe and effective method of permanent contraception. A proportion of men will regret the procedure and some may experience chronic testicular pain. National recommendations in the UK advocate that couples requesting sterilization should be counselled and given access to Long Acting Reversible Contraceptive (LARC) methods. This study aims to ascertain usage of LARC methods in couples attending for vasectomy counselling. METHOD: A case notes review of 200 consecutive couples attending for vasectomy counselling between January and May 2006. RESULTS: Most couples were using condoms for contraception (51%) prior to vasectomy counselling. Only 11% of couples were using a LARC and 25% of couples had ever used one. The copper intrauterine device was the most popular LARC with 16% having ever used it; hormonal LARCs were unpopular. Some couples (9.5%) expressed dissatisfaction with current methods and associated health risks. CONCLUSION: Usage of LARC methods was low but similar to that of the background population in the UK. Couples attending for vasectomy are seeking effective contraception but prefer non-hormonal methods. LARC uptake in the UK is poor; there is a need for wider education and awareness of all LARC methods including side effects and safety.

Adequacy of contraception and missed opportunities for provision in a genitourinary medicine setting.

BACKGROUND AND METHODOLOGY: Sexually active women presenting to genitourinary medicine (GUM) clinics are at risk of both sexually transmitted infections and unwanted pregnancies. Emergency hormonal contraception is the only contraceptive service provided in our GUM clinic in Birmingham, UK. We wanted to assess whether contraception use was adequate in women attending our clinic and whether we were missing opportunities to provide more reliable contraception. All new female patients attending the clinic in January 2006 had their notes reviewed to determine current contraception, adequacy of use and contraceptive advice given. RESULTS: A total of 266 women were eligible for contraception. Overall, 148 (56%) of the women used reliable methods. Fifty-five (21%) women were using no contraception and not planning a pregnancy. The under-20s, over-30s and ethnic minorities were more likely to use inadequate or no contraception. DISCUSSION AND CONCLUSIONS: Almost half (43%) the women attending our GUM clinic had inadequate or no contraception, and in addition documentation of contraceptive advice and further information was poor (5%). Young people and ethnic minorities seem particularly vulnerable and at present we are not addressing their contraceptive needs. We plan to conduct a prospective survey to assess this issue further and address feasibility for an on-site contraceptive service.

Current practice for the laparoscopic diagnosis and treatment of endometriosis: a national questionnaire survey of consultant gynaecologists in UK.

OBJECTIVE: To determine current practice regarding laparoscopic diagnosis and treatment of endometriosis. DESIGN: A prospective questionnaire survey. SETTING: The United Kingdom. POPULATION: All 1411 UK consultant gynaecologists identified from a Royal College of Obstetricians and Gynaecologists database. METHODS: A postal questionnaire was sent to all consultants with reply paid envelopes. A postal reminder was sent three months following the initial questionnaire. MAIN OUTCOME MEASURE: Current practice for the laparoscopic diagnosis and treatment of endometriosis and willingness to participate in a randomised trial. RESULTS: The response rate was 66% (893/1411). Diagnostic laparoscopy was performed by 87% (772/893) of respondents. Seventy-six percent of these (58/772) were confident to visually diagnose endometriosis and 6% (47/772) routinely verified the diagnosis histologically. Laparoscopic surgery was routinely undertaken by 41% (318/772) of respondents. Ablative therapy was the most frequently employed technique utilised [620/653 (95%)] and electrodiathermy was the most popular energy modality (80%). Among respondents expressing a preference, excision of disease was believed to be more effective, but less safe compared with ablation. One-third of respondents (273/893) were willing to enter patients into a randomised controlled trial to compare laparoscopic treatments for pelvic pain associated with endometriosis. CONCLUSION: Laparoscopic surgery for endometriosis associated with pelvic pain is routinely undertaken by a large number of UK consultant gynaecologists, but techniques used and beliefs about efficacy vary. In view of this division of opinion regarding the relative roles of laparoscopic treatment methods, a randomised trial comparing the efficacy and safety of these methods is urgently needed.

Effect of prize draw incentive on the response rate to a postal survey of obstetricians and gynaecologists: a randomised controlled trial. [ISRCTN32823119].

BACKGROUND: Response rates to postal questionnaires are falling and this threatens the external validity of survey findings. We wanted to establish whether the incentive of being entered into a prize draw to win a personal digital assistant (PDA) would increase the response rate for a national survey of consultant obstetricians and gynaecologists. METHODS: A randomised controlled trial was conducted. This involved sending a postal questionnaire to all Consultant Obstetricians and Gynaecologists in the United Kingdom. Recipients were randomised to receiving a questionnaire offering a prize draw incentive (on response) or no such incentive. RESULTS: The response rate for recipients offered the prize incentive was 64% (461/716) and 62% (429/694) in the no incentive group (relative rate of response 1.04, 95% CI 0.96 - 1.13) CONCLUSION: The offer of a prize draw incentive to win a PDA did not significantly increase response rates to a national questionnaire survey of consultant obstetricians and gynaecologists.

A pilot randomised controlled study of three models of follow-up of patients treated for gynaecological cancer: attitudes in general practice and feasibility of randomisation.

The value of routine follow-up in secondary care for cancer patients has been widely questioned. Within our network cancer centre for gynaecological malignancies current follow-up protocols have been associated with delays in diagnosing recurrence. The aim of this study was to ascertain general practitioners' (GPs') attitudes and feasibility of randomisation for a pilot randomised controlled trial to evaluate follow-up of patients treated for gynaecological malignancy. There was a 78% response rate to the postal questionnaire; overall, GP attitudes were positive, with randomisation seeming feasible. We await the results from the pilot trial.