Medical Tattooing in Hospital Settings versus Parlors and the Challenging Hygiene Requirements.

Sir, Nipple-areola complex reconstruction, which is the final step in breast reconstruction surgery, is extremely important for good aesthetic outcomes and improved patient satisfaction.1 Among the many procedures reported,2 nipple-areola complex reconstruction using a local flap or nipple graft in combination with medical tattooing is widely used today. However, only a few studies have reported its procedural details and modifications.3 Here, the authors report our 4 innovative modifications of medical tattooing that enhance cosmetic outcomes of nipple-areola complex reconstruction. This study was approved by the Ethics Committee of Tokyo Women’s Medical University. Subjects were 56 breasts of 56 patients who underwent nipple-areola complex reconstruction using medical tattooing at the Department of Plastic and Reconstructive Surgery, Tokyo Women’s Medical University between April 2014 and October 2016. Our modified medical tattooing technique was performed using a Permark UltraEnhancer (PMT Corp., Minn.), a #18 needle (PMT Corp.) and several pigments (PMT Corp.). All medical tattoos were performed by a plastic and reconstructive surgeon. The time required for the procedure was about 30 minutes. The first of the 4 modifications was blurring the margin of the areola to create a natural appearance by depositing pigments in irregular alignment for a gradation effect. A needle angled perpendicular to the skin was used to ensure the finest micropigmentation, together with a scratch micropigmentation method. The degrees of gradation created were adjusted for individual patients (Fig. 1A). The second modification was creating the illusion of the uneven surface (bumps) of the areola due to the Montgomery glands. A polka dot pattern was created using either a darker or a lighter shade of pigment based on close examination of the contralateral healthy areola, to maintain similar appearances in individual cases (Fig. 1B). The third modification was adjustment of the areola position so that the breasts looked as symmetric and natural as possible. The conventional method that determines the areola position in relation to the apex of the reconstructed breast or the nipple would have emphasized asymmetry when breast reconstruction did not provide good symmetry. Instead of opting for conventional approaches such as determining the areola position in relation to the apex of the ipsilateral breast or the reconstructed nipple, the provisional position of the areola was marked for evaluation by using that of healthy side, and the final position, agreed with by the patient, was determined after fine adjustment in this study (Fig. 1C). The fourth modification was creating the illusion of the height of the transplanted or reconstructed nipple, by adding a shadow effect such as a trick art; the top and root of the nipple was covered by a lighter shade and a darker shade of pigment, respectively (Fig. 1D). The appropriate combinations of each of these 4 modifications was determined individually for each patient, resulting in successful nipple-areola complex reconstruction without complications (eg, cutaneous ulceration) in all patients (Fig. 2). Patient satisfaction, which was not examined in this study, needs to be studied in the future. Also, the optimal timing of tattooing, long-term follow-up results, pigment preparation methods, and the necessary number of tattooing sessions need to be elucidated in future studies.Fig. 1.: Our 4 modifications of medical tattooing procedures in nipple-areola complex reconstruction. A, Blurring the areola margin. B, Creating the illusion of the Montgomery glands (areolar bumps). C, Adjusting the areola position to achieve symmetry. D, Creating the illusion of the height of the nipple by using shading.Fig. 2.: Clinical photographs of the nipple-areola complexes reconstructed using the modified medical tattooing techniques.

Bacterial infection of tattoos remains a common complication. Pyogenic bacteria can cause infections shortly after the tattoo is made. Severity of infection varies from minor to major, ultimately with life-threatening septicemia. Viral infections may be introduced, i.e. HVB, HVC, and HIV. The risk of infection depends on the following triad: microbial pathogen and its aggressiveness, individual resistance of the tattooed, and inoculation and exposures by the tattoo needle and in the tattoo parlor. Some infectious risks can be controlled. Persons with weaknesses can refrain from tattooing. Tattoo parlors and tattooing can be hygienic and clean albeit not sterile; much has improved helped by hygiene guidelines of professional tattooists' organizations and through control instituted by local and national authorities. Tattoo inks remain a potential source of infection difficult to control in a low-priced competitive market operating over the Internet and across national borders. Ten percent of new inks are contaminated with bacteria pathogenic to humans, independent of a claim of 'sterility'. Known brands and established manufacturers are considered safer. Work is in progress aiming at common European standards for tattoo hygiene. Doctors have a role not only in treating tattoo infections but also in reporting cases to the competent authority in their country to support the monitoring of tattoo infections at any time, as an instrument for the authority to detect local outbreaks of tattoo infections early and prevent that new tattoo customers become infected. It is a potential risk of the future that new and very aggressive bacteria not seen in the past may unexpectedly show up in the tattoo scene.

Vitiligo is an acquired skin depigmentation disorder that affects 0.5-2% of the world population. It is characterized by loss of the natural brown melanin pigment of the skin clinically manifested as few or many white patches on the skin and microscopically with the total absence of me-lanocytes in the epidermis. The change in appearance caused by vitiligo can affect persons' emotional and psychological well-being and may cause them to alter their lifestyle. The social complication of vitiligo depends on ethnicity and on geography and local opinion, which may deem vitiligo contagious. The aim of the medical tattooing procedure in vitiligo is to revert the white vitiligo patches to normal-looking skin of natural or near natural color through installation of brownish tattoo pigment. The coloring effect is not permanent and tends to fade over time, and repeated treatment may be needed after about a year. This chapter reviews vitiligo and indications, technique, and procedures associated with medical tattooing of the disease.

Background: Nipple-areola tattoos can provide restoration of a natural looking breast that more closely resembles its pre-surgical appearance while avoiding additional surgeries. To date, the majority of nipple-areola tattoo procedures are performed by healthcare providers with minimal training in tattoo procedures. Substandard results explain the high rates of dissatisfaction among women who receive nipple-areola tattoos. In response, professional tattoo artists have emerged as an alternative provider for women seeking reconstruction. However, few studies have examined expectations and experiences of women undergoing nipple-areola tattoo procedures provided by a professional tattoo artist outside of the traditional healthcare setting. Methods: In-depth interviews were conducted with a racially/ethnically diverse group of 30 women who had undergone nipple-areola tattooing in the past 0-2 years. Interviews were conducted in English, Spanish, Chinese, and Arabic, recorded, and translated and transcribed into English for analysis. A team of three researchers conducted iterative reviews of the data which included closely reading each transcript, coding, running queries of codes, and developing summary documents to highlight recurrent concepts and patterns which were shared and discussed in group meetings. Results: Interview narratives addressed the often unexpected impact nipple-areola tattooing had on body image, self-esteem, emotional well-being, and interpersonal relationships. Women described their decision-making processes as weighing concern about the needle, the pain, and uncertainty about the tattoo artist, setting for the procedure, and outcome with the opportunity to return to a more “normal” appearance without further surgeries. Women discussed how their initial preconceptions of tattoos and tattoo parlors were ameliorated by the spa-like setting and the tattoo artist's anticipation of such concerns which enhanced her ability to put them at ease and provide professional and compassionate care. Participants noted the integral role the tattoo artist played in their positive experiences, describing her as both an “artist” and “caregiver.” The manner in which she guided them through the decision-making process regarding the color, size, shape, and placement of their nipple-areola tattoo was noted as particularly significant and empowering. Conclusions: Nipple-areola tattooing is an acceptable and meaningful reconstruction process for medically underserved public hospital patients. Our results indicate that women should be informed of nipple-areola tattooing as an alternative to more invasive, surgical reconstruction options. Results also illustrate how the healthcare system can extend beyond the traditional healthcare setting to include and leverage non-clinical and non-traditional specialists to provide appropriate care and positive breast health outcomes for women. In order to increase access and legitimacy to these services, additional research is needed to understand how to bring tattoo artists “in-house” (i.e., into the medical setting) and how to incorporate tattoo artists into breast health teams. Citation Format: Napoles TM, Guerra C, Orenstein F, Luce JA, Merritt S, Burke NJ. Healing art: Breast cancer survivor experiences with nipple-areola tattoo procedures during breast reconstruction [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-19.

This chapter reviews our present knowledge about equipment used for cosmetic (decorative) and medical tattooing and its function with respect to installation of tattoo ink into the skin. In the following text, the word "tattooing" refers to body tattooing, permanent makeup (PMU), microblading, and medical micropigmentation. The major consumer risks related to unsafe tattoo and PMU equipment are reconsidered. Such health risks mainly include the danger of non-sterile needles or needle cartridges, cross contamination of equipment and lack of biocompatibility. Even though state-of-the-art tattoo equipment will support the tattooist to reduce such health risks, also today unsafe equipment still might affect consumer health due to malpractice advertising and fraudulent CE certificates by questionable manufacturers and suppliers not being transparent to parlors and artists. For artists, it is therefore of growing importance to understand how to distinguish well-made safe tattoo equipment from fraudulent unsafe products.

Tattoos have become increasingly popular in recent years. In the United States, the estimated percentage of adults with one or more tattoos increased from 14% in 2008 to 21% in 2012.1 The process of tattooing exposes the recipient to risks of infections with various pathogens, some of which are serious and difficult to treat. Historically, the control of tattoo-associated dermatologic infections has focused on ensuring safe tattooing practices and preventing contamination of ink at the tattoo parlors — a regulatory task overseen by state and local authorities.2 In recent months, however, reported outbreaks of nontuberculous mycobacterial infections associated with contaminated . . .

PurposeThe objectives of this study were to compare the hygiene standards and food handling practices between sole-proprietor and the corporate-managed restaurants in Lebanon and to determine whether the variations between both groups are explained by and directly related to the type of management.Design/methodology/approachAn in-depth observation assessment of food safety environment and practices was conducted on a convenient sample of 50 food businesses in Beirut, which are typical of foodservice outlets in Lebanon and in many countries of the Middle East. The observation assessment checklist comprised six constructs of 2–7 components for analysis. It covered all areas including documentation and record-keeping requirements, which are crucial parts of a food safety system.FindingsThere was a significant difference in the visual assessment score between sole-proprietor (77.9 ± 18.4) and corporate group (48.5 ± 12.8). Food handlers' behavior and hygiene standards were significantly associated with the type of management. However, there were still critical gaps in the food safety performance of the corporate group suggesting other underlying factors than the type of management.Practical implicationsAdditional elements were drawn from this study for future food safety culture research. Understanding the food safety attitudes and perception of risks of the management representatives, leaders, or food business owners is vital to develop appropriate food safety interventions and foster a positive food safety culture in the foodservice industry.Originality/valueTo the authors’ knowledge, this is the first study not only in Lebanon (or MENA) but also in other regions to measure the association of management type, that is, sole-proprietor management and corporate management, with the food hygiene standards and food safety practices in the foodservice establishments. This paper presents new findings that will be of value for researchers in food safety and will complement the existing literature on food safety culture in the foodservice industry.

In recent years, Italy has seen a constant upward trend in the practice of tattooing. The Italian National Health Institute has conducted a national survey to determine the prevalence of tattooed people in Italy and to study related features of the phenomenon. Establish the prevalence and characteristics of the tattooed population and evaluate awareness of the risks associated with tattoos, which can contribute to consumer health protection. Computer-assisted telephone interviews and computer-assisted web interviews were completed by a sample of the general population; 7608 people aged between 12 and 75+. The prevalence of tattooed people was 12.8% of the general population in Italy (95% CI: 12.05%-13.55%), equivalent to an estimated 6 900 000 tattooed individuals. Tattoos were more prevalent among women, at 13.8%, while tattooed men accounted for 11.8%. The vast majority of tattooed subjects had decorative tattoos of small dimensions, with a higher prevalence of monochromatic tattoos. Only a minority of tattooed participants reported having cosmetic tattoos (3.0%) or medical tattoos (0.5%). According to the data, 3.3% of tattooed subjects claimed complications or reactions; of these, only 21.3% consulted a dermatologist/general practitioner; more than half (51.3%) did not consult anyone. In general, only 58.2% of the sample were aware of health risks. The Italian survey showed that 36.7% of all tattoos had been performed in the last five years prior to the interview. The estimated prevalence of tattoos in Italy is in agreement with the statistics of the European Union. The prevalence in the age group 35-44 years is almost double that of the Italian population and it is higher in women than in men. Tattooing is relevant to public health. The high number of tattooed Italians, the potential long-term effects on health and the reported complications call for the awareness of health authorities. Appropriate intervention should ensure safer tattooing by reinforcing the training of tattooists, by improving surveillance and by providing information to raise public awareness of the risks and contraindications of tattooing.

Background: The role of food handlers in maintaining food safety, especially in healthcare settings, cannot be overstated. Poor hygiene practices can lead to foodborne illnesses, which are particularly dangerous in a hospital environment where patients may have compromised immune systems. Ensuring high standards of personal hygiene among food handlers is crucial in healthcare settings to prevent foodborne illnesses. This study focuses on the hygiene practices of food handlers in a hospital environment. Objective: To assess the personal hygiene practices of food handlers in District Hospital Parbhani. The study aims to identify the adherence level to hygiene standards and pinpoint areas for potential improvement in food safety practices. Methodology: A cross-sectional survey was employed, targeting food handlers in District Hospital Parbhani. The survey utilized a structured questionnaire to collect data on various aspects of personal hygiene, including hand hygiene, personal cleanliness, and safe food handling methods. The participants were also interviewed to understand their knowledge and attitudes towards food safety. The data collected was then systematically an analysed to identify patterns, strengths, and areas needing improvement in the hygiene practices of the food handlers. Results: In our study at District Hospital Parbhani, among the 126 food handlers, a notable 45.24% were below 30 years of age. When assessing hygiene practices, 74% of the handlers had clean nails, and approximately 50% practiced hand washing with soap and water after using the toilet. The cleanliness of kitchen areas was maintained by 73% of the establishments, with 62% using soap and detergents for cleaning purposes. Conclusion: The study highlights the critical role of rigorous personal hygiene practices among food handlers in healthcare settings. It recommends ongoing training and periodic evaluations at District Hospital Parbhani to sustain and enhance these hygiene standards, thereby ensuring the health and safety of patients and staff.

Medical tattooing of the areola is widely performed in Korea. However, cosmetic tattoos containing flesh-tone, purple-red, and yellow dyes are sometimes resistant to Q-switched laser and may even become darker. Two Korean women in their 30s who had a mastectomy got light brown to red areolar medical tattoos but they were not satisfied with the shape and size of the tattoos. They underwent Q-switched alexandrite laser treatment with a 3 mm collimated beam at fluences of 7.5-8 J/cm2 in order to trim the irregular contour and reduce the diameter of the tattoos. Within 5 minutes a dark gray to black discoloration of the treated area was evident and remained dark for 6 weeks. Improvement was not noted after two further Q-switched Nd:YAG laser treatments. Medical areolar tattoos should be approached with extra caution when attempting their removal with high-energy pulsed lasers such as Q-switched alexandrite laser and a small test site should be performed prior to treatment.

Purpose: The societal perception of tattoos has evolved, and tattooing procedures have become more prevalent. However, tattooing constitutes a medical procedure involving invasive actions on the skin, thereby falling within the scope of medical practices. Unless performed by qualified medical professionals possessing medical expertise, there is a constant risk of jeopardizing the life, physical well-being, or public health of tattoo recipients. Consequently, this paper seeks to investigate the current state of tattooing practices in South Korea, examining the legal issues at hand, and proposing measures to mitigate potential harm to consumers.
 Method: Through a comprehensive review of prior research and analysis of relevant literature, including an examination of judicial precedents, this study aims to examine the stance of the Constitutional Court and the Supreme Court regarding tattooing. Additionally, it seeks to review the legislative systems pertaining to tattooing in foreign countries such as the United States and Japan in order to propose improvements to the current tattooing system and suggest measures for consumer protection.
 Results: Through a review of legal precedents in our country, we have identified the evolving perception regarding the practice of tattooing. Additionally, by conducting research on foreign laws and systems, we have gained new insights into the legalization of tattooing and the considerations for potential solutions. By engaging in comprehensive discussions encompassing the protection of citizens' right to life and health, public health concerns, as well as the artistic nature, freedom of expression, and freedom of occupational choice associated with tattoos, we have sought to explore measures for improvement in the field of tattooing.
 Conclusion: Through this study, it was possible to ascertain the changing public perception of tattooing. Additionally, by conducting an analysis of foreign legal systems that reflect the evolving perception of tattoos, avenues for the legalization of tattooing could be explored. Protecting the right to life and promoting health, which are the objectives of medical law, naturally entail reserving medical procedures for qualified healthcare professionals. However, given the difficulty of reversing the widespread acceptance of tattooing brought about by societal changes, it is now necessary to consider the legalization of tattooing through legal and regulatory frameworks. This should be accompanied by consistent governmental oversight and supervision by the Ministry of Health and Welfare to safeguard the health rights of the population.

Imatinib Resistance and/or Intolerance in Clinical Practice in Europe: The “Unmet Needs in CML and Ph+ALL” (UNIC) Study.

Actions for prevention and control of health threats related to maritime transport in European Union

To assess the rate and determinants of sharp injuries during the previous 6 months among health care workers at first-level care facilities in two districts of Pakistan. Cross-sectional survey at public, general practitioners and non-licensed private practitioners selected through stratified random sampling. At each facility, we interviewed a prescriber and a dispenser/injection provider about knowledge of bloodborne pathogens transmission and preventive practices, risk perception, and use of precautions and sharp injuries received during the previous 6 months. Multivariable Poisson regression was used to assess the factors associated with the number of sharp injuries. Fifty-four percentage of the 233 workers had at least one injury during the previous 6 months. The overall rate of sharp injuries per person per year was 3.7; among non-physician prescribers (9%), it was 4.3; among dispensers (69%), it was 3.7, and among physicians (18%), it was 2.1. In the multivariable model, work experience, risk perception and type of health care worker were significantly associated with receiving sharp injuries during the previous 6 months. In the model including dispensers only, a higher knowledge score was associated with fewer sharp injuries, while perceived severity of disease and lack of professional qualification were associated with more. Sharp injuries are common in Pakistan. Better knowledge about modes of bloodborne pathogen transmission and professional qualification may reduce their incidence.

ProblemSafe sleep programs have been existing since the concept was first defined in 1969. The need for health care providers to model safe sleep practices is essential for successful adherence; however, barriers to promoting safe sleep practices hinder healthcare providers' ability to implement safe sleep in hospital settings. AimTo determine the barriers to promoting safe sleep practices amongst healthcare workers in the hospital setting. MethodsWhittemore & Knafl's framework (2005) guided this integrative review. CINAHL, PubMed, and Academic Search Complete databases were used as a search strategy. Inclusion criteria was limited to studies between 2010 and 2021, were peer-reviewed, in English, and quality improvement projects consisting of barriers to implementing safe sleep practices within hospitals. To assess quality of the included studies, the Mixed Methods Appraisal Tool and Standards for Quality Improvement Reporting Excellence were used. The studies were analyzed by two of the authors with data further categorized using the Social Ecological Model (SEM) to develop themes. ResultsFindings of the 10 included studies were presented in the form of a data display matrix. The authors used the SEM to categorize the findings under three main categories at the organizational, individual, and cultural levels. ConclusionsBarriers need to be addressed in hospital settings to reduce the risk of sudden infant death syndrome. Therefore, it is vital to consider those barriers while providing teaching programs in hospital settings. ImplicationsFindings from this review provide the core elements to consider for the development of safe sleep programs in the hospital setting.