A gender comparison of psychological distress among medical students in Nigeria during the Coronavirus pandemic: a cross-sectional survey

BackgroundThe Coronavirus disease (COVID-19) pandemic as a large scale stressor could have negative effects on the mental health of medical students. Since gender differences in mental health may exist, it is important to see if a large scale stressor like the pandemic may be associated with variances in the psychological distress between both genders.ObjectivesTo assess and compare the psychological distress of male and female medical students during the COVID-19 pandemic.MethodsA cross-sectional survey was carried out among 1010 medical students from three universities in southwestern Nigeria within the first six months of the first reported case of the COVID-19 pandemic. The respondents were purposively selected. Data was obtained online on participants'' demographic and psychological distress using the General Health Questionnaire 12 (GHQ-12). Data was analyzed using the SPSS version 21, student t and chi-square tests were used to assess gender differences, and multivariate regression to assess the predictors of psychological distress among both genders. p values less than 0.05were considered statistically significant.ResultsOverall, female participants (OR=1.455, 95% CI= 1.095–1.936) were twice more likely to have experienced psychological distress than males during the COVID-19 pandemic. Age (OR=0.922, 95% CI= 0.867–0.979), being in pre-clinical years (OR= 1.394, 95% CI= 1.004–1.938), having a family income less than 100,000 naira (OR= 1.379, 95% CI=1.442–6.723) a previous history of mental illness (OR=3.077, 95% CI= 1.430–6.615) and having a relative/acquaintance diagnosed with COVID 19(OR=1.646, 95% CI= 1.062–2.551) were independently associated with psychological distress among the respondents. When comparing both genders, among females, age (OR=0.886, 95% CI= 0.803–0.978), family income less than 100,000 naira (OR=1.898, 95% CI= 1.306–2.759) and a previous history of mental illness (OR=5.266, 95% CI= 1.894–14.635) were associated with psychological distress, while, being in pre-clinical years (OR= 1.713, 95% CI= 1.052–2.790) was associated with psychological distress among males.ConclusionFemales had more psychological distress compared to male students. It is recommended that gender-specific interventions addressing psychological distress among medical students are instituted.     

Women's status within the household as a determinant of maternal health care use in Nigeria

BackgroundAlthough gender inequality is often cited as a barrier to improving maternal health in sub-saharan Africa, there is lack of empirical data on how women''s socio-cultural characteristics may influence use of health services in Nigeria.ObjectiveTo describe how women''s position in the household affects receipt of maternity care services.MethodsSecondary data analysis of 10,052 and 4,590 currently married women aged 15 to 49 years from the 2008 Nigerian DHS who receive skilled antenatal and delivery care at least till pregnancy was done.ResultsReceipt of skilled delivery care was by 37.9% while, natal care was by 98.4%. Education, residence and wealth index all significantly influenced receipt of maternal health care. Women who were involved in decision making on their own health (aOR=1.97; 95%CI=1.88–2.06) and were employed throughout the year (aOR=1.11; 95%CI=1.01–1.23) were more likely to receive skilled antenatal care, while those who justified physical intimate partner violence were less likely to receive both skilled antenatal care (aOR=0.92; 95%CI=0.85–0.98) and delivery services (aOR 0.54; 95% CI 0.33–0.87).ConclusionInterventions aimed at improving maternal care should promote women empowerment (decision making, self worth, educational and economic) and should involve partners.     

Predictors of utilization of facility-based ante-natal care and delivery services in a Nigerian Rural Community

BackgroundWith maternal mortality ratio of 2,000/100,000 live births and perinatal mortality rate of 40/1,000 total births, Cross River State is one of the states with the highest maternal and perinatal deaths in Nigeria. One of the causes of these poor health indices is low utilization of facility-based maternal and child healthcare services during pregnancy and childbirth. The objective of this study was to assess the predictors of utilization of antenatal care and delivery services in Akpabuyo, a rural community in Cross River State of Nigeria.MethodThis was an analytical cross-sectional survey. Data were collected from 370 pregnant women between June and July, 2013 and analyzed using SPSS version 25.ResultsBinary logistic regression showed that compared with women with tertiary education, women with non-formal education were less likely to attend antenatal clinic (AOR=0.510, 95% CI=0.219–1.188) although the difference was not statistically significant. Also, compared with farmers, full-time housewives were less likely to deliver in a health facility (AOR=0.650, 95% CI=0.305–1.389) while civil servants were nearly five times more likely to deliver in the health facility (AOR=4.750, 95%CI=1.616–13.962).ConclusionThe predictors of antenatal care and facility delivery services utilization identified by the study were educational status and occupation. This raises the need for policies and programmes to ensure girl child education and the economic empowerment of women.     

Cerebrovascular accidents differ between patients with atrial flutter and patients with atrial fibrillation

IntroductionFew studies have explored the potential impact of atrial flutter (AFl) on ischaemic stroke (IS) outcome. The aim of the present study was to compare the clinical course of IS in patients with AFl and patients with atrial fibrillation (AF).Material and methodsA retrospective analysis of patients consecutively admitted to a tertiary care centre between 2013 and 2015 due to IS or transient ischaemic attack with permanent AFl or permanent or persistent AF was performed.ResultsThe study groups consisted of 528 patients, including 490 (92.8%) patients with AF and 38 (7.2%) patients with AFl. The mean age and prestroke CHA2DS2-VASc scores were similar between the patients with AFl and those with AF. Most IS cases in the AF group were classified as cardioembolic strokes (74.9% vs. 39.5% in AFl, p < 0.01), and lacunar strokes were the most common in the AFl group (47.4% vs. 14.3% in AF, p < 0.01). The multivariable analysis revealed that the presence of AF (OR = 8.6, 95% CI: 1.2–57, p = 0.02), lacunar stroke (OR = 0.1, 95% CI: 0.03–0.31, p < 0.001), baseline Rankin scale score (OR = 16.6, 95% CI: 9.8–28), lack of prestroke therapeutic anticoagulation (OR = 6.1, 95% CI: 1.1–33), diabetes (OR = 2.9, 95% CI: 1.3–6.5, p < 0.01), chronic heart failure (OR = 14.2, 95% CI: 5.8–34, p < 0.001), and current smoking (OR = 0.92, 95% CI: 0.39–0.99, p < 0.01) were significantly associated with the stroke outcome.ConclusionsDisabling or fatal IS was observed less often in patients with AFl than in patients with AF. This finding can possibly be explained by the more frequent occurrence of lacunar strokes in the AFl group compared with that in the AF group.     

Health care related factors associated with severe malaria in children in Kampala,Uganda

Background

Severe malaria is responsible for the high load of malaria mortality. It is not clearly understood why some malaria episodes progress to severe malaria.

Objective

To determine factors associated with severe malaria in children aged 6 months to 5 years living in Kampala.

Methods

Over a 6-month period, 100 children with severe malaria were matched by age and place of residence with 100 children with non-severe malaria. We collected health care information from care takers.

Results

Mean duration of illness before getting antimalarial treatment was shorter for controls than cases (8hours vs. 20hours, p 0.015). Children with severe malaria were less likely to have been treated with sulphadoxine-pyrimethamine in the preceding 2 weeks (OR 0.2, 95% CI 0.04–0.85, p 0.016). Odds of severe malaria were higher in those who reported lack of protective measures (mosquito coils (OR = 20.63, 95% CI 1.5–283.3, p=0.02 and insecticide sprays OR 10.93, 95% CI 1.13–105.64, p=0.03), although few reported their use.

Conclusions

Early anti-malarial treatment and use of barriers against mosquitoes prevent severe malaria in children. There is need to increase the use of barriers against mosquito bites and to scale up prompt treatment and community-based interventions to reduce the incidence of severe malaria in children.     

Respiratory effects of biomass fuel combustion on rural fish smokers in a Nigerian fishing settlement: a case control study

BackgroudThe aim was to study the prevalence of respiratory symptoms and assess the lung function of fish smokers in Nigeria.MethodsA case control study was done among fish smokers in Nigeria. Women aged 15 years or older (n=210) involved in fish smoking and equal number of matched controls were interviewed on respiratory symptoms and their peak expiratory flow rate (PEFR) measured. Data was analysed using chi square test, student''s t-test and odd ratios.ResultsBoth groups were similar in their personal characteristics. The test group had significantly increased occurrence of sneezing (153; 72.86%), catarrh (159; 75.71%), cough (138; 65.71%) and chest pain (59; 28.10%) compared with the control group, odds ratio (OR) 2.49, 95% confidence interval CI (1.62–3.82), P < 0.001), OR 3.77,95% CI (2.44– 5.85), P < 0.001, OR 3.38, 95% CI (2.22–5.15), P < 0.001, and OR 6.45,95% CI (3.22–13.15), P < 0.001, respectively. The mean PEFR of 321±58.93 L/min among the fish smokers was significantly lower than 400±42.92 L/min among the controls (p = 0.0001).ConclusionFish smokers have increased risk of respiratory symptoms and reduced pulmonary function. There is a need for protective equipment and periodic evaluation.     

Associations of insomnia symptoms with subsequent health services use among community-dwelling U.S. older adults

Study ObjectivesDetermine the association of insomnia symptoms with subsequent health services use, in a representative sample of U.S. older adults.MethodsParticipants were 4,289 community-dwelling Medicare beneficiaries who had continuous fee-for-service Medicare coverage 30 days before, and 1 year after the National Health and Aging Trends Study (NHATS) Round 1 interview. Participants reported past-month insomnia symptoms (i.e. sleep onset latency >30 min, difficulty returning to sleep) which we categorized as 0, 1, or 2 symptoms. Outcomes were health services use within 1 year of interviews from linked Medicare claims: emergency department (ED) visits, hospitalizations, 30-day readmissions, home health care (all measured as yes/no), and number of hospitalizations and ED visits.ResultsOverall, 18.5% of participants were hospitalized, 28.7% visited the ED, 2.5% had a 30-day readmission, and 11.3% used home health care. After adjustment for demographics, depressive and anxiety symptoms, medical comorbidities, and BMI, compared to participants with no insomnia symptoms, those with two insomnia symptoms had a higher odds of ED visits (odds ratio [OR) = 1.60, 95% confidence interval [CI] = 1.24–2.07, p < 0.001), hospitalizations (OR = 1.29, 95% CI = 1.01–1.65, p < 0.05), and 30-day readmissions (OR = 1.88, 95% CI = 1.88–3.29, p < 0.05). Reporting 2 insomnia symptoms, versus no insomnia symptoms, was associated with a greater number of ED visits and hospitalizations (incidence rate ratio (IRR) = 1.52, 95% CI = 1.23–1.87, p < 0.001; IRR = 1.21, 95% CI = 1.02–1.44, p < 0.05, respectively) after adjusting for demographic and health characteristics.ConclusionsAmong older adults, insomnia symptoms are associated with greater health services use, including emergency department use, hospitalization, and 30-day readmission. Targeting insomnia may lower health services use.     

On the way to universal coverage of maternal services in Iringa rural District in Tanzania. Who is yet to be reached?

BackgroundStrategies to tackle maternal mortality in sub-Saharan Africa include expanding coverage of reproductive services. Even where high, more vulnerable women may not access services. No data is available on high coverage determinants. We investigated this in Tanzania in a predicted high utilization area.MethodsData was collected through a household survey of 464 women with a recent delivery. Primary outcomes were facility delivery and ≥4 ANC visits. Determinants were analysed using multivariate regression.ResultsAlmost all women had attended ANC, though only 58.3% had ≥4 visits. ≥4 visits were more likely in the youngest age group (OR 2.7 95% CI 1.32–5.49, p=0.008), and in early ANC attenders (OR 3.2 95% CI 2.04–4.90, p<0.001). Facility delivery was greater than expected (87.7%), more likely in more educated women (OR 2.7 95% CI 1.50–4.75, p=0.002), in those within 5 kilometers of a facility (OR 3.2 95% CI 1.59–6.48, p=0.002), and for early ANC attenders (OR 2.4 95% CI 1.20–4.91, p=0.02).ConclusionRural contexts can achieve high facility delivery coverage. Based on our findings, strategies to reach women yet unserved should include promotion of early ANC start particularly for the less educated, and improvement of distant communities'' access to facilities.     

Systematic review with meta-analysis: Non-alcoholic fatty liver disease and the association with pregnancy outcomes

Background/AimsMaternal and fetal outcomes in pregnant patients with Non-alcoholic fatty liver disease (NAFLD) have been largely unexplored. To determine the level of evidence associated with maternal and fetal outcomes in pregnant women with NAFLD.MethodsWe conducted a comprehensive literature search. The studies included pregnant patients with a previous, current or subsequent diagnosis of NAFLD. We used a random-effects model using odds ratios (OR) with 95% confidence intervals (CI).ResultsTwenty-two studies, with 13,641 female NAFLD patients were reviewed. The results highlight that NAFLD patients had a statistically significant increased likelihood of baseline diabetes mellitus (OR, 6.00; 95% CI, 2.21–16.31; P<0.001; n=7), baseline Hypertension (OR, 3.75; 95% CI, 2.13–6.59; P<0.001; n=4), gestational hypertension (OR, 1.83; 95% CI, 1.03–3.26; P=0.041; n=2), and pre-eclampsia (OR, 2.43; 95% CI, 1.46–4.04; P=0.001; n=3). The odds for a past and current history of gestational diabetes mellitus were OR, 3.78; 95% CI, 2.21–6.44; P<0.001; n=5 and OR, 3.23; 95% CI, 1.97– 5.31; P<0.001; n=6, respectively. As for fetal outcomes, pregnant NAFLD patients were significantly more likely to have a premature birth (OR, 2.02; 95% CI, 1.44–2.85; P<0.001; n=4), large for gestational age birth (OR, 2.01; 95% CI, 1.72–2.37; P<0.001; n=2) or a history of prior miscarriage or abortion (OR, 1.15; 95% CI, 1.02–1.30; P=0.02; n=2). Egger’s regression revealed no evidence of publication bias (P>0.05).ConclusionsThis meta-analysis provides pooled evidence that NAFLD is associated with a substantial increase in maternal diabetic and hypertensive complications and multiple adverse fetal outcomes. This data is important for clinicians managing these patients before, during and after pregnancy.     

Provider barriers to hydroxyurea use in adults with sickle cell disease: a survey of the Sickle Cell Disease Adult Provider Network

The FDA approved hydroxyurea for use in adults with sickle cell disease (SCD) in 1998. In 2002, the NHLBI published recommendations for the use of hydroxyurea in this patient population. The purpose of this study was to evaluate providers' awareness of the NHLBI recommendations regarding hydroxyurea prescribing, whether these recommendations have changed providers' practices and how these providers prescribed hydroxyurea. We chose to survey a select group of providers of care to adults with SCD, members of the Sickle Cell Adult Provider Network. The response rate was 47%. Eighty-one percent of respondents reported they had read the NHLBI recommendations on hydroxyurea use, and 76% of respondents agreed with the NHLBI recommendations. Only 45% of respondents to this survey reported that they prescribe hydroxyurea to every eligible patient. Black respondents reported a higher percentage of their eligible patients being on hydroxyurea than white respondents. Seventy-seven percent of respondents thought that hydroxyurea was effective or very effective in patients with SCD. Ninety-four percent of black versus 73% of white versus 40% of other race respondents thought that hydroxyurea was effective or very effective in SCD patients (p = 0.006). The results of this survey suggest that lack of awareness, agreement and belief in the benefits of hydroxyurea contributes to providers underprescribing hydroxyurea.     

Right ventricular dysfunction and pulmonary hypertension in COVID-19: a meta-analysis of prevalence and its association with clinical outcome

IntroductionRapid spread of COVID-19 has caused detrimental effects globally. Involvement of the ACE2 receptor has identified COVID-19 as a multi-organ disease. Preliminary studies have provided evidence that cardiac involvement, including right ventricular dysfunction (RVD) and pulmonary hypertension (PH), were found in COVID-19 cases, even in the non-advanced stage. This meta-analysis aims to analyze the prevalence of RVD and PH, and their association with COVID-19 clinical outcome.Material and methodsA systematic data search was conducted through PubMed, medRxiv, ProQuest, Science Direct, and Scopus databases using constructed keywords based on MeSH terms. Any outcomes regarding mortality, severity, ICU admission, and mechanical ventilation usage were analyzed using RevMan v.5.4 and Stata v.16.ResultsA total of 16 eligible studies (1,728 patients) were included. Pooled prevalence of RVD in COVID-19 was 19% (95% CI: 13–25%), and PH was 22% (95% CI: 14–31%). RVD was associated with increased mortality (OR = 2.98 (95% CI: 1.50–5.89), p = 0.002), severity (OR = 3.61 (95% CI: 2.05–6.35), p < 0.001), ICU admission (OR = 1.70 (95% CI: 1.12–2.56), p = 0.01), and mechanical ventilation (MV) usage (OR = 1.60 (95% CI: 1.14–2.25), p = 0.007). PH was also associated with increased mortality (OR = 5.42 (95% CI: 2.66–11.060, p < 0.001), severity (OR = 5.74 (95% CI: 2.28–14.49), p < 0.001), and ICU admission (OR = 12.83 (95% CI: 3.55–46.41), p < 0.001).ConclusionsRVD and PH were prevalent in COVID-19 and associated with mortality, severity, ICU admission, and MV usage in COVID-19 patients. Bedside echocardiography examination could be considered as a novel risk stratification tool in COVID-19.     

Patient characteristics and frequency of bodily distress syndrome in primary care: a cross-sectional study

BackgroundBodily distress syndrome (BDS) is a newly proposed diagnosis of medically unexplained symptoms, which is based on empirical research in primary care.AimTo estimate the frequency of BDS in primary care and describe the characteristics of patients with BDS.MethodData were obtained from GP one-page registration forms, patient questionnaires (including a checklist for BDS), and national registers.ResultsA total of 1356 primary care patients were included, of whom 230 patients (17.0%, 95% confidence intervals [CI] = 15.0 to 19.1) fulfilled the BDS criteria. BDS was more common among primary care patients aged 41–65 years (odds ratio [OR] = 1.9, 95% CI = 1.3 to 3.0) and was equally frequent among males and females (female sex, OR 0.9, 95% CI = 0.6 to 1.3). Patients with BDS were characterised by poor health-related quality of life (HRQOL) on the 12-item Short-Form Health Survey, that is, physical component summary scores <40 (OR 20.5, 95% CI = 12.9 to 32.4) and mental component summary scores <40 (OR 3.5, 95% CI = 2.2 to 5.6). Furthermore, patients with BDS were more likely to have high scores on the Symptom Checklist for anxiety (OR 2.2, 95% CI = 1.4 to 3.4) and depression (OR 5.1, 95% CI = 3.3 to 7.9), but regression analyses showed that mental morbidity did not account for the poor HRQOL.ConclusionBDS is common among primary care patients, and patients with BDS have a higher probability of poor HRQOL and mental health problems.     

Clinical characteristics and risk factors for 28-day mortality in critically ill patients with COVID-19: a retrospective cohort study

BackgroundTo date, the coronavirus disease 2019 (COVID-19) caused more than 2.6 million deaths all around the world. Risk factors for mortality remain unclear. The primary aim was to determine the independent risk factors for 28-day mortality.Materials and MethodsIn this retrospective cohort study, critically ill patients (≥ 18 years) who were admitted to the intensive care unit due to COVID-19 were included. Patient characteristics, laboratory data, radiologic findings, treatments, and complications were analyzed in the study.ResultsA total of 249 patients (median age 71, 69.1% male) were included in the study. 28-day mortality was 67.9% (n = 169). The median age of deceased patients was 75 (66–81). Of them, 68.6% were male. Cerebrovascular disease, dementia, chronic kidney disease, and malignancy were significantly higher in the deceased group. In the multivariate analysis, sepsis/septic shock (OR, 15.16, 95% CI, 3.96–58.11, p < 0.001), acute kidney injury (OR, 4.73, 95% CI, 1.55–14.46,p = 0.006), acute cardiac injury (OR, 9.76, 95% CI, 1.84–51.83, p = 0.007), and chest CT score higher than 15 (OR, 4.49, 95% CI, 1.51-13.38, p = 0.007) were independent risk factors for 28-day mortality.ConclusionEarly detection of the risk factors and the use of chest CT score might improve the outcomes in patients with COVID-19.     

Factors associated with gastro-duodenal ulcer in compensated type 2 diabetic patients: a Romanian single-center study

IntroductionHelicobacter pylori infection is accepted as the leading cause of chronic gastritis, ulcer disease and gastric cancer, with an important impact on health care burden, especially in countries with a high prevalence of infection. The aim of the study was to investigate the influence of H. pylori infection, medication, associated medical conditions or social habits on endoscopic ulcer occurrence in the compensated type 2 diabetic population.Material and methodsTwo hundred and sixty type 2 diabetic patients investigated on endoscopy (57 patients with peptic ulcer and 203 controls) with a complete set of biopsies, demographic and medical data were enrolled.ResultsOn univariate regression analysis, H. pylori infection (42.1% vs. 35.5%, p = 0.359) or a history of peptic ulcer (61.4% vs. 61.6%, p = 0.981) was not a predictor for ulcer on endoscopy in the diabetic population, and heartburn was more frequent in diabetics without ulcer (21.2% vs. 8.8%, p = 0.033). Anemia was the best predictor for ulcer on endoscopy in both diabetics with (p < 0.001, OR = 4.77, 95% CI: 2.02–11.28) and without (p = 0.027, OR = 2.76, 95% CI: 1.10–6.91) chronic proton pump inhibitor (PPI) therapy. In diabetic patients on PPI more than 1 month anticoagulants – acenocoumarol or low-weight molecular heparin (p = 0.038, OR = 2.37, 95% CI: 1.04–5.40), low-dose aspirin 75–125 mg/day (p = 0.029, OR = 2.61, 95% CI: 1.08–6.28) and alcohol consumption (p = 0.015, OR = 2.70, 95% CI: 1.19–6.13) were predictors for ulcer on endoscopy.ConclusionsIn diabetic patients, anemia is the most important predictor for ulcer on endoscopy, but not H. pylori or digestive symptoms, while low-dose aspirin or anticoagulant therapy and alcohol consumption are the most important predictors for ulcer in diabetics on chronic proton pump inhibitor therapy.     

Maternal and neonatal outcomes of grand multiparity in Khartoum,Sudan

ObjectivesGrand multiparity is a major health problem that leads to adverse maternal and perinatal outcomes. We aimed to assess the maternal and perinatal outcomes of grand multiparity.MethodsA case-control study was conducted in Saad Abualila Hospital, Khartoum, Sudan from February to December 2019. The cases were grand multiparous (≥ 5 deliveries) women. The controls were women with low parity (multiparous women who delivered two to four times). Maternal and perinatal characteristics were compared between the two groups. Logistic regression analysis was performed.ResultsThere was a significant association between grand multiparity and higher maternal age (adjusted odds ratio [AOR]=1.19, 95% confidence interval [CI]=1.16–1.23), lower education level (AOR=3.38, 95% CI=2.49–5.58) and lower antenatal care attendance (AOR=1.73, 95% CI=1.02–2.92). Grand multiparous women were at increased risk for Anemia (AOR=1.48, 95% CI=1.08–2.03), diabetes mellitus (AOR=10.61, 95% CI=4.89–23.00), caesarean delivery (AOR=1.87, 95% CI=1.40–2.48), preterm birth (AOR=1.90, 95% CI=1.37–2.62) and admission to the neonatal intensive care unit (AOR=3.8, 95% CI=1.95–7.75).ConclusionsGrand multiparity was associated with poor maternal and neonatal outcomes. Development of a national health program addressing family planning, health education and improvement of antenatal, intrapartum and neonatal care are needed.     

Visceral Fat Mass Has Stronger Associations with Diabetes and Prediabetes than Other Anthropometric Obesity Indicators among Korean Adults

PurposeThis study determined which obesity measurement correlates the best with diabetes and prediabetes.ResultsAfter adjusting for age and other potential confounding factors, participants with a visceral fat mass in the upper 10th percentile had a higher odds ratio (OR) for diabetes and prediabetes than the upper 10th percentile of other adiposity indices [men, OR=15.9, 95% confidence interval (CI)=6.4–39.2; women, OR=6.9, 95% CI=3.5–13.7]. Visceral fat mass also had the highest area under the curve with diabetes and prediabetes in both men (0.69, 95% CI=0.64–0.73) and women (0.70, 95% CI=0.67–0.74) compared to other anthropometric measurements of obesity.ConclusionVisceral fat mass measured using DXA is an indicator of diabetes or prediabetes, due to its ability to differentiate between abdominal visceral and subcutaneous fat.     

Risk Factors of Acoustic Neuroma: Systematic Review and Meta-Analysis

PurposeMany epidemiological studies have investigated environmental risk factors for the development of acoustic neuroma. However, these results are controversial. We conducted a meta-analysis of case-control studies to identify any potential relationship between history of noise exposure, smoking, allergic diseases, and risk of acoustic neuroma.ResultsEleven case-control studies were included in our meta-analysis. Acoustic neuroma was found to be associated with leisure noise exposure [odds ratio (OR)=1.33, 95% confidence interval (CI): 1.05–1.68], but not with occupational noise exposure and ever noise exposure (OR=1.20, 95% CI: 0.84–1.72 and OR=1.15, 95% CI: 0.80–1.65). The OR of acoustic neuroma for ever (versus never) smoking was 0.53 (95% CI: 0.30–0.94), while the subgroup analysis indicated ORs of 0.95 (95% CI: 0.81–1.10) and 0.49 (95% CI: 0.41–0.59) for ex-smoker and current smoker respectively. The ORs for asthma, eczema, and seasonal rhinitis were 0.98 (95% CI: 0.80–1.18), 0.91 (95% CI: 0.76–1.09), and 1.52 (95% CI: 0.90–2.54), respectively.ConclusionOur meta-analysis is suggestive of an elevated risk of acoustic neuroma among individuals who were ever exposed to leisure noise, but not to occupational noise. Our study also indicated a lower acoustic neuroma risk among ever and current cigarette smokers than never smokers, while there was no significant relationship for ex-smokers. No significant associations were found between acoustic neuroma and history of any allergic diseases, such as asthma, eczema, and seasonal rhinitis.     

Predictors of exclusive breastfeeding practice among nursing mothers attending a health care facility in a peri-urban setting in Lagos State,Nigeria

BackgroundThe Nigerian government initiated various national infant and young child feeding programmes (1992–2005) to improve juveniles well-being. Despite these efforts, under-five children feeding related diseases and mortality still escalate. Investigating the drivers of exclusive breastfeeding (EBF) is exigent in tackling this menace.ObjectiveTo investigate maternal socio-demographic and index child variables that serve as predictors of EBF practice among nursing mother attending a healthcare facility in Lagos, western Nigeria.MethodsOne hundred and twenty (N=120) consenting nursing mothers (15–49 years) with infants between 0–24 months completed a structured, self-administered questionnaire. Scores of current practice level for EBF was computed and adjusted odd ratios (aORs) generated from a logistic regression model.ResultsRespondents mean age was 28.7 ± 2.3 years. Of 120 respondents, 82(68.3%) and 38(31.7%) had good and poor EBF practice respectively. Having an index child <6months age (aOR=5.02, 95% confidence intervalCI=1.28–15.43), being in monogamy (aOR=3.0, 95% CI=1.80–6.73), having tertiary education (aOR=3.12, 95% CI=1.39–8.96), being married (aOR=2.0, 95% CI=0.1–0.8) and vaginal delivery (aOR=2.96, 95% CI=1.75–7.48) increased the odds of EBF practice.ConclusionAge of index child, marriage type, maternal education, marital status and nature of delivery independently predicted EBF practice.     

Role of frailty in prediction of hospitalized older adult patient’s outcomes: a prospective study

Background/aim Frailty is associated with an increased risk of negative short-term and long-term hospital outcomes. This study aimed to evaluate the role of frailty in predicting readmission, length of stay, and quality of life in the hospitalized older adults.Materials and methods This observational study was conducted at Ziaiyan Hospital, Tehran, Iran. In total, 304 participants (65–85 years), were enrolled through the inclusion criteria from August to December 2019. The frailty index (FI) was assessed by the minimum data set-home care. Readmission was obtained through telephone interviews. The length of stay was gathered by the patient’s hospital records, and the EuroQol questionnaire was used for assessing the quality of life. Data were collected by a researcher nurse at the admission time, 30, 60, and 90 days after discharge. The logistic regression model and repeated measures ANOVA were employed to analyze the association between frailty and outcomes.ResultsAccording to FI, 102 (33.55%) participants were pre-frail, whereas 35 (11.51%) were frail. In the fully-adjusted model for readmission, the pre-frail participants had a higher risk of readmission at the hospital in comparison with the nonfrail and frail groups (OR = 1.88, 95% CI = 1.90–3.26), and also for GP visits, frail patients showed nearly significant differences (OR = 2.45, 95% CI = 0.99–6.06) but there were no differences between frail and pre-frail patients in readmissions in the emergency ward. In a fully-adjusted prolonged stay model, pre-frail patients had a higher probability to stay longer in hospital (OR = 2.28, 95% CI: 1.24–4.18). The fully-adjusted model for QoL showed, frail patients were more prone to the declined levels of QoL in comparison with pre-frail patients (OR = 10.77, 95% CI: 3.97–29.18).ConclusionsThe findings indicated that frailty worsened negative outcomes and declined QoL. Early diagnosis in hospital settings could be beneficial for designing optimal care plans for the frail and pre-frail patients.