Cholecystectomy: indications at University of Calabar Teaching Hospital, Calabar, Nigeria

BACKGROUND/OBJECTIVE: The relative rarity of gallbladder disease has been documented in various parts of Africa. Recently the incidence has been reported as rising in some African countries. We undertook this study to evaluate the indications for cholecystectomy in our center and compare with others. METHODS: This is a retrospective study of 18 open cholecystectomies in 10 years. RESULTS: The ages ranged from 13 and 65 years (mean 39.2 years). There were 15 females and 3 males (F:M? = ?ratio 5:1). Calculous cholecystitis 9 (50%) in patients, acalculous cholecystitis 8 (44.4%) and a patient with carcinoma of the gallbladder were offered cholecystectomy. The commonest stone was mixed multiple stones. CONCLUSION: The numbers of cholecystectomies attest to the rarity of gallbladder disease in this environment. This may be due to the high fiber and low cholesterol diet predominant in this costal population in southern Nigeria.     

Knowledge and perception of stroke among at risk medical out-patients in a tertiary health institution in Nigeria

BACKGROUND: Patients who recognize their increased risk of stroke are more likely to engage in stroke prevention practices than those who do not. METHOD: All patients attending medical out-patient clinic of the Federal Medical Center, Ido, Ekiti-State, Nigeria between January 2004-December 2004 were recruited into the screening process following their verbal consent. A set of questionnaire was administered to collect data. RESULTS: A total of 155 patients were studied having satisfied the inclusion criteria. The mean age of the patients was 58.4 +/- 18.7 years. Majority of the patients indicated paralysis of one side of the body as the most common symptom of stroke. Patients with higher education p = 0.002 and men p = 0.004 were more aware of their increased risk factor for stroke than those with low education and women. CONCLUSION: Perception about stroke among the at risk medical out patients as found out in this study indicates that more health education both at the community and the hospital is very vital to reducing the prevalence, recurrence, disability and mortality of stroke. Health providers are enjoined to communicate information about stroke risk to their patients.     

Perceptions of vaginal microbicides as an HIV prevention method among health care providers in KwaZulu-Natal, South Africa

Background  

The promise of microbicides as an HIV prevention method will not be realized if not supported by health care providers. They are the primary source of sexual health information for potential users, in both the public and private health sectors. Therefore, the aim of this study was to determine perceptions of vaginal microbicides as a potential HIV prevention method among health care providers in Durban and Hlabisa, South Africa, using a combination of quantitative and qualitative methods.     

Knowledge, attitudes, and behaviors of healthcare providers for botanical and dietary supplement use for postmenopausal health

OBJECTIVE: To identify the knowledge, attitudes, and behaviors of health care providers (physicians and nurses) regarding the use of botanical dietary supplements (BDS) for peri- and postmenopausal women. DESIGN: Health care providers (physicians and nurse practitioners/nurse midwives) completed a questionnaire to assess knowledge, attitudes, and behaviors regarding botanical dietary supplement use for peri- and postmenopausal women. A total of 62 providers were included in the final analysis. RESULTS: Two thirds of providers reported that they had limited or no knowledge about botanical dietary supplements. By far, the majority of providers had no formal training nor had they studied these supplements on their own. Although knowledge was limited, a majority of providers wanted additional training predominantly because of growing patient awareness and use and were open to using these therapies for their patients either in combination with conventional Western medicine or as the only support for relief of peri- and postmenopausal symptoms. However, only 25% of providers regularly asked their peri- and postmenopausal patients about use of botanical dietary supplements. Providers who had practiced longer (> or =11 y) were more likely to be knowledgeable about dietary supplements and to have studied on their own (P < 0.01), to believe that botanicals are part of evidence-based medicine (P < 0.05), and to have talked to their patients (P < 0.05) about use of these therapies. Increased knowledge also appeared to predict a more positive attitude on the part of providers toward their patients who use BDS (P < 0.001) as well as more proactive behavior related to referring and recommending these therapies as treatment (P < 0.01). CONCLUSIONS: Our findings suggest that knowledge about botanical therapies among health care providers caring for peri- and postmenopausal women is quite low, but they are open to learning more about these modalities and using them for treatment, if appropriate. Our results suggest that increased years in practice is related to increased knowledge, more positive attitudes, and more proactive behaviors related to botanical dietary supplements.     

Metabolic syndrome and its components among HIV/AIDS patients on Antiretroviral Therapy and ART-Naïve Patients at the University of Calabar Teaching Hospital,Calabar, Nigeria

BackgroundAlthough an increasing access to ART in sub-Saharan Africa has made it possible for HIV/AIDS patients to live longer, clinicians managing such patients are faced with the challenge of drug-related metabolic complications.MethodsA cross -sectional study was carried out at the University of Calabar Teaching Hospital, Nigeria, on three groups of participants; namely HIV patients on ART, ART-naïve patients and HIV negative subjects (n =75). Demographic and anthropometric data were collected using a well-structured questionnaire while biochemical parameters were measured using colorimetric methods.ResultsThe highest prevalence of MS was associated with the HIV/AIDS patients on ART (i.e. 32.0 %, and 50.3% for NCEP-ATP III and IDF criteria respectively). Patients on ART had significant increases (p< 0.05) in waist to hip ratio, FPG, serum TG and LDL-c; and a significantly higher (p< 0.05) prevalence of hypertension, diabetes, low HDL-c and hypertriglyceridaemia compared to the ART-naïve patients. Low serum HDL-c was the most prevalent form of dyslipidaemia in all three groups and the most prevalent component of MS in HIV patients.ConclusionART increases the risk of MS and CVD. HIV/AIDS patients on ART should be advised on lifestyle modifications and undertake regular assessment of their cardiovascular risk factors.     

Factors affecting vaccine handling and storage practices among immunization service providers in Ibadan,Oyo State,Nigeria

BackgroundImproper handling has been identified as one of the major reasons for the decline in vaccine potency at the time of administration. Loss of potency becomes evident when immunised individuals contract the diseases the vaccines were meant to prevent.ObjectiveAssessing the factors associated with vaccine handling and storage practices.MethodsThis was a cross-sectional study. Three-stage sampling was used to recruit 380 vaccine handlers from 273 health facilities from 11 Local Government areas in Ibadan. Data was analysed using SPSS version 16ResultsSeventy-three percent were aware of vaccine handling and storage guidelines with 68.4% having ever read such guidelines. Only 15.3% read a guideline less than 1 month prior to the study. About 65.0% had received training on vaccine management. Incorrect handling practices reported included storing injections with vaccines (13.7%) and maintaining vaccine temperature using ice blocks (7.6%). About 43.0% had good knowledge of vaccine management, while 66.1% had good vaccine management practices. Respondents who had good knowledge of vaccine handling and storage [OR=10.0, 95%CI (5.28 – 18.94), p < 0.001] and had received formal training on vaccine management [OR=5.3, 95%CI (2.50 — 11.14), p< 0.001] were more likely to have good vaccine handling and storage practices.ConclusionRegular training is recommended to enhance vaccine handling and storage practices.     

Knowledge and indulgence in substsance abuse among adolescents in Anambra state,South-East Nigeria

BackgroundSubstance abuse is a growing societal problem with adolescents being at increased risk. The few studies in Nigerian adolescents have not factored in their knowledge base with regard to the concept of substance abuse.ObjectivesThis study determined the indulgence in and knowledge of substance abuse and associated factors among adolescents.MethodsThis was a questionnaire based study involving 10 to 19year olds recruited from an adolescent summer camp in Anambra state, South-East Nigeria.ResultsThe data of 276adolescents was analyzed, male–91, 33%, M: F = 1: 2. Mean age was 16.4 ± 1.4years. 13.8% (38) accepted they had abused substances in the past; 74.3% (205) had the correct knowledge of the meaning of substance abuse; 10.1% (28) admitted taking substances for pleasure. The substances taken included Alcohol (67.9%), Cigarette (25.0%), Tramadol (10.7%), Cocaine (7.1%), among others. Multiple substances were taken 28.6% of the time.Age category had no significant association with the abuse of substances (X2–2.656, p = 0.282). Stratified by age category, gender had a significant association with substance abuse in Late adolescence (n = 11; M–9, 81.8%; F–2, 18.2%; X2 = 6.893, p = 0.016) but not Mid-adolescence (n = 27; M – 10, 37.0%; F – 17, 63.0%; X2 = 0.749, p = 0.500).ConclusionAn unacceptable proportion of the adolescents were already exposed to substances/drugs in spite of having suboptimal knowledge. Adolescents need to be educated on substance abuse and its dangers in order to curb this in the society.     

Building a generic architecture for medical information exchange among healthcare providers

Due to the inability to exchange clinical information among hospitals, continuity of care cannot be maintained and a tremendous amount of medical resource has been wasted. This paper describes an architecture that would facilitate exchange of clinical information among heterogeneous hospital information systems. It is dubbed 'Medical Information Exchange Center' or MIEC as part of a six-year Health Information Network Project hosted by the Department of Health. MIEC was designed so that it is innovative yet technically feasible today. It is convenient for authorized users yet secure enough so people can trust and has minimal impact to participated hospitals. Authorized users will be able to access information through two web-based interfaces directed to physician and non-physician users respectively. Hospitals are connected through a virtual private network to exchange patient information and users need to obtain a private key from the certificate authority in order to securely connect to MIEC. A pilot project was conducted to demonstrate the feasibility of this architecture and the problems encountered were discussed.     

Calcium,inorganic phosphates,alkaline and acid phosphatase activities in breast cancer patients in Calabar,Nigeria

Background

Breast cancer is the commonest malignancy of women in Nigeria. Change in serum levels of some biochemical parameters could assist diagnosis and follow-up of breast cancer.

Objective

To determine serum levels of calcium, inorganic phosphates, alkaline phosphatase (ALP) and acid phosphatase (ACP) activities in patients with breast cancer, and change in the serum levels over time.

Methods

Total serum calcium and inorganic phosphates, and serum ALP and ACP activities were determined in 25 women with breast cancer and 25 age-matched controls using colorimetric and enzymatic methods, over 6 months with bimonthly analysis.

Results

The serum calcium level, ALP and ACP activities were significantly higher (p<0.05) in the study group than in the control group. No significant difference was seen in the inorganic phosphate levels of both groups. There were significant increases in serum calcium levels, ALP and ACP activities in the study group with time (p<0.05), whereas no significant increase was observed in the control group.

Conclusion

Breast cancer patients have higher calcium levels and higher ALP and ACP activities. The increase in the levelsof these parameters with time shows that they could be of importance in monitoring treatment and disease progress in a resource-poor setting.Key words: Breast cancer, serum calcium, inorganic phosphate, alkaline phosphatase, acid phosphatase, tumor markers     

Rh antigens and phenotype frequencies of the Ibibio, Efik, and Ibo ethnic nationalities in Calabar, Nigeria

This report forms part of the study on the Rh phenotypes within the various ethnic nationalities in the south-south region of Nigeria. The aim is to demonstrate the Rh polymorphisms among the people of African descent. The frequencies of Rh blood group antigens and phenotypes of the Ibibio, Efik, and Ibo ethnic nationalities in Calabar municipality, Nigeria, were determined using standard serologic techniques. Of the 720 Calabar individuals tested, the frequencies of the Rh antigens within the nationalities were c (100%), e (96.38%), D (96.38%), E (15.22%), and C (3.62%) for the Ibibios; c (100%), e (95.60%), D (96.70%), E (21.98%), and C (0%) for the Efiks; and c (100%), e (94.29%), D (91.43%), E (28.57%), and C (2.86%) for the Ibos. The overall frequencies of the Rh antigens in these 720 individuals were c (100%), e (95.56%), D (94.44%), E (18.89%), and C (2.78%). Forty (5.56%) were found to be D-, while all were found to possess the c antigen. The most frequently occurring Rh phenotype was Dccee, with a frequency of 73.61 percent. The alternative allele, C, did not appear in homozygous form (CC) in the population tested. This study further demonstrates the variability of Rh blood group phenotypes in Nigeria and Africa.     

Knowledge, attitudes and practice of healthcare ethics and law among doctors and nurses in Barbados

Background  

The aim of the study is to assess the knowledge, attitudes and practices among healthcare professionals in Barbados in relation to healthcare ethics and law in an attempt to assist in guiding their professional conduct and aid in curriculum development.     

Exploring beliefs on diabetes treatment adherence among Dutch type 2 diabetes patients and healthcare providers

Objective

Despite well-known beneficial effects, adherence to core elements of diabetes treatment is suboptimal. This study, conducted in the Netherlands, aimed to explore if and how treatment adherence success factors are applied in diabetes consultations, and to explore salient personal beliefs about type 2 diabetes treatment including both healthy lifestyle adaptations and pharmacotherapy.

Mindfulness for healthcare providers fosters professional quality of life and mindful attention among emergency medical technicians

ObjectiveEmergency medical service (EMS) providers are systematically subjected to intense stimuli in their work that may result in distress and emotional suffering. While it is known that mindfulness-based stress reduction (MBSR) helps to foster well-being in healthcare workers, the effectiveness of MBSR among EMS providers is less understood. We explored the impact of a modified version of MBSR for healthcare workers called Mindfulness for Healthcare Providers (MHP) on reducing distress and promoting wellbeing in EMS providers.MethodsA one-arm pilot study was conducted. We implemented eight two-and-a-half hour sessions of Mindfulness for Healthcare Providers with an additional day-long retreat at the end. Feasibility, perceived stress, professional quality of life, and trait mindfulness were assessed prior to and after the intervention. The professional quality of life scale includes measures of compassion satisfaction, burnout, and secondary trauma.ResultsFifteen veteran EMS providers enrolled in the course; four participants dropped out. Prior to initiation of the study, no significant differences were revealed between those who did not participate (n = 48) and those who did (n = 11). After the intervention EMS providers endorsed statistically significant increases in compassion satisfaction, trait mindfulness, and decreases in burnout compared to the beginning of the program. These changes were sustained at six months post-completion. No significant changes over time were found for secondary trauma or perceived stress.ConclusionsTo our knowledge, this study is the first to employ Mindfulness for Healthcare Providers in an EMS population and to demonstrate a positive impact on self-reported compassion, trait mindfulness, and burnout in this population. Additional research regarding mindfulness training within EMS populations should be conducted to further understand the relationship between mindfulness and perceived stress over time.     

A structural regression analysis of trauma-informed climate factors,organizational commitment,and burnout among behavioral healthcare providers in a large public hospital

As an approach to organizational change, trauma-informed care is contextualized within the broader organizational literature by examining the associations between organizational conditions (i.e., psychological experiences of choice and collaboration in the work environment) with precursors to organizational effectiveness (i.e., affective commitment and burnout). The study occurred within a large public hospital's behavioral health department located in the Western New York region (N = 197). Structural regression analyses were conducted, and the primary findings, while nuanced, include support for choice and collaboration's prediction of employee commitment and burnout. Organizational interventions that improve worker's experiences of choice and collaboration may result in increased commitment, reduced burnout, and possibly improved effectiveness. Future research should employ longitudinal designs to further examine the condition–performance relationship and include direct measures of clinical effectiveness.     

Safety, acceptability, and tolerability of 3 topical microbicides among heterosexual Kenyan men

OBJECTIVES: To compare the acceptability, tolerability, and safety of 3 topical microbicide formulations (62% ethyl alcohol in emollient gel and 0.1% and 0.4% benzalkonium chloride on a sanitary wipe) for use on male genitalia. DESIGN: This triple-randomized crossover study among men attending a sexually transmitted disease (STD) clinic in Nairobi, Kenya assigned individuals without clinical evidence of an STD to apply products to the penis in a predetermined random order, each for a 2-week period with a 1-week washout period between each product. Men recorded side effects and were examined for adverse events. RESULTS: Of 39 participants, 33 (84%) completed 6 clinic visits plus 3 home visits by community health workers. Participants reported use of 62% ethanol gel and 0.1% and 0.4% benzalkonium on 99%, 99%, and 96% of daily scheduled applications; 99%, 98%, and 97% of preintercourse applications, and 99%, 94%, and 98% of postintercourse applications. All participants said they would recommend all 3 products to a friend; 72% preferred the 62% ethanol gel, 17% the 0.1% benzalkonium, and 11% the 0.4% benzalkonium. One person developed objective signs of a genital ulcer after 14 days of 0.4% benzalkonium wipe use. CONCLUSIONS: Two of the 3 topical microbicides had minimal reported adverse effects, and no adverse effects were observed during use of the ethanol gel, which was preferred by most men.