Prevalence and correlates of suicidal behaviour among adolescents in southwest Nigeria

BACKGROUND: Despite being recognized by the World Health Organization as a significant social and health concern, information on suicidal behaviours in Nigerian adolescents is unknown. AIMS: To establish the prevalence and associated psychosocial correlates of suicidal ideation and attempts in Nigerian youth. METHODS: Stratified sampling was used to identify youth aged 10-17 years who completed the Nigeria version of the Global School Health Questionnaire (GSHQ) and the Diagnostic Predictive Scale (DPS) for youths (suicidal behaviour questions) in a classroom setting. RESULTS: A total of 1429 youth completed the instruments. Over 20% reported suicidal ideation and approximately 12% reported that they had attempted suicide in the last year. Adolescents living in urban areas, from polygamous or disrupted families, had higher rates of suicidal behaviour. Multiple psychosocial factors such as sexual abuse, physical attack and involvement in physical fights were significant predictors of suicidal behaviour. CONCLUSION: Factors associated with suicidal ideation and behaviours are similar to those found in other studies but the rates of both suicidal ideation and attempts are towards the upper limit of rates for youth. This study suggests that there is an urgent need for Nigerian policymakers and health providers to review and address this issue.     

A profile on HIV prevalence and risk behaviors among injecting drug users in Nigeria: Should we be alarmed?

ObjectiveInjecting drug use is now recognized as a significant risk factor for HIV in sub-Saharan Africa. We evaluated prevalence and correlates of HIV among injecting drug users (IDUs) in Nigeria.MethodsA cross sectional design using respondent driven sampling was conducted in six states in 2010. Weighted HIV prevalence and injecting risk behaviors calculated using RDS analytic tool. Logistic regression was used to determine correlates of HIV infection, stratified by state.ResultsTotal numbers of IDUs ranged from 197 in Lagos to 273 in Cross River and Oyo states. HIV prevalence was highest in Federal Capital Territory (FCT) at 9.3%, Kaduna 5.8%, Oyo 5.1%, Kano 4.9%, CR 3.3% and Lagos 3.0%. Although >90% of participants were male, females had higher HIV prevalence in all states surveyed except FCT (range: 7.4% in CR to 37.7% in Kano). Logistic regression showed that females were significantly more likely to be HIV positive in Kano [OR = 33.2, 95% CI: 6.8–160.4], Oyo [AOR = 15.9, 95% CI: 3.69–68.51], Lagos [OR = 15.5, 95% CI: 2.41–99.5] and Kaduna states [AOR = 19.6, 95% CI: 4.4–87.6]. For injecting risk behavior, only receptive sharing was associated with HIV [AOR = 7.6, 95% CI: 1.2–48.7] and [AOR = 0.2, 95% CI: 0.04–0.92] in Oyo and Kaduna states respectively.ConclusionsConsiderable heterogeneity in the prevalence of HIV and associated risk behaviors exist among IDUs across Nigeria. Females had higher HIV prevalence among IDUs in five of six states, suggesting a need for targeted interventions for this hidden subgroup. Further research is needed to understand HIV transmission dynamics of IDUs in Nigeria. Community-based opioid substitution therapy and needle exchange programs should be implemented without delay.     

Widening inequalities in MMR vaccine uptake rates among ethnic groups in an urban area of the UK during a period of vaccine controversy (1994-2000)

We examined MMR vaccine uptake among ethnic groups in Birmingham, UK between 1994 and 2000, a period incorporating adverse MMR vaccine publicity. From 1994 to 2000 overall uptake: (1) fell significantly from 91.1% in 1994 to 89.8% (chi(2) for trend p<0.001) in 2000, (2) in Asian children significantly increased (chi(2) for trend p<0.001), and (3) in White children significantly decreased (chi(2) for trend p<0.001). Differences between ethnic groups with the highest (Asian) and the lowest (Black Caribbean) uptake rates increased from 2.1% in 1994 (p=ns) to 6.8% in 2000 (p<0.001). This study suggests underlying ethnic inequalities in MMR vaccine uptake and differential response to adverse vaccine publicity.     

Extensive Plexiform Neurofibroma in a Premature Neonate

We describe a premature neonate with an extensive plexiform neurofibroma. Prenatal ultrasound at 32 weeks of gestation was normal. Postnatal examination was significant for a palpable left neck mass. Magnetic resonance imaging (MRI) of the head demonstrated a mass involving the left cavernous sinus with spreading to the left orbital region. MRI of the neck was positive for extensive adenopathy, left more than right, with extension into the deep face region and infratemporal fossa on the left side. MRI of the chest, abdomen, and pelvis demonstrated a mass extending from the superior mediastinum to the left pelvic retroperitoneal region, including the mesenteric vasculature and spinal canal at multiple levels with compression of the spinal cord. Biopsy of the left neck mass confirmed for plexiform neurofibroma. A careful search of the literature revealed no previous report of such an extensive neurofibroma in a premature neonate. Surgical decompression in this premature neonate was not possible because of the extensive nature of the disease; it is known that neurofibroma is non-respondent to chemotherapy and radiotherapy. Therefore, alternative treatment is needed to improve the outcome.     

Current status of oral and maxillofacial radiology in West Africa

Background

Oral and maxillofacial radiology became the ninth dental specialty recognized by the American Dental Association (ADA) in 1999. This came about following the discovery of X-rays by Wilhelm Conrad Roentgen in 1895 and, 14 days later, the application of X-rays to making dental radiographs by Otto Walkhoff. The purpose of this narrative study was to review the evolution of oral and maxillofacial radiology as a dental specialty in the USA and its recognition as a program of training by the West African College of Surgeons.

Methods

This study was conceptualized as a narrative review of the literature focusing on the history and development of oral and maxillofacial radiology in the USA. It builds a synthesis that describes the recognition of oral and maxillofacial radiology as a specialty of dentistry in West Africa, UK, Japan, and Australia.

Results

The main finding was that oral and maxillofacial radiology became the ninth specialty recognized by the American Dental Association, ADA, in October 13, 1999. On March 20, 2014, the West African College of Surgeons recognized this specialty and granted accreditation for postgraduate training. In the UK, Japan, and Australia, the postgraduate education in oral and maxillofacial radiology has two patterns, namely professional training and academic training.

Conclusions

The primary goal of the postgraduate training curriculum is to train radiologists who are competent to deliver care to patients in any clinical setting, including a dental school, hospital radiology practice, or private practice.

     

Type 2 diabetes in adult Nigerians: a study of its prevalence and risk factors in Port Harcourt, Nigeria

OBJECTIVES: This study aimed to assess the prevalence rates of type 2 diabetes and to determine potential associated risk factors of the disease in Port Harcourt, Nigeria. RESEARCH DESIGN AND METHODS: Five hundred and two (502) subjects aged above 40 years, obtained by a two-stage cluster sampling technique participated in this survey. Casual (random) plasma glucose estimations were done for all subjects after relevant personal data were obtained. Subjects with casual plasma glucose (CPG) > or =7.0 mmol/l had oral glucose tolerance tests (OGTT) done. Fasting and 2 h post glucose load blood samples were analyzed for plasma glucose levels. RESULTS: Thirty-four (34) subjects had diabetes, giving a crude prevalence rate of 6.8% (CI=4.6-9.0%), and standardized rate of 7.9%. The crude prevalence rates were 7.7 and 5.7% for males and females, respectively. Of the 34 diabetic subjects seen, 14 (41.2%) of them were not previously known to have diabetes; 83.7% of these were asymptomatic. Body mass index (BMI) > or = 25 kg/m2 and WHR > or = 0.85, family history of diabetes, physical inactivity, heavy consumption of alcohol, older age as well as high social status and Hausa-Fulani or Ibibio origin were associated with significantly higher prevalence of type 2 diabetes. CONCLUSION: The prevalence of type 2 diabetes in Port Harcourt is relatively high. Changing lifestyle associated with industrialization may explain this. A significant proportion of the diabetic subjects are asymptomatic and undiagnosed. The risk factors as shown in our study clearly emphasize the point that type 2 diabetes is to a large extent a preventable disease.     

Pulmonary delivery of opioids as pain therapeutics

Pulmonary opioid delivery, on the basis of the fact that small molecular entities can be rapidly and completely absorbed from the peripheral lung, poses a unique opportunity for the treatment of severe (breakthrough) pain, which currently is treated with intravenous therapy. Early clinical studies involving inhaled opioids were focused on treatment of dyspnoea and not pain management, but they showed that inhalation of various opioid compounds is safe, even in severely ill patients. The advent of specialized and efficient pulmonary drug delivery systems has facilitated the evaluation of inhaled opioids, such as morphine and fentanyl, for management of severe pain associated with surgery or malignant disease. This review will summarize recent literature on the pharmacokinetics and pharmacodynamics of inhaled opioids and will discuss safety and efficacy in comparison to injection and other opioid dosage forms available for pain therapy. Finally, regulatory considerations will be discussed towards the approval of this new delivery paradigm for opioid drugs.