Gait quality and physical functioning of stroke survivors with and without aphasia

Gait, often impaired after stroke, has not been adequately compared between survivors with aphasia (SWA) and those without aphasia (SWNA). Since a relationship exists between severity of motor deficit in stroke and aphasia, this study investigated differences in the gait quality and also physical functioning (PF) between the two groups. This cross-sectional, exploratory study involved 10 SWAs and 16 SWNAs. Gait parameters (stride length, step length, step width, gait velocity, and cadence) were evaluated while PF was measured with the Stroke Impact Scale (version 16). Data analysis was done using frequency, percentages, mean ± SD, two-sample t test and Spearman rank-order correlation. SWNAs had significantly (p < 0.05) higher step length (0.29 ± 0.11 m vs. 0.17 ± 0.08 m), stride length (0.58 ± 0.20 m vs. 0.38 ± 0.14 m), cadence (86.3 ± 17.1 steps/min vs. 57.7 ± 20.4 steps/min) and PF (67.1 ± 13.1 vs. 49.6 ± 12.9) than SWAs. PF had no significant relationship with any of the gait parameters in either group. In conclusion, SWAs had poorer gait quality and PF than SWNAs. The presence of aphasia with stroke merits more attention from the clinicians when it comes to designing gait rehabilitation programs for this client group.     

Regional differences in the vasorelaxant effects of nicorandil and amlodipine on isolated porcine coronary arteries

Summary— The vasorelaxant effects of nicorandil, a K⁺-channel opener, and amlodipine, a dihydropyridine-type Ca²⁺-channel blocker, were investigated on partially and maximally K⁺-depolarized ring preparations from the porcine left anterior descending coronary artery. By comparing vascular responses in the proximal and distal parts of the epicardial segment, the scope of the study was to evaluate regional differences in the action of nicorandil and amlodipine. Nicorandil (10 ⁷- 10^-4 M) shifted the K⁺ concentration-response curves to the right and depressed the maximal contractile responses in a concentration-dependent manner, consistent with K⁺-channel opening and secondary non-K⁺-channel opening mechanisms of action. Nicorandil had a significantly more potent relaxant effect in the proximal compared to the distal arterial rings contracted with 85 mM K⁺. Pretreatment with methylene blue (10^-5 M) did not significantly influence the regional difference in the action of nicorandil. Amlodipine (10⁹- 10^-6 M) had a significantly more potent and effective inhibitory and relaxant effect than nicorandil under the same conditions. In contrast to nicorandil, the effect of amlodipine was more prominent in the distal compared to the proximal vessel rings. The cumulative addition of extracellular Ca²⁺ exhibited a more potent contractile response in the distal rather than in the proximal rings. Nicorandil totally and amlodipine partly eliminated the contractile responses to the lowest concentration of Ca²⁺. The inhibitory effect of amlodipine on the contractile responses to higher Ca²⁺ concentrations was more pronounced than that of nicorandil. The results show that there are regional differences in the responsiveness of porcine coronary arteries to Ca²⁺, nicorandil and amlodipine. Our findings indicate that the regional difference in nicorandil-induced vasodilation was caused neither by the K⁺-channel opening nor by the nitrate-like mechanism of action, but could be due to a direct Ca²⁺-influx blocking effect of the drug.     

Unavailability of essential obstetric care services in a local government area of south-west Nigeria

This paper reports the findings at baseline in a multi-phase project that aimed at reducing maternal mortality in a local government area (LGA) of South-West Nigeria. The objectives were to determine the availability of essential obstetric care (EOC) services in the LGA and to assess the quality of existing services. The first phase of this interventional study, which is the focus of this paper, consisted of a baseline health facility and needs assessment survey using instruments adapted from the United Nations guidelines. Twenty-one of 26 health facilities surveyed were public facilities, and five were privately owned. None of the facilities met the criteria for a basic EOC facility, while only one private facility met the criteria for a comprehensive EOC facility. Three facilities employed a nurse and/or a midwife, while unskilled health attendants manned 46% of the facilities. No health worker in the LGA had ever been trained in lifesaving skills. There was a widespread lack of basic EOC equipment and supplies. The study concluded that there were major deficiencies in the supply side of obstetric care services in the LGA, and EOC was almost non-existent. This result has implications for interventions for the reduction of maternal mortality in the LGA and in Nigeria.     

The role of men in family planning decision-making in rural and urban Nigeria.

OBJECTIVES: To determine the role of men in family planning decision-making in both rural and urban areas of Nigeria. METHODS: A total number of 370 married men (244 rural and 126 urban) were interviewed using a pre-tested, semi-structured interviewer based questionnaire. The study was conducted in the Iwaro community in Atakumosa West Local Government area (rural men) and the Oranfe Community in Ife East Local government area (urban men), both in Osun State, South West Nigeria. RESULTS: The results showed a high level of awareness of family planning among both study groups (98.3% rural and 98.4% urban). Most men in both groups believe that a decision about family planning should be made jointly by the spouses instead of being the prerogative of either. This contrasts with the generally held belief that men are opposed to family planning and a take predominant role in contraceptive decision-making. The condom was the most commonly known and used method with a preponderance among urban (81.1%) over rural men (69.4%). Many men would use family planning if their wives demanded it. However, most respondents in both study groups believed that men should not accompany their wives to the family planning centre to obtain contraceptive supplies and advice. CONCLUSION: Deciding about contraception should be done jointly by men and women in South West Nigeria.     

Evaluating progress of labor in nulliparas and multiparas using the modified WHO partograph

OBJECTIVE: To evaluate the progress of labor in nulliparas and multiparas using the modified World Health Organization (WHO) partograph. METHOD: In a prospective study 259 nulliparas and 204 multiparas were compared for rates of normal labor progression in the active phase; of cervical dilatation plots crossing the alert line of the partograph; and of plots reaching or crossing the action line. Outcome measures were total duration of labor, mode of delivery, incidence of labor augmentation, and number of vaginal examinations. RESULTS: Labor duration was similar in the 2 groups and cervical dilatation remained normal for most women. In both groups, the incidence of spontaneous vaginal delivery was highest among women with normal labor progress and the incidence of both labor augmentation and operative intervention increased when labor progress was delayed. CONCLUSION: Labor progress and duration were found similar for nulliparas and multiparas when monitored with the modified WHO partograph. Delay in labor progress increased the need for operative intervention and adversely affected fetal outcome.     

Towards an Effective Health Interventions Design: An Extension of the Health Belief Model

Introduction

The recent years have witnessed a continuous increase in lifestyle related health challenges around the world. As a result, researchers and health practitioners have focused on promoting healthy behavior using various behavior change interventions. The designs of most of these interventions are informed by health behavior models and theories adapted from various disciplines. Several health behavior theories have been used to inform health intervention designs, such as the Theory of Planned Behavior, the Transtheoretical Model, and the Health Belief Model (HBM). However, the Health Belief Model (HBM), developed in the 1950s to investigate why people fail to undertake preventive health measures, remains one of the most widely employed theories of health behavior. However, the effectiveness of this model is limited. The first limitation is the low predictive capacity (R² < 0.21 on average) of existing HBM’s variables coupled with the small effect size of individual variables. The second is lack of clear rules of combination and relationship between the individual variables. In this paper, we propose a solution that aims at addressing these limitations as follows: (1) we extended the Health Belief Model by introducing four new variables: Self-identity, Perceived Importance, Consideration of Future Consequences, and Concern for Appearance as possible determinants of healthy behavior. (2) We exhaustively explored the relationships/interactions between the HBM variables and their effect size. (3) We tested the validity of both our proposed extended model and the original HBM on healthy eating behavior. Finally, we compared the predictive capacity of the original HBM model and our extended model.

Methods:

To achieve the objective of this paper, we conducted a quantitative study of 576 participants’ eating behavior. Data for this study were collected over a period of one year (from August 2011 to August 2012). The questionnaire consisted of validated scales assessing the HBM determinants – perceived benefit, barrier, susceptibility, severity, cue to action, and self-efficacy – using 7-point Likert scale. We also assessed other health determinants such as consideration of future consequences, self-identity, concern for appearance and perceived importance. To analyses our data, we employed factor analysis and Partial Least Square Structural Equation Model (PLS-SEM) to exhaustively explore the interaction/relationship between the determinants and healthy eating behavior. We tested for the validity of both our proposed extended model and the original HBM on healthy eating behavior. Finally, we compared the predictive capacity of the original HBM model and our extended model and investigated possible mediating effects.

Results:

The results show that the three newly added determinants are better predictors of healthy behavior. Our extended HBM model lead to approximately 78% increase (from 40 to 71%) in predictive capacity compared to the old model. This shows the suitability of our extended HBM for use in predicting healthy behavior and in informing health intervention design. The results from examining possible relationships between the determinants in our model lead to an interesting discovery of some mediating relationships between the HBM’s determinants, therefore, shedding light on some possible combinations of determinants that could be employed by intervention designers to increase the effectiveness of their design.

Conclusion:

Consideration of future consequences, self-identity, concern for appearance, perceived importance, self-efficacy, perceived susceptibility are significant determinants of healthy eating behavior that can be manipulated by healthy eating intervention design. Most importantly, the result from our model established the existence of some mediating relationships among the determinants. The knowledge of both the direct and indirect relationships sheds some light on the possible combination rules.