A national survey: percussion, vibration, shaking and active cycle breathing techniques used in patients with acute exacerbations of chronic obstructive pulmonary disease

Objectives

Chronic obstructive pulmonary disease (COPD) is a frequent cause of hospital admission in older people. There is a perception that manual chest physiotherapy techniques are commonly used in the treatment of patients admitted with acute exacerbations of COPD (AECOPD). However, it is not clear which chest physiotherapy techniques benefit patients admitted with AECOPD, or even which techniques are currently being employed. The aim of this study was to investigate the use of percussion, vibration, shaking and active cycle breathing techniques (ACBT) by physiotherapists working in respiratory care and treating patients admitted with AECOPD.

Design

A postal questionnaire was used to survey physiotherapists working in respiratory care in 190 acute hospital trusts in the UK about chest clearance physiotherapy techniques used in the treatment of patients admitted with AECOPD.

Results

Of the 190 questionnaires mailed, 146 (77%) complete responses were received. One hundred and twenty-nine (88%) respondents reported that they always or often used ACBT, compared with 38 (26%), 16 (11%) and 12 (8%) respondents for vibration, shaking and percussion, respectively. The differences were statistically significant: ACBT used always/often versus vibration used always/often (χ² = 5.8, P = 0.01); ACBT used always/often versus percussion used always/often (χ² = 8.3, P < 0.0001); and ACBT used always/often versus shaking used always/often (χ² = 6.7, P < 0.001).

Conclusions

Manual chest physiotherapy techniques (vibration, percussion and shaking) were used infrequently for chest clearance in patients admitted with AECOPD, whereas ACBT was used always or often by 88% of responders.     

Soil-Transmitted Helminthic Infections and Geophagia among Pregnant Women in Jimma Town Health Institutions,Southwest Ethiopia

BackgroundPregnancy is a key step for human''s reproduction and continuity of generation. Pregnant women are among at risk groups for the infection of soil-transmitted helminths (STHs). STHs are highly prevalent in low- and middle-income countries due to the deprived environmental sanitation and personal hygiene. Eating soil (geophagia) is also commonly practiced by pregnant women, particularly in developing countries. The aim of this study was to determine the prevalence of STHs and geophagia, and to assess associated factors among pregnant women in Jimma, Southwest Ethiopia.MethodsA cross sectional study was conducted among 407 pregnant women attending antenatal care (ANC) at different health facilities located in Jimma Town. Data related to sociodemographic and geophagia practice was collected using a structured questionnaire and STH infections status was determined by using McMaster technique.ResultsA total of 407 pregnant women were included in this study. The overall prevalence of any STHs was 19.7% (80/407). Ascaris lumbricoides was the most prevalent 45(56.2%), followed by Trichuris trichiura 19(23.8%) and hookworms 12(15%). There were 4(5%) of double infection with A. lumbricoides and T. trichiura. Overall, 71 (17.4%) of the pregnant women responded to practice geophagia. STHs infection was significantly higher among geophagic pregnant women (p<0.01) and pregnant women who practiced geophagia were 3 times more likely (OR 2.9, 95% CI 1.3–4.2) to have the STHs compared to non-geophagic. Out of those who claimed soil eating habits, 59.1% preferred reddish soil type. Geophagia practice was significantly higher during the third trimester as compared to first and second (p<0.05).ConclusionGeophagia is a risky behavior and this study showed a significant association of geophagia practice with STH infections, although the causal relation could not be established.     

Physical Violence and Associated Factors among Women of Reproductive Age in Gedeo Zone,Southern Ethiopia

BackgroundPhysical violence against women of reproductive age is a significant public health problem worldwide. This study aimed to assess physical violence and associated factors among women of reproductive age.MethodA community-based cross-sectional study design was implemented from August 1 to September 30, 2018, including women of reproductive age in Gedeo Zone Southern Ethiopia. A stratified, two-stage cluster sampling technique was used. Finally, the study population was selected from the respective source population using a simple random sampling technique. Data were checked, coded, and entered Epi data version 3.1 and exported to SPSS version 20 for analysis. The wealth index was computed using the principal component analysis. Bivariate and multivariable analyses were computed to identify the determinants of physical violence among women of reproductive age.ResultsExperiencing at least one type of physical violence among women of reproductive age was 14.7% (95%CI: 11.7, 17.4). Study participants whose spouse had any habit (AOR: 3.56; 95%CI: 1.75, 7.25) and whose spouse had watched pornography counterpart ((AOR: 1.58; 95%CI: 1.02, 3.17) had significantly higher odds of experiencing physical violence among women of reproductive age. Spouses had any habit like alcohol drinking, chat chewing, cigarette smoking, and seeing pornography significantly increased physical violence among reproductive-age women. Therefore, the responsible stakeholders should work on the means to the spouse can alleviate any form of habit like alcohol drinking, chat chewing, cigarette smoking, and seeing pornography could decrease physical violence in women of reproductive age.     

Pulmonary rehabilitation programmes in the UK: a national representative survey

BACKGROUND: Respiratory disease is a common cause of disability in middle and late life. Pulmonary rehabilitation programmes improve exercise capacity and quality of life in patients with chronic lung diseases. However, currently, in the UK the availability of pulmonary rehabilitation programmes and their characteristics are unknown. METHODS: We surveyed pulmonary rehabilitation programmes in terms of number, size, duration, content of educational and exercise programme, and staffing. We mailed a 17-item questionnaire previously used in Canadian study to 190 physiotherapy departments within acute hospitals in UK. RESULTS: One hundred and seventy-one (90%) responses were received. Sixty-eight centres (40%) run a pulmonary rehabilitation programme (99% outpatient). Mean age of subjects was > or = 70 in only seven centres (10%), though most cited no upper age limit. Ninety-nine per cent of centres incorporated exercise training. Programmes recruited a median group size of 10 patients (range 4-17) at a given time with a median duration of eight weeks (range 5-24) weeks. Most (71%) run twice per week with a duration of 2 hours (63%). Only half offered smoking cessation support, and a minority gave advice on coping with disease, travel and sexual matters. CONCLUSION: Around 40% of surveyed hospitals run a pulmonary rehabilitation programme and most of the programmes are similar in their format, content and staffing. Despite the high prevalence of chronic obstructive pulmonary disease (COPD)-related disability in old age most programmes chiefly included younger subjects. This may reflect lack of referral. Greater awareness and expansion of availability of programmes is indicated.     

Clinical course and outcome of schizophrenia in a predominantly treatment-naive cohort in rural Ethiopia

The established view that schizophrenia may have a favorable outcome in developing countries has been recently challenged; however, systematic studies are scarce. In this report, we describe the clinical outcome of schizophrenia among a predominantly treatment-naive cohort in a rural community setting in Ethiopia. The cohort was identified in a 2-stage sampling design using key informants and measurement-based assessment. Follow-up assessments were conducted monthly for a mean duration of 3.4 years (range 1-6 years). After screening 68 378 adults, ages 15-49 years, 321 cases with schizophrenia (82.7% men and 89.6% treatment naive) were identified. During follow-up, about a third (30.8%) of cases were continuously ill while most of the remaining cohort experienced an episodic course. Only 5.7% of the cases enjoyed a near-continuous complete remission. In the final year of follow-up, over half of the cases (54%) were in psychotic episode, while 17.6% were in partial remission and 27.4% were in complete remission for at least the month preceding the follow-up assessment. Living in a household with 3 or more adults, later age of onset, and taking antipsychotic medication for at least 50% of the follow-up period predicted complete remission. Although outcome in this setting appears better than in developed countries, the very low proportion of participants in complete remission supports the recent observation that the outcome of schizophrenia in developing countries may be heterogeneous rather than uniformly favorable. Improving access to treatment may be the logical next step to improve outcome of schizophrenia in this setting.     

Candidatus Rickettsia hoogstraalii in Ethiopian Argas persicus ticks

Ethiopian soft ticks Argas persicus, hard ticks including both Amblyomma variegatum and Rhipicephalus (Boophilus) spp., and fleas were collected from livestock, traditional human dwellings, and cracks and crevices of trees. They were assessed in pools for the presence of Rickettsia using PCR-based methods. The extracted tick DNA was subjected to molecular screening for Rickettsia, which revealed 50.5% of the pooled samples to be positive for Rickettsia spp. These were then subjected to multi-gene analysis using both outer surface proteins and housekeeping genes with proven discriminatory potential. Sequencing of the citrate synthase and outer membrane genes clearly led to the identification of three distinct rickettsial species, Candidatus Rickettsia hoogstraalii in Argas persicus ticks; R. africae in hard tick pools, and R. felis in fleas. Furthermore, we demonstrated the presence of the plasmid-borne small heat-shock protein gene hsp2 in DNA from A. persicus ticks suggesting that Candidatus R. hoogstraalii carried by these ticks possess a plasmid. Unlike chromosomal gene sequences, the hsp2 gene failed to cluster with Candidatus R. hoogstraalii, instead falling into an isolated separate clade, suggesting a different origin for the plasmid.