Perceived family-related stressors and clinical manifestations of patients with psychosomatic morbidity attending general outpatient clinic university college hospital

Background: Depression, anxiety and somatoform disorder account for psychosomatic morbidity (PSM), the most prevalent mental disorder encountered in primary care. Prominent clinical manifestations of PSM can result from perceived stress and are general and unspecified symptoms (GUS) which most times are unexplained. These symptoms vary in individuals, usually multiple and affect different body parts. Studies have shown that stress relating to health, work and financial problems is common among primary health care attendees, but association with pattern and extent of PSM has not been widely studied in Nigeria.Objective: This study sought to explore the relationship between severity of patients' clinical manifestations and perceived family related stressors (PFRS).Method: The study span for three months, during which 1402 patients ≥18 years who presented at the out-patient clinic for various complaints were encountered. The sample size was determined using the prevalence of 63.1%. for psychosomatic disorder from Ogunsemi et al's study. A sample of 360 patients with varying forms of PSM identified by ≥ 5 from symptoms in the primary evaluation of mental disorder- patient health questionnaire somatoform, anxiety and depression modules (PRIME-MD PHQ SADs) was recruited consecutively out of the patients encountered during the study period. The clinical manifestations of these patients were categorized using international classification for primary care second electronic version (ICPC-2E). The ICPC-2E was modified by the addition of somatic symptoms observed to be peculiar in people with PSM in the study area. The Social Readjustment Rating Scale (SRRS) was used to explore the PFRS. Data were analyzed using statistical package for Social Sciences soft ware version 17. Tables and diagrams in form of graphs, charts were used for relevant variables. Cross tabulations of some independent variables and dependent variable were analyzed using independent t-test and analysis of variance. Statistical significance level was set at p ≤ 0.05.Results: The age of respondents ranged between 18 and 80 years with mean age of 42.2 years + 15.2. Two-thirds of them (67.8%) were females and majority had married once 76.4% [this comprised those that were living with their spouses (62.5%), separated/divorced (3.1%) and widowed (10.8%), while (23.6%) were never married. Commonest complaints observed were GUS (23.3%), cardiovascular system complaints (14.2%), gastrointestinal (11.9%), musculoskeletal complaints (11.4%), gynaecological symptoms (10.6%), neurological (8.6%) and symptoms from other body parts constituted 20%. GUS complaints in this study contained additional features (crawling body sensation, sensation of pain or heaviness in the head, peppery body sensation, migratory body pains and migratory body movement) included in the modified ICPC-2E classification. Almost all respondents screened in with PSM (95.6%) had somatoform disorder by the (PRIME MD) PHQ-SAD questionnaire used.The second and third parts of PHQ-SADS diagnosed that only few have depressive disorder (40%) and anxiety disorder (44.4%). The mean scores for PFRS were higher in respondents with moderate to severe PSM. However, respondents with anxiety related symptoms are more likely to have greater PFRS (p = 0.03).Conclusion: GUS were predominant complaints identified in patients with PSM in this study. Females tend to perceive more psychosocial stressors when compared with males and are more likely to report their symptoms. The study finding suggests that risk factor for a severe manifestation of patients with PSM is higher PFRS

Perceived family support and its effect on cardiovascular disease risk among hypertensive patients presenting at a family medicine practice in south west nigeria

Background: Lifestyle modification and health care behaviour are influenced by the support of family members. Family support is asocioeconomic factor that affects many chronic medical illnesses' outcome. It influences medication adherence, blood pressure control and could affect the risk of developing cardiovascular disease.The aim of this study is to assess the level of family support and determine the relationship between family support and cardiovasculardisease risk in patients with hypertension.Methods: This was a descriptive cross-sectional study of 345 hypertensive patients ages 30 years and above using simple randomtechnique. Data were collected with an interviewer-administered questionnaire, physical examination and blood investigation.Perceived family support and cardiovascular disease risk were assessed with Perceived Social Support Family Scale and FraminghamGeneral cardiovascular risk score respectively. Level of significance was set at p < 0.05.Results: Majority (75.5%) of the respondents was females, 40.3% were elderly and 71.7% were married. Most of the respondents (93.3%) had strong perceived family support while 1.7% and 4.7% had no and weak perceived family support respectively. Blood pressure was controlled in 58.6% of the respondents and 30.7% had low cardiovascular disease risk. Strong perceived family supportwas associated with being currently married. There was no association found between blood pressure control, cardiovascular diseaserisk and perceived family support.Conclusions: The proportion of hypertensive patients with strong perceived family support is high in this practice setting. However,there was no association found between perceived family support and cardiovascular disease risk. Keywords: Hypertension, perceived family support, blood pressure control, cardiovascular disease risk, family medicine practic

Relationship between Knowledge of Hypertension and 10-Year Cardiovascular Risk among Patients with Hypertension at a Primary Care Clinic in Nigeria.

Background:Good knowledge of the risk factors, course and consequences of high blood pressure by patients with hypertension can influence their lifestyle, drug adherence and the risk of subsequent development of cardiovascular disease. We aimed at determining the relationship between the knowledge of hypertension and 10-year cardiovascular risk among patients with hypertension. Materials and Methods: It was a cross-sectional survey of 345 hypertensive patients attending the general outpatient clinic of the University College Hospital. Knowledge of hypertension and 10-year cardiovascular risk were estimated using hypertension fact questionnaire and Framingham General cardiovascular risk score respectively. Chi-square and t-test statistics were used for bivariate analysis with a p-value set at 0.05. Results: The age range of the respondents was 35-82 years. Coexistence of other cardiovascular risk factors such as physical inactivity, diabetes mellitus and obesity were found in 66.1%, 35.4 % and 71.3% participants respectively. Less than half (44.3%) of the participants had adequate knowledge about hypertension. There was a significant association between hypertension knowledge and 10-year cardiovascular risk (χ2= 14.70, p=.001). Also, a significant difference was found in the mean of systolic and diastolic blood pressure, hypertension knowledge score, total cardiovascular risk and physical activity between respondents with adequate and inadequate hypertension knowledge. Conclusion: Given the high inadequate hypertension knowledge and its significant association with 10-year cardiovascular risk. Comprehensive health education on hypertension and its complications should be given to patients to promote their cardiovascular health

The role of physical exercise in management of depression among adult depressive patients attending family medicine practice of a Federal Teaching Hospital, South west Nigeria

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Relationship between patient satisfaction with medical care and medication non-adherence among hypertensive patients attending a general outpatient department in southwest Nigeria

Background: Medication non-adherence (MNA) is prevalent in hypertension. Patient satisfaction is derived from the patient's appraisal of how well the provider meets his or her personal emotional and physical needs. The objectives of this study were to determine the factors associated with medication non-adherence; and to also ascertain the relationship between patient satisfaction with medical care and medication non-adherence among hypertensive patients. Methods: Cross sectional study which was conducted in the Family Medicine clinic of the Federal Teaching Hospital, Ido-Ekiti. The sample size was 337. Morisky Medication Adherence Scale (MMAS-8), and the Patient Satisfaction Questionnaire (PSQ-18) were the questionnaires used. Data was analysed using the Statistical Package for Social Sciences (SPSS). Results: The majority {185 (54.9%)} of the hypertensives were in the age-group 45 – 64 years. The male to female ratio was 1:0.67. The largest proportion of the respondents {134 (39.8%)} had low adherence (medication non-adherence), while 104 (30.9%) and 99 (29.3%) had medium and high medication adherence level respectively. Mean satisfaction scores of 3 and above were obtained in the Technical Quality (3.54 ± 0.81), Accessibility and Convenience (3.48 ± 0.87), Communication (3.23 ± 0.95) and Interpersonal Manner (3.09 ± 0.98) subscales. The subscales with mean satisfaction scores of less than 3 were the General Satisfaction (2.82 ± 1.23), Financial Aspects (1.91 ± 0.82), and Time Spent with Doctor (1.85 ± 0.82) which had the least score. There were statistically significant strong positive correlations between medication adherence and each of the seven patient satisfaction subscales. The significant predictors of medication non-adherence were having primary education or no formal education,  having monthly income of less than ₦50,000, and being overweight or obese. Conclusion: Physicians should deliver quality care in a way to achieve high ratings of patient satisfaction. This will influence patients to adhere better to their antihypertensive medications. Keywords: Patient satisfaction, medication non-adherence, blood pressure, hypertension, Nigeri

Relationship between patient satisfaction with medical care and medication non-adherence among hypertensive patients attending a general Outpatient Department in southwest Nigeria

Background: Medication non-adherence (MNA) is prevalent in hypertension. Patient satisfaction is derived from the patient's appraisal of how well the provider meets his or her personal emotional and physical needs. The objectives of this study were to determine the factors associated with medication non-adherence; and to also ascertain the relationship between patient satisfaction with medical care and medication non-adherence among hypertensive patients.Methods: Cross sectional study which was conducted in the Family Medicine clinic of the Federal Teaching Hospital, Ido-Ekiti. The sample size was 337. Morisky Medication Adherence Scale (MMAS-8), and the Patient Satisfaction Questionnaire (PSQ-18) were the questionnaires used. Data was analysed using the Statistical Package for Social Sciences (SPSS).Results: The majority {185 (54.9%)} of the hypertensives were in the age-group 45 – 64 years. The male to female ratio was 1:0.67. The largest proportion of the respondents {134 (39.8%)} had low adherence (medication non-adherence), while 104 (30.9%) and 99 (29.3%) had medium and high medication adherence level respectively. Mean satisfaction scores of 3 and above were obtained in the Technical Quality (3.54 ± 0.81),  Accessibility and Convenience (3.48 ± 0.87), Communication (3.23 ± 0.95) and Interpersonal Manner (3.09 ± 0.98) subscales. The subscales with mean satisfaction scores of less than 3 were the General Satisfaction (2.82 ± 1.23), Financial Aspects (1.91 ± 0.82), and Time Spent with Doctor (1.85 ± 0.82) which had the least score. There were statistically significant strong positive correlations between medication adherence and each of the seven patient satisfaction subscales. The significant predictors of medication non-adherence were having primary education or no formal education,  having monthly income of less than ₦50,000, and being overweight or obese.Conclusion: Physicians should deliver quality care in a way to achieve high ratings of patient satisfaction. This will influence patients to adhere better to their antihypertensive medications. Keywords: Patient satisfaction, medication non-adherence, blood pressure, hypertension, Nigeri

Relationship between Perceived Spousal Social Support and Blood Pressure Control among Hypertensive Patients Attending General Outpatient Clinic in Federal Teaching Hospital, IdoEkiti, Nigeria

Background: Despite many approaches to control hypertension, a lot of people still experience challenges keeping their Blood Pressure (BP) under control, and because the condition requires life - long treatment, many patients will need additional effort from their spouses. The spouse shares intimacy with patient and is the chief source of social support that provides fi nancial assistance, reminds and encourages medication use, shows concern and interest by discussing issues related to the disease. Therefore, exploring the relationship between Perceived Spousal Social Support (PSSS) and BP control will help the physician and other stakeholders harness the gains of this association to achieving BP control, prevent complications and death associated with hypertension. Objective: To identify the relationship between perceived spousal social support and blood pressure control among hypertensive patients attending General Outpatient Clinic (GOPC) in Federal Teaching Hospital, Ido-Ekiti, Nigeria. Materials and methods: This was a hospital - based cross - sectional study carried out between June and August 2016 among 298 hypertensive patients aged 18 and 65 years attending GOPC of the Federal Teaching Hospital, Ido Ekiti. Collection of data was done using pre-tested, semi-structured questionnaire on sociodemographic characteristics, blood pressure measurement and 4-point Likert Social Support questionnaire to measure the perceived spousal social support. Data was analysed using SPSS IBM version 17.0. Results: Mean age of respondents was 56.0 ± 8.5 years and seventy percent were females with male to female ratio of 1:2.3. Less than half of the respondents, 47.7% and about half of the respondents, 50.3% achieved BP control and demonstrated strong PSSS respectively. There was statistically signifi cant relationship between PSSS and BP control (χ2 = 27.05, p < 0.001). Conclusion: Social support perceived by participants positively infl uenced their BP control. Family Physicians and other health care providers should therefore determine and enhance the level of this support and encourage spouses to provide this support for their partners who have hypertension or those having diffi culty controlling their BP despite the appropriate use their medications

Immunocompromised patients with acute respiratory distress syndrome : Secondary analysis of the LUNG SAFE database

The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p < 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p < 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013

Mechanical ventilation in patients with cardiogenic pulmonary edema : a sub-analysis of the LUNG SAFE study

Patients with acute respiratory failure caused by cardiogenic pulmonary edema (CPE) may require mechanical ventilation that can cause further lung damage. Our aim was to determine the impact of ventilatory settings on CPE mortality. Patients from the LUNG SAFE cohort, a multicenter prospective cohort study of patients undergoing mechanical ventilation, were studied. Relationships between ventilatory parameters and outcomes (ICU discharge/hospital mortality) were assessed using latent mixture analysis and a marginal structural model. From 4499 patients, 391 meeting CPE criteria (median age 70 [interquartile range 59-78], 40% female) were included. ICU and hospital mortality were 34% and 40%, respectively. ICU survivors were younger (67 [57-77] vs 74 [64-80] years, p < 0.001) and had lower driving (12 [8-16] vs 15 [11-17] cmHO, p < 0.001), plateau (20 [15-23] vs 22 [19-26] cmHO, p < 0.001) and peak (21 [17-27] vs 26 [20-32] cmHO, p < 0.001) pressures. Latent mixture analysis of patients receiving invasive mechanical ventilation on ICU day 1 revealed a subgroup ventilated with high pressures with lower probability of being discharged alive from the ICU (hazard ratio [HR] 0.79 [95% confidence interval 0.60-1.05], p = 0.103) and increased hospital mortality (HR 1.65 [1.16-2.36], p = 0.005). In a marginal structural model, driving pressures in the first week (HR 1.12 [1.06-1.18], p < 0.001) and tidal volume after day 7 (HR 0.69 [0.52-0.93], p = 0.015) were related to survival. Higher airway pressures in invasively ventilated patients with CPE are related to mortality. These patients may be exposed to an increased risk of ventilator-induced lung injury. Trial registration Clinicaltrials.gov NCT02010073

Resolved versus confirmed ARDS after 24&#160;h: insights from the LUNG SAFE study

Purpose: To evaluate patients with resolved versus confirmed ARDS, identify subgroups with substantial mortality risk, and to determine the utility of day 2 ARDS reclassification. Methods: Our primary objective, in this secondary LUNG SAFE analysis, was to compare outcome in patients with resolved versus confirmed ARDS after 24\ua0h. Secondary objectives included identifying factors associated with ARDS persistence and mortality, and the utility of day 2 ARDS reclassification. Results: Of 2377 patients fulfilling the ARDS definition on the first day of ARDS (day 1) and receiving invasive mechanical ventilation, 503 (24%) no longer fulfilled the ARDS definition the next day, 52% of whom initially had moderate or severe ARDS. Higher tidal volume on day 1 of ARDS was associated with confirmed ARDS [OR 1.07 (CI 1.01\u20131.13), P = 0.035]. Hospital mortality was 38% overall, ranging from 31% in resolved ARDS to 41% in confirmed ARDS, and 57% in confirmed severe ARDS at day 2. In both\ua0resolved and confirmed\ua0ARDS, age, non-respiratory SOFA score, lower PEEP and P/F ratio, higher peak pressure and respiratory rate were each\ua0associated with mortality. In confirmed ARDS, pH and the presence of immunosuppression or neoplasm were also associated\ua0with mortality. The increase in area under the receiver operating curve for ARDS reclassification on day 2 was marginal. Conclusions: ARDS, whether resolved or confirmed at day 2, has a high mortality rate. ARDS reclassification at day 2 has limited predictive value for mortality. The substantial mortality risk in severe confirmed ARDS suggests that complex interventions might best be tested in this population. Trial Registration: ClinicalTrials.gov NCT02010073. \ua9 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM