The correlates of stress, coping styles and psychiatric morbidity in the first year of medical education at a Nigerian University

Objectives: This study was prompted by the heightened concerns about the stress inherent in medical education evident from the incessant requests for suspension of studies due to psychological problems. The objectives of the study were to: (i) survey the students for possible psychological problems at admission, and follow them up till exit for possible changes in morbidity, and (ii) ascertain possible risk factors, and coping strategies. Method: This is a preliminary 2-stage cross-sectional report, which is partof a longitudinal survey. It involves first year medical students of the College of Health Sciences of University of Ilorin between March and April, 2011. Questionnaires used included socio demographic, sources of stress, the general health questionnaire-12 (GHQ-12), Maslachfs burnout inventory (MBI), and Brief COPE. Data were analysed using SPSS version 15 at 5% significance level. Chi-square, frequency distributions, Pearsonfs correlation, Odd ratios, and Confidence Intervals were calculated to determine the levels of risk.Results: 79 students returned completed questionnaires. 12 (15.2%) were ghq-12 cases (i.e., scored . 3). Students who had morbidity were 9 times at risk of being stressed consequent upon ecompeting with their peersf and 4 times at risk due to einadequate learning materialsf. Morbidity was significantly more likely to engender use of ereligionf, 4 times less likelyto engender use of epositive reframingf with a trend in the use of eself blamef as coping strategies. Conclusion: Aside from psychosocial/ personal issues in this cohort, academic demand was an additional source of psychological problems thereby causing those who had morbidity to utilize ereligionf and epositive reframingf to cope. There is therefore an apparent need to incorporate the principle of mental health promotion in medical education.Keywords: Stress; Coping styles; Psychiatric morbidity; Medical education; Nigeri

Psychosocial impairments among adults with epilepsy in a neurology clinic in Nigeria

Objective: Psychosocial problems unattended to may compromise adequate control of seizures and elevate the risk of psychopathology. We assessed for psychosocial impairments and associated psychopathology in patients with epilepsy, with the hope that findings will help initiate formal psychosocial care for patients attending the neurology clinic.Methods: Consecutive patients with epilepsy seen at the neurology clinic that met the inclusion criteria and gave consent were interviewed in a 2 stage procedure. In the first stage patients were assessed with a semi-structured questionnaire containing psychosocial variables while probable psychiatric morbidity was assessed with General Health Questionnaire (GHQ-12). In the second stage psychiatric diagnoses were assessed with Schedule for Clinical Assessment in Neuropsychiatry (SCAN).Results: Many of the patients reported difficulties in at least one or more of the psychosocial domains assessed; areas of difficulty included: physical activity (52.4%), occupational activity (46.8%); finances (41.3%); stigma (33.3%); inadequate social support by relatives (31.7%), and perceived inadequate general adjustment (34.9%). Psychosocial factors significantly associated with increased rate of psychopathology included: being a woman, having low education; financial difficulties and limitations in physical activities while significant clinical factors included: having frequent fits and partial epilepsy. Multiple logistic regression analyses indicated that being a woman and having partial seizures were the most important predictors of psychopathology among the patients.Conclusion: This study has provided evidence of the need to introduce routine psychosocial care in our neurology clinic which hitherto did not carry out structured routine assessment of psychosocial problems in order to reduce risk of psychopathology.Keywords: Psychosocial impairments, adults, epilepsy, neurology clinic, Nigeri

Self-reported sleep parameters among secondary school teenagers in middle-belt Nigeria

Background: Available evidences seem to suggest increasing trend in sleep deficit among teenagers worldwide, and there is limited information on this among Nigerian teenagers. This study was carried out to determine the basic sleep schedule and sleep duration among schooling teenagers in Ilorin, Nigeria.Methods: This is a descriptive cross‑sectional study conducted among 20 selected public secondary schools in Ilorin, Nigeria. A multistage sampling technique was used to randomly select participating schools.Result: A total of 1033 students participated in the study; of these 47.3% were males and 51.7% females. Students mean age (standard deviation) was 15.3 ± 1.6 years with a range of 12–19 years. Majority (76.2%) of participants co‑share bed with at least one person and some (23.8%) slept alone in bed. The three leading reasons given for going to bed were: Tiredness ‑ 31.1%, completion of house assignment ‑ 20.5%, and parental directive ‑ 12.4%. 10% of teenagers do make regular phone calls at night and 5.5% surf internet and use computers at night. Regular habits of daytime sleepiness were reported by 8.2% of study participants. Students’ mean sleep duration during school days was 9.33 ± 2.29 h compared to 10.09 ± 1.32 h at weekend (P < 0.05). The duration of night time sleep was adequate (>9 h) in 41% of students; borderline (8–9 h) in 44.3% while 13.3% of the students had insufficient nighttime sleep duration (<8 h) P < 0.05.Conclusion: A substantial number of students had borderline nighttime sleep duration and so had potentials to transit into the problematic insufficient range. To prevent this, there is a need to educate schooling teenagers on the dangers associated with prolonged sleep insufficiency.Key words: Bedtime, schooling, sleep duration, teenagers, wake‑up‑tim

Psychiatric morbidity in a Nigerian neurology clinic

Objective: The objective of the study was to determine the prevalence and nature of psychiatric morbidity among patients attending a neurology outpatient clinic.Design: A two-stage screening procedure with General Health Questionnaire (GHQ-12) and Schedules for Clinical Assessment in Neuropsychiatry (SCAN) was used to assess psychological disorders over a one year period. Psychiatric diagnosis was based on ICD-10 criteria.Setting: University of Ilorin Teaching Hospital (UITH), Ilorin- NigeriaSubjects: Two hundred and thirty-five (235) patients aged 18 years and above attending the neurology outpatient clinic.Results: Overall prevalence of psychiatric morbidity was 26.0% (61/235). The most frequent diagnoses were depression (14.9%), generalised anxiety disorder (5.5%), dementia (2.6%) and substance use disorder (1.3%). Significantly more patients with stroke had psychiatric morbidity.Conclusion: The study supports previous reports that psychiatric disorders are quite common among patients with neurological disorders. Efforts should, therefore, be directed at identifying and treating neurological patients with psychiatric morbidity since this will ensure improved outcome. In this regard, mental health professionals would need to provide liaison services for the neurologists and train them in the use of simple screening instruments for detecting associated psychiatric disorders with appropriate referral where necessary

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Background: Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. // Methods: We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung's disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. // Findings: We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung's disease) from 264 hospitals (89 in high-income countries, 166 in middle-income countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in low-income countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. // Interpretation: Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between low-income, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Scientific Letter: Monosymptomatic Hypochondriacal Psychosis (somatic delusional disorder): A report of two cases

Scientific Letter - No Abstract Availabl

A prospective analysis of in-patient consultation-liaison psychiatry in a Nigerian teaching hospital

Objectives: To determine the pattern of psychiatric referrals over a six-month period categorise the psychiatric referrals into clinical syndromes and describe the nature of psychiatric intervention and outcome of such intervention on discharge and within the first three months after discharge. Design: A descriptive prospective study. Setting: University of Ilorin Teaching Hospital (UITH), Ilorin Nigeria. Subjects: Forty seven inpatients (26 females and 21 males) referred to the psychiatric department from other specialist units of the hospital between May and October 2001. Results: The mean (+/-SD) of patients was 33.9±18 years. The highest rate of referral came from the internal medicine department. The most common psychiatric disorders referred were acute organic brain syndrome (32%) and neurological disorders (15%). Psychiatric interventions included medication in about two-thirds of the patients and counselling in about a quarter. Half of the discharged patients out rightly defaulted on their first outpatient clinic department appointment. Conclusion: The study indicate the need for greater inter-departmental liaison learning and training activities, the need to emphasize training in organic psychiatry, as well as the need to establish community-based outreach services as a means of ensuring continuity of care for discharged patients. East African Medical Journal Vol.81(12) 2004: 620-62

Psychiatric Disorders Among Patients With Chronic Kidney Disease In A Nigerian Teaching Hospital

Click on the link to view the abstract.The Tropical Journal of Health Sciences Vol 20 No 2 (July 2013

De Clerambault\'s syndrome in a paranoid Schizophrenia: a case report

No Abstract.Tropical Journal of Health Sciences Vol. 15 (2) 2008: pp. 56-6