Screening for Adverse Childhood Experiences in Primary Care.

Adverse Childhood Experiences (ACEs) include childhood exposure to abuse or violence, a parents\u27 divorce, mental illness, substance use disorder, and are identified as risk factors for negative life outcomes. While ACEs screenings are commonly used in mental health and pediatric settings, screening for ACEs in primary care settings is less prevalent. The purpose of this project is to integrate screening for ACEs into a primary care setting and make appropriate referrals for follow-up, thus reducing potential negative life outcomes. The process was designed for a primary care practice located in Winston-Salem, North Carolina. Part one assessed level of awareness and screening history which determined training focus. Each provider and staff member received 30-45 minutes of training on ACEs screening algorithm, a detailed approach to guide treatment. The training was followed by question-and-answer sessions to address concerns. Part two, involved screening using the Center for Youth Wellness, Adverse Childhood Experiences Questionnaire for Children (CYW ACE-Q Child) which was initiated by the front office employee. Front office employee identified patients present for an annual well visit, briefly explained the screening tool, and handed it to the patient on a clipboard. The patient returned the completed form to the Certified Medical Assistant (CMA) when called in from the waiting room. The provider reviewed the ACEs screening and made referrals as appropriate. Part three involved data collection and analysis. Responses were collected weekly for nine weeks. The responses collected will be analyzed using quantitative statistics. The expected outcome is to note progressive increase in screening activities and when appropriate, followed by referrals to community agencies and organizations. The project educated clinicians about ACEs and created awareness among clinicians in a primary care setting to mitigate potential negative life outcomes. Barriers to integrating ACEs screening included employees\u27 absence of training, lack of confidence in the subject matter, limited time frame to complete the screening, and fear of damaging patient-provider relationships. Barriers were mitigated through employee training, repetitive implementation of ACEs screening, and therapeutic communication with patients. The CYW ACE-Q was reserved for those arriving early or on time for their annual wellness visit to allow adequate time for completion. Recommendations include incorporating the CYW ACE-Q into all primary care visits to further intervene with referrals thereby enhancing patients\u27 overall quality of life

Instructional Supervisory Practices and Teachers’ Role Effectiveness in Public Secondary Schools in Calabar South Local Government Area of Cross River State, Nigeria

The study investigated the relationship between instructional supervisory practices and teachers’ role effectiveness in public secondary schools in Calabar South Local Government Area of Cross River State. Two null hypotheses were formulated to guide the study. Ex-post facto research design was adopted for the study. The population of the study comprises all public secondary school principals and teachers in the study area. There are a total of six (6) principals and four hundred and thirty-three (433) teachers. Simple random sampling technique was used to select one hundred and ninety-five (195) teachers from six (6) public secondary schools. A well structured questionnaire tagged “Instructional Supervisory Practices Questionnaire (ISPQ) and Teachers’ Role Effectiveness Questionnaire (TREQ)” were used for data collection. The results of the analysis revealed that there was a significant positive relationship between instructional supervisory practice of classroom observation and teachers’ role effectiveness. The result also revealed that, there was a significant positive relationship between instructional supervisory practice of checking of teachers’ lesson notes and teachers’ role effectiveness. It was concluded that a closer, regular and continuous instructional supervisory practice rather than snappy, unscheduled and partial supervision is what is urgently needed especially now that a lot of changes have been introduced into the school curriculum. It was recommended among others that Government through the Ministry of Education should organize training programmes for principals as well as teachers on the need for effective instructional supervision. Keywords: Principals, Instructional Supervisory Practices, Teachers’ Role Effectiveness, Classroom Observation, Checking of Teachers’ Lesson Notes, Teachers

Enrolment patterns in federal universities based on three criteria (2010-2031): A time series approach

Introduction: There is a general agreement among previous studies that gender, merit and catchment area criteria allows for access to university education, but the pattern of these variables over the years has not been proven in these studies. Purpose: This study used a times series approach to evaluate the enrolment patterns in federally owned universities in South-South Zone, Nigeria, based on the gender, merit and catchment area criteria. Methodology:  The descriptive survey design was adopted for this study. A purposive sampling technique was adopted to choose three universities based on the generation of their establishment. The evaluation covered from 2010 to 2019 using stationary time-bound data collected from the academic planning units of the institutions through a checklist. Future enrolment forecasts were made to 2031 using the moving average forecasting technique. Results: A gender-based difference in enrolment, in favour of males was recorded between 2010 and 2019; there were notable fluctuations in the enrolment pattern based on the merit criterion from 2010 to 2019; the enrolment pattern in terms of the catchment area criterion was consistent from 2010 – 2019. In terms of the projection, it was predicted that enrolment at the aggregate level would rise continuously across federal universities, but not at the institutional level. more women than men are expected to be enrolled in academic programmes at federal institutions, while at the institutional level, gender-based enrolment can fluctuate. Recommendations/Classroom Implications: Based on these findings, implications are discussed for future enrolment decisions at both the institutional and national levels

A Survey of Community Opinion and Perceptions toward Gamete Donation in North Central Nigeria

Background: Gamete donation supports in vitro fertilization services. Donation of gametes began in the developed world in 1884, but there is no documentation of when it started in Nigeria. The donors may be sourced from the community where such services are available. The objectives of this study are to determine the opinion of a community in north-central Nigeria toward gamete donation and determine the factors that influence their opinion. Materials and Methods: This is a cross‑sectional survey of 300 individuals in a community regarding their opinions and perceptions about gamete donation in the setting. The survey involved using a questionnaire with the questions structured in a Likert format. Results: Two hundred and four (68%) of the respondents had knowledge of gamete donation, and 96 (32%) had none. Fifty‑five (18%) respondents did not support gamete donation, whereas 153 (51%) did. Fifty‑five (18%) disagreed and 158 (52.7%) agreed that gamete donation is justified. Forty‑one (14%) disagreed, while 201 (67%) agreed that financial gain is the reason for gamete donation. One hundred disagreed (33.3%) and 113 (37.7%), respectively, agreed that religious beliefs prevent people from donating or receiving gametes. Forty‑seven (16%) agreed, and 180 (60%) disagreed that donation can lead to childlessness in the future. Ninety‑three (31%) agreed while, 130 (43.3%) disagreed with the possibility of their acceptance of gamete donation if needed. Eighty (2.6%) will not while 149 (49.6%) will support a friend/acquaintance who wants to donate their gamete. Significantly, more males agreed that religion forbids donating or receiving gametes (P = 0.047). Conclusion: There is a high awareness and favorable predisposition toward gamete donation but a low willingness to donate or accept same. More advocacy and enlightenment are needed to increase the participation of this community in gamete donation. Keywords: Advocacy, community opinion, gamete donatio

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

Summary 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 middleincome 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 lowincome 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 lowincome, 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

Malarial infection among antenatal and maternity clinics attendees at the Federal Medical Centre, Makurdi, Benue State, Nigeria

This study assessed the level of malarial infection in relation to some epidemiological factors, gravidity and pregnancy period of antenatal clinic attendees of the Federal Medical Centre, Makurdi, Benue State, Nigeria. We also assessed malarial infection in placental blood in relation to gravidity of pregnant women at delivery in the maternity clinic of the same hospital. Thin and thick blood films were prepared for microscopic examination. A questionnaire was administered to each pregnant woman at the antenatal clinic to collect data on educational level, occupation, gravidity, pregnancy period, malaria preventive measures and malaria symptoms. Of the 163 pregnant women examined at the antenatal clinic, 68.3% (111/163) were infected with malaria. Pregnant women that are illiterates (χ2=15.44, P=0.100) and those that are farmers (χ2=9.20, P=0.270) had the highest infection rate with no significant difference respectively. Malarial infection was significantly higher in the multigravidae, 57.6% (34/59) (χ2=5.16, P=0.007) and non-significant in the pregnant women at their third trimester of pregnancy, 60.9% (53/89) (χ2=4.45, P=0.108). Placental malaria was significantly higher in the primigravidae among pregnant women at delivery (χ2=9.33, P=0.000). A significant difference (χ2=33.52, P=0.000) was observed between pregnant women that did not use any malaria preventive methods, 91.2% (31/34) and those that used single, 64.3% (65/101) and combined, 46.4% (13/28) methods of prevention. Malaria remains highly prevalent among antenatal clinics attendees in Makurdi, Nigeria. Combined method of prevention (insecticides treated nets and insecticide spray) yielded good results and its use is advocated in preventing malaria among the pregnant women

Enrolment patterns in Federal universities based on three criteria (2010-2031): A time series analysis

Introduction: There is a general agreement among previous studies that gender, merit and catchment area criteria allows for access to university education, but the pattern of these variables over the years has not been proven in these studies. Purpose: This study used a times series approach to evaluate the enrolment patterns in federally owned universities in South-South Zone, Nigeria, based on the gender, merit and catchment area criteria. Methodology: The descriptive survey design was adopted for this study. A purposive sampling technique was adopted to choose three universities based on the generation of their establishment. The evaluation covered from 2010 to 2019 using stationary time-bound data collected from the academic planning units of the institutions through a checklist. Future enrolment forecasts were made to 2031 using the moving average forecasting technique. Results: A gender-based difference in enrolment, in favour of males was recorded between 2010 and 2019; there were notable fluctuations in the enrolment pattern based on the merit criterion from 2010 to 2019; the enrolment pattern in terms of the catchment area criterion was consistent from 2010 – 2019. In terms of the projection, it was predicted that enrolment at the aggregate level would rise continuously across federal universities, but not at the institutional level. more women than men are expected to be enrolled in academic programmes at federal institutions, while at the institutional level, gender-based enrolment can fluctuate. Recommendations/Classroom Implications: Based on these findings, implications are discussed for future enrolment decisions at both the institutional and national levels