Awareness and attitudes towards total cardiovascular disease risk assessment in clinical practice among physicians in Southern Nigeria

Introduction: The disparity between the increasing burden of cardiovascular disease (CVD) and available resources to treat it in sub-Saharan Africa necessitates preventive strategies. Total CVD risk assessment is a cost-effective approach to guide primary preventive therapy. However, in order to utilise this approach there has to be an understanding about it among the end-users. The objective of this study was to determine the awareness, use, and attitudes regarding total CVD risk assessment in clinical practice among physicians in Port Harcourt, Nigeria.Methods: a cross-sectional survey of 150 physicians in government hospitals and private practices in Port Harcourt city. The characteristics of ‘users’ versus ‘non-users’ of CVD risk assessment were compared with the Chi-Square test of significance.Results: 106 physicians completed the questionnaires. 74 (69.8%) reported awareness of tools available to assess total CVD risk. Among those aware, 87.1% agreed that CVD risk assessment is useful, 81% agreed it improves patient care, 74.3% agreed it leads to better decisions about recommending preventive therapies and 60% agreed that it increased the likelihood that they would recommend risk-reducing therapies to high-risk patients. However, 62.9% of these physicians felt it was time-wasting to use and only 21 (28.4%) actually use CVD risk assessment regularly in practice. The most commonly reported barrier was unfamiliarity with how to use risk estimation tools (52.8%). Majority who use it do so to guide preventive therapy. Female sex and the use of an Internet-enabled smartphone were associated with increased odds of being a ‘user’ of risk estimation tools (odds ratios 4.8, CI 1.4-16.9; and 5.9, CI 1.7-20.0 respectively).Conclusion: Utilisation of risk assessments in clinical practice is low. A major barrier was nonfamiliarity with how to use the tools. Continuous medical education and wider use of smartphone technology may represent health system approaches to tackling this issue.Keywords: Risk assessment, cardiovascular disease, and primary preventio

Key influences in the design and implementation of mental health information systems in Ghana and South Africa

Introduction Strengthening of mental health information systems (MHIS) is essential to monitor and evaluate mental health services in low and middle-income countries. While research exists assessing wider health management information systems, there is limited published evidence exploring the design and implementation of MHIS in these settings. This paper aims to identify and assess the key factors affecting the design and implementation of MHIS, as perceived by the key stakeholders in Ghana and South Africa. Methods We report findings from the Mental Health and Poverty Project, a 5-year research programme implemented within four African countries. The MHIS strengthening in South Africa and Ghana included two related components: intervention and research. The intervention component aimed to strengthen MHIS in the two countries, and the research component aimed to document interventions in each country, including the key influences. Data were collected using semi structured interviews with key stakeholders and reviews of key documents and secondary data from the improved MHIS. We analyzed the qualitative data using a framework approach. Results Key components of the MHIS intervention involved the introduction of a redesigned patient registration form, entry into computers for analysis every 2 months by clinical managerial staff, and utilization of data in hospital management meetings in three psychiatric hospitals in Ghana; and the introduction of a new set of mental health indicators and related forms and tally sheets at primary care clinics and district hospitals in five districts in the KwaZulu-Natal and Northern Cape provinces in South Africa. Overall, the key stakeholders perceived the MHIS strengthening as an effective intervention in both countries with an enhanced set of indicators in South Africa and introduction of a computerized system in Ghana. Discussion Influences on the design and implementation of MHIS interventions in Ghana and South Africa relate to resources, working approaches (including degree of consultations during the design stage and communication during implementation stage) and the low priority of mental health. Although the influencing factors represent similar categories, more influences were identified on MHIS implementation, compared with the design stage. Different influences appear to be related within, and across, the MHIS design and implementation and may reinforce or negate each other thus leading to the multiplier or minimization effects. The wider context, similar to other studies, is important in ensuring the success of such interventions. Conclusion Future MHIS strengthening interventions can consider three policy implications which emerged from our analysis and experience: enhancing consultations during the intervention design, better consideration of implementation challenges during design, and better recognition of relations between different influence

Involvement of young people in a qualitative study that seeks to explore experiences of renal replacement therapy choice selection

Introduction: Patient and Public involvement (PPI) has become one of the drivers in health care and seen as an integral part of the research process. PPI promotes research questions that reflect the priorities and concerns of the relevant population and develops outcomes that are important to patients (INVOLVE, 2012; Evans et al, 2014; Hickey et al, 2018). Young adults with end-stage kidney disease are supported by clinicians and their families to make decisions about their preferred renal replacement therapy (NICE, 2018). However, they can become overwhelmed with the burden of long-term chronic illness and often struggle to accept diagnosis and prognosis and cope with the complex management of their condition (Coulter and Collins, 2011; Ritchie et al., 2012). They can consequently become disengaged with the service and less involved in their care (Ritchie et al, 2012; Robinski et al, 2014). The current study explores young people’s experiences of renal replacement therapy choice selection. The study team has involved young people in the study’s development. Aims and objectives: The aim of the involvement group in this study is to involve the young people in all stages of the research process: ensuring that the research question has the correct focus, that the participant information sheet is clear and that the recruitment strategy is appropriate. In due course, the young people’s group will be involved in qualitative data analysis and in dissemination of findings. Method: The involvement group comprised three people with experiences of dialysis and kidney transplant treatment as children and young adults. They were recruited via existing networks in the research team. A role description on what was to be expected of the group members was discussed, alongside what was expected from the research team (training and travel expenses for example). Communication is via face-to face meetings and also by email. This first face-to-face meeting discussed and shaped the research question, and the possible recruitment process. Further email discussions have explored the participant information sheet, consent forms plus the development of the video and poster advert to aid recruitment. Results: The impact of PPI on the research process is already providing valuable insights into how the research design should be conducted. The first face-to-face meeting with the group highlighted the difficulties that young people face when making choice of renal replacement therapy, especially psychosocial impact and mental well-being, so the impact the choice makes on well-being was added as a secondary research question. The acceptability of the recruitment method (via social media) was discussed and a video advert was developed for the recruitment process. Members also contributed to the review of some of the research documents; participant information sheet, consent forms, posters, research proposal and piloted a validation questionnaire for suitability. Impact: Involvement of patients helped situate the study to meet the current needs of young adults diagnosed with end stage renal disease who are faced with choosing dialysis or kidney transplantation

Performance of rice under different water regimes and plant nutrient sources

Field experiment was carried out at the Soil and Irrigation Research Centre, University of Ghana, Kpong in 2015 and 2016 cropping seasons to evaluate the effect of different soil water condition and plant nutrient sources on the growth and yield of rice. The experiment was laid out in a split plot design with three replications. Water regime and nutrient source were the main and sub-plot factors, respectively. Water regimes included; continuous flooding (CS), alternate wetting and drying (AWD) and moist soil condition between field capacity and permanent wilting point (MC) while the nutrient fertilizer treatments included no fertilizer (N0), 90 kg N/ha mainly from urea fertilizer (N1), 90 kg N/ha from 12.8 tons of compost (N2) and 45 kg N/ha from urea fertilizer + 45 kg N/ha from 6.4 tons of compost (N3). Results from the study revealed that keeping the soil periodically in aerobic and anaerobic condition through AWD method of water management recorded similar growth and grain yield of rice as with complete submergence of paddy field. Combination of inorganic fertilizer and compost for each to supply 45 kg N/ha under AWD produced the highest rice growth and grain yield. There was a positive and significant correlation between grain yield and growth parameters (plant height, chlorophyll content and above ground biomass accumulation).

Enhanced Respiratory Chain Supercomplex Formation in Response to Exercise in Human Skeletal Muscle.

Mitochondrial dysfunction is a hallmark of multiple metabolic complications. Physical activity is known to increase mitochondrial content in skeletal muscle, counteracting age-related decline in muscle function and protecting against metabolic and cardiovascular complications. Here, we investigated the effect of 4 months of exercise training on skeletal muscle mitochondria electron transport chain complexes and supercomplexes in 26 healthy, sedentary older adults. Exercise differentially modulated respiratory complexes. Complex I was the most upregulated complex and not stoichiometrically associated to the other complexes. In contrast to the other complexes, complex I was almost exclusively found assembled in supercomplexes in muscle mitochondria. Overall, supercomplex content was increased after exercise. In particular, complexes I, III, and IV were redistributed to supercomplexes in the form of I+III2+IV. Taken together, our results provide the first evidence that exercise affects the stoichiometry of supercomplex formation in humans and thus reveal a novel adaptive mechanism for increased energy demand