Increased risk of incident dementia following use of anticholinergic agents: A systematic literature review and meta-analysis

Background/rationale: Long-term treatment with anticholinergic agents may increase the risk of cognitive impairment or dementia. This systematic literature review and meta-analysis aimed to assess the impact of ≥3 months of exposure to anticholinergics as a class on the risk of dementia, mild cognitive impairment, and change in cognitive function. The impact of anticholinergic agents specifically used to treat overactive bladder was also evaluated. Materials and Methods: A systematic literature review was conducted to identify English language articles evaluating the impact of anticholinergic use for ≥3 months on dementia or cognitive function in adult patients. Databases searched included PubMed, Embase, and the Cochrane Library. Meta-analyses were conducted using random-effects models; 95% confidence intervals (CIs) and 95% prediction intervals (PIs) were reported. Results: A total of 2122 records were identified. Out of those, 21 studies underwent qualitative synthesis and 6 reported endpoints relevant for inclusion in a meta-analysis assessing the risk of incident dementia. The overall rate ratio for incident dementia was 1.46 (95% CI: 1.17–1.81; 95% PI: 0.70–3.04; n = 6). The risk of incident dementia increased with increasing exposure (n = 3). In addition, two studies from the meta-analysis reported an increased risk of dementia with ≥3 months of use of bladder antimuscarinics (adjusted odds ratios ranged from 1.21 to 1.65, depending on exposure category). Conclusion: Anticholinergic use for ≥3 months increased the risk of dementia on average by an estimated 46% versus nonuse. This relationship was consistent in studies assessing overactive bladder medications. The risk of developing dementia should be carefully considered in the context of potential benefit before prescribing anticholinergics

Would expected hyper-inflation induced generalized healthcare price increases in Nigeria reduce facility patronage? Prediction using experience of Onitsha based private dental clinic

Background: Expected hyper-inflation following diminished proceeds from crude oil and drastic devaluation of the currency, will ultimately raise healthcare prices in Nigeria. Financial experts have predicted bleak economic future and private healthcare practitioners are worried about the prospect of empty consulting rooms.Objective: To investigate the effect of hyper-inflation induced generalized healthcare price increases on facility patronage using past hyper-inflation experience of Onitsha based dental clinic.Method: Data concerning treatment prices, registration fees and dental services rendered from 1996 to 2005 were collected from the clinic’s diaries and record books using self-devised Data Collection Schedule Form. Nigeria was then reeling under resonating hyper-inflation associated with crude oil price tumble of late 1970’s. Analysis was by frequency, grand mean and inferential statistics of Spearman Rank Order Correlation Coefficient.Result: There was no significant relationship between hyper-inflation period healthcare patronage and unit treatment prices or with registration fees when increases were based on fair pricing.Conclusion: Though superimposed recession depresses businesses, appropriate pricing involving generalized healthcare price increases per se would not significantly reduce previous pattern of healthcare facility patronage during the inflationary period in Nigeria. This prediction is on the understanding that a careful combination of caution, proper business practices, altruism, rapport and other patient friendly considerations guide healthcare private practice.Keywords: Unit treatment price, Appropriate pricing, Corner-cutting, Healthcare shoppin

Familiarity deficit, knowledge and related bioethical attributes of Nigerian university final year public health students after cancellation of free-standing bioethics course

Background: Free-standing ethics course offered to Public Health students at Madonna University Elele Campus, Rivers State, Nigeria, was cancelled. The medical ethics course is considered inadequate for public health practice. Further, theoretical ethics knowledge was criticized as not being translated to expected high standard of ethical conduct. Ethics training was thus left to mentoring, insertions and case discussions across subjects.Objective: To assess the extent of familiarity deficit with ethics related items and the level of knowledge in healthcare ethics of the affected final year students.Methodology: Self administered structured questionnaire using modified past ethics questions was the instrument for data collection. Analysis was by use of electronic calculator with results presented in percentages and bar chart.Result: Of a total of 1320 respondents the overall familiarity deficit was 380 (29%). The highest was in Evolution of Healthcare Ethics 205 (62%). Judgment of Actions in Healthcare had the least 12 (3.6%). The overall level of ethics knowledge was 284 (21.5%). The highest was in Judgment of Actions in Healthcare 126 (38%). The least was in Evolution of Healthcare Ethics 36 (11%).Conclusion: Absence of free-standing course is associated with deficiency in ethics language, history, concepts and knowledge. Free–standing course, ethical insertions across domains, awareness of mutuality of benefits in good behaviour plus character training might improve informed ethical conduct.Keywords: Hobbes, Butler, Harm, Mutuality, Benefits, Moralit

Guest Editorial: Understanding How Centuries of Abandonment and Rejection Forced Dentistry to Professional Autonomy in The Field of Medicine

No Abstract

Nutrition knowledge of young, post-year one, non-biological science female students at a private university in Rivers State, Nigeria

Background: Nutrition knowledge, highly associated with healthy eating is especially needed by women of child-bearing age. High knowledge is expected of female university students but, in nonbiosciences this may not hold because of inadequate study of life sciences.Objectives: To assess nutrition knowledge and effects of age, course of study and birth order of second to final year students of Madonna University Elele, in non-biological science disciplines. Methodology: Data were collected from engineering and computer science students using semi-structured questionnaire. Analysis was by frequency, percentage and SPSS version 20 statistical soft-ware.Results: Students generally had fair nutrition knowledge (59.7%). Further, 10.1% of engineering and 3.2% of computer science students had very good knowledge. Students who were their families’ only daughters had the highest knowledge (9.1% had very good knowledge) followed by 1st daughters (7.1% had very good knowledge). Daughters who were the last offsprings had the least knowledge (1.6% had very good knowledge). Effect of age could not be determined due to low number between 25–29years age group.Conclusions: Course of study impacted on nutrition knowledge. Careers in non-bioscience disciplines did not favour adequate nutrition knowledge. However, chemistry as an essential component of such courses could mitigate the knowledge deficiency. Birth order that exposed a child to household responsibilities favoured nutrition knowledge.Keywords: Birth order, child-bearing age, neuro-developmental process, periconceptionfolic acid deficiency, wome

A Systematic Review of Racial/Ethnic Disparities in Female Pelvic Floor Disorders

Numerous studies have investigated the influence of health disparities among women with pelvic floor disorders with varied results. Racial/ethnic disparities, in particular, inconsistently indicate differences in prevalence of disease, disease severity, and treatment outcomes. We aim to review the body of literature examining racial/ethnic disparities in pelvic floor disorders, including overactive bladder, stress urinary incontinence, pelvic organ prolapse, and interstitial cystitis. A better understanding of these disparities may help guide clinicians, researchers, and advocates in providing improved education, outreach opportunities, and access to care in minority women with pelvic floor disorders

Pelvic Floor Disorders among Minority Women: Differences in Prevalence, Severity and Health-Related Social Needs

To characterize prevalence and severity of pelvic floor disorders (PFDs) in various healthcare settings and to examine unmet Health-related Social Needs (HRSN) among minority women. Minority women with PFDs were recruited from our academic urogynecology clinic (UG), a general urology clinic at our institution's safety net hospital (SNH), and a community outreach mobile clinic (MC). Questions from the Urinary Distress Index-6 (UDI), Pelvic Organ Prolapse Distress Inventory-6 (POPDI), and Female Genitourinary Pain Index (GUPI) were used to identify patients with stress urinary incontinence (SUI), overactive bladder (OAB) and chronic pelvic pain syndrome (CPPS). 61 (46.6%) women identified as Hispanic, 53 (40.4%) as Black, and 17 (12.9%) as Other. Overall, self-reported PFDs included SUI in 45%, OAB in 74.8%, and CPPS in 24.4% of women. Hispanic women were more likely to report OAB symptoms, compared to Black women (OR 3.4 [1.2-10.2], p = 0.03) or Other women (OR = 5.1 [1.3-20.4], p = 0.02). Participants held a median of five unmet HRSN. Minority women facing issues with family and community support, transportation, and utilities were more likely to report CPPS symptoms, compared to those without psychosocial issues (Support OR: 4.8 [1.7-13.7], p = 0.002; Transportation OR: 2.0 [1.0-8.2], p = 0.05; Utility OR: 7.0 [1.9-28.1], p = 0.005). Minority women with PFDs may have several unmet HRSNs which impact their ability to receive appropriate medical care. Our findings may assist in the development of effective strategies to improve healthcare outcomes for women dealing with PFDs

Inherited IFNAR1 deficiency in otherwise healthy patients with adverse reaction to measles and yellow fever live vaccines.

Vaccination against measles, mumps, and rubella (MMR) and yellow fever (YF) with live attenuated viruses can rarely cause life-threatening disease. Severe illness by MMR vaccines can be caused by inborn errors of type I and/or III interferon (IFN) immunity (mutations in IFNAR2, STAT1, or STAT2). Adverse reactions to the YF vaccine have remained unexplained. We report two otherwise healthy patients, a 9-yr-old boy in Iran with severe measles vaccine disease at 1 yr and a 14-yr-old girl in Brazil with viscerotropic disease caused by the YF vaccine at 12 yr. The Iranian patient is homozygous and the Brazilian patient compound heterozygous for loss-of-function IFNAR1 variations. Patient-derived fibroblasts are susceptible to viruses, including the YF and measles virus vaccine strains, in the absence or presence of exogenous type I IFN. The patients' fibroblast phenotypes are rescued with WT IFNAR1 Autosomal recessive, complete IFNAR1 deficiency can result in life-threatening complications of vaccination with live attenuated measles and YF viruses in previously healthy individuals