Does health-related quality of life in asthma patients correlate with the clinical indices?

Background: Assessment of health-related quality of life (HRQOL) has been shown to be more relevant to patients who have chronic diseases such as asthma, as achieving the best possible quality of life is the  paramount objective in the management of such patients. This study assessed the quality of life of asthma patients and correlated it with the various clinical indices of asthma, such as age, sex, the duration of the asthma, medication used and its severity.Design: The study was a cross-sectional, analytical, case-control design, involving three approaches, i.e. quality of life, clinical assessment and lung function assessment. The patients who participated in this study completed the Asthma Quality of Life Questionnaire (AQLQ) and Asthma Control Questionnaire (ACQ). Statistical analysis was performed using Epi Info™ version 6.04.Setting and subjects: The clinical setting was the respiratory unit of the department of Medicine, University of Benin Teaching Hospital, Benin City, Nigeria. The recruited patients held various professions. A diagnosis of asthma was made using the clinical features of asthma and lung function measurements with a spirometer and MicroWright® Peak flow meters.Outcome measures: The outcome measures were the quality of life score scores and clinical indices of asthma in patients attending the respiratory unit of the University of Benin.Results: Subjects had significantly low lung function values when compared with the controls (p-value < 0.05). The quality of life of asthmatics was 4.82 ± 1.16 (1-7) and correlated with the duration of asthma (r = -0.83), body mass index, medication used (r = 0.96), asthma severity (r = 0.96) and gender (r = 1). The difference between male and female quality-of-life values was significant (p-value < 0.05). However, there was no correlation between age and quality of life (r = 0.06).Conclusion: The overall assessment showed that quality of life with regard to asthma was low in this study, and correlated with some clinical asthma indices. The determinants of quality of life in this study included the  duration of asthma, body mass index, asthma severity, medication use and gender

Concentrations of formaldehyde in rain waters harvested at the Nigerian institute for oil palm research

Formaldehyde has been recognized as one of the most important pollutants and a carcinogen that is present in the air, water, foods, soils, fabrics, cosmetics, cigarette smoke and treated wood. Related health effects and hazards are linked to formaldehyde, depending on mode of exposure which includes: weakness, blindness, vomiting et cetera. Additionally, occupational exposure through vapours, results in a temporary reversible decrease in lung function. Ocular exposure to formaldehyde could result in permanent alterations to vision or blindness. At concentrations below maternal toxicity, formaldehyde is considered not to be a reproductive or developmental toxicant. Sufficient evidence is now available for the carcinogenicity of formaldehyde in both humans and animals. The International Agency for Research on Cancer has classed formaldehyde as a group 1carcinogen. Rain water is harvested and used for domestic and industrial purposes in Nigeria. Scarce information isavailable in the developing countries like Nigeria, relating to the sources of exposure to formaldehyde and other toxic substances. It was against the above background that samples of rain water were collected between April and October, 2008, 2009 and 2010 at the meteorological research unit of the Nigerian Institute for Oil Palm Research (NIFOR) in order to monitor the concentrations of formaldehyde, which were subsequently consumed by ingestion and thus generate data on same for the populace of the area of study. The chromotropic acid method described by the National Institute for Occupational Safety and Health (NIOSH) was adopted for the determination of formaldehyde in the rain waters. Results indicated that the concentration range of the formaldehyde in the rain waters varied from month to month throughout the six months duration of analysis. The values detected were below the toxicity level recommended by the World Health Organization (WHO) and other world bodies for drinking water. In conclusion, the results of the rain waters collected for the period of assay suggests that the values did not cause any toxicity effects and thus were fit for human consumption based on the low formaldehyde concentrations.  Key words: Formaldehyde, Rain Water, NIFOR, Toxicit

Factors influencing compliance in patients with tuberculosis on directly observed therapy at Ile-Ife, Nigeria

Background: Increased morbidity and mortality of tuberculosis have been blamed on neglect of the human dimension of tuberculosis control. One of such factors included in human dimension is non-compliance, a behavioural parameter, which has led to the emergence of multi-drug resistant tuberculosis, and poor treatment outcome.Objective: To explore the impact of directly observed therapy (DOT) on compliance and the factors influencing it.Design: A retrospective study.Setting: Chest clinic of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria.Methods: Directly observed therapy (DOT) was employed. Records of the socio-demographic characteristics, treatment categories, complications developed, results of investigations, level of compliance and treatment outcome for the patients were kept. The data for thepatients seen between May 1996 and April 1997 were retrieved and analysed. Those that complied were compared with those that did not comply.Results: One hundred and ninety nine patients comprising ninety one males and 108 females, were seen during the period .They were mostly between the ages of 16 years and 45 years(mean ± SD = 31.7±14.98). One hundred and fifty eight (73%) complied and all of themwere cured. The only factor that significantly influenced rate of compliance was proximity to the chest clinic.Conclusion: DOT improves the rate of compliance. No socio-demographic factors considered significantly influenced the rate of compliance under DOT, and as such they are not reliablepredictive factors. Locating chest units in the existing primary health care facilities will improve the rate of compliance with antituberculosis therapy. More attention should be paid to behavioural aspect of tuberculosis control

Peak Expiratory Flow as a Surrogate for Health Related Quality of Life in Chronic Obstructive Pulmonary Disease: A Preliminary Cross Sectional Study

Background: Health Related Quality of Life (HRQL) measures can capture the non-respiratory effects of Chronic Obstructive Pulmonary Disease (COPD). However the relationship with Peak Expiratory Flow (PEF) is not well understoodAim: To determine the relationship of PEF and quality of life measurements in patients with COPD Settings and Design: A cross section of consecutive patients in a university clinicMethods: Stable patients with COPD defined by the Global Initiative on chronic Obstructive Lung Disease (GOLD) criteria, were recruited into the study. Spirometry was done using American Thoracic Society’s standards and  reference equations from African American norms of the US population. Quality of life was measured with the St George’s Respiratory Questionnaire (SGRQ)Results: Out of 50 patients recruited for the study, 48 provided complete data with acceptable spirometry and PEF data. The mean (SD) age and body mass index was 68.4 (8.9) years and 21.4 (4.6) kg/m2 respectively and 96% of the patients were in moderate-severe stages of COPD using the GOLD criteria. Percent predicted PEF correlated with percent predicted FEV1; r= 0.559 p<0.001 and also showed a significant, though moderate correlation between PEF readings and SGRQ scores especially in the activity (r= -0.455 p< 0.01) and total scores (r=-0.415 p<0.01) for pre bronchodilator (BD) percent predicted PEF. In regression analysis, PEF was associated with SGRQ (-0.11 95% CI -0.19, -0.03) after adjusting for age, sex, height, smoking and disease severityConclusions: PEF correlates with SGRQ scores and may be a useful surrogate for HRQL in patients with COPDKey words: Peak expiratory flow, quality of life, spirometry, primary car

COP27 climate change conference: Urgent action needed for Africa and the world

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Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study.

BACKGROUND: In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda. METHODS AND FINDINGS: Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045). CONCLUSION: Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART