Burden and psychological effects : caregiver experiences in a psychiatric outpatient unit in Lagos, Nigeria

Objective: Worldwide, research into experiences of care givers are gradually increasing and their central role in community care is being acknowledged. Caregivers experience a multidimensional range of problems, often associated with their caregiving role. It becomes important to identify these areas of burden and provide necessary support. The study sought to determine the prevalence of psychological distress and experience of burden of care among the caregivers of mentally ill patients. Method: A cross sectional descriptive study. Eligible consecutive subjects were recruited to the study over a 6 month period. Fifty three caregiver relatives of patients diagnosed with a psychiatric illness were assessed using the General Health questionnaire version 12, an Adapted Burden of Care (BOC) Schedule and a Sociodemographic questionnaire. Results: The caregivers were 51% male and 49% female. Most were above 35years in age (66.1%). They were either parents (38.8%), siblings (18.4%), uncle/aunt (14.3%), first cousin (12.2%) or other extended relatives (16.3%). Almost half of the relatives had psychological distress (43.8%) and most of which (63%) had more burden. The mean score on the BOC among the caregivers was 41 (±18.68SD), with scores ranging from 0.00-89.00, and 45.3% of relatives experiencing more than average burden of care. Conclusion: There is a significant level of burden and psychological distress experienced by caregivers in this study location. It is recommended that effectively planned interventions are targeted at  alleviating this burden and at improving the ability of caregivers to cope, within the Nigerian mental health service delivery system.Key Words: Caregiver; Burden; Patients; Psychiatry; Nigeri

Socioeconomic inequalities and family planning utilization among female adolescents in urban slums in Nigeria

Background/statement of problem: Family planning (FP) utilization is important for preventing unwanted pregnancy and achieving optimal reproductive health. However, the modern contraceptive prevalence rate (mCPR) among women of childbearing age is still low in many low- and middle-income countries (LMIC), particularly in Nigeria, despite interventions to increase access and utilization. The low mCPR has been associated with a high prevalence of unwanted pregnancy, unsafe abortion, sexually transmitted infections such as HIV/AIDS, and high maternal and infant mortality in LMIC. Despite existing studies associating high family planning utilization to urban settings relative to the rural areas, the socioeconomic inequality in urban settings, especially among adolescents in urban slums has been given less research attention. This study examines the role of socioeconomic inequality on family planning utilization among female adolescents of various ethnic backgrounds in urban slums in Nigeria. Methods: The study utilized data from the Adolescent Childbearing Survey (2019). A total sample of 2,035 female adolescents of ages 14-19 years who were not pregnant at the time of the study and were resident in selected slums. Associations between socioeconomic inequalities-measured by wealth index, social status, and education-and modern contraceptive use were examined using relative and slope inequality indices, and logistic regression models. Results: The results show that only 15% of the female adolescents in the North, and 19% in the South reported modern contraceptive use. While wealth index and education were important predictors of FP use among adolescents in southern urban slums, only education was important in the North. However, the relative and slope inequality indices further indicate that adolescents with no education and those in the lowest social status group use much fewer contraceptives compared to their counterparts with higher wealth and social statuses. Those with secondary/higher education and the highest social status group, respectively, were more disadvantaged in terms of FP utilization (Education: RII = 1.86, p < 0.05; 95% C.I. = 1.02-2.71; Social Status: RII = 1.97, p < 0.05; 95% C.I. = 1.26-2.68) with results showing a more marked level of disparity when disaggregated by North and South. Conclusion: The persistent socioeconomic inequalities among female adolescents in Nigeria, especially those in the urban slums, have continued to limit their utilization. Policy measure in education, communication and subsidized contraceptives should be intensified for vulnerable female adolescents in the slums

Incidence and correlates of delirium in a West African mental health clinic

Objective: &lt;br/&gt; &lt;br/&gt; To determine the incidence of delirium in those patients presenting to a psychiatric clinic in Nigeria and to examine if any demographic or clinical variables were correlated with this diagnosis. &lt;br/&gt; &lt;br/&gt; Method &lt;br/&gt; &lt;br/&gt; A prospective survey design; 264 consecutive new referrals to a psychiatric clinic in Nigeria were assessed for the presence of delirium using a standardised diagnostic scale. Data was analysed for normality and appropriate statistical test employed to examine the relationships between the presence of delirium and demographic and clinical variables. &lt;br/&gt; &lt;br/&gt; Results &lt;br/&gt; &lt;br/&gt; Of individuals presenting to the mental health clinics, 18.2% had delirium. No demographic variable was significant regarding the presence or absence of delirium. With regard to clinical variables duration of current symptoms, referral source and the presence of comorbid physical illness were significantly associated with the presence of delirium. Most delirium was due to infections. Nearly all patients with delirium were prescribed psychotropic medication (95.2%), and most attributed their symptoms to a spiritual cause.Conclusion(s) Delirium presents more commonly to psychiatry services in the less developed world compared to the West. Development efforts should focus on recognition and management of delirium to improve outcomes and maximise resource

Devil is Virtual: Reversing Virtual Inheritance in C++ Binaries

Complexities that arise from implementation of object-oriented concepts in C++ such as virtual dispatch and dynamic type casting have attracted the attention of attackers and defenders alike. Binary-level defenses are dependent on full and precise recovery of class inheritance tree of a given program. While current solutions focus on recovering single and multiple inheritances from the binary, they are oblivious to virtual inheritance. Conventional wisdom among binary-level defenses is that virtual inheritance is uncommon and/or support for single and multiple inheritances provides implicit support for virtual inheritance. In this paper, we show neither to be true. Specifically, (1) we present an efficient technique to detect virtual inheritance in C++ binaries and show through a study that virtual inheritance can be found in non-negligible number (more than 10\% on Linux and 12.5\% on Windows) of real-world C++ programs including Mysql and libstdc++. (2) we show that failure to handle virtual inheritance introduces both false positives and false negatives in the hierarchy tree. These false positves and negatives either introduce attack surface when the hierarchy recovered is used to enforce CFI policies, or make the hierarchy difficult to understand when it is needed for program understanding (e.g., during decompilation). (3) We present a solution to recover virtual inheritance from COTS binaries. We recover a maximum of 95\% and 95.5\% (GCC -O0) and a minimum of 77.5\% and 73.8\% (Clang -O2) of virtual and intermediate bases respectively in the virtual inheritance tree.Comment: Accepted at CCS20. This is a technical report versio

Exposure to suicide in the family: Suicide risk and psychache in individualswho have lost a family member by suicide

Objective: The aim of the present study was to compare a sample of Portuguese individuals exposed to suicide in their families with a control group, for lifetime suicidality. This study also evaluated the incremental value of psychache (i.e., extreme psychological pain) in determining suicide risk beyond the contribution associated with having lost a family member by suicide. Method: A total of 225 community adults participated. Two groups were defined: a group exposed to suicide (n=53), and a control group (n = 172). Results: Results demonstrated that groups did significantly differ on the total score of the Suicide Behaviors Questionnaire-Revised (SBQ-R), on the four individual SBQ-R items, and on psychache. Results from a hierarchical multiple regression analysis demonstrated that having lost a family member by suicide and the construct of psychache each provided a significant unique contribution to explaining variance in suicide risk. The interaction between group membership and psychache also provided a further enhancement to the statistical prediction of suicide risk. Conclusion: Findings are discussed with regard to their implications for clinical intervention and postvention

Structure: Activity and Emerging Applications of Spices and Herbs

Herbs and spices are plant parts (herbs from leaves and spices from other parts) that are conventionally used in their fresh or dried state for flavouring, natural condiments, preservatives and for medicinal purposes. Worldwide, most spices are classified on the basis of taste, season of growth, economic importance, growth habit and plant part used. Black pepper, chilies, small cardamom, ginger and turmeric are some of the widely used spices while common herbs include thyme, basil and bay leaves. These herbs are basically classified according to usage, active constituents and period of life. Secondary metabolites such as Eugenol, thymol, limonene, cuminaldehyde, curcumin, piperine, quercetin, luteolin in these plant parts have been found to be responsible for anticancer, antimicrobial, antiviral, antidiabetic, antioxidant, anti-inflammatory and hypocholesterolemic effects. Their application in water fortification, milk and cheese processing, production of beauty products and pesticides among others could not be underestimated. Finally, adulteration, toxicity and allergic reactions are some of the identified limitations and challenges often encountered in the use of herbs and spices

Presentation and Follow-up Patterns of Child and Adolescent Patients attending a Teaching Hospital Psychiatric Clinic in Lagos, Nigeria.

Background: Child and Adolescent Mental Health is a fast developing subspeciality of psychiatry in low income countries. Units in tertiary hospital settings are well positioned to be useful referral centres for young patients from other areas of medicine in such hospitals. Aim: The authors aimed at describing the ways in which the children/ adolescents presented at the psychiatric out patient clinics and their follow up attendance patterns. Method: The study was retrospective in nature, with data gathered basically from the case file records. All the records of patients that were aged below 16 years old at first presentation and were registered between January 1993 and December 2008 were included. Results: A total of 106 cases were included in the study. Mean age was 8.84 + / - 3.5) years and 60.4% were male and 39.6 female. For majority of them, the key informant at presentation was the mother (55.3%), followed by the father (19.4%) and in some cases both parents (15.1)%. It was seen from this study that more than half (55.6%)of the patients seen in the unit were referred from the paediatric neurology clinic within the teaching hospital, while another quarter (25.5%) were from child guidance centres in the community; only 15.1% walked in from the community on their own initiative. Abnormal behaviours , seizures and restlessness were the commonest reasons for presenting. Over 88% had stopped attending the clinic over the years while about 11% were still attending regularly. The average total number of clinic visits was 7.65 + - total 8.5). Conclusion: Child and Adolescent units are relevant referral units for patients with developmental or neurological problems identified from other hospital units and community child service providers. Default rates in clinic attendance is however high.Key Words: Child, Adolescent, Psychiatry, Africa, Hospita