Myopathy in older people receiving statin therapy: a systematic review and meta-analysis

Objective The aim of the present study was to determine the risk of myopathy in older people receiving statin therapy. Methods Eligible studies were identified searching Ovid Medline, EMBASE, Scopus, CINAHL, Cochrane and PSYCHINFO databases (1987 to July 2014). The selection criteria comprised randomized controlled studies that compared the effects of statin monotherapy and placebo on muscle adverse events in the older adult (65+ years). Data were extracted and assessed for validity by the authors. Odds ratios and 95% confidence intervals (CIs) were used to calculate binary outcomes. Evidence from included studies were pooled in a meta-analysis using Revman 5.3. Results The trials assessed in the systematic review showed little or no evidence of a difference in risks between treatment and placebo groups, with myalgia [odds ratio (OR) 1.03, 95% CI 0.90, 1.17; I2 = 0%; P = 0.66] and combined muscle adverse events (OR 1.03, 95% CI 0.91, 1.18; I2 = 0%; P = 0.61) (myopathy). No evidence was found for an increased risk of rhabdomyolysis (OR 2.93, 95% CI 0.30, 28.18; I2 = 0%; P = 0.35) in the seven trials that reported this. No trials reported mortality due to a muscle-related event. Discontinuations due to an adverse effect were reduced in the treatment group compared with placebo (OR 0.74, 95% CI 0.50, 1.09; I2 = 0%; P = 0.13). Conclusion The results obtained from the present review suggest that statins are relatively safe, even in older people. There was no evidence to suggest an increased risk of myopathy in older adults receiving statin therapy. There is slightly increased seen with rhabdomyolysis when compared with the general population, although the event is relatively rare. Statins should be prescribed to elderly people who need it, and not withheld, as its myopathy safety profile is tolerable

Promoting Sexual and Reproductive Health and Rights in Nigeria through Change in Medical School Curriculum

Significant developments have occurred in the field of sexual and reproductive health and rights (SRHR) globally in the last decade. However, this is yet to translate into improved status of SRHR in developing countries. One of the strategies recognised worldwide for addressing the poor status of SRHR is human capacity building at all levels. A pilot work conducted in two federal university medical schools identified a major gap in knowledge among medical students on issues related to SRHR. This called for a review of the curriculum to enable the incorporation of relevant and topical issues. This article describes the processes leading to the adoption of the Nigerian medical schools' sexual and reproductive health and rights curriculum. The exercise culminated in the identification of internal and external stakeholders and needs of the Nigerian medical schools in teaching reproductive health. The participation of lecturers (bottom-up approach) brought about a sense of ownership of the document and promoted the broad consultation and participation of all participants. It also identified capacity building and the need for evaluation as a basis for further review. (Afr J Reprod Health 2004; 8[1]:85-91) RÉSUMÉ Promotion des droits de la santé et sexuelle de reproduction au Nigéria à travers la modification du programme scolaire medical. Il y a eu des développements importants dans le domaine de la santé et les droits sexuels et de reproduction (SDSR) dans le monde entier au cours de la dernière décennie. Pourtant ceci n‘a pas encore été tradiut en une meilleure condition de la SDSR dans les pays en voie de développement. Une des stratégies reconnues dans le monde entier pour aborder le statut faible de la SDSR est le renforcement de capacité humaine à tous les niveaux. Une etude pilote menée au sein de deux écoles médicales des universités fédérales a identifié un écart important dans la connaissance chez les étudiants en médicine sur des questions liées à la SDSR. Ceci nous a obligé de revoir le programme afin d‘inclure des sujets pertinents et d‘actualité. Cet article décrit le processus menant à l‘adoption du programme de l‘ école médicale nigériane sur la santé sexuelle et les droits de reproduction. Le projet a abouti à l‘identification des partenaires sociaux internes et externes et les besoins des écoles médicales nigérianes dans l‘enseignement de la santé de reproduction. La participation des enseignants (l‘approche de bas en haut) a provoqué un sens de la propriété du document et elle a encouragé de grandes consultation et participation de tous les participants. Elle a également identifié le renforcement de capacité et la nécessité d‘une évaluation comme base pour d'autres examens. (Rev Afr Santé Reprod 2004; 8[1]:85-91

Induced Abortion in Nigeria: Findings from Focus Group Discussion

Abortion is carried out daily in Nigeria despite the restrictive abortion law. This study was carried out to obtain information on societal attitude to the issues of family planning, unwanted pregnancy, abortion, adoption of children and laws relating to them. Focus group discussions were held in south-western Nigeria among 11 sub-groups. Participants felt that there was high prevalence of unwanted pregnancy and abortion particularly among youths. They had high level awareness of contraceptives and ascribed its low use to negative side effects, high cost and provider bias. Christians favoured planning of pregnancies while the Muslims did not. Majority of the respondents had negative perception of induced abortion. Some of them supported abortion if the education of the young girl would be disrupted, if paternity of pregnancy is in dispute, or if it would save the family from shame. Participants supported the enactment of laws that would make adoption of unwanted children easier. (Afr J Reprod Health 2005; 9[1]: 133-141

Contraceptive Prevalence at the Community Level in South-Western Nigeria

This is a community-based study of contraceptive prevalence using a questionnaire instrument and interview. It is hoped to provide information for the appraisal of current interventions/strategies aimed at preventing unsafe abortion and a baseline for the development of future strategies. This study shows a very high level of contraceptive awareness, 91.3%, but a low prevalence rate, 23.4%. The most commonly used contractive was the pill but with a reported high failure rate of 18.3% among the study population suggesting improper usage. The high disparity between awareness and usage highlights the need for further research to determine the possible causes and develop strategies to bridge the gap. NQJHM Vol. 13 (3-4) 2003: pp. 49-5

Characteristics of Abortion Care Seekers in South- Western Nigeria

This prospective hospital-based study was carried out to understand the characteristics of abortion care seekers in south-western Nigeria. Information was obtained from a total of 1876 women seeking abortion at hospitals using a questionnaire. The results show that majority (60%) were between the ages of 15 and 24 years, of which adolescents between the ages of 15 and 19 years constituted 23.7%. Most (63.2%) of the respondents were unmarried, but married women also constituted a significant proportion (30.2%) of the abortion care seekers. Students were the single highest group, while the predominant economic activity was trading (26.7%). Respondents terminated their pregnancies mainly because they were students or because they did not desire to have children. Most (35.5%) of the women were introduced to providers by friends. Average contraceptive prevalence among the abortion care seekers was 27.4%. It is obvious from the results that young persons, especially in-school adolescents, should be targeted for comprehensive sexuality education especially in view of the current HIV/AIDS pandemic. (Afr J Reprod Health 2004; 8[3]: 81-91

Community-Based Survey of Unwanted Pregnancy in Southwestern Nigeria

Unwanted pregnancy, and consequently unsafe abortion, remains major reproductive health problems in Nigeria that needs to be tackled. Unfortunately, there is a dearth of information on this problem at the community level. This study therefore examined the prevalence of unwanted pregnancy in the community as well as associated factors including the views, perceptions and attitudes of community members towards unwanted pregnancy and the pattern of help-seeking behaviour on unwanted pregnancy. Information was obtained from 3,743 women in urban and rural communities in two Nigerian states of Lagos and Edo. At some point in life, 26.6% of the respondents had had unwanted Pregnancy while abortion prevalence was 21.7%. Short birth intervals (21.1%), high cost of raising children (20.1%), interruption of education (20.1%) and being unmarried (17.3%) were the most common reasons for not wanting pregnancies. Most of the respondents (91.3%) were aware of some form of contraception but ever-use rate was only 36.6% while current use rate was 23.4%. Both abortion and contraceptive use were significantly associated with increasing levels of education. Unwanted pregnancy constitutes a problem even at the community level and more research is needed to understand the persistent disparity between contraceptive knowledge and usage, as increased usage will reduce unwanted pregnancy and induced abortion. (Afr J Reprod Health 2004; 8[3]:103-115