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

TECHNICAL AND VOCATIONAL EDUCATION: A SOLUTION TO PRECARIOUS YOUTH UNEMPLOYMENT IN NIGERIA

Unemployment is one of the most serious problems facing Nigeria like many other countries in the world. Nigeria is becoming a predominantly youth society with high rate of unemployment. The development of youth is critical to economic survival and vibrancy of any nation. In order for a country to achieve her development aspiration, the youths need to have access to education that will enable them to enhance their standard of living and gain competitive skills that will be in high demand in the labour market. Young people that lack skills that are valued in global and local economies face limited job opportunities and income growth. The changing nature of work today is placing increased pressure on the youths to acquire technical and vocational education skills. With the youths among the big losers of the recent economic crisis, technical and vocational education is often seen as the silver bullet to the problem of youth joblessness.  Article visualizations

Parent-mediated communication interventions for improving the communication skills of preschool children with non-progressive motor disorders

Background: Children with motor disorders can have difficulties in producing accurate and consistent movements for speech, gesture or facial expression (or a combination of these), making their communication difficult to understand. Parents may be offered training to help recognise and interpret their child's signals and to stimulate their children's development of new communication skills. Objectives: To assess the effectiveness of parent-mediated communication interventions, compared to no intervention, treatment as usual or clinician-mediated interventions, for improving the communication skills of preschool children up to five years of age who have non-progressive motor disorders. Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, 12 other databases and three trials registers in July 2017. We also searched the reference lists of relevant papers and reviews, and contacted experts working in the field to find unpublished studies. Selection criteria: We included studies that used randomised or quasi-randomised designs; compared a parent-mediated communication intervention with no treatment, treatment as usual or clinician-mediated therapy; and included children with non-progressive motor disorders up to five years of age. Data collection and analysis: We used the standard methodological procedures expected by Cochrane. Main results: This review included two randomised controlled trials involving 38 children (20 boys, 18 girls), aged 15 to 96 months, and their mothers. All children had developmental disabilities; 10 had motor disorders, but it was unclear if these motor disorders affected their gestural, vocal or verbal communication. Mothers attended eight group training sessions over 11 to 12 weeks and received two or three home visits. Outcomes were assessed immediately after training. We found no report of longer-term follow-up. One study took place at an intervention centre in Canada and the other in South Korea. Both studies recruited small numbers of participants from single centres. Since it is not possible to blind participants attending or therapists providing training to group allocation, we considered both studies to be at high risk of performance bias. We also rated one study at high risk of attrition bias, and both studies at low risk of reporting bias. There was very low-quality evidence for all outcomes assessed. There was no evidence of an effect of training for children's initiation of conversation or engagement in joint attention during interaction with their mothers. Mothers who received training became more responsive to their children's communication, but there were no differences in the extent to which they controlled conversation by directing their children. Missing data meant that we were unable to evaluate the effects of training on children's frequency of communication, frequency of spoken language in conversation, speech production, or receptive or expressive language development. There were no effects on maternal stress. We found no reports of the effects of parent training on children's use of individual communication skills, such as asking questions or providing information, on their generic participation or adverse outcomes. Neither did we find reports of mothers' satisfaction with treatment, its acceptability or their compliance with it. Authors' conclusions: There is only limited, very low quality evidence that parent-mediated communication interventions may be associated with improvements in interaction between mothers and their preschool children who have motor disorders. The indirectness of the study samples and high risk of bias in the included the studies significantly limits our confidence in the evidence, as do issues with study design and lack of detail in results. It is not clear if training has been tested with children whose motor disorders limit the consistency and accuracy of movements underpinning spoken or gestural communication. Some speech and language therapists currently provide communication training for parents. Further research, with larger numbers of children whose movement disorders affect their speech and gestures, coupled with detailed reporting of children's baseline skills, is needed to test whether communication training for parents can help them to promote the communication development of their young children with movement disorders

Assessment of iron Parameters and Transient Elastography (FibroScan) Pattern amongPatients with Chronic Viral Hepatitis Infection in Jos, Nigeria

Background:The long-termeffect of excess iron deposition in the liver include fibrosis and cirrhosis which may progress to hepatocellular carcinoma. We assessed iron parameters among patients with chronic viral hepatitis B and C infection (CVHBI; CVHCI) to determineif any correlation existed with the degree of fibrosis in the liver. Methods: A cross-sectional descriptive study was carried out on 186 patients, made up of 132 patients withCVHBI and 54 patients with CVHCI. Serum ferritin and C-reactive protein were done by ELISA, serum iron and total iron binding capacity (TIBC) by colorimetric technique while transferrin saturation (Tsat) was calculated using serum iron and TIBC values. Liver fibrosis was assessed using fibroscan.Obtained data wereanalysed using SPSS version 20 and p values < 0.05 were considered statistically significant.  Results: The mean values for serum ferritin, iron, TIBC and Tsat were 218.1±325.6µg/L, 25.1±22.8µmol/L, 71.13 ± 35.92µmol/L and 45.2 ± 49.9% respectively. There were no significant differences in iron parameters between patients with CVHBI and CVHCI. Elevated serum ferritin was found in 15.2% and 20.4% of CHBVI and CHCVI patients respectively; while an elevated Tsat was seen in 22.7% and 24.1% of CHBVI and CHCVI patients respectively. Using a combination of elevated serum ferritin and Tsat, the prevalence of iron overload was found to be1.6%. Fibroscan scores did not differ significantly between patients with orwithout elevated iron parameters. Conclusion:Chronic viral hepatitis infection is associated elevated iron parameters though withminimal effect on liver fibrosis. Conflict of interest: Ni

The burden of Hepatitis B and C virus infections in patients with sickle cell anaemia in Jos – Nigeria

Background: Sickle cell anaemia (SCA) is an important public health problem in Nigeria associated with frequent blood transfusion. Patients with this disease are at increased risk of contracting hepatitis B and C virus through blood transfusions.Objective: The study aimed at determining the burden of hepatitis B and C virus infections in patients with sickle cell anaemia and the role of blood transfusion in these infections acquisition in Jos.Materials and methods: This was an observational cross-sectional study conducted on patients with SCA attending the Haematology Out-patient Clinic of Jos University Teaching Hospital,between November 2014 and August 2015.Consenting patients with SCA had their blood screened for anti- HBV and HCV antibodies using fourth generation Elisa techniques after completing a questionnaire.Results: One hundred and eleven patients with SCA participated. Antibodies to Hepatitis B virus (HBV) was detected in 21 (18.9%) while that to Hepatitis C virus (HCV) was found in 16 (14.7%). Seventy six (68.5%) of the participants had history of blood transfusion while 35 (31.5%) were never transfused. 22.4% and 15.8% of those transfused were positive for HBV and HCV antibodies respectively. There was no significant difference in the proportion of those positive for anti HBV or HCV with respect to their transfusion status (p=0.24 and 0.81 respectively).Conclusion: The proportion of our patients with SCA that were anti HBV and anti-HCV positive was high. Blood transfusion did not significantly influence their positive status. Strategies aimed at controlling these viral infections in these patients and the general population should be enforced after public awareness campaigns and advocacy are instituted.Keywords: Sickle Cell Anaemia, burden, Hepatitis B Virus, Hepatitis CVirus, infection, Blood Transfusio

Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review

BACKGROUND: Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. METHODS: A desk review is conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization in countries such as Tanzania, Malawi, Mozambique, Zambia, Ghana etc., using curricula, evaluations and key-informant questionnaires. RESULTS: The cost-effectiveness of using substitutes and their relative retention within countries and in rural communities underlies their advantages to African health systems. Some studies comparing clinical officers and doctors show minimal differences in outcomes to patients. Specialized substitutes provide services in disciplines such as surgery, ophthalmology, orthopedics, radiology, dermatology, anesthesiology and dentistry, demonstrating a general bias of use for clinical services. CONCLUSIONS: The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity. Understanding the roles and conditions under which such cadres best function, and managing the skepticism and professional turf protection that restricts their potential, will assist in effective utilization of substitutes

Two Strategies for the Delivery of IPTc in an Area of Seasonal Malaria Transmission in The Gambia: A Randomised Controlled Trial

Bojang and colleagues report a randomized trial showing that delivery of intermittent preventive treatment for malaria in children by village health workers is more effective than delivery by reproductive and child health trekking clinics

Challenges Facing Nigeria’s Urban Environment: The Abuja Case

The continued growth of urban population in Nigeria and sub-Saharan Africa has brought along with it, a myriad of challenges. Exacerbated by high birth rate and a continued increase in the level of rural-urban migration, the economic, infrastructural, and social conditions in these urban centres have been incapable of providing a good standard of living for its inhabitants. With a population of about 188 million and a HDI of 152 in 188 ranked countries, urban centres in Nigeria are plagued with poor security, epileptic power and water supply, poor sanitation, health challenges, high cost of construction amongst other challenges (NPC, 2017). This qualitative study expands on current knowledge with regards to the current challenges facing Nigeria’s urban environment with focus on Abuja, the Federal Capital of Nigeria as a primary case. This paper also analyses some of these long standing challenges, their interrelatedness and how they exacerbate the inability of the Nigerian government to solving them. Furthermore, the conclusion lays a response to these challenges with recommendation on the process of unravelling the complex conglomerate issues

Study of occurrence of Multidrug Resistant Escherichia coli Clinical isolates as a result of Extended Spectrum Beta-Lactamase (Esbls) Production

Resistance to antibiotics by microorganisms has increased dramatically in the past few years. Resistance to third-generation cephalosporins and other classes of antibiotics is attributed to the production of beta-lactamase genes located on mobile genetic elements, which facilitate their transfer between different species. This study was undertaken to determine the presence of ESBLs in 400 isolates of Escherichia coli obtained from various clinical specimens (urine, stool, blood, wound swabs, sputum and throat swabs) collected from 216 female and 184 male patients attending various health facilities in Makurdi, Benue State, Nigeria; and to relate ESBL production with antibiotic resistance. Antibiotic susceptibility test using penicillin, ceftriaxone, ceftazidime, cefuroxime, cefotaxime, amoxicillin and clavulanic acid, gentamycin, chloramphenicol and imipenem antibiotic discs sourced from OXOID, USA was carried out, using NCCLS guidelines on the isolates. The presence of ESBLs was determined using the Double Disc Synergy (DDST) test. The isolates showed the highest resistance to penicillin 392(98%) producing 62(15.8%) ESBLs. Only 8 (2%) isolates were susceptible to penicillin. This was closely followed by resistance to ceftriaxone (385; 96.3%), producing 62(16.1%) ESBLs. The isolates were also resistant to other classes of antibiotics:  aminoglycosides (gentamycin) 331(82.7%), carbapenem, imipenem 2(0.5%) which was the least. Three hundred and ninety-eight (99.5%) of the isolates were susceptible to imipenem. Isolates from blood specimens (26.3%; n=5) harboured the highest percentage of ESBLs, followed by isolates from wound swab specimens (17.3%; n=9). The study showed moderate production of ESBLs resulting in multiple antibiotic resistance

Phytochemical and antimicrobial studies of Commiphora africana root extracts

ABSTRACT The crude ethanolic extract of Commiphora africana root was partitioned with n-hexane, chloroform; water and 10% aqueous methanol and screened for chemical constituents and antimicrobial activity. The n-hexane fraction, which was the most bioactive was chromatographed on a column silica gel to give a number of purified components. The components from the nhexane were found to be active against Staphylococcus aureus, E. coli and C. albicans. S. aureus (ATCC 13709) was susceptible to fractions C 1 -C 11 giving zonal inhibition of between 1-3 mm. Ethanolic crude root extract (2000 µg mL -1 ) proved highly active against C. albicans, while 10% aqueous methanol was the most active against E. coli. Though C. africana root crude extracts, fractions and components showed promising in-vitro antimicrobial activity, it was not as high as that of the standard antibiotics used for comparison