Assessment of socioeconomic status and control of asthma in adults

Background: Asthma is a chronic disease which places considerable economic, social and public health burdens on the society. Education, occupation and income are the most widely used indicators of socioeconomic status (SES). Studies have shown increased asthma hospital admissions for those who are materially deprived and increased asthma severity in low social class groups. The aim of this study is to determine the impact of socioeconomic status on control of asthma in adults.Methods: The study was a cross-sectional analytical one, conducted over a year at the Medical Outpatient Clinic of the University College Hospital Ibadan. The study population was composed of 355 randomly selected adults aged between 18years and 55years with an established diagnosis of asthma already on treatment.Results: Respondents with monthly income of N40000 and above had a higher proportion with good asthma control (74.1%) compared to those that earned N10000 to N39999 (69.0%) and less than N10000 (47.8%). This was statistically significant. Respondents in occupational class I/II had a slightly higher proportion with good asthma control (70.9%) compared to those in occupation class III/IV (70.1%) and occupation class V/VI (50.6%). This was statistically significant at p = 0.003.Conclusion: Respondents in the higher occupational class had better asthma control than respondents in the lower occupational class. Respondents who were earning N40000 and above as monthly income had better control of asthma than other respondents. After adjusting for other variables, the predictor of good asthma control was monthly income of the respondents.Keywords: Education, Occupation, Monthly income, Asthma contro

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Perceived family-related stressors and clinical manifestations of patients with psychosomatic morbidity attending general outpatient clinic university college hospital

Background: Depression, anxiety and somatoform disorder account for psychosomatic morbidity (PSM), the most prevalent mental disorder encountered in primary care. Prominent clinical manifestations of PSM can result from perceived stress and are general and unspecified symptoms (GUS) which most times are unexplained. These symptoms vary in individuals, usually multiple and affect different body parts. Studies have shown that stress relating to health, work and financial problems is common among primary health care attendees, but association with pattern and extent of PSM has not been widely studied in Nigeria.Objective: This study sought to explore the relationship between severity of patients' clinical manifestations and perceived family related stressors (PFRS).Method: The study span for three months, during which 1402 patients ≥18 years who presented at the out-patient clinic for various complaints were encountered. The sample size was determined using the prevalence of 63.1%. for psychosomatic disorder from Ogunsemi et al's study. A sample of 360 patients with varying forms of PSM identified by ≥ 5 from symptoms in the primary evaluation of mental disorder- patient health questionnaire somatoform, anxiety and depression modules (PRIME-MD PHQ SADs) was recruited consecutively out of the patients encountered during the study period. The clinical manifestations of these patients were categorized using international classification for primary care second electronic version (ICPC-2E). The ICPC-2E was modified by the addition of somatic symptoms observed to be peculiar in people with PSM in the study area. The Social Readjustment Rating Scale (SRRS) was used to explore the PFRS. Data were analyzed using statistical package for Social Sciences soft ware version 17. Tables and diagrams in form of graphs, charts were used for relevant variables. Cross tabulations of some independent variables and dependent variable were analyzed using independent t-test and analysis of variance. Statistical significance level was set at p ≤ 0.05.Results: The age of respondents ranged between 18 and 80 years with mean age of 42.2 years + 15.2. Two-thirds of them (67.8%) were females and majority had married once 76.4% [this comprised those that were living with their spouses (62.5%), separated/divorced (3.1%) and widowed (10.8%), while (23.6%) were never married. Commonest complaints observed were GUS (23.3%), cardiovascular system complaints (14.2%), gastrointestinal (11.9%), musculoskeletal complaints (11.4%), gynaecological symptoms (10.6%), neurological (8.6%) and symptoms from other body parts constituted 20%. GUS complaints in this study contained additional features (crawling body sensation, sensation of pain or heaviness in the head, peppery body sensation, migratory body pains and migratory body movement) included in the modified ICPC-2E classification. Almost all respondents screened in with PSM (95.6%) had somatoform disorder by the (PRIME MD) PHQ-SAD questionnaire used.The second and third parts of PHQ-SADS diagnosed that only few have depressive disorder (40%) and anxiety disorder (44.4%). The mean scores for PFRS were higher in respondents with moderate to severe PSM. However, respondents with anxiety related symptoms are more likely to have greater PFRS (p = 0.03).Conclusion: GUS were predominant complaints identified in patients with PSM in this study. Females tend to perceive more psychosocial stressors when compared with males and are more likely to report their symptoms. The study finding suggests that risk factor for a severe manifestation of patients with PSM is higher PFRS

Family characteristics and childhood predictors of overweight and obesity in adults attending general outpatient clinic, Ibadan

Background: The World Health Organization has reported that there is an increasing rate of overweight and obesity and this has reached an epidemic proportion. Parental influence during childhood and family routine characteristics are been proposed as contributing factors for overweight and obesity. Objective: The study therefore sought to determine the relationship between familycharacteristics, childhood predictors and overweight/obesity.Methodology: This was a case-control study amongst adult patients aged 18 -60 years. Cases were respondents with Body Mass Index (BMI) ≥ 25 kg/m2 ; they were age and sex matched with controls (BMI 18.5 < 25 kg/m2 ), in ratio 1:1 (N=342). Interviewer administered questionnaires were applied to consenting patients to gather information on socio-demography, parental influence during childhood, family routine characteristics. The pattern of family meals was assessed with the Family Ritual Questionnaire dinnertime scale. Data was analysed with SPSS version 22. McNemar Chi-square and logistic regression were used to draw inferences at p<0.05 level of significance. Result: The mean BMI of the case and control groups was 30.08(±4.25) kg/m2 and 21.74(±2.35) kg/m respectively. Amongst thecases, 102 (59.6%) were overweight while 69(40.4%) were obese. There was no significant difference in the socio-demographicprofiles of the groups. Having a self-reported history of childhood/adolescent obesity, family history of obesity, desire for large bodysize and having a poor family mealtime routine were statistically associated with overweight and obesity with p-value < 0.05.Respondents with history of obesity in childhood/adolescent and family history of obesity were 3.6 and 3 times respectively morelikely to be overweight or obesity than if there was no such history.Conclusion: Childhood/adolescent obesity and family history of obesity are predictors of obesity. Involving the family as a unit inweight loss control may be beneficial for both the identified patient and his/her (immediate) family members who are at increased riskof becoming overweight and obese themselves. Keywords: Family characteristics, Childhood Predictors, Overweight and Obesit

Effects of adherence to antiretroviral therapy on body mass index, immunological and virological status of Nigerians living with HIV/AIDS

Objective: This study determined the effect of adherence to highly active antiretroviral therapy (HAART) on body mass index (BMI) and immunological and virological parameters of people living with HIV/AIDS (PLWHA) attending University College Hospital, Ibadan. Methodology: Prospective cohort of consenting PLWHA was followed up for a minimum of 3 months, had their drug adherence determined using pharmacy records and self-reporting. The sociodemographic data, weight, height, plasma viral load and CD4 count were recorded at baseline and 3 months. These data were entered into the computer and analyzed. Results: A total of 318 PLWHA with a median age of 38 ± 9.6 years participated. Fifty-four percent were female. Sixty-three percent were 95% adherent to HAART. Most (99.4%) were on non-nucleoside reverse transcriptase inhibitor-based therapy. There was a remarkable fall in viral load to non-detectable levels among adherent compared with non-adherent PLWHA. Furthermore, there was a significant increase in CD4 count among adherent compared with non-adherent PLWHA. Adherent clients showed marked improvement in BMI and immunological and virological status. Conclusion: Adherence to HAART reduced viral load to an undetectable level and increased CD4 count among adherent PLWHA on HAART

Prevalence of obesity among women attending a Nigerian primary care clinic.

The objective was to determine the prevalence of obesity and associated risk factors among women in a Nigerian Out-Patient clinic. A pre-tested structured questionnaire was administered on women at the General Outpatients' Department (G.O.P.D.) of the University College Hospital (U.C.H.), Ibadan. The prevalence of obesity was 41.8%. Age was significantly associated with obesity, p=0.001. Majority of the obese participants (68.9%) in comparison to non obese (46.4%) were traders, p=0.001. Many of the obese respondents were married (82.6%) in comparison to non obese respondents who were widowed (67.4%), p=0.001. Many of the obese respondents were multiparous (44.3 %) having more than 4 children in comparison to the non obese respondents with the highest proportion of women with no children (36.1%), p=0.001. Fewer of the obese women had no formal education (28.1%) and no primary education (26.4%), in comparison to the non obese with 32.2% having secondary education and 27% having post-secondary education, p=0.015.Majority of the obese women (62.3%) were pre-menopausal in comparison to the non obese with 79.0% being pre-menopausal, p=0.001. Multivariate analysis done using logistic regression showed that risk factors for obesity included age group 50-59 years (Odds Ratio 15.914, 95% CI=1.389-182.26, p=0.026), and being menopausal (Odds Rat io 1.452. 95%CI=0.587-3.594,p=0.017).Having greater than five children was also found to be a risk factor for obesity (OR=3.321,95%CI=1.236-8.921,p=0.017). The prevalence of obesity among Nigerian women remains high. There is a need to plan and implement measures for control.Keywords: Prevalence, obesity, women, primary care, Nigeria