HRQOLISP-26: A Concise, Multiculturally Valid, Multidimensional, Flexible, and Reliable Stroke-Specific Measure

Background. A multidimensional, brief, and flexible stroke-specific health-related quality of life (HRQOL) measure is still needed. The aim was to develop a shortened version of the HRQOLISP-102, a multiculturally generated measure with excellent psychometric properties. Methods. Participants included 100 (Ibadan, Nigeria) and 103 (Berlin, Germany) stroke patients compared to 100 (Ibadan) and 50 (Berlin) apparently healthy adults. Using standard protocol, the 26-item version was generated, consisting of therapeutically relevant physical, psychological, cognitive, and ecosocial domains. Criterion validity of the HRQOLISP-26 was determined using Bland-Altman statistics. “Known groups” validity was assessed using NIHSS, stroke levity score, and modified Rankin scale. Results. HRQOLISP-26 was easily interpretable and precise with no significant floor/ceiling effect. It can be completed within 7 minutes. It showed good content, construct, “known groups,” and criterion validity. It demonstrated good internal consistency (α = 0.81, 0.89) and test-retest reliability. Conclusions. HRQOLISP-26 is novel, brief, multiculturally-valid, and flexible for routine assessment of HRQOL in stroke patients

Challenges and Prospects of Property Ownership in Ado-Odo/Ota Local Government Area, Ogun State, Nigeria: A Review of Literature

The aim of this paper is to identify property ownership challenges and prospects in Ado-Odo/ Ota Local Government Area, Ogun State with a view to guide property owners towards homeownership or property ownership. In the course of writing this paper, secondary data were collected from both published and unpublished journals, articles, reports, maps, and the internet was consulted to acquire more data as regards this study.  Data sources are websites, government publications, books, internal records, journal articles, etc. Property ownership benefits identified include; property owner gain prestige and political power; provides shelter, health, welfare and wealth; good investment as regards to stable income generation; provides long-term monetary security; tax benefits; value appreciation overtime; provides hedge against inflation; etc.  Property ownership challenges identified include; improper or lack of title document that could result to property ownership insecurity and denial to credit facilities; gender discrimination in accessing land or property; inadequate or lack of access to justice; presence of ineffective and inefficient land management system, laws and agencies; land dealings fraudulence and conflicts; poverty or lack of finance; etc. Some of the recommendations to mitigate property ownership challenges include; government and land policymakers should ensure that laws and management system are efficient and effective, property market should be flexible for easy access to land and information, programmes should be scheduled to guard against gender discrimination as regard property ownership, law officials should ensure court proceedings are less costly and flexible for easy access to justice, etc

Profile of Generic and Disease-Specific Health-Related Quality of Life Among Nigerians with Parkinson's Disease

Background There is mounting evidence that Parkinson's disease causes significant disability and  impairs health-related quality of life. However, this dimension has not been fully characterised, particularly among Africans. We examined the generic and diseasespecific health related quality of life profiles of Nigerian Africans with Parkinson's disease in comparison to demographically-matched controls.Methods Thirty-six consecutive Nigerian patients with Parkinson's disease were assessed using a battery comprising of the Parkinson's disease questionnaire-39 (a disease-specific instrument), and the EQ- 5D (a generic instrument whose maximum score of 1.00 indicates best quality of life). A structured questionnaire interview and a complete neurological examination including the Hoehn and Yahr stage of illness scale and the motor section of the Unified Parkinson's  Disease Rating Scale were performed on the same day. Thirtysixages and gender- matched apparently healthy controls were also assessed.Results There was no significant difference in age between the patients (64.3 + 10years) and controls (63. 7 + 9 years). The patients had significantly poorer EQ-5D score (0.31 + 0.23) compared to the  controls (0.84+ 0.12 for the controls, P< 0.001). The Parkinson's disease questionnaire- 39demonstrated poor quality of life in patients with the poorest performances in the mobility, activities of daily living and emotional well-being dimensions. However the social support dimension was not impaired.Conclusion Patients with Parkinson's disease had much poorer generic and specific health related quality of life in comparison to their healthy counterparts. Management should be multi disciplinary in order to holistically improve quality of life in all affected domains.Keywords Parkinson's disease; Health Related Quality of Life; Nigeri

Frailty and mortality among older patients in a tertiary hospital in Nigeria

Background: This study determined the frailty status and its association with mortality among older patients.Design: A prospective cohort design.Setting: Study was conducted at the medical wards of University College Hospital, Ibadan, Nigeria. Participants and study tools: Four hundred and fifty older patients (>60 years) were followed up from the day of admission to death or discharge. Information obtained includes socio-demographic characteristics and clinical frailty was assessed using the Canadian Study of Health and Aging (CSHA) scale. Bivariate and multivariate analyses were carried out using SPSS version 21 at a p <0.05.Results: Overall, frailty was identified in 285 (63.3%) respondents. Mortality was significantly higher among frail respondents (25.3%) than non-frail respondents (15.4%) p=0.028. Logistic regression analysis showed factors associated with frailty were: male sex (OR=1.946 [1.005–3.774], p=0.048), non-engagement in occupational activities(OR=2.642 [1.394–5.008], p=0.003), multiple morbidities (OR=4.411 [1.944–10.006], p<0.0001), functional disability (OR=2.114 [1.029–4.343), p=0.042], malnutrition (OR=9.258 [1.029–83.301], p=0.047) and being underweight (OR=7.462 [1.499–37.037], p=0.014).Conclusion: The prevalence of frailty among medical in-hospital older patients is very high and calls for its prompt identification and management to improve their survival.Keywords: Frailty, Mortality, Older patients, in-hospital, NigeriaFunding: The study was self-funded by the author

Physicians’ Knowledge of the Glasgow Coma Scale in a Nigerian University Hospital: Is the Simple GCS Still Too Complex?

Objective: The Glasgow Coma Scale, GCS, is a universal clinical means of quantifying the level of impaired consciousness. Although physicians usually receive undergraduate and postgraduate training in the use of this scale in our university hospital we are aware of studies suggesting that the working knowledge of the GCS among practising physicians might not be adequate. Methods: We carried out a questionnaire-based survey across all specialties and levels of training of physicians in active patient care in a Nigerian university hospital. Results: Of the 100 physicians sampled, 98 correctly spelled out what the three-letter abbreviation, GCS, stands for. Ninety-three percent also conceded it to be an important clinical rating scale. However, only 55–89% of the participants correctly identified the three respective clinical variables, (eye opening, verbal response, and motor response), of the GCS. More particularly, the participants’ ability to itemize and correctly score all the respective components of each of the three clinical variables ranged from 0 to 35% across specialties and levels of training. Performance was best for the four-item eye opening variable and, worst for the six-item motor response variable. Conclusion: In our university hospital, practising physicians’ working knowledge of the GCS is inadequate and is dependent on the degree of the complexity of each of the three clinical variables of the scale

Controlling cardiovascular diseases in low and middle income countries by placing proof in pragmatism

Low and middle income countries (LMICs) bear a huge, disproportionate and growing burden of cardiovascular disease (CVD) which constitutes a threat to development. Efforts to tackle the global burden of CVD must therefore emphasise effective control in LMICs by addressing the challenge of scarce resources and lack of pragmatic guidelines for CVD prevention, treatment and rehabilitation. To address these gaps, in this analysis article, we present an implementation cycle for developing, contextualising, communicating and evaluating CVD recommendations for LMICs. This includes a translatability scale to rank the potential ease of implementing recommendations, prescriptions for engaging stakeholders in implementing the recommendations (stakeholders such as providers and physicians, patients and the populace, policymakers and payers) and strategies for enhancing feedback. This approach can help LMICs combat CVD despite limited resources, and can stimulate new implementation science hypotheses, research, evidence and impact

Prevalence of ECG abnormalities among adults with metabolic syndrome in a Nigerian Teaching Hospital

Background: Co-existence of metabolic syndrome (MetS) and electrocardiography (ECG) abnormalities heightens the risk of sudden cardiac death. However, there is a gap in evidence of how ECG changes cluster among continental Africans with or without MetS. Methods: We included 491 participants with interpretable ECG tracings who were consecutively recruited into the Cardiovascular Risk Prediction Registry (CRP). CRP is a registry of newly presenting patients into cardiology clinic of the University College Hospital, Nigeria, with a main objective of cardiovascular risk stratification to prevent cardiovascular morbidity and mortality. Using the International Diabetic Federation (IDF) criteria they were divided into those with metabolic syndrome and non-metabolic syndrome. Results: Four hundred and ninety-one participants comprising 48.3% women with mean age 53.72\ub115.2 years who met the IDF criteria with complete ECG interpretations were analyzed with 44.2% (men 38.6%; women 50.2%) of the participants having MetS while 74% had ECG abnormalities. Compared to women, men had higher mean serum total cholesterol, creatinine, smoking, and alcohol use, family history of hypertension and diabetes mellitus, QT prolongation, LVH plus or minus strain pattern, and ECG abnormalities in general. Women were heavier, had higher heart rate and proportions of MetS. ECG findings among those with or without MetS were not significantly different. In men, IDF metabolic score was associated with conduction abnormalities (p=0.039) and combined ECG abnormality (p=0.042) which became more significant with an exclusion of QT prolongation (p=0.004). Also, IDF abdominal obesity was associated with QT prolongation (p=0.017), combined ECG abnormality (p=0.034) while HDLc correlated with ECG abnormalities (0.037) in men. There was no significant associations of components of metabolic syndrome with ECG abnormalities among women. Conclusion: There was a high prevalence of MetS and abnormal ECG among the studied population. Abnormal ECG findings were more common in men with no differential association in people with or without MetS. However, a significant association existed between certain components of MetS and ECG abnormalities in men only. Male gender and HDLc were independent predictors of ECG Abnormalities