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

Abstract 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

Familial and socio-economic correlates of somatisation disorder

Background: Somatisation disorder can result from an interplay between suboptimal family environment and socio-economic deprivation, which enhances the underlying cognitive tendency for this disorder. There are pertinent familial and socio-economic factors associated with this disorder, but research addressing this is sparse. Aim and setting: The study aims to evaluate family and socio-economic factors that are associated with somatisation disorder amongst patients presenting to the Family Medicine clinic, University College Hospital, Ibadan, Nigeria. Methods: This is an observational case-control study of 120 participants who presented to the clinic between May and August 2009. Data collection was by interviewer-administered structured questionnaire using the World Health Organization Screener for Somatoform Disorder and Somatoform Disorder Schedule to ascertain somatisation in 60 patients who were then matched with 60 controls. The respondents’ demographic and family data were also collected and their interpersonal relationships were assessed with the Family Relationship Index. Results: The somatising patients were mostly females (70%), with a female to male ratio of 2.3:1 and mean age of 43.65 ± 13.04 years.Living in a polygamous family (as any member of the family) was significantly related to somatisation (p = 0.04). Somatisation was also more common in people who were separated, divorced or widowed (p = 0.039). Somatisers from a lower social class or those earning below a dollar a day experienced poorer cohesion (p = 0.042) and more conflicts (p = 0.019) in their interpersonal relationship. Conclusion: This study was able to demonstrate that a polygamous family setting, disrupted marriage, low social status and financial constraints are correlates of somatisation. It is of essence to identify these factors in holistic management of somatising patients

Knee osteoarthritis and perceived social support amongst patients in a family medicine clinic

Background: Knee osteoarthritis is a chronic disease affecting the lives of patients and their families, with the family characteristics moderating the illness course. The perceived social support received by a patient helps in determining the health and functionality of the patient.Methods: A cross-sectional study was undertaken of 270 patients with knee osteoarthritis attending a family medicine clinic between January and March 2011. The socio-economic and family characteristics of the respondents were obtained. The Multidimensional Scale of Perceived Social Support (MPSS) was used to assess perceived social support by the respondents, while functional health was assessed using the Ibadan Knee/Hip Osteoarthritis Measure (IKHOAM).Results: The majority (68.8%) of the respondents perceived an adequate level of social support from their family members, majorly from their children. Individuals who perceived strong support from their family (69.9%) and friends (71.6%) had a good health perception at a p-value of 0.002 and 0.037 respectively. The study also showed a statistically significant association between strong perceived family support and high functional health status (p = 0.000).Conclusions: The health perception of patients and their physical functionality was positively associated with strong perceived family support. Families and friends can be effective sources of social support for patients with knee osteoarthritis, which help to promote their health outcomes

Pattern of breast cancer risk factors among pre and post-menopausal women at a Primary Care Clinic in Nigeria

Context: The incidence of breast cancer is increasing worldwide. In black women, breast cancer is associated with aggressive features and poor survival. Objective: Identification of risk factors such as early age of menarche, obesity and family history of breast cancer may permit preventive strategies. Study Design: A cross-sectional comparative study design was used and questionnaires were administered to 400 adult women at a tertiary health centre in Nigeria. The data was analyzed with the Statistical Package for the Social Sciences version 17; the level of significance set at alpha = 0.05. Results: There was significant association between pre-menopausal and post-menopausal women with positive family history of breast cancer with P = 0.010. Majority of the respondents with a positive family history of breast cancer were menopausal (P = 0.010). There was a statistically significant association between menopausal status and ever consuming alcohol-based herbal concoctions (P = 0.010) and in those whose partners smoked cigarettes (P = 0.001). Majority of respondents were not currently on any form of contraceptives. Parity, breastfeeding and use of hormonal contraceptives were all statistically significant (P < 0.001, P < 0.001 and P = 0.004, respectively). Almost all the women in our study, 97%, had never had a mammogram. There was a significant association between pre-menopausal and post-menopausal women with positive family history of breast cancer (P = 0.010). Conclusion: With increasing incidence of breast cancer worldwide and late presentation in developing countries with high morbidity and mortality, effective screening for risk factors will go a long way in reducing the incidence of breast cancer