Intern Physicians’ views of Generic Medicines in a Teaching Hospital in Southwest Nigeria

Background: The use of generic medicines in practice is an effective pharmaceutical cost containment strategy. However, prescribing of generic medicines has remained relatively moderate compared to that of innovator brands in many developing countries. To improve generic medicine utilization, there is a need to understand prescribers’ views of generic medicines and related practices.Objectives: To explore the views of intern physicians on generic medicines, generic prescription and substitution practices.Methods: This study employed qualitative methods. The study participants were intern physicians in a tertiary hospital. The participants were recruited using snowballing technique and interviews were continued until an adequate sample size was attained. The method for data collection was face-to-face individual in-depth semi-structured interviews. A total of 12 interviews were conducted. The interviews were audio recorded, transcribed using a denaturalized approach. Data analysis was by thematic analysis based on the framework approach. Results: Three major themes were identified on their views on generic medicines; 1) insufficient knowledge about generic medicines, 2) ambivalent dispositions to generic medicines, 3) trust of innovator brands. Their views appear not very supportive of generic substitution practice. Possibly, due to a gulf in communication between dispensing pharmacists and prescribing physicians, as well as past experiences with inappropriate substitutions.Conclusion: Trust in the innovator product appears an important factor in the prescribing of medications. The participants seem to have less trust in generic medicines, hence they prescribe innovator brands more

Professional Development and Career Pathway in Nursing

Abstract: The professional (registered) nurse needs to possess the necessary skills and competencies in discharging her duty to the society. These skills are acquired through professional development, clinical experiences and educational advancement. The nurse personally develops the ambition while the institution helps to actualize this. Professional development is one of the criteria that make nursing to be a profession especially in this world of professional leadership tousle among health care workers. It is expected that the nurse develop herself through evidenced base practices, reflective practices and continue education. The competent nurse engages in ongoing selfdirected learning with the understanding that knowledge and skills are dynamic and evolving; in order to maintain competency one must continuously update the knowledge, she also demonstrates leadership in nursing and health care through the understanding that an effective nurse is able to take a leadership role to meet client needs, improve the health care system and facilitate community problem solving. Ensuring that nurses have the appropriate skills, knowledge, competencies and professional values to achieve reform objectives is contingent upon their engagement in higher education. The time has come for the nursing profession to outline a preferred future for the preparation of nurse educators to ensure that these individuals are appropriately prepared for the responsibilities they will assume as faculty and staff development educators and to implement strategies that will serve to retain a qualified nurse educator workforce

Impact of the Mandatory Community Midwifery Service on the Utilization of Maternal Health Care by Women in Ondo State, Nigeria

The study explored the perceived impact of the mand atory community midwifery service on utilization of maternal health care by women, using the General Sy stem Theory and the Logic Model. The research was c onducted in three selected Local Government Areas (LGAs). The researc h design for this study was the time-series type of non-controlled experimental design. The researcher assessed record s of maternal health care attendance from the selec ted health facilities from July 2002 to July 2011 to generate data for the stu dy. The study population comprised of 306 women of reproductive age group (15-49) in the three selected communities (who have participated in the programme) where the three pri mary health care centres are located. Multistage sampling technique was adopted to select three Local Government Areas (LGAs) from where data was collected. In-depth interview guide, quest ionnaire and format for recording data from records were used in the study. The result obtained from the study indicated that t here was no significant difference in the levels of utilization of maternal care services before and after the inception of the mand atory community service except for the slight incre ase in antenatal care utilization. Majority of the women expressed satisf action with the services they received from the mid wives. The study also revealed a slight increase in the levels of utiliza tion of antenatal attendance while not much change had occurred in the use of facility based delivery care as well as postnatal c ar

Effect of the Mandatory Community Midwifery Service on Maternal Health Care Utilization in Nigeria

The unacceptably high maternal mortality in Nigeria led the Nursing and Midwifery Council of Nigeria t o introduce the basic midwifery training with the vie w of producing skilled personnel to provide midwife ry services. Built into the programme is the one-year mandatory community s ervice. The one-year mandatory community service in an intervention aimed at ensuring the availability of midwives (ski lled attendants) to provide maternal care in the co mmunities and thus encourage women to access care at the health centre . The study investigated the variation in the level s of utilization of maternal healthcare before and after the inception of the on e year mandatory midwives’ community service by ass essing the perceptions of the Midwives regarding the impact of the mandato ry service on the utilization of maternal care serv ices. The General System Theory and the Logic Model were the theoreti cal models used in this study. The research was con ducted in three selected local government areas (LGAs) out of the e ighteen (18) LGAs in Ondo State. The time-series ty pe of non-controlled experimental design was the research design used fo r the study. Records of maternal health care attend ance from the selected health facilities from July 2002 to July 2010 were assessed to generate data for the study. The study population comprised the midwives who had participated in the mandatory serv ice in the three selected communities where the thr ee primary health care centres are located. Multistage sampling technique was adopted to select three Local Government Areas (LGAs) from where data was collected. All midwives that have served o r are still serving in the selected PHCs were purpo sely involved, a total of 50 in number. In-depth interview guide and format f or recording data from records were used in the stu dy. The interview guide was divided into two sections. Section A, was a che cklist was used to explore the participants’ opinio ns on the mandatory community service and Section B was a questionnaire to assess the midwives experience, opinions and ch allenges. Lastly, a format/checklist was developed to record data from records (antenatal care attendance, deliveries and postnatal care attendance between July 2002 and July 2011). Data from the stu dy was analyzed using both descriptive and inferent ial statistics utilizing the Statistical Package for the Social Sciences (SP SS) Correlation coefficient was used. The result ob tained from the study indicated that there was no significant difference in the levels of utilization of maternal care servi ces before and after the inception of the mandatory community service except for the slight increase in antenatal care utilizat ion. The majority of the midwives claimed that their presence had increased the patronage of maternal care services. However th is subjective data was not justified by the statistics obtained. The midwi ves also highlighted their challenges as well as th e way forward

Cavernous lymphangioma of the breast

<p>Abstract</p> <p>Background</p> <p>Cavernous lymphangioma is a rare lesion in the breast of adults. Only a few cases have been documented in literature.</p> <p>Case presentation</p> <p>We describe a 38-year-old woman who presented with a palpable breast lump, which measured 5 × 4 cm. A local excision of the lump was performed and a diagnosis of cavernous lymphangioma was made. The patient is alive and well, after five years of follow-up, with no complaints or recurrence.</p> <p>Conclusion</p> <p>To the best of our knowledge, this is the first case to be documented in a black African woman. Complete surgical excision seems to be the best modality of treatment of this lesion.</p

Exploring the binding interactions of structurally diverse dichalcogenoimidodiphosphinate ligands with α-amylase: Spectroscopic approach coupled with molecular docking

regulation of α-amylase activity is now becoming a promising management option for type 2 diabetes. The present study investigated the binding interactions of three structurally diverse dichalcogenoimidodiphosphinate ligands with α-amylase to ascertain the affinity of the ligands for α-amylase using spectroscopic and molecular docking methods. The ligands were characterized using 1H and 31P NMR spectroscopy and CHN analysis. Diselenoimidodiphosphinate ligand (DY300), dithioimidodiphosphinate ligand (DY301), and thioselenoimidodiphosphinate ligand (DY302) quenched the intrinsic fluorescence intensity of α-amylase via a static quenching mechanism with bimolecular quenching constant (Kq) values in the order of x1011 M-1s-1, indicating formation of enzyme-ligand complexes. A binding stoichiometry of n≈1 was observed for α-amylase, with high binding constants (Ka). α-Amylase inhibition was as follow: Acarbose > DY301>DY300>DY302. Values of thermodynamic parameters obtained at temperatures investigated (298, 304 and 310 K) revealed spontaneous complex formation (ΔG<0) between the ligands and α-amylase; the main driving forces were hydrophobic interactions (with DY300, DY301, except DY302). UV–visible spectroscopy and F¨orster resonance energy transfer (FRET) affirmed change in enzyme conformation and binding occurrence. Molecular docking revealed ligands interaction with α-amylase via some key catalytic site amino acid residues (Asp197, Glu233 and Asp300). DY301 perhaps showed highest α-amylase inhibition (IC50, 268.11 ± 0.74 μM) due to its moderately high affinity and composition of two sulphide bonds unlike the others. This study might provide theoretical basis for development of novel α-amylase inhibitors from dichalcogenoimidodiphosphinate ligands for management of postprandial hyperglycemia

a-Amylase inhibition, anti-glycation property and characterization of the binding interaction of citric acid with a-amylase using multiple spectroscopic, kinetics and molecular docking approaches

The quest to suppress complications associated with diabetes mellitus is ever increasing, while food additives and preservatives are currently being considered to play additional roles besides their uses in food enhancement and preservation. In the present study, the protective prowess of a common food preservative (citric acid, CA) against advanced glycation end-products (AGEs) formation and its binding interaction mechanism with a-amylase (AMY), an enzyme linked with hyperglycemia management, were examined. Enzyme inhibition kinetics, intrinsic fluorescence, synchronous and 3D fluorescence spectroscopies, ultraviolet–visible (UV–Vis) absorption spectroscopy, Fourier transform-infrared (FT-IR) spectroscopy, thermodynamics, and molecular docking analyses were employed. Results obtained showed that citric acid decreased a-amylase activity via mixed inhibition (IC50 = 5.01 ± 0.87 mM, Kic = 2.42 mM, Kiu = 160.34 mM) and suppressed AGEs formation (IC50 = 0.795 ± 0.001 mM). The intrinsic fluorescence of free a-amylase was quenched via static mechanism with high bimolecular quenching constant (Kq) and binding constant (Ka) values. Analysis of thermodynamic properties revealed that AMY-CA complex was spontaneously formed (DG DH), with involvement of electrostatic forces. UV–Vis, FT-IR and 3D fluorescence spectroscopies affirmed alterations in aamylase native conformation due to CA binding interaction. CA interacted with His-101, Asp-197, His- 299, and Glu-233 within AMY active site. Our findings indicated that CA could impair formation of AGEs and interact with a-amylase to slow down starch hydrolysis; vital properties in management of type 2 diabetes complications

Optimizing Blood Transfusion Service Delivery across the West Africa Sub-Region

The sub-continent of West Africa is made up of 16 countries: Benin, Burkina Faso, Cape Verde, Ghana, Guinea, Guinea-Bissau, Ivory Coast, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, The Gambia and Togo. As of 2018, the population of the sub-continent was estimated at about 381 million. The main challenge associated with blood transfusion service delivery across the sub-region concerns adequacy and safety. In this chapter, we highlighted the challenges associated with the delivery of a quality blood transfusion service in countries in the sub-region including: implementation of component therapy rather than whole blood transfusion, effective cold chain management of blood and blood products, alloimmunization prevention, implementation of column agglutination and automation rather than the convention manual tube method in blood transfusion testing, effective management of major haemorrhage, optimization of screening for transfusion transmissible infections, optimizing blood donation, implementation of universal leucodepletion of blood and blood products, effective management of transfusion-dependent patients, pre-operative planning and management of surgical patients, management of Rhesus D negative pregnancy and women with clinically significant alloantibodies, implementation of haemovigilance system, implementation of alternatives to allogenic blood, availability and use of specialized blood products, optimizing safe blood donation, enhancing blood transfusion safety, operating a quality management system-based blood transfusion service and implementation of non-invasive cell-free foetal DNA testing. There is the urgent need for the implementation of evidence-based best practices in blood transfusion service delivery across the sub-region to allow for excellent, safe, adequate and timely blood transfusion service delivery across the sub-region

Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic

Burden of disease scenarios for 204 countries and territories, 2022–2050: a forecasting analysis for the Global Burden of Disease Study 2021

Background: Future trends in disease burden and drivers of health are of great interest to policy makers and the public at large. This information can be used for policy and long-term health investment, planning, and prioritisation. We have expanded and improved upon previous forecasts produced as part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) and provide a reference forecast (the most likely future), and alternative scenarios assessing disease burden trajectories if selected sets of risk factors were eliminated from current levels by 2050. Methods: Using forecasts of major drivers of health such as the Socio-demographic Index (SDI; a composite measure of lag-distributed income per capita, mean years of education, and total fertility under 25 years of age) and the full set of risk factor exposures captured by GBD, we provide cause-specific forecasts of mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) by age and sex from 2022 to 2050 for 204 countries and territories, 21 GBD regions, seven super-regions, and the world. All analyses were done at the cause-specific level so that only risk factors deemed causal by the GBD comparative risk assessment influenced future trajectories of mortality for each disease. Cause-specific mortality was modelled using mixed-effects models with SDI and time as the main covariates, and the combined impact of causal risk factors as an offset in the model. At the all-cause mortality level, we captured unexplained variation by modelling residuals with an autoregressive integrated moving average model with drift attenuation. These all-cause forecasts constrained the cause-specific forecasts at successively deeper levels of the GBD cause hierarchy using cascading mortality models, thus ensuring a robust estimate of cause-specific mortality. For non-fatal measures (eg, low back pain), incidence and prevalence were forecasted from mixed-effects models with SDI as the main covariate, and YLDs were computed from the resulting prevalence forecasts and average disability weights from GBD. Alternative future scenarios were constructed by replacing appropriate reference trajectories for risk factors with hypothetical trajectories of gradual elimination of risk factor exposure from current levels to 2050. The scenarios were constructed from various sets of risk factors: environmental risks (Safer Environment scenario), risks associated with communicable, maternal, neonatal, and nutritional diseases (CMNNs; Improved Childhood Nutrition and Vaccination scenario), risks associated with major non-communicable diseases (NCDs; Improved Behavioural and Metabolic Risks scenario), and the combined effects of these three scenarios. Using the Shared Socioeconomic Pathways climate scenarios SSP2-4.5 as reference and SSP1-1.9 as an optimistic alternative in the Safer Environment scenario, we accounted for climate change impact on health by using the most recent Intergovernmental Panel on Climate Change temperature forecasts and published trajectories of ambient air pollution for the same two scenarios. Life expectancy and healthy life expectancy were computed using standard methods. The forecasting framework includes computing the age-sex-specific future population for each location and separately for each scenario. 95% uncertainty intervals (UIs) for each individual future estimate were derived from the 2·5th and 97·5th percentiles of distributions generated from propagating 500 draws through the multistage computational pipeline. Findings: In the reference scenario forecast, global and super-regional life expectancy increased from 2022 to 2050, but improvement was at a slower pace than in the three decades preceding the COVID-19 pandemic (beginning in 2020). Gains in future life expectancy were forecasted to be greatest in super-regions with comparatively low life expectancies (such as sub-Saharan Africa) compared with super-regions with higher life expectancies (such as the high-income super-region), leading to a trend towards convergence in life expectancy across locations between now and 2050. At the super-region level, forecasted healthy life expectancy patterns were similar to those of life expectancies. Forecasts for the reference scenario found that health will improve in the coming decades, with all-cause age-standardised DALY rates decreasing in every GBD super-region. The total DALY burden measured in counts, however, will increase in every super-region, largely a function of population ageing and growth. We also forecasted that both DALY counts and age-standardised DALY rates will continue to shift from CMNNs to NCDs, with the most pronounced shifts occurring in sub-Saharan Africa (60·1% [95% UI 56·8–63·1] of DALYs were from CMNNs in 2022 compared with 35·8% [31·0–45·0] in 2050) and south Asia (31·7% [29·2–34·1] to 15·5% [13·7–17·5]). This shift is reflected in the leading global causes of DALYs, with the top four causes in 2050 being ischaemic heart disease, stroke, diabetes, and chronic obstructive pulmonary disease, compared with 2022, with ischaemic heart disease, neonatal disorders, stroke, and lower respiratory infections at the top. The global proportion of DALYs due to YLDs likewise increased from 33·8% (27·4–40·3) to 41·1% (33·9–48·1) from 2022 to 2050, demonstrating an important shift in overall disease burden towards morbidity and away from premature death. The largest shift of this kind was forecasted for sub-Saharan Africa, from 20·1% (15·6–25·3) of DALYs due to YLDs in 2022 to 35·6% (26·5–43·0) in 2050. In the assessment of alternative future scenarios, the combined effects of the scenarios (Safer Environment, Improved Childhood Nutrition and Vaccination, and Improved Behavioural and Metabolic Risks scenarios) demonstrated an important decrease in the global burden of DALYs in 2050 of 15·4% (13·5–17·5) compared with the reference scenario, with decreases across super-regions ranging from 10·4% (9·7–11·3) in the high-income super-region to 23·9% (20·7–27·3) in north Africa and the Middle East. The Safer Environment scenario had its largest decrease in sub-Saharan Africa (5·2% [3·5–6·8]), the Improved Behavioural and Metabolic Risks scenario in north Africa and the Middle East (23·2% [20·2–26·5]), and the Improved Nutrition and Vaccination scenario in sub-Saharan Africa (2·0% [–0·6 to 3·6]). Interpretation: Globally, life expectancy and age-standardised disease burden were forecasted to improve between 2022 and 2050, with the majority of the burden continuing to shift from CMNNs to NCDs. That said, continued progress on reducing the CMNN disease burden will be dependent on maintaining investment in and policy emphasis on CMNN disease prevention and treatment. Mostly due to growth and ageing of populations, the number of deaths and DALYs due to all causes combined will generally increase. By constructing alternative future scenarios wherein certain risk exposures are eliminated by 2050, we have shown that opportunities exist to substantially improve health outcomes in the future through concerted efforts to prevent exposure to well established risk factors and to expand access to key health interventions