Surgically correctable adrenal-dependent hypertension: a report of five cases

Although endocrine causes of secondary hypertension are relatively uncommon, medical practitioners must maintain a high index of suspicion for them in certain categories of patients. Such patientsinclude young individuals, those with difficult- to-treat hypertension and those presenting with symptoms, clinical signs and/or laboratoryparameters well-known to be associated with Cushing’s syndrome, Conn’s syndrome or phaeochromocytoma. This paper reports on 5 patients identified over a 2-year period with various hormonally-activeadrenal adenomas causing hypertension in an environment where, hitherto, the occurrence of these conditions was generally thought to be rare. Aspects of the patients’ histories, examination and laboratory findings that drew attention to the possibility of the diagnosis in each case are highlighted, as are the confirmatory investigationsand management methods used by a multidisciplinary team of medical practitioners. The clinical outcome with appropriate treatment of adrenalrelated hypertension is good and can result in significantcost savings in the long term

The Metabolic Syndrome Among Patients With Cardiovascular Disease in Accra, Ghana

Background: There is evidence linking the Metabolic Syndrome with an increased risk of developing cardio-vascular disease, previously thought to be rare in Af-rica but now a major public health concern.Objectives: To determine the frequency of occurrence of the Metabolic Syndrome among patients presenting with cardiovascular disease at the Korle Bu Teaching Hospital, Ghana.Methods: This was a case-control study of 100 con-secutive cardiovascular disease patients and 100 age- and sex- matched controls who underwent an interview and physical examination. Anthropometric measure-ments and fasting blood samples for plasma glucose and lipids were taken. The National Cholesterol Educa-tion Programme: Adult Treatment Panel III criteria were used for the diagnosis of the Metabolic Syn-drome.Results: The prevalence of Metabolic Syndrome among cases and controls was 54% and 18% respec-tively, with the prevalence increasing with advancing age. Hypertension and central obesity were the two components with the highest frequency among indi-viduals with Metabolic Syndrome. The Metabolic Syn-drome was associated with the development of cardio-vascular disease (OR = 5.35, 95% CI: 2.81 – 10.18, p= 0.0001), with the odds ratio increasing with the number of components present.Conclusion: The Metabolic Syndrome is prevalent among cardiovascular disease patients attending the Korle Bu Teaching Hospital, with a significant associa-tion between the number of components of the Meta-bolic Syndrome present and the probability of develop-ing a cardiovascular disease. A policy to institute rou-tine screening in clinical practice and provision of ap-propriate interventions for Metabolic Syndrome com-ponents among Ghanaian adults is needed

Do leadership styles influence productivity?

Background: Leadership and productivity in nursing and midwifery have become topical issues for discussion. This is possibly due to nurses constituting the largest group of the healthcare workforce. Nurses and midwives have been held accountable for low productivity and inappropriate leadership in the past. However, there has been limited consensus in the nursing literature about the impact of nurse managers' leadership styles on nurses' and midwives' productivity levels. Method: Two hundred and seventy five nurses and midwives (response rate of 99.2%) were asked to take part in a cross-sectional survey from five hospitals in the eastern region of Ghana, to examine the impact of nurse managers' leadership styles on self-reported productivity levels. Descriptive summaries, Pearson's correlations and linear regressions are presented. Results: Findings show for every hour of lost productive time, four hours of unpaid overtime in the course of the month was accrued due to staff shortages. Nurse managers' most frequently exercised a supportive leadership style, and a directive leadership style the least. Within the last one month of work experience prior to the study, nurses' self-perception of productivity levels were high (8.39 on a 10-point scale), 10% more productive than their peers in the same unit. Nurses believed their own productivity improved by about 1.8% over the preceding six months. Leadership styles explained only 6.9% (95% CI: 4.6-9.3%) of the variance in nurses' perceived level of productivity. Achievement-oriented leadership style most significantly improved productivity by 18.4% (95% CI: 13.0-24.0%). Implications for management and policy: There is a need to strengthen supervision and establish performance benchmarks within nursing and midwifery to measure staff performance, addressing health worker productivity more seriously through research and policy. Health institutions should invest in leadership development programmes for nurses and midwives to maximise productivity

Ghana’s burden of chronic non-communicable diseases: Future directions in research, practice and policy

The prevalence of major chronic non-communicable diseases and their risk factors has increased over timeand contributes significantly to the Ghana’s disease burden. Conditions like hypertension, stroke anddiabetes affect young and old, urban and rural, and wealthy and poor communities. The high cost of caredrives the poor further into poverty. Lay awareness and knowledge are limited, health systems (biomedical,ethnomedical and complementary) are weak, and there are no chronic disease policies. These factorscontribute to increasing risk, morbidity and mortality. As a result chronic diseases constitute a public healthand a developmental problem that should be of urgent concern not only for the Ministry of Health, but alsofor the Government of Ghana. New directions in research, practice and policy are urgently needed. Theyshould be supported by active partnerships between researchers, policymakers, industry, patient groups,civil society, government and development partners.Keywords: chronic non-communicable diseases, health systems, policy, research, Ghan

Ghana's burden of chronic non-communicable diseases:future directions in research, practice and policy

The prevalence of major chronic non-communicable diseases and their risk factors has increased over time and contributes significantly to the Ghana's disease burden. Conditions like hypertension, stroke and diabetes affect young and old, urban and rural, and wealthy and poor communities. The high cost of care drives the poor further into poverty. Lay awareness and knowledge are limited, health systems (biomedical, ethnomedical and complementary) are weak, and there are no chronic disease policies. These factors contribute to increasing risk, morbidity and mortality. As a result chronic diseases constitute a public health and a developmental problem that should be of urgent concern not only for the Ministry of Health, but also for the Government of Ghana. New directions in research, practice and policy are urgently needed. They should be supported by active partnerships between researchers, policymakers, industry, patient groups, civil society, government and development partners

Factors affecting the delivery, access, and use of interventions to prevent malaria in pregnancy in sub-Saharan Africa: a systematic review and meta-analysis.

BACKGROUND: Malaria in pregnancy has important consequences for mother and baby. Coverage with the World Health Organization-recommended prevention strategy for pregnant women in sub-Saharan Africa of intermittent preventive treatment in pregnancy (IPTp) and insecticide-treated nets (ITNs) is low. We conducted a systematic review to explore factors affecting delivery, access, and use of IPTp and ITNs among healthcare providers and women. METHODS AND RESULTS: We searched the Malaria in Pregnancy Library and Global Health Database from 1 January 1990 to 23 April 2013, without language restriction. Data extraction was performed by two investigators independently, and data was appraised for quality and content. Data on barriers and facilitators, and the effect of interventions, were explored using content analysis and narrative synthesis. We conducted a meta-analysis of determinants of IPTp and ITN uptake using random effects models, and performed subgroup analysis to evaluate consistency across interventions and study populations, countries, and enrolment sites. We did not perform a meta-ethnography of qualitative data. Ninety-eight articles were included, of which 20 were intervention studies. Key barriers to the provision of IPTp and ITNs were unclear policy and guidance on IPTp; general healthcare system issues, such as stockouts and user fees; health facility issues stemming from poor organisation, leading to poor quality of care; poor healthcare provider performance, including confusion over the timing of each IPTp dose; and women's poor antenatal attendance, affecting IPTp uptake. Key determinants of IPTp coverage were education, knowledge about malaria/IPTp, socio-economic status, parity, and number and timing of antenatal clinic visits. Key determinants of ITN coverage were employment status, education, knowledge about malaria/ITNs, age, and marital status. Predictors showed regional variations. CONCLUSIONS: Delivery of ITNs through antenatal clinics presents fewer problems than delivery of IPTp. Many obstacles to IPTp delivery are relatively simple barriers that could be resolved in the short term. Other barriers are more entrenched within the overall healthcare system or socio-economic/cultural contexts, and will require medium- to long-term strategies. Please see later in the article for the Editors' Summary