Patients' views on improving sickle cell disease management in primary care: focus group discussion.

OBJECTIVES: To assess sickle cell disease (SCD) patient and carer perspectives on the primary care services related to SCD that they receive from their general practitioner (GP). DESIGN: A focus group discussion was used to elicit the views of patients about the quality of care they receive from their primary health-care providers and what they thought was the role of primary care in SCD management. The focus group discussion was video recorded. The recording was then examined by the project team and recurring themes were identified. A comparison was made with notes made by two scribes also present at the discussion. SETTING: Sickle Cell Society in Brent, UK. PARTICIPANTS: Ten participants with SCD or caring for someone with SCD from Northwest London, UK. MAIN OUTCOME MEASURES: Patients perceptions about the primary care services they received, and a list of key themes and suggestions. RESULTS: Patients and carers often bypassed GPs for acute problems but felt that GPs had an important role to play around repeat prescriptions and general health care. These service users believed SCD is often ignored and deemed unimportant by GPs. CONCLUSION: Participants wanted the health service to support primary health-care providers to improve their knowledge and understanding of SCD. Key themes and suggestions from this focus group have been used to help develop an educational intervention for general practice services that will be used to improve SCD management in primary care

Cervical Cancer Screening by Female Workers in South East Nigeria

Cervical cancer is one of the commonest female cancers especially in developing countries. Efforts towards its prevention worldwide have focused on screening women at risk of disease using Pap smears and treating pre-cancerous lesions. A good knowledge and understanding of the level of practice of cervical cancer screening among female workers in south east Nigeria will help in creating population-specific healthcare programs and interventions aimed at improving women’s health. OBJECTIVES: To determine the perception and practice of cervical cancer screening among female workers in south east Nigeria as well as ascertain the influence of age, educational status and marital status on the practice of cervical cancer screening among this group. METHOD: A cross-sectional descriptive study carried out among female workers in Nnewi who were selected using multi-stage approach between December 2007 and January 2008. Tests of statistical significance were done using chi square test at 95% confidence interval. RESULTS A total of 172 females responded. The mean age was 29.7 ± 8.8 years and the ages ranged from 15 to 65 years. One hundred and twenty-three respondents (71.5%) knew about cervical cancer screening. Only 12 (9.8%) of the respondents who were aware of Pap smear had done the test, of which 9 (75.0%) had disease detected. There was no statistically significant association between educational level, age andmarital status respectively and the practice of cervical cancer screening. CONCLUSION: There is avery lowlevel of practice of cervical cancer screening in this group. Educational level, age and marital status were found not to affect the practice of cervical cancer screening. Key Words: Cervical cancer, workers, practice, Nigeri

Stabilisation of metastable polymorphs: the case of paracetamol form III

YesThe design of a melt synthesis of the first air-stable formulation of the metastable form III of paracetamol is derived from thermo-spectroscopic and thermo-diffraction experiments. Melt crystallisation in the presence of β-1,4-saccharides produces form III selectively and the excipients appear to act as stabilising ‘active’ templates of the metastable polymorph.This article is part of themed collection: Pharmaceutical Solids

Altered T Cell Memory and Effector Cell Development in Chronic Lymphatic Filarial Infection That Is Independent of Persistent Parasite Antigen

Chronic lymphatic filarial (LF) infection is associated with suppression of parasite-specific T cell responses that persist even following elimination of infection. While several mechanisms have been implicated in mediating this T cell specific downregulation, a role for alterations in the homeostasis of T effector and memory cell populations has not been explored. Using multiparameter flow cytometry, we investigated the role of persistent filarial infection on the maintenance of T cell memory in patients from the filarial-endemic Cook Islands. Compared to filarial-uninfected endemic normals (EN), microfilaria (mf) positive infected patients (Inf) had a reduced CD4 central memory (TCM) compartment. In addition, Inf patients tended to have more effector memory cells (TEM) and fewer effector cells (TEFF) than did ENs giving significantly smaller TEFF ∶ TEM ratios. These contracted TCM and TEFF populations were still evident in patients previously mf+ who had cleared their infection (CLInf). Moreover, the density of IL-7Rα, necessary for T memory cell maintenance (but decreased in T effector cells), was significantly higher on memory cells of Inf and CLInf patients, although there was no evidence for decreased IL-7 or increased soluble IL7-Rα, both possible mechanisms for signaling defects in memory cells. However, effector cells that were present in Inf and CLInf patients had lower percentages of HLA-DR suggesting impaired function. These changes in T cell populations appear to reflect chronicity of infection, as filarial-infected children, despite the presence of active infection, did not show alterations in the frequencies of these T cell phenotypes. These data indicate that filarial-infected patients have contracted TCM compartments and a defect in effector cell development, defects that persist even following clearance of infection. The fact that these global changes in memory and effector cell compartments do not yet occur in infected children makes early treatment of LF even more crucial

Maternal and child health interventions in Nigeria: a systematic review of published studies from 1990 to 2014

BACKGROUND: Poor maternal and child health indicators have been reported in Nigeria since the 1990s. Many interventions have been instituted to reverse the trend and ensure that Nigeria is on track to achieve the Millennium Development Goals. This systematic review aims at describing and indirectly measuring the effect of the Maternal, Newborn, and Child Health (MNCH) interventions implemented in Nigeria from 1990 to 2014. METHODS: PubMed and ISI Web of Knowledge were searched from 1990 to April 2014 whereas POPLINE® was searched until 16 February 2015 to identify reports of interventions targeting Maternal, Newborn, and Child Health in Nigeria. Narrative and graphical synthesis was done by integrating the results of extracted studies with trends of maternal mortality ratio (MMR) and under five mortality (U5MR) derived from a joint point regression analysis using Nigeria Demographic and Health Survey data (1990-2013). This was supplemented by document analysis of policies, guidelines and strategies of the Federal Ministry of Health developed for Nigeria during the same period. RESULTS: We identified 66 eligible studies from 2,662 studies. Three interventions were deployed nationwide and the remainder at the regional level. Multiple study designs were employed in the enrolled studies: pre- and post-intervention or quasi-experimental (n = 40; 61%); clinical trials (n = 6;9%); cohort study or longitudinal evaluation (n = 3;5%); process/output/outcome evaluation (n = 17;26%). The national MMR shows a consistent reduction (Annual Percentage Change (APC) = -3.10%, 95% CI: -5.20 to -1.00 %) with marked decrease in the slope observed in the period with a cluster of published studies (2004-2014). Fifteen intervention studies specifically targeting under-five children were published during the 24 years of observation. A statistically insignificant downward trend in the U5MR was observed (APC = -1.25%, 95% CI: -4.70 to 2.40%) coinciding with publication of most of the studies and development of MNCH policies. CONCLUSIONS: The development of MNCH policies, implementation and publication of interventions corresponds with the downward trend of maternal and child mortality in Nigeria. This systematic review has also shown that more MNCH intervention research and publications of findings is required to generate local and relevant evidence

Perception and Practice of Periodic Medical Checkup by Traders in South East Nigeria

BACKGROUND Periodic medical checkup helps improve life expectancy. Traders are a major economically active population in south eastern Nigeria and are expected to benefit from periodic medical checkup. A good knowledge and understanding of the prevailing health knowledge, attitude and preventive health behaviour of these traders is essential for creating population-specific health programs. OBJECTIVES To determine the knowledge, attitude and practice of periodic medical checkup by traders in South east Nigeria, as well as the influence of age, gender and educational status on its practice in this group. METHODS: A questionnaire- based descriptive study carried out among traders in Nnewi, South east Nigeria, who were selected randomly between September and October 2010. A total of 323 traders responded, 252 males (78.0%) and 71(22.0%)females. Themeanagewas 31.9± 10 years and the ages ranged from15 to 65 years withmajority(49.2%) between 20-29 years. Majority (61.0%) had secondary school education and 1.2% had post secondary school education. About 74.9% were aware of periodic medical checkup; all females and 67.9% of males. Major source of information was through friends (61.2%), then mass media(18.2%). The commonest known type of medical checkup was general examination (60.7%), then blood pressure measurement (55.4%). About 63.8% feel everybody needs medical checkup. Most (85.5%) feel medical checkups can improve their work efficiency. Only 29.4% of males and 39.4% of females practice periodic medical checkup. Age, gender and educational status were found not to affect practice of periodic medical checkup significantly. CONCLUSION: This study revealed a high level of awareness of periodic medical checkup, but a very low level of practice among this group. Effort should be made by health agencies to educate traders on the various types of medical check up, their indications and benefits as well as its practice encouraged. Keywords: Periodic medical checkup, traders,Nigeria