Psychological complications of childhood chronic physical illness in Nigerian children and their mothers: the implication for developing pediatric liaison services

<p>Abstract</p> <p>Background</p> <p>Pediatric liaison services attending to the psychological health needs of children with chronic physical illness are limited or virtually non-existent in Nigeria and most sub-Saharan African countries, and psychological problems complicate chronic physical illness in these children and their mothers. There exist needs to bring into focus the public health importance of developing liaison services to meet the psychological health needs of children who suffer from chronic physical illness in this environment. Sickle cell disease (SCD) and juvenile diabetes mellitus (JDM) are among the most common chronic physical health conditions in Nigerian children. This study compared the prevalence and pattern of emotional disorders and suicidal behavior among Nigerian children with SCD, JDM and a group of healthy children. Psychological distress in the mothers of these children that suffer chronic physical illness was also compared with psychological distress in mothers of healthy control children.</p> <p>Methods</p> <p>Forty-five children aged 9 to 17 years were selected for each group of SCD, JDM and controls. The SCD and JDM groups were selected by consecutive clinic attendance and the healthy children who met the inclusion criteria were selected from neighboring schools. The Youth version of the Computerized Diagnostic Interview Schedule for Children, version IV (C- DISC- IV) was used to assess for diagnosis of emotional disorders in these children. Twelve-item General Health Questionnaire (GHQ – 12) was used to assess for psychological distress in mothers of these children and healthy control children.</p> <p>Results</p> <p>Children with JDM were significantly more likely to experience DSM – IV emotional disorders than children with SCD and the healthy group (p = 0.005), while children with JDM and SCD were more likely to have 'intermediate diagnoses' of emotional disorders (p = 0.0024). Children with SCD and JDM had higher rates of suicidal ideation when compared to healthy control children and a higher prevalence of maternal psychological distress was found in their mothers when compared to the mothers of healthy children (p = 0.035).</p> <p>Conclusion</p> <p>The higher prevalence of emotional disorders and suicidal ideation among children with SCD and JDM points to a need for development of liaison services in pediatric facilities caring for children with chronic physical illness to ensure holistic approach to their care. The proposed liaison services would also be able to provide family support interventions that would address the psychological distress experienced by the mothers of these children.</p

Clinical effects of Garcinia kola in knee osteoarthritis

<p>Abstract</p> <p>Objectives</p> <p>Over the past years, there has been a growing number of knee osteoarthritis (KOA) patients who are not willing to comply with long-term non-steroidal anti-inflammatory drugs (NSAID) treatment and wish to use herbal anti- rheumatic medicine. This study assessed the clinical effects of <it>Garcinia kola </it>(GK) in KOA patients.</p> <p>Patients and methods</p> <p>Prospective randomized, placebo controlled, double blind, clinical trial approved by the institutional medical ethics review board and written informed consent obtained from each patient. All KOA patients presenting at the Obafemi Awolowo University Teaching Hospital complex were recruited into the study. The patients were grouped into four (A = Placebo, B = Naproxen, C = <it>Garcinia kola</it>, D = Celebrex). The drugs and placebo were given twice a day per oral route. Each dose consisted of 200 mg of <it>G. kola</it>, Naproxen (500 mg), Celebrex (200 mg) and Ascorbic acid (100 mg). The primary outcome measure over six weeks study period was the change in mean WOMAC pain visual analogue scales (VAS). Secondary outcome measures included the mean change in joint stiffness and physical function (mobility/walking).</p> <p>Results</p> <p>143 patients were recruited, 84 (58.7%, males – 24, females – 60) satisfied the selection criteria and completed the study. The effect of knee osteoarthritis bilateralism among the subjects was not significant on their outcome (p > 0.05). The change in the mean WOMAC pain VAS after six weeks of <it>G. kola </it>was significantly reduced compared to the placebo (p < 0.001). Multiple comparisons of the mean VAS pain change of <it>G. kola </it>group was not lowered significantly against the naproxen and celebrex groups (p > 0.05). The onset of <it>G. kola </it>symptomatic pain relief was faster than the placebo (p < 0.001). However, it was slower than the active comparators (p > 0.05). The duration of therapeutic effect of <it>Garcinia kola </it>was longer than the placebo (p > 0.001). <it>G. kola </it>period of effect was less than naproxen and celebrex (p < 0.001). <it>G. kola </it>subjects had improved mean change mobility/walking after six weeks better than the control group(p < 0.001). The mean change in mobility of the <it>G. kola </it>group when compared to the active comparators was not significantly better (p < 0.05). The mean change of knee joint stiffness (p < 0.001) and the change of mean WOMAC score (p < 0.001) were improved on <it>Garcinia kola </it>as compared to the placebo. The mid term outcome of eleven <it>Garcinia kola </it>subjects after cessation of use had a mean pain relief period of 17.27 +/- 5.15 days (range: 9–26 days). There was no significant cardiovascular, renal or drug induced adverse reaction to <it>Garcinia kola</it>.</p> <p>Conclusion</p> <p><it>Garcinia kola </it>appeared to have clinically significant analgesic/anti-inflammatory effects in knee osteoarthritis patients. <it>Garcinia kola </it>is a potential osteoarthritis disease activity modifier with good mid term outcome. Further studies are required for standardization of dosages and to determine long-term effects.</p

Global, regional, and national burden of traumatic brain injury and spinal cord injury, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016.

Traumatic brain injury (TBI) and spinal cord injury (SCI) are increasingly recognised as global health priorities in view of the preventability of most injuries and the complex and expensive medical care they necessitate. We aimed to measure the incidence, prevalence, and years of life lived with disability (YLDs) for TBI and SCI from all causes of injury in every country, to describe how these measures have changed between 1990 and 2016, and to estimate the proportion of TBI and SCI cases caused by different types of injury. METHODS: We used results from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) Study 2016 to measure the global, regional, and national burden of TBI and SCI by age and sex. We measured the incidence and prevalence of all causes of injury requiring medical care in inpatient and outpatient records, literature studies, and survey data. By use of clinical record data, we estimated the proportion of each cause of injury that required medical care that would result in TBI or SCI being considered as the nature of injury. We used literature studies to establish standardised mortality ratios and applied differential equations to convert incidence to prevalence of long-term disability. Finally, we applied GBD disability weights to calculate YLDs. We used a Bayesian meta-regression tool for epidemiological modelling, used cause-specific mortality rates for non-fatal estimation, and adjusted our results for disability experienced with comorbid conditions. We also analysed results on the basis of the Socio-demographic Index, a compound measure of income per capita, education, and fertility. FINDINGS: In 2016, there were 27·08 million (95% uncertainty interval [UI] 24·30-30·30 million) new cases of TBI and 0·93 million (0·78-1·16 million) new cases of SCI, with age-standardised incidence rates of 369 (331-412) per 100 000 population for TBI and 13 (11-16) per 100 000 for SCI. In 2016, the number of prevalent cases of TBI was 55·50 million (53·40-57·62 million) and of SCI was 27·04 million (24·98-30·15 million). From 1990 to 2016, the age-standardised prevalence of TBI increased by 8·4% (95% UI 7·7 to 9·2), whereas that of SCI did not change significantly (-0·2% [-2·1 to 2·7]). Age-standardised incidence rates increased by 3·6% (1·8 to 5·5) for TBI, but did not change significantly for SCI (-3·6% [-7·4 to 4·0]). TBI caused 8·1 million (95% UI 6·0-10·4 million) YLDs and SCI caused 9·5 million (6·7-12·4 million) YLDs in 2016, corresponding to age-standardised rates of 111 (82-141) per 100 000 for TBI and 130 (90-170) per 100 000 for SCI. Falls and road injuries were the leading causes of new cases of TBI and SCI in most regions. INTERPRETATION: TBI and SCI constitute a considerable portion of the global injury burden and are caused primarily by falls and road injuries. The increase in incidence of TBI over time might continue in view of increases in population density, population ageing, and increasing use of motor vehicles, motorcycles, and bicycles. The number of individuals living with SCI is expected to increase in view of population growth, which is concerning because of the specialised care that people with SCI can require. Our study was limited by data sparsity in some regions, and it will be important to invest greater resources in collection of data for TBI and SCI to improve the accuracy of future assessments

Underweight, overweight and obesity in adults Nigerian living in rural and urban communities of Benue State

Objective: To assess the prevalence of underweight, overweight and obesity among Nigerians aged 18-45 years, living in urban and rural settlements in one state in Nigeria. Materials and Methods: Four hundred and thirty-five subjects between 18 and 45 years of age were recruited for height, weight and waist circumference (WC) measurements. Body mass index (BMI) was calculated (weight/height 2, kg/m 2 ); WHO criteria determined BMI and WC categories. Results: Based on BMI, about 2% of the study population was underweight, 22% was overweight and 4% was obese. There were more normal weight persons in rural than in urban settlement. About 40 and 30% of females in urban and rural settlement, respectively, were either overweight or obese. Based on WC of the sample population, 10.34% had increased risk for metabolic syndrome [action level I (defi ned as WC &ge;94 cm in men and &ge;80 cm in women)] and 2.8% had substantially increased risk [action level II (defi ned as WC &ge;102 cm in men and &ge;88 cm in women)]. At action level II, there was no obese male. Conclusion: This study revealed that underweight, overweight and obesity exist in young adults, but overweight and obesity are more prevalent. Therefore, concerted efforts should be made to control this in young adults for their present well-being and to possibly avoid the risk of disease later in life.DOI: 10.4103/1596-3519.8208

Correlation studies of heavy metals concentration with sediment properties of some rivers surrounding the Lagos lagoon

Lagos lagoon is a highly polluted water body, which receives enormous amount of domestic and industrial wastes from rivers and streams. In this study, two main Lagos urban rivers Odo-Iyaalaro and Shasha rivers that receive industrial effluents and empty into the Lagos Lagoon were examined. The sediments at the bottom of waters play a role in the study of pollution in the rivers. Upstream of Odo-Iyaalaro River (Point 1) receives the largest volume of effluents and showed the highest level of heavy metals in sediments with concentrations of 108.3mg/l for Pb, 805mg/l for Zn, 94.5mg/l for Cu, 31mg/l for Cr and 42.1 mg/l for Cd. Down the river, the levels decreased to 25mg/l for Pb, 64.5 mg/l for Zn, 22mg/l for Cu, 15.9 mg/l for Cr and 1.9 mg/l for Cd. A good correlation was found to exist between the level of Zn in water and sediment, and also between the CEC and %silt-clay of sediments. Shasha River receives relatively fewer amounts of industrial effluents, but is relatively the main receptacle for municipal and land-based waste. The levels of heavy metals in Shasha River were lower compared with that of Odo-Iyaalaro River, with the upstream points showing concentrations of 20.5mg/l for Pb, 25.3mg/l for Zn, 7.9mg/l for Cu, 30.8 mg/l for Cr and 1.5mg/l for Cd. A good correlation exists between the CEC and all the metals determined, and between the %organic carbon and all the metals determined. Compared with literature data, the results of heavy metals gave an indication of pollution. KEYWORDS: correlation, heavy metals, sediments, caution exchange capacity, rivers, lagoon Nigerian Journal of Health and Biomedical Sciences Vol. 5(1) 2006: 118-12

Determination of Land Surface Temperature (LST) and Potential Urban Heat Island Effect in Parts of Lagos State using Satellite Imageries

Temperature is an important component of the climate. The temperature of a developing city or state is constantly changing. The trend in temperature change in Nigeria is not consistent. Changes in temperature appear to be closely related to concentrations of atmospheric carbon dioxide. The degree of concentration depends on human interventions and the amount of sunlight reaching the earth's surface. Lagos State particularly in recent time has experienced decrease in vegetation and water pervious surfaces, which reduces surface temperature through evapotranspiration. This is as a result of rapid urbanization arising from inundating rural-urban migration. One of the implications is that anthropogenic heat is released to the environment due to energy consumption and increased impervious surface coverage thereby increasing the surface and atmospheric temperatures. LandSat Satellite imageries have been used to estimate Land Surface Temperature (LST) and urban thermal conditions. The mean LST result shows that, there is a significant increase in the temperature values from 1984 to 2002 (28.40oC-28.86oC). However, in 2006 the temperature decreases significantly to 28.37oC below 2002 temperatures in all LGAs. This variation could be attributed to the economic crisis/power outage in Nigeria which left manufacturing companies out of production/manufacturing between 2002 and 2006. Findings from this study reveals that there is a relationship between the surface temperature and the various Land Cover types. It shows a broad classification of the Land Cover types into Water bodies, Vegetation and Built-up areas respectively. With the spatial resolution and temporal coverage of two Landsat data of the environment, the derivation of the temperature information was achieved