Placing care:The Impact of the Physical Environment on Experiences of Providing and Utilizing Palliative Care

Background: Environmental design in palliative and end-of-life care is known to improve care outcomes, service-user satisfaction, and the continuation of service uptake. No study in the literature has investigated the influence of the environment on palliative and end-of-life care in Nigeria or other African contexts.Purpose: This study was designed to explore the impact of the physical environment (i.e., place and people) on staff and service users and how these influence the experiences of providing and using palliative and end-of-life care in a Nigerian hospital context.Methods: Ethnographic methodology was employed because this approach facilitates understanding of environmental realities. This study is part of a larger ethnographic research project developed to uncover aspects of organizational complexities related to the provision and use of palliative and end-of-life care in the Nigerian context. Three hundred fifty hours of participant observation was achieved, and semistructured interviews were used to gather data from 26 participants, including 10 patients, 11 members of a palliative care team, and five hospital managers. Informal chats and photographic capture were additional methods used in data collection. Thematic analysis was conducted to identify and analyze patterns within the collected data.Results: Physical space, equipment, and placing staff were the three primary themes identified. The physical environment was untidy, and the ward layout prevented privacy, dignity, or comfort for patients and families. The equipment was old and inadequate, and the context of care was worsened by insufficient staffing and neglect of the environmental needs of the staff.Conclusions: Hospital design for palliative and end-of-life care in Nigeria is “autoinhibitory” (a negative feedback mechanism whereby hospital design detracts rather than promote quality of care), and a physical environment that supports the provision and utilization of care must be implemented to promote palliative and end-of-life care success. Urgent policy action is needed to improve environmental and staffing conditions to advance palliative and end-of-life care in Nigeria

An Ethnographic Study of Palliative and End-of-Life Care in a Nigerian Hospital:Impact of Education on Care Provision and Utilization

Most clinicians receive little or no palliative care (PC) education. Similarly, patients and their families receive little or no information on PC. Our study explored education in PC, while examining for its impacts on service delivery and utilization from the perspective of health care professionals (HCPs), patients, and their families. An ethnographic approach was utilized to gather data from 41 participants. Spradley’s ethnographic analytical framework guided data analysis. Two themes identified were inadequate HCPs’ knowledge base and impact of service-users’ inadequate health education. The findings show that most HCPs had no formal education in PC, attributed to the lack of PC residency programs and the absence of educational institutions that provide such education. Patients and families also conveyed poor understandings of their illness and palliation, rooted in the HCP culture of partial disclosure of information about their diagnosis, care, and prognosis. Findings suggest a cultural shift that supports PC education for professionals is required to promote realist medical approach in the care for patients with life-limiting illnesses. </jats:p

Effects of Ethanolic Root Bark Extract of Chrysophyllum albidum on Serum Superoxide Dismutase, Catalase and Malondialdehyde in Rat

Abstract: Purpose: The ethanolic root bark of Chrysophyllum albidum were evaluated for their effect on antioxidant enzymes such as superoxide dismutase (SOD), catalase (CAT) and lipid peroxidation (malondialdehyde) activities in rats. Methods: Eighteen male Wister rats weighing 100-200g were divided into three groups of six animals each. Two treated groups received a daily dose of ethanolic root bark of Chrysophyllum albidum at 100mg/kg and 200mg/kg body weight respectively via gastric gavage, while equal volume of normal saline was administered to the control group for 3 weeks. Result: All the in vitro models showed dose dependent activity. However the weight gain was dose related with a decrease activity of SOD and CAT (p&lt;0.05) in 100mg/kg treated rats, indicating an altered oxidative statues in the animals but as the dose increase, SOD and CAT activity increase. MDA concentration was reduced (p&lt;0.05) in the treated rats. Conclusion: The result suggests that the root bark extract of C. albidum has evidence of scavenging and antiperodative properties

Effect of the Golden Liquid from Honeybees and Refined Granulated Sugar on the Blood Glucose and Serum Iron Levels of Albino Rats.

Honey is a naturally sweet substance produced by honeybees from water, pollen, and nectar. Due to its unique nutritional and therapeutic benefits, which are ascribed to the interaction of the various chemical groups it contains, natural honey is one of the most popular consumed products. Modern-day individuals consume a lot of refined granulated sugar, either directly through foods or indirectly from other sources. The consumption of large amounts of refined granulated sugar alters hematological and physiological changes in the body. According to several scientific studies, honey can be a healthier alternative to refined granulated sugar because it does not threaten human health. Consuming natural honey raises serum iron levels and red blood cell counts since it is known that the iron in honey serves as a precursor to hemoglobin. Overconsumption of refined granulated sugar has been identified as a risk factor for metabolic disorders such as obesity, cardiovascular disease, type 2 diabetes, and non-alcoholic fatty liver disease. This study, therefore, investigated the effect of the golden liquid from honeybees (natural honey) and refined granulated sugar on the blood glucose and serum iron levels of 25 Wistar albino rats. The experimental animals used in this study were grouped into five treatments based on the dose of natural honey and refined granulated sugar administered namely: T1 (1.02 g of honey /kg BW), T2 (1.40g of honey /kg BW), T3 (1.02 g of refined granulated sugar /kg BW), T4 (1.40g of refined granulated sugar /kg BW), rats in T5 were not administered honey, and refined granulated sugar served as the control. The blood glucose concentration of the albino rats was measured using the glucose strips with a glucometer while the serum iron analysis was conducted using Atomic Absorption Spectrophotometer. The result revealed that the mean blood glucose level of the rats was highest in T3 (112.95mg/dl), followed by T5 (92.20mg/dl) while the least value was recorded in T2 (74.86mg/dl). There was a significant difference in the blood glucose levels of albino rats orally administered natural honey and refined granulated sugar at varying levels (P0.05) among treatments. It was found that the highest serum iron level was recorded in T5 (1.31±0.395 ppm) followed by T2 (1.22± 0.115 ppm), while the least serum iron level was recorded in T1 (0.88±1.319ppm). It was observed that there were no significant differences in the serum iron levels of the albino rats (p\u3e0.05) among treatments The use of natural honey is recommended since albino rats orally administered honey at varying doses had lower blood glucose levels than those given refined granulated sugar. This work will be a useful tool for understanding the role of honey over granulated sugars, especially among prediabetic and diabetic patients in order to control their sugar levels using diet as a source. This implies that the consumption of natural honey did not significantly increase blood glucose levels. It was therefore recommended that physicians and dietitians should advocate for natural honey use over refined granulated sugar which could be safe for consumption by diabetic patients

Genotype by environment interaction on resistance to cassava green mite associated traits and effects on yield performance of cassava genotypes in Nigeria

Open Access Journal; Published online: 04 Sept 2020Cassava is the main source of carbohydrate for over 70% of the people in Nigeria, the world’s largest producer and consumer of the crop. The yields of cassava are, however, relatively low in Nigeria largely due to pests and disease infections that significantly lead to inconsistencies in productivity of cassava genotypes in various environments. Fifty-eight F1 hybrid cassava genotypes plus their two parents which served as check varieties were evaluated in three locations for two years (that is six environments). The objectives of the study were to evaluate genotype by environment interactions (GEI) on resistance to cassava green mite [CGM, Mononychellus tanajoa (Bondar)] associated traits and effects on yield performance of cassava genotypes in Nigeria and to identify superior genotypes that exhibit high stability which combine CGM resistance and high fresh root yield with general and specific environmental adaptation using additive main effects and multiplicative interaction (AMMI) and genotype stability index (GSI). The combined analysis of variance based on AMMI revealed significant genotype, environment, and genotype by environment interactions (GEI) for all traits. The percentage variation due to environment was higher than the percentage variation due to genotype for cassava green mite severity (CGMS), leaf retention (LR), root dry matter content (RDMC), and fresh root yield (FRY) indicating that environment greatly influenced the expression of these traits. The percentage variation due to GEI accounted for higher percentage variation than that of genotype and environment separately for all traits, indicating the influence of genotype by environment interaction on expression of the traits. These findings reveal that screening/evaluating for these traits needs multi-environment trials. According to GSI ranking, genotypes G31 (IBA131794), G19 (IBA131762), the check variety G52 (TMEB778), and G11 (IBA131748) were identified as the most stable and most resistant to CGM which also combine high FRY and other useful agronomic traits, implying that these traits in cassava can even be incorporated as preferred by farmers. These genotypes can be tested in more environments to determine their adaptability and potential recommendation for release to farmers for growing

Cassava Brown Streak Disease response and association with agronomic traits in elite Nigerian cassava cultivars

Open Access Journal; Published online: 22 Nov 2021Cassava mosaic geminiviruses (CMGs) and cassava brown streak viruses (CBSVs) cause the highest yield losses in cassava production in Africa. In particular, cassava brown streak disease (CBSD) is and continues to be a significant constraint to optimal cassava production in Eastern and Southern Africa. While CBSD has not been reported in West Africa, its recent rapid spread and damage to cassava productivity in Eastern, and Southern Africa is alarming. The aim of this study was to evaluate Nigerian cassava genotypes in order to determine their responses to CBSD, in the event that it invades Nigeria, the world’s largest cassava producer. The study gathered information on whether useful CBSD resistance alleles are present in the elite Nigerian cassava accessions. A total of 1,980 full-sib cassava seedlings from 106 families were assessed in the field at the seedling stage for a year. A subset of 569 clones were selected and assessed for another year at the clonal stage in Namulonge, central Uganda, a known hotspot for CBSD screening. Results indicated that foliar and root incidences and severities varied significantly (p ≤ 0.01, p ≤ 0.001) except for CBSD foliar incidence at 6 months (CBSD6i). Highest and lowest plot-based heritability estimates for CBSD were registered for CBSD root severity (CBSDrs) (0.71) and CBSD6i (0.5). Positive and highly significant correlations were noted between CBSD root incidence (CBSDri) and CBSDrs (r = 0.90∗∗∗). Significant positive correlations were also noted between CBSD foliar severity at 3 months (CBSD3s) and CBSD foliar incidence at 6 months (CBSD6i ) (r = 0.77∗∗∗), CBSD3s and CBSDrs (r = 0.35∗∗∗). Fresh root weight (FreshRW) negatively correlated with CBSDri and CBSDrs, respectively (r = −0.21∗∗∗ and r = −0.22∗∗∗). Similarly, CBSD3s correlated negatively with cassava mosaic disease severity at 3 (CMD3s) and 6 months (CMD6s), respectively (r = −0.25∗∗∗ and r = −0.21∗∗∗). Fifteen clones were selected using a non-weighted summation selection index for further screening. In conclusion, results revealed that the elite Nigerian accessions exhibited significant susceptibility to CBSD within 2 years of evaluation period. It is expected that this information will aid future breeding decisions for the improvement of CBSD resistance among the Nigerian cassava varieties

Impact of Mobile Technologies on Cervical Cancer Screening Practices in Lagos, Nigeria (mHealth-Cervix): A Randomized Controlled Trial

Purpose We assessed the impact of mHealth on Pap test screening uptake and also determined the factors that affect screening uptake among women in Lagos, Nigeria. Materials and Methods A randomized controlled trial was carried out among women in two tertiary health institutions in Lagos, Nigeria, between July 2020 and March 2021. Participants were randomly assigned to either a text message (mHealth) intervention or usual care arm. The main study outcome was the uptake of Pap smear testing within 6 months of enrollment in the study. We tested the associations between two groups of continuous variables using the unpooled independent-sample t-test (normal distribution) and that of two groups of categorical variables with the chi-square (χ2) test. Using a multinomial logistic regression model, we adjusted for relevant sociodemographic and clinical predictors of uptake of Pap smear screening. Statistical significance was defined as P < .05. Results There was a significantly higher rate of uptake of Pap smear screening among women in the mHealth arm compared with those in the usual care arm (51.0% v 35.7%, P = .031). Following adjustment in the final multivariate model, level of income (odds ratio [OR] = 5.13, 95% CI, 1.55 to 16.95), awareness of Pap smear (OR = 16.26; 95% CI, 2.49 to 76.64), General Outpatient clinic attendance, and introduction of mHealth intervention during follow-up (OR = 4.36; 95% CI, 1.44 to 13.22) were the independent predictors of Pap smear uptake. Conclusion The use of mHealth technologies intervention via short-text message services is a feasible solution for cervical cancer prevention in low- and middle-income countries, and thus, the widespread use of mHealth services by health care providers and policymakers could contribute to the implementation of cervical cancer prevention services in Nigeria and in the settings of other low- and middle-income countries

Herbal medicine use by surgery patients in Hungary: a descriptive study

BACKGROUND: The popularity of non-conventional treatments, especially the consumption of herbs is showing an increasing tendency all over the world. The consumption of herbal medicines might cause several complications during perioperative care. METHODS: The survey was conducted at the First Department of Surgery of Semmelweis University and focused on the demographics of patients consuming herbal medicines who had undergone elective surgery between July 1(st) 2014 and February 28(th) 2015. A one-page questionnaire, that the patients filled in individually and anonymously, was used. The response rate was 17.3 %. RESULTS: Out of the 390 patients who filled in the questionnaire, 7.2 % (28 patients) used herbal medicines, 3.6 % (14 patients) of them two weeks prior to their hospitalization. The other 3.6 % (14 patients) took herbal medicines sometime in the past. The majority of those who have ever consumed herbs are women (18/28), have completed secondary or tertiary education (23/28), more than half of them suffer from tumorous diseases and only a quarter of them (7/28) informed their physician about their use of herbal medication of their own accord. CONCLUSIONS: Attention must be paid to the exploration of herb consumption habits of surgery patients during the preoperative examinations in order to avoid potential side effects, complications or drug interactions. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12906-015-0890-2) contains supplementary material, which is available to authorized users