The experiences affecting sub-Saharan African patients' engagement in antiretroviral clinical trials: an exploratory participative action research study

Gertrude Othieno discussed community participation from an African perspective. She presented an overview of an ongoing study, (undertaken with Kevin Corbett at St. George’s Hospital, South London), investigating the experiences of Africans involved in anti-retroviral trials. The study sought to enhance the enrolment of Africans and to increase user consultation. Using an action research methodology the researchers employed several cycles of activities. The research process involved cycles of planning, acting, observing and reflecting, embedded in the overall process of the different communities engaging in the study. The researchers put together a Research Advisory Group (RAG) comprised of patients, academic researchers, doctors, nurses and other health practitioner to assist in achieving study aims and objectives. The advisory group slowly developed into a reference group. The RAG will eventually become a user forum which will continue after 18 month research study has finished. The study strived to be as democratic as possible with no one individual having absolute power. However, it was not a classic “bottom up” model, having greatly facilitated by researchers and clinicians. The researchers came across many challenges, from misconceptions about the role of the RAG to clinicians who did not fully embrace the exploratory research approach. About Gertude Othieno Gertrude Othieno is Director of African Culture Promotions (ACP) a voluntary organisation that provides specialist community-based HIV prevention services to African communities. She is also Research Assistant currently undertaking research into the service involvement of patients/users at St George's Healthcare NHS Trust. Gertrude is a representative of South West London African HIV Forum on the African HIV Policy Network (AHPN). She is Editor of African Cultural and Social Structures, a handbook that provides useful information to the health, social care and voluntary sectors. About Kevin Corbett Dr Kevin Corbett is a senior lecturer in the Faculty of Health and Social Care Sciences at St. George's Hospital Medical School where he teaches on undergraduate and postgraduate programmes. Kevin has a PhD in medical sociology and is undertaking research into the service involvement of patients/users

Exploring the challenges and responsibilities of mutual engagement within participatory action research

This paper draws on a London-based exploratory action research study into the factors affecting the engagement in UK National Health Service (NHS) clinical trials of African patients and the wider African communities. The paper argues for the use of participatory qualitative methodologies in relation to centralizing the voices of those who are mostly easily marginalized by mainstream UK health and social care policies. The paper describes how the co-researchers in this study (professional/lay members from within the affected communities and academic researchers) shaped the study methodology. The challenges and responsibilities of the co-researchers within this process of mutual engagement are further described in relation to identifying the perspectives of all co-researchers within a methodology that strives to mutually engage diverse communities of NHS clinicians, academic researchers and service users. Drawing on the findings from the data analysis, the paper will discuss emergent issues that are of particular relevance for New Labour’s policies on social exclusion, cultural competence and NHS service user involvement

Determination of LDL-cholesterol: direct measurement by homogeneous assay versus Friedewald calculation among Makerere University undergraduate fasting students

The treatment of patients for coronary heart disease risk requires knowledge of the plasma lipid levels. Low density lipoprotein cholesterol (LDL) levels make a strong basis for therapeutic decisions. Although there are incongruities among values of LDL from different methods of determining LDL, the clinician is not routinely informed of the method used. The purpose of this study was to compare LDL levels determined by the Friedewald equation with those assayed by the Kyowa Madox method. The lipid results previously measured by Kyowa Madox method among Makerere University fasting students and reported earlier wereretrieved. The measured values of total cholesterol (TC), High Density Lipoprotein cholesterol (HDL) and triacylglycerols (TG) were used to calculate LDL using Friedewald equation in which LDL= TC-HDL-TG/2.2mmol/L. The values obtained were compared non parametrically with the assayed values previously reported. Our results showed a high value of correlation between measured and calculated LDL so that in general, the two methods can be used interchangeably in this population. However, in cases of dyslipidaemia, the calculated values tend to be lower than the assayed values. It is therefore recommended that clinical laboratories should report the LDL values along with the determination method used, the alert values, the reference ranges, the desirable ranges and the therapeutic targets. © 2010 International Formulae Group. All rights reserved.Keywords: Homogeneous assay, LDL cholesterol, direct measurement, Friedewald equation, comparison

Presyncope Is Associated with Intensive Care Unit Admission in Emergency Department Patients with Acute Pulmonary Embolism

Introduction: Syncope is common among emergency department (ED) patients with acute pulmonary embolism (PE) and indicates a higher acuity and worse prognosis than in patients without syncope. Whether presyncope carries the same prognostic implications has not been established. We compared incidence of intensive care unit (ICU) admission in three groups of ED PE patients: those with presyncope; syncope; and neither.Methods: This retrospective cohort study included all adults with acute, objectively confirmed PE in 21 community EDs from January 2013–April 2015. We combined electronic health record extraction with manual chart abstraction. We used chi-square test for univariate comparisons and performed multivariate analysis to evaluate associations between presyncope or syncope and ICU admission from the ED, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI).Results: Among 2996 PE patients, 82 (2.7%) had presyncope and 109 (3.6%) had syncope. ICU admission was similar between groups (presyncope 18.3% vs syncope 25.7%) and different than their non-syncope counterparts (either 22.5% vs neither 4.7%; p<0.0001). On multivariate analysis, both presyncope and syncope were independently associated with ICU admission, controlling for demographics, higher-risk PE Severity Index (PESI) class, ventilatory support, proximal clot location, and submassive and massive PE classification: presyncope, aOR 2.79 (95% CI, 1.40, 5.56); syncope, aOR 4.44 (95% CI 2.52, 7.80). These associations were only minimally affected when excluding massive PE from the model. There was no significant interaction between either syncope or presyncope and PESI, submassive or massive classification in predicting ICU admission.Conclusion: Presyncope appears to carry similar strength of association with ICU admission as syncope in ED patients with acute PE. If this is confirmed, clinicians evaluating patients with acute PE may benefit from including presyncope in their calculus of risk assessment and site-of-care decision-making

Human immunodeficiency virus and AIDS and other important predictors of maternal mortality in Mulago Hospital Complex Kampala Uganda

BACKGROUND: Women with severe maternal morbidity are at high risk of dying. Quality and prompt management and sometimes luck have been suggested to reduce on the risk of dying. The objective of the study was to identify the direct and indirect causes of severe maternal morbidity, predictors of progression from severe maternal morbidity to maternal mortality in Mulago hospital, Kampala, Uganda. METHODS: This was a longitudinal follow up study at the Mulago hospital's Department of Obstetrics and Gynaecology. Participants were 499 with severe maternal morbidity admitted in Mulago hospital between 15th November 2001 and 30th November 2002 were identified, recruited and followed up until discharge or death. Potential prognostic factors were HIV status and CD4 cell counts, socio demographic characteristics, medical and gynaecological history, past and present obstetric history and intra- partum and postnatal care. RESULTS: Severe pre eclampsia/eclampsia, obstructed labour and ruptured uterus, severe post partum haemorrhage, severe abruptio and placenta praevia, puerperal sepsis, post abortal sepsis and severe anaemia were the causes for the hospitalization of 499 mothers. The mortality incidence rate was 8% (n = 39), maternal mortality ratio of 7815/100,000 live births and the ratio of severe maternal morbidity to mortality was 12.8:1.The independent predictors of maternal mortality were HIV/AIDS (OR 5.1 95% CI 2-12.8), non attendance of antenatal care (OR 4.0, 95% CI 1.3-9.2), non use of oxytocics (OR 4.0, 95% CI 1.7-9.7), lack of essential drugs (OR 3.6, 95% CI 1.1-11.3) and non availability of blood for transfusion (OR 53.7, 95% CI (15.7-183.9) and delivery of amale baby (OR 4.0, 95% CI 1.6-10.1). CONCLUSION: The predictors of progression from severe maternal morbidity to mortality were: residing far from hospital, low socio economic status, non attendance of antenatal care, poor intrapartum care, and HIV/AIDS.There is need to improve on the referral system, economic empowerment of women and to offer comprehensive emergency obstetric care so as to reduce the maternal morbidity and mortality in our community

A Millennium Learning Goal for education post‐2015: a question of outcomes or processes

As the target year for the current Millennium Development Goal of universal completion of primary education approaches, three World Bank economists have proposed its replacement with a Millennium Learning Goal. This is part of a trend of increased privileging of learning outcomes. The proposal is assessed from the perspective of human rights-based and social justice conceptualisations of education quality. A Millennium Learning Goal may enhance information on inclusion, conceived as equal opportunity to achieve learning outcomes. However, there is a danger that it would be misused to generate high stakes tests that can be detrimental to the achievement of goals that are not readily measurable and hence to the relevance of education. It is argued that a process goal with qualitative targets for the assessment of learning, for the monitoring of educational processes and for the processes by which learning goals are determined would be more appropriate for the international level.As the target year for the current Millennium Development Goal of universal completion of primary education approaches, three World Bank economists have proposed its replacement with a Millennium Learning Goal. This is part of a trend of increased privileging of learning outcomes. The proposal is assessed from the perspective of human rights-based and social justice conceptualisations of education quality. A Millennium Learning Goal may enhance information on inclusion, conceived as equal opportunity to achieve learning outcomes. However, there is a danger that it would be misused to generate high stakes tests that can be detrimental to the achievement of goals that are not readily measurable and hence to the relevance of education. It is argued that a process goal with qualitative targets for the assessment of learning, for the monitoring of educational processes and for the processes by which learning goals are determined would be more appropriate for the international level

Prevalence, withdrawal symptoms and associated factors of khat chewing among students at Jimma University in Ethiopia

Background: Recently, khat chewing has become a common practice among high school, college, and university students. Regular khat chewing is thought to be a predisposing factor for different physical and mental health problems. It can lead to absenteeism from work and classes. In Ethiopia, to our knowledge no published study has investigated khat withdrawal symptoms. Therefore, this study was conducted to determine the prevalence, withdrawal symptoms, and associated factors of khat chewing among regular undergraduate students on the main campus of Jimma University in Ethiopia. Methods: The institution-based, cross-sectional study was conducted in January 2016. Data were collected from 651 main campus regular undergraduate students with a structured, self-administered questionnaire, entered into Epidata 3.1 and exported to SPSS version 20 for Windows. Bivariate and multivariate logistic regressions were used to explore associations and identify variables independently associated with khat chewing. Results: The study found that the lifetime and current prevalence of khat chewing among students were 26.3% (95% CI: 24.3, 28.3) and 23.9% (95% CI: 21.94, 25.86), respectively. About 25.7% of students started chewing after joining university, and 60.5% of these students started during their first year. The main reason given for starting khat chewing was for study purposes (54.6%), followed by socialization purposes (42.3%). Among current khat chewers, 72.9% reported that they had chewed khat for 1 year or more and 68.2% reported that they had experienced various withdrawal symptoms. The most frequently reported withdrawal symptoms were feeling depressed, craving, and feeling fatigued. Being male, attending a place of worship daily/2-3 times per week, cannabis use, smoking cigarettes, and having family members currently chewing khat were independently associated with khat chewing. Conclusions: This study found that large numbers of university students were currently chewing khat. In this study withdrawal symptoms and factors that significantly affect khat chewing were identified. Besides it gave new ideas regarding khat withdrawal symptoms in Ethiopia. It serves as a critical role of providing information to form rational foundation for public health policy, prevention and planning to bring change in contributing factors for Khat chewing. The finding will be serving as base line information for further study