Is Cannabis Use Related to Road Crashes? A Study of Long Distance Commercial Drivers in Nigeria

Factors associated with driving under the influence of cannabis (DUIC) and related road crashes among 422 commercial drivers were studied. A multivariate analysis was conducted to understand the associations between risk factors and DUIC and car crashes respectively. Young age, OR = 3.6, 95% CI 1.9-7.6; cannabis abuse, OR = 4.1, 95% CI, 1.9-8.2; cannabis dependence, OR = 4.4, 95% CI, 2.1- 7.8; hire- driver, OR = 5.3, 95% CI, 2.0- 14.2, remained associated with DUIC after model adjustments while previous DUIC accidents, OR = 4.5, 95% CI, 2.2 -11.0; combined DUIC and driving under influence of alcohol (DUIA), OR = 5.1, 95% CI, 2.7 – 14.0, remained associated with cannabis related crashes after model adjustment. DUIC increases the risk of involvement in a crash most particularly if there is associated DUIA. Key Words: Cannabis, driving under influence, Nigeria, road crashes, commercial driver

Rapid situation assessments of alcohol and substance use among commercial vehicle drivers in Nigeria

Objectives: To describe the current situation with respect to substance use and related harms among commercial vehicle drivers, and to identify a range of interventions that could be feasibly implemented to minimise harms related to substance use.Study design: Observational and group interviews.Setting: Four different motor parks in Ibadan, Nigeria.Subjects: Data were obtained from a sample of commercial vehicle drivers, community and members of the law enforcement agencies.Results: Widespread use of psychoactive substances was reported. New trend of local alcohol beverage generally called ‘sepe’ tended to have replaced older ones such as palm wine. All substances of abuse were freely available and openly displayed at motor parks except for cocaine and narcotics. There was poor law provision and enforcement of laws prohibiting sale and use around motor parks or while driving.Conclusions: This study shows the feasibility and value of conducting rapid assessments among commercial vehicle drivers in Nigeria. One outcome of this study is the development of a guide on rapid assessment of alcohol and other substance use assessment and a measure of brief intervention among them. Presentation of these findings should contribute to increased awareness and improved response from the government

Need for screening for alcohol and drugs in Emergency Trauma Units

Objectives: To examine the prevalence of alcohol and drug use and abuse, to identify socio-demographic  characteristics that correlated with injury and to identify risk factors for injury in a Nigerian Trauma unit.Design: Descriptive cross sectional study.Setting: The study was carried out a general hospital trauma unit in Nigeria.Subjects: One thousand one hundred and twenty one trauma patients and 303 controls.Results: Of all injuries, 50.1% were road accidents, mean injury severity score was 41.3 SD (11.2), prevalence of alcohol abuse was 27.9%, cannabis abuse 14.0% and pretrauma alcohol use 41.2%, pre-trauma cannabis use was 6.9%. Multivariate analysis shows that age < 31 years 95% CI (0.26-0.89), alcohol abuse 95% CI (1.84-4.64), binge drinking in the previous 30 days 95% CI (1.76-6.46), cannabis abuse 95% CI (1.45-2.88) and pretrauma combined alcohol and cannabis use 95% CI (3.34-11.78) were risk factors for severe injury.Conclusion: Use and abuse of alcohol and drugs is highly prevalent among trauma patients seeking emergency care. Therefore trauma patients require routine toxicological screening to provide basis for preventive programmes or referrals for them

Post Partum Psychosis, Infanticide, Case Report, Nigeria.

Introduction: Mental illnesses are very prevalent and highly disabling. Adults with mental illness in primary care are also more likely to be experiencing poorer overall health than those without. They also report more disability days in previous month. The chronic or recurrent nature of mental disorders make relatives fed up with endless care giving and social support rendering a good number of mentally ill homeless. Mental illness and homelessness have been reported to be associated with substance use, chronic medical diseases, self reported poor health and many barriers to service utilization. Method: Descriptive fact finding method of all homeless persons referred for treatment at State hospital, Ring Road, Ibadan between 2004 and 2007. Results: The median age of the respondents was 40 years, 60% were females, the median number of years of education was 3 years, 83.9% were never married, 60% had been on the streets for 5-10 years and 84.3% had never had contact with any formal mental care facility. The most prevalent DSM IV diagnosis was schizophrenia, (34.3%), followed by substance use disorder and co-morbid substance use plus psychosis, 15.7% respectively, 2.8% was commercial sex workers, while one (1.4%) received no diagnosis and was a criminal. All of them had at least a clinical health problem. While the most commonly reported social problem was financial problems leading to begging (95.7%). Conclusion: Homelessness among mentally ill is associated with physical health and social problems, therefore such patients need integrated multidisciplinary approach in designated centers for their care.Key Words: Mental Disorders, Homelessness, Public Health

Is Red Wine a Good Medicine?

Introduction: Various studies have highlighted the health benefits of alcohol, most especially red wine with respect to its antioxidant, fibrinolytic and vasodilator effects. The health benefits of alcohol spans beyond its cardioprotective characteristic to include its neuroprotective, immune modulatory, antiobesity and antidiabetic characteristic. Although most studies on alcohol and health have been in vitro, there are evidences from clinical studies in human beings of health benefits particular from wed wine derived polyphenols. However, there are far more evidences in terms of health hazards as a result of excessive alcohol intake (> 3 units/day). The risk of injury is undoubtedly high as a result of the characteristic binge use of alcohol in this environment. Method: The methodology employed in this article was by review of literatures. Results: This article has highlighted that both in-vitro and in-vivo studies have indicated that moderate amount of alcohol most especially in the form of red wine has certain pharmacological properties that may be of health benefit across various medical conditions. However, there are a number of vegetables and fruits that also contain polyphenols that are believed to offer this health benefit. Conclusion: In conclusion, in considering the relative health benefits of red wine, the characteristic pattern of binge use of alcohol particularly in this environment poses a caution on those who desire a change of beveragetype with preference for red wine. Binge use of alcohol is a high risk factor for injuries and physical health problems.Key Words: Red wine, Good Medicine

Profile of Problems Associated with Psychoactive Substance Use Among Long Distance Commercial Automobile Drivers in Ibadan.

Introduction: Automobile drivers are vulnerable to psychoactive substanceuse often to their detriment in terms of the health hazards of these  substances and also to the detriment of commuters in terms of their safety. The objectives of the study were to identify pattern of psychoactive substance use among long distance commercial drivers in general and also with respect to their status (hired or owner) and also to identify the profile of health and social problems associated with substance use disorders among them. Method: Four hundred and twenty two commercial drivers selected through a multi stage stratified sampling technique from four motor parks in Ibadan were interviewed using the alcohol and drug section of the CIDI. The CIDI auto program was used to generate psychiatric diagnosis. The CIDI auto is a computer program which could concurrently generate both ICD 10 and DSM IIIR diagnoses using various indices which include physical and social health problems. Focus group discussion and direct observation were also conducted in each of the study parks. Results: Their median age was 39 years, 76.8% were married, 5.0% had no formal education. Alcohol was the most prevalent currently used substance, 324 (76.8%). The most prevalent current single ICD 10 diagnosis was harmful use of alcohol, 61 (14.5%), while the most prevalent current multiple ICD 10 diagnoses were harmful use of alcohol/harmful use of cannabinnoids, 33 (7.8%). In all, 124 (29.4%) respondents had single ICD 10 diagnosis, while 46 (10.9%) hadmultiple ICD 10 diagnoses. Current ICD 10 diagnosis was significantly most reported among young drivers, p < 0.01, drivers with low educational level, p < 0.01 and also among hired drivers, p < 0.001. Each ICD 10 versus DSM diagnosis showed good to excellent agreement (k) = 0.68 – 1.0. Predictors of any ICD 10 diagnosis were: age range 25 – 34 years, OR = 5.7, 95% CI (1.3 – 11.5) p < 0.01, being single, OR = 8.8, 95% CI (2.5 – 21.9), p = 0.00, hired drivers, OR = 6.2, 95% CI (2.4 – 13.4) p = 0.00, drivers whose route was outside the country, OR = 3.7, 95% CI (1.2 – 7.9),p = 0.01. Road accidents were the most common problems reported inthis study, 112 (26.8%) and were commonest among those with alcohol related disorders. Risk factors for road accidents were: age range 25 – 34years, OR = 7.4, 95% CI (2.3 – 21.5) p = 0.00, hired drivers, OR = 7.6, 95% CI (2.7 – 25.4) p = 0.00, harmful use of alcohol, OR = 2.6, 95% CI (1.4 – 11.9), p=0.03, dependence syndrome alcohol, OR = 2.7, 95% CI (1.3 – 13.2), p = 0.02, harmful use alcohol/harmful use cannabinoids, 0R= 8.8, 95% CI (2.5 – 31.9), p = 0.00, harmful use alcohol/dependence syndrome cannabinoids, 0R= 5.5, 95% CI (1.5 – 20.5), p = 0.00.Conclusion: Psychoactive substance use was common among long distance automobile drivers with consequent social and physical health consequences. The government should randomly screen commercial drivers plying the roads for drug use and increase the frequency of educational programs to improve their knowledge about its harmful effects in order to ensure commuters’ safety.Key Words: Psychoactive Substances, Automobile Driving, ICD 10/DSM III

Social network as a determinant of pathway to mental health service utilization among psychotic patients in a Nigerian hospital

Objective: The main objectives of the study were to determine the&nbsp; relationship between social network and pathway to service utilization among psychotic patients.Materials and Methods: This descriptive study was carried out in a&nbsp; psychiatric unit in a general hospital in South West Nigeria. Using structured questionnaires, primary data were collected from 652 psychotic patients on their social network, health behaviors and pathway to current service use. Logistic regression analysis was used to assess the effect of social network on patients' use of services, controlling for sociodemographics, health and functional status.Results: Mean age of the respondents was 29.0 &plusmn; 7.5 years, range 14-58 years, males constituted 52.6%. Regarding pathway to services, alternative sources of care such as priests, spiritualists, natural therapists, herbalists, was the first port of call for 78.9% of respondents. Family dominated the social network in 51.1% of patients. The presence of some social network and social support structures were significantly associated with the use of general medical and specialty psychiatric services for patients with&nbsp; schizophrenia (P = 0.03), schizoaffective disorder (P = 0.02), bipolar I disorder (P = 0.01), but not with major depression and symptoms of&nbsp; psychological distress.Conclusions: Findings indicate that social support and social network&nbsp; enhanced utilization of mental health services for psychiatric patients except for those with psychotic depression or those with symptoms of psychological distress. In addition, alternative sources of care are still relevant in mental health service delivery in South West Nigeria

Psychiatric Psychosocial Rebilibation in Nigeria; What Needs to be Done

Nigerians who suffer from severe mental illness also need psychiatricpsychosocial rehabilitation. Despite the availability of a wide range of mental health services in Nigeria, majority of Nigerians with mental health relatively have their needs unmet. To fill this unmet gap, Nigerian psychiatrists should also make psychiatric psychosocial interventions available at the primary health care centres and in the rural communities. When these services are available in the community, Nigerians with mental health disorders can easily acquire the available social, emotional and intellectual skills provided by mental health experts to enable them live and work with minimal supervision from clinicians. The aim of this paper is therefore to further sensitize Nigeria mental health care providers on the need to make psychiatric psychosocial services available at the primary health care centres and rural communities for every Nigerian with mental illness.Key words: psychosocial, rehabilitation, psychiatry, Nigeri