Screening for Risk Factors: Adolescent Sexual Risk Behavior as a Symptom of Disordered Family Structure and Functioning.

Background: Adolescent transition is associated with risky sexual behavior. Evidence has demonstrated the impact of family factors mediated through parental attachment on adolescents’ decisions on sexual debut and practice. Health provider initiated focused intervention targeting  at risk adolescents and their families  is needed  but measures for family factors have not been incorporated into adolescents screening  instruments. This gap in literature and adolescent health packages demands attention. Aim and Objectives: This study aims to use the Family Circle and APGAR Questionnaire to elicit the pattern of parental attachment and perceived family functioning and their relationship with sexual debut with a view to recommending them as screening instruments. Method: Over 400 senior secondary school students randomly selected participated using self administered instruments including the Family Circle and APGAR Questionnaire. P value was set at 0.05. Results: The Family Circle elicited the pattern of parental attachment   and showed a significant relationship with sexual debut and parent adolescent communication on sexuality. The APGAR elicited the perceived family functioning among the respondents. A significant relationship was established between sexual debut and parents’ educational status and parents' separation. Conclusion: This study demonstrated the impact of disordered family structure and functioning on adolescent sexual practice mediated through parental attachment  using the Family Circle and APGAR questionnaire. The utility of these instruments in eliciting parental attachment and perceived family functioning makes them vital tools proposed for screening and detection of at risk adolescents. Key words: adolescent, parental attachment, family structure, functioning, sexual debut

Adolescent Transition: Impact on Pattern of Perceived Family Functioning, Parental Attachment and Relationship with Family Structure and Risk Behavior

Background: Family approach to adolescent care is advocated to harness family protective factors and reduce adverse factors for adolescent risk behavior. Family Physicians can take the lead in providing this care but data on adolescent transition and perception of their family processes is lacking in our locale. There is need to bridge this gap and broaden the perspectives for successful adolescent care.Aim and Objectives: To determine the pattern of perceived family functioning and parental attachment, the impact of family structure and relationship to risk behavior among adolescents using the APGAR Questionnaire and Family Circle.Method: Over four hundred secondary school adolescents randomly selected participated using self administered customized instruments. Data was analyzed using the SPSS 21.p value was set at 0.05.Results: Most respondents (56.3%) rated their families as highly functional but deficient in the Growth and Affection domains of the APGAR. Parental attachment was healthy for majority (91.4%) with mother attachment (86.9%)significantly higher than father attachment (57.7%). Divorce had significant negative impact on functioning and all dimensions of attachment worse than families with a deceased parent. Work separation negatively impacted functioning, parental attachment was preserved. Risk behavior prevalence was high (25.6%), had significant relationship with family structure, functioning and parental attachment.Conclusion: Parental attachment mediates the impact of family structure and functioning on adolescent risk behavior. Most adolescents had healthy parental attachment, in functional families but with deficiency in the Growth and Affection domains and Father attachment indicating needed intervention to optimize family conditions for positive adolescent development. Keywords: adolescent, family functioning, family structure, parental attachment, risk behavior.

Poor Health Care Access in Nigeria: A Function of Fundamental Misconceptions and Misconstruction of the Health System

Health care access in Nigeria is very limited in all dimensions due to factors within and beyond the health system. Misconception of primary health care and poor leadership resulted in a stunted health system development which has failed to align system structures and processes to the goal of achieving universal health access. Improving financial access through compulsory health insurance will not be enough to reverse this status without a holistic primary health care reform to correct the system misconstruction, achieve high quality health care that is efficient, acceptable to the people and therefore sustainable and capable of driving growth and development for the health system and the country. A primary health care movement consisting of health professionals within the country and the diaspora and other stakeholders is needed to drive this process and overcome the inertia of political leadership in this regard

The Effect of Low CD4+ Lymphocyte Count on the Radiographic Patterns of HIV Patients with Pulmonary Tuberculosis among Nigerians

Objective. To assess the radiographic features in patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis (PTB), and the association with CD4 lymphocyte count and sputum smear. Method. A prospective study was carried out on 89 HIV positive patients with PTB. The demographics, smoking history, sputum smear result, chest radiographic findings and CD4 lymphocyte count were documented. Results. Out of the 89 patients recruited in the study, 41 were males and 48 were females. Eighteen (18) patients had typical radiographic features, 60 patients had atypical radiographic features while only 11 of them had normal radiographic films. Sixty eight (68) patients had CD4 count <200 cells/mm3, 19 patients had CD4 count between 200–499 cells/mm3, while only 2 patients had CD4 count from 500 cells/mm3 upwards. The association between low CD4 count and radiographic finding was statistically significant, ( value ). Sixty (60) patients had negative sputum smear for Acid and Alcohol Fast Bacilli (AAFB), while the remaining 29 patients had positive smear. The association between low CD4 count and negative smear was statistically significant ( value ). Conclusion. The radiographic pattern and the result of the sputum smear for AAFB has a significant relationship and association with the immune status of patients with Human Immunodeficiency Virus (HIV) complicated by pulmonary tuberculosis