Developing caries inequalities risk prediction tools for children under the age of six

Introduction: Dental caries in deciduous teeth is the 10th-most prevalent condition, affecting 621 million children worldwide (Kassebaum et al., 2015). Although overall prevalence of Early Childhood Caries (ECC) is declining, but there is no improvement in the unequal distribution of caries across social gradients. It is therefore important to investigate and demonstrate the relationships between the factors responsible for caries inequalities in children under the age of six. Methods This thesis used systematic review methods and the Cochrane-validated tool (PROGRESS-PLUS) to explore factors implicated in ECC inequalities. Existing conceptual ECC frameworks were then evaluated (mapped) against factors identified from the review. The relationship between identified factors were established using Directed Acyclic Graphs and path analyses to create new conceptual models, and their predictability assessed using traditional and machine learning statistical techniques. Results Sixty-seven publications were eligible for this review and the result showed that there are 24 ECC-related risk factors. The mapping of existing caries frameworks also revealed that none of the current caries conceptual model had more than 48% relevant Social Determinants of Health (SDH) in their frameworks. Two separate ECC conceptual frameworks (temporal and hierarchical) were developed based on systematic review evidence, and the predictability of the models also showed an Area under Receiver Curve (AUC) of 76% and 74% for the child-level and area-level prevalence prediction respectively. Conclusion This thesis found that existing conceptual frameworks lacked in-depth consideration of the full wider determinants that are responsible for health inequalities, which may be the cause of the current low ECC prevalence, but widening or stagnant caries inequalities pattern seen globally. The model developed in this thesis included more SDH content (64%) than any existing models and therefore increases the chances that preventive measures, built on the new SDH models, will be able to address both prevalence and inequalities. This model also demonstrated good predictive capabilities

A conceptual framework of environmental sustainability in the oil and gas supply chains: natural resource based view (NRBV) and institutional theory approaches

Purpose: The aim of this paper is to conceptualise a structural model of environmental sustainability for the O and G SC. Following the recommendation of Carters and Rodgers (2008) that a conceptual framework should be underpinned by strong theoretical foundation, we combined the relevant elements of the Institutional theory (Dimmagio and Powell 1983) with the Natural Resource Based View (NRBV) of Hart (1995) to depict the roles of regulatory pressures in driving supply chain innovations and environmental capabilities towards competitiveness of O and G firms. This research proposes structural model and relevant hypothesis to delineate the causal relationships among constructs. Design: This research adopts a theory building approach (Meredith 1983) to develop a conceptual framework of environmental sustainability for the O and G SC. The proposed model is based on a structured literature review which synthesised the extant into four clusters (coercive pressures, resources, strategic environmental capabilities and competitive advantage) that are considered relevant to the objectives of the study within the two theoretical lenses (Institutional theory and NRBV). These clusters were developed into various constructs that made up our model, based on hypothesis developed from the extant literature. Finally, the managerial implications, value and limitations of the study were highlighted. Findings: In line with Liang et al. (2007), we found that regulatory pressure is a critical factor in the O and G firm’s adoption of environmental practices, hence we depict this as the antecedent of resources and environmental capabilities in our proposed model. We also found that environmental capabilities can enhance the competitiveness of O and G firms. Based on the above, an overarching model of environmental sustainability of the O and G supply chain was developed. Value: In the first instance, this paper has contributed to theory building process in the field of GSCM/SSCM by developing a new theoretical model for the O and G SC. Unlike previous models on environmental sustainability in the O and G industry, our study utilised relevant components of existing theories propose a new model of environmental sustainability in the O and G SC. Besides, our model depiction of clean technology as one of the strategic environmental capabilities needed by O and G firms is very novel in the O and G industry considering the global drive towards clean energy and renewables. Academic limitations/ implications: Although the model is purely conceptual at this stage, its development have also contributed to theory-based research in the field of supply chain management. Practical implications: On empirical verification, this work can furnish the supply chain managers with validated measurement scales to evaluate the strengths and weakness in their supply chain innovation and the impacts on environmental capabilities and competitive advantage. It can also assist policy makers in the O and G industry to evaluate the impacts of sustainability policies on firms’ acquisition of strategic resources and capabilities

Fine Needle aspiration of superficial Lymph node enlargement seen in Lagos, Nigeria: our experience over a six-year period

Background: Lymphadenopathy is one of the common palpable superficial tumours in the body. The diagnosis of these masses can be challenging to physicians. Fine needle aspiration cytology (FNAC) is a cost effective investigation for the diagnosis especially in resource limited settings like ours.Objectives: The aim of this study is to present the use of FNAC of lymph nodes, highlighting the benefits of this investigation.Methods: This is a six year retrospective study of all lymph nodes FNAC performed in two laboratories in Ikeja, Lagos between January 2008 and December 2013. All cytological slides were retrieved and re-evaluated. Clinical details including age, gender, site of aspirations were retrieved from the request forms.Results: A total of 128 cases were seen during the study period with an age range of 1 to 84 years and male to female ratio of 1:1.1. Cervical lymph node (90/128) was the commonest aspirated site. Tuberculous lymphadenitis accounted for 32.3% of cases. Diagnosis of malignancy accounted for 25% of cases comprising metastatic carcinoma (71.9%) and lymphoma (28.1%). All cases of lymphoma diagnosed were from cervical lymph node which also accounted for 60.9% metastatic carcinoma diagnosis.Conclusion: Chronic granulomatous lymphadenitis is a very common cause of lymphadenopathy in our environment. Metastatic carcinoma is the most common cause of malignant lymphadenopathy. FNAC is a veritable tool for the diagnosis of lymphadenopathy and it can be performed on all age groups. Introduction of special technique such as immunohistochemistry and flow cytometry is advocated for definitive diagnosis of lymphomas.Keywords: Lymphadenopathy, FNAC, tuberculous lymphadenitis, metastatic carcinoma, lymphoma

Prevalence, intensity and complications of Microsporidium spores amongst HIV-positive hospital patients in Ilorin, Nigeria

Background: Microsporidiasis, which is of great concern for immunocompromised patients, is poorly studied in developing countries. Objectives: A study was carried out amongst HIV-positive hospital patients and HIV-negative hospital controls in Ilorin, Nigeria, between January 2009 and July 2010 to determine the prevalence and intensity of Microsporidium spores and the complications associated with their presence. Method: Stool samples from 750 HIV-positive patients and 375 HIV-negative patients were studied using the Chromotrope-2R staining technique. Determination of CD4+ count was performed on the Partec Cyflow SL-3 CD4/8 instrument. Intensity of spores was determined by counting the total number of the spores in a 10 μl stained smear of stool. Images were captured with Phenix Microimage Analysis Software and data obtained were analysed using the Statistical Package for the Social Sciences. Results: The prevalence of Microsporidium isolates amongst the HIV-positive hospital patients was significantly higher (42.4%) than amongst the HIV-negative controls (19.2%)(p < 0.05). The intensity of microsporidial spores amongst HIV-positive hospital patients was also significantly higher than amongst the controls (p < 0.05). However, the difference in the intensity of spores amongst HIV-positive patients who were on antiretroviral therapy(n = 411) and those who were not (n = 339) was not significant (p = 0.236). Microsporidiasis in HIV infection infection was common amongst patients with with low CD4+ counts, diarrhoea, body rashes and cough. Conclusion: Both the prevalence and intensity of Microsporidiasis are high amongst HIV-positive hospital patients; campaigns to promote awareness, prevention and control are required. Laboratory testing for microsporidia in HIV patients should be performed routinely so as to identify the organism for prompt medical attention

Male Partner Involvement on Initiation and Sustainment of Exclusive Breastfeeding Among HIV-infected Post-partum Women: Study Protocol for a Randomized Controlled Trial

Exclusive Breastfeeding (EBF) among human immunodeficiency virus (HIV)-infected mothers is known to be associated with a sustained and significant reduction in HIV transmission and has the potential to reduce infant and under-five mortality. Research shows that EBF is not common in many HIV-endemic, resource-limited settings despite recommendations by the World Health Organization. Although evidence abounds that male partner involvement increases HIV testing and uptake and retention of prevention of mother-to-child transmission interventions, few studies have evaluated the impact of male partners\u27 involvement and decision-making on initiation, maintenance, and sustainment of EBF. We propose a comparative effectiveness trial of Men\u27s Club as intervention group compared to the control group on initiation and sustainment of EBF. Men\u27s Club will provide male partners of HIV-infected pregnant women one 5-hr interactive educational intervention to increase knowledge on EBF and explore barriers and facilitators of EBF and support. Additionally, participating male partners in the Men\u27s Club as intervention group will receive weekly text message reminders during the first 6-week post-natal period to improve initiation and sustainment of EBF. Participants in the Men\u27s Club as control group will receive only educational pamphlets. Primary outcomes are the differences in the rates of initiation and sustainment of EBF at 6 months between the two groups. Secondary outcomes are differences in male partner knowledge of infant feeding options and the intent to support EBF in the two groups. Understanding the role and impact of male partners on the EBF decision-making process will inform the development of effective and sustainable evidence-based interventions to support the initiation and sustainment of EBF

Effect of Cnidoscolous aconitifolius (Miller) I.M. Johnston leaf extract on reproductive hormones of female rats

Background: The increase in the rate of infertility in women has prompted the need to search for plants with antifertility potentials. Objective: The effect of administration of aqueous extract of Cnidoscolous aconitifolius leaves for seven days on reproductive hormones of female Wistar rats was investigated. Materials and Methods: Sixty female albino rats were grouped into four (A, B, C and D) of 15 each. Group A (the control) received orally 6.5 ml kg-1 body weight of distilled water on daily basis for 7 days. Groups B, C and D were treated like the control except that they received 250, 500 and 1000 mg kg-1 body weight of the extract. Results: Phytochemical screening of the extract revealed the presence of alkaloids, saponins, phenolics, tannins, flavonoids, anthraquinones, phlobatannins and triterpenes. Administration of the extract produced significant increase (p<0.05) in the serum prolactin concentration whereas those of estradiol, progesterone, follicle stimulating and luteinizing hormones were significantly reduced. Conclusion: The alterations in the female rat reproductive hormones by the extract are indications of adverse effect on the maturation and ovulation of follicles. Consequently, the extract may impair fertility and conception in female rats. Thus, the Cnidoscolous aconitifolius leaf extract may be explored as a female contraceptive