Persistent oxidative injury and neurobehavioral impairment in adult male and female Nauphoeta cinerea exposed to perfluorooctanoic acid.

This study aimed to elucidate if the toxicity of perfluorooctanoic acid (PFOA), an emerging persistent organic contaminant, is reversible or not in adult male and female Nauphoeta cinerea. Both sexes of Nauphoeta cinerea were separately exposed to 0, 1 and 5 mg/L PFOA in drinking water for 21 consecutive days. PFOA-exposed Nauphoeta cinerea exhibited significant deficits in the locomotor and exploratory capabilities with concomitant increase in anxiogenic behaviors which persisted after cessation of PFOA exposure. Moreover, PFOA-induced decrease in acetylcholinesterase activity persisted after cessation of PFOA exposure in both insects' sexes. Catalase and superoxide dismutase activities were increased in the midgut but restored to control following cessation of PFOA exposure. The increased reactive oxygen and nitrogen species, nitric oxide and hydrogen peroxide levels persisted in the head whereas they were abated in the midgut after cessation of PFOA exposure. However, PFOA-induced persistent increase in lipid peroxidation and protein carbonyl levels in the head and midgut of insects. Collectively, PFOA exposure elicited persistent neurobehavioral and oxidative injury similarly in both sexes of adult Nauphoeta cinerea during this investigation.

Implementing a Health Utility Assessment Platform to Acquire Health Utilities in a Hemodialysis Outpatient Setting: Feasibility Study.

BACKGROUND: Patients with end-stage kidney disease (ESKD) wait roughly 4 years for a kidney transplant. A potential way to reduce wait times is using hepatitis C virus (HCV)-viremic kidneys. OBJECTIVE: As preparation for developing a shared decision-making tool to assist patients with ESKD with the decision to accept an HCV-viremic kidney transplant, our initial goal was to assess the feasibility of using The Gambler II, a health utility assessment tool, in an ambulatory dialysis clinic setting. Our secondary goals were to collect health utilities for patients with ESKD and to explore whether the use of race-matched versus race-mismatched exemplars impacted the knowledge gained during the assessment process. METHODS: We used The Gambler II to elicit utilities for the following ESKD-related health states: hemodialysis, kidney transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney. We created race exemplar video clips describing these health states and randomly assigned patients into the race-matched or race-mismatched video arms. We obtained utilities for these 3 health states from each patient, and we evaluated knowledge about ESKD and HCV-associated health conditions with pre- and postintervention knowledge assessments. RESULTS: A total of 63 patients with hemodialysis from 4 outpatient Dialysis Center Inc sites completed the study. Mean adjusted standard gamble utilities for hemodialysis, transplant with HCV-unexposed kidney, and transplantation with HCV-viremic kidney were 82.5, 89, and 75.5, respectively. General group knowledge assessment scores improved by 10 points (P<.05) following utility assessment process. The use of race-matched exemplars had little effect on the results of the knowledge assessment of patients. CONCLUSIONS: Using The Gambler II to collect utilities for patients with ESKD in an ambulatory dialysis clinic setting proved feasible. In addition, educational information about health states provided as part of the utility assessment process tool improved patients' knowledge and understanding about ESKD-related health states and implications of organ transplantation with HCV-viremic kidneys. A wide variation in patient health state utilities reinforces the importance of incorporating patients' preferences into decisions regarding use of HCV-viremic kidneys for transplantation.

Unraveling racial disparities in asthma emergency department visits using electronic healthcare records and machine learning.

OBJECTIVE: Hospital emergency department (ED) visits by asthmatics differ based on race and season. The objectives of this study were to investigate season- and race-specific disparities for asthma risk, and to identify environmental exposure variables associated with ED visits among more than 42,000 individuals of African American (AA) and European American (EA) descent identified through electronic health records (EHRs). METHODS: We examined data from 42,375 individuals (AAs = 14,491, EAs = 27,884) identified in EHRs. We considered associated demographic (race, age, gender, insurance), clinical (smoking status, ED visits, FEV1%), and environmental exposures data (mold, pollen, and pollutants). Machine learning techniques, including random forest (RF), extreme gradient boosting (XGB), and decision tree (DT) were used to build and identify race- and -season-specific predictive models for asthma ED visits. RESULTS: Significant differences in ED visits and FEV1% among AAs and EAs were identified. ED visits by AAs was 32.0% higher than EAs and AAs had 6.4% lower FEV1% value than EAs. XGB model was used to accurately classify asthma patients visiting ED into AAs and EAs. Pollen factor and pollution (PM2.5, PM10) were the key variables for asthma in AAs and EAs, respectively. Age and cigarette smoking increase asthma risk independent of seasons. CONCLUSIONS: In this study, we observed racial and season-specific disparities between AAs and EAs asthmatics for ED visit and FEV1% severity, suggesting the need to address asthma disparities through key predictors including socio-economic status, particulate matter, and mold.

Incorporating Patients' Values and Preferences Into Decision Making About Transplantation of HCV-Naïve Recipients With Kidneys From HCV-Viremic Donors: A Feasibility Study.

Introduction. While use of (hepatitis C virus) HCV-viremic kidneys may result in net benefit for the average end-stage kidney disease (ESKD) patient awaiting transplantation, patients may have different values for ESKD-related health states. Thus, the best decision for any individual may be different depending on the balance of these factors. Our objective was to explore the feasibility of sampling health utilities from hemodialysis patients in order to perform patient-specific decision analyses considering various transplantation strategies. Study Design. We assessed utilities on a convenience sample of hemodialysis patients for health states including hemodialysis, and transplantation with either an HCV-uninfected kidney or an HCV-viremic kidney. We performed patient-specific decision analyses using each patient's age, race, gender, dialysis vintage, and utilities. We used a Markov state transition model considering strategies of continuing hemodialysis, transplantation with an HCV-unexposed kidney, and transplantation with an HCV-viremic kidney and HCV treatment. We interviewed 63 ESKD patients from four dialysis centers (Dialysis Clinic Inc., DCI) in the Cincinnati metropolitan area. Results. Utilities for ESKD-related health states varied widely from patient to patient. Mean values were highest for -transplantation with an HCV-uninfected kidney (0.89, SD: 0.18), and were 0.825 (SD: 0.231) and 0.755 (SD: 0.282), respectively, for hemodialysis and transplantation with an HCV-viremic kidney. Patient-specific decision analyses indicated 37 (59%) of the 63 ESKD patients in the cohort would have a net gain in quality-adjusted life years from transplantation of an HCV-viremic kidney, while 26 would have a net loss. Conclusions. It is feasible to gather dialysis patients' health state utilities and perform personalized decision analyses. This approach could be used in the future to guide shared decision-making discussions about transplantation strategies for ESKD patients.

Automated Tool for Health Utility Assessments: The Gambler II.

Background. The Gambler II is a web-based utility assessment tool supporting visual analogue scale (VAS), standard gamble (SG), and time trade-off (TTO) utility assessments. It contains novel features, including an easy to use project development authoring tool and use of multimedia clips for health state descriptions. Objectives. Evaluate the usability and understandability of the patient-facing side of The Gambler. Investigate the feasibility of using The Gambler and evaluate its impact on patient knowledge regarding the relevant health states. Materials and Methods. We used The Gambler to assess utilities on a convenience sample of 55 users for common long-term complications of type 2 diabetes mellitus: diabetic neuropathy, diabetic retinopathy, and diabetic foot infection requiring transmetatarsal amputation. Using VAS, SG, and TTO, we collected metadata, such as time spent on each assessment and the entire assessment process. We evaluated usability with an adaptation of the System Usability Scale survey and understandability. We evaluated impact on knowledge gained through knowledge assessments about these complications before and after use of The Gambler. Results. Overall satisfaction with The Gambler was high, 4.02 on a 5-point scale. Usability rated highly at 84.93 on a normalized scale between 0 and 100. Knowledge scores increased significantly following use of The Gambler from pretest mean of 68% to posttest mean of 76% (P < 0.01). Average time using the software: ∼7½ minutes. Conclusions. The Gambler is an easy to use and understand computer-based tool for utility assessment. It is feasible to use within clinical encounters to support shared decision making, and it has unique features that make it a powerful tool for investigators interested in research on health utilities.

Use and effectiveness of commercial flit-spray insecticides in control of mosquito population in Sagamu, Southwest Nigeria.

INTRODUCTION: Control of mosquito vector is crucial to reducing the burden of malaria in endemic region. In the present study, we investigated the use of commercial insecticides in families and their effectiveness in control of mosquito population in Sagamu, southwest Nigeria. MATERIALS AND METHODS: A pretested structured questionnaire was used to determine mosquito adulticides techniques employed in the community and most commonly used adulticides were evaluated for effectiveness by exposing adult mosquitoes to varying concentrations of the insecticides and responses monitored. RESULTS: Families differ in methods adopted to prevent mosquito and use of flit-spray insecticide was commoner. Although parents constitute 64% of those applying the insecticide, 22.2% were children. Household pyrethroid insecticide products of Baygon (Imiprothrin, Prallethrin plus Cyfluthrin), Mobil (Neopynamin, Prallethrin plus Cyphenothrin) and Raid (Pynamin forte, Neopynamin plus Deltimethrin) were three commonly used in the community. The exposure tie interval for eath of osquitoes was shorter with Raid (100% at 8 minutes) when compared with Mobil (80%) and Baygon (85%) at 10 minutes (p = 0.005). Kaplan-Meier survival curve of cumulative probability of surviving exposure to insecticide was lowest with Raid (log rank 2 = 14.56, P = 0.001). CONCLUSION: Although flit-spray insecticides are affordable with simple application tool, inexplicit use-instruction on labels may cause discrepancies in application. Monitoring responses of mosquitoes to commercial flit-spray insecticide may support effective control technique and prevention of vector resistance in poor resource communities.

The reported preparedness and disposition by students in a Nigerian university towards the use of information technology for medical education.

BACKGROUND: The computer and information technology (IT) revolution have transformed modern health care systems in the areas of communication, storage, retrieval of medical information and teaching, but little is known about IT skill and use in most developing nations. OBJECTIVES: The aim of this study has been to evaluate the reported preparedness and disposition by medical students in a Nigerian university toward the use of IT for medical education. METHODS: A self-administered structured questionnaire containing 24 items was used to obtain information from medical students in the University of Ilorin, Nigeria on their level of computer usage, knowledge of computer software and hardware, availability and access to computer, possession of personal computer and e-mail address, preferred method of medical education and the use of computer as a supplement to medical education. RESULTS: Out of 479 medical students, 179 (37.4%) had basic computer skills, 209 (43.6%) had intermediate skills and 58(12.1%) had advanced computer skills. Three hundred and thirty (68.9%) have access to computer and 451(94.2%) have e-mail addresses. For medical teaching, majority (83.09%), preferred live lecture, 56.78% lecture videos, 35.1% lecture handout on web site and 410 (85.6%) wants computer as a supplement to live lectures. Less than half (39.5%) wants laptop acquisition to be mandatory. Students with advanced computer skills were well prepared and disposed to IT than those with basic computer skill. CONCLUSION: The findings revealed that the medical students with advanced computer skills were well prepared and disposed to IT based medical education. Therefore, high level of computer skill is required for them to be prepared and favorably disposed to IT based medical education.

Awareness and knowledge of eye care providers among government workers in Ilorin, Nigeria.

OBJECTIVES: Often the public cannot differentiate among eye care providers with adverse effect on ocular health. This is to ascertain awareness and knowledge of Nigerian public workers about eye care providers. METHODS: Structured self administered questionnaire on respondents' socio-demography, awareness and knowledge about eye care providers was distributed to 500 consenting public workers in Ilorin, Nigeria. RESULTS: Four hundred and fifty one respondents, aged 20 to 57 years comprising 213 (50.8%) men and 206 (49.2%) women participated. Majority 348 (87.9%) had tertiary education while the remaining had at least primary education. Most respondents 392 (88.9%) were aware of the availability of eye care providers while 49 (11.1%) were unaware. Based on their knowledge of the eye care providers, three categories of respondents emerged: majority had correct perception, some had wrong perception and some knew nothing about eye care providers. The level of education was found to be significantly associated with the level of awareness and knowledge of the respondents (p< 0.05) while gender was not (p>0.05). CONCLUSION: Despite the majority of the respondents having good perception of eye care providers, the respondents who had wrong perception and those who were oblivious of eye care providers could be draw backs to eye health care.

Ophthalmology training in Nigeria: the trainee ophthalmologists' perspective.

OBJECTIVE: To know the perspective of trainee Ophthalmologists on the present state of Ophthalmology training in Nigeria. MATERIALS AND METHODS: Semi structured questionnaires were administered on trainee ophthalmologists from 13 different training centres across Nigeria during revision courses and Fellowship examination in year 2004. Included were age, sex, training levels and number of year in training. Also assessed were information on acquisition of theoretical knowledge, surgical and managerial skills as well as availability of relevant ophthalmic resource materials and equipment in their training institutions. Suggestions on the ways to improve the training in Nigeria were also noted. RESULTS: There were 51 trainees with ages ranging from 29 to 51 years, with a mean of 34.65 (S.D+4.76) year. The male to female ratio was 1.6:1. There were 18 (36%) senior registrars, 31 (62%) registrars and 1 (2%) senior house officer. The period spent in training varied from 2 months to 10 years with a mean of. 3.6 years (S.D+2.2). Acquisition of theoretical knowledge was judged to be adequate by 48 (98%) of trainees. Also acquisition of surgical and managerial skills as well as availability of qualitative ophthalmic resource material were judged to be adequate by 35 (68.7%), 40 (81.6%) and 38 (74.5%) trainees respectively. Suggestions among others include improvement in quantity and quality of ophthalmic resource materials, high volume ophthalmic surgery to aid surgical skill acquisition and structured training programme. CONCLUSION: Ophthalmology training in Nigeria offers adequate theoretical knowledge and managerial skills acquisition. However, there is the need for further improvement in the area of surgical and diagnostic skills transfer and acquisition as well as availability of quality ophthalmic resources and a well-structured training programme in all the centres.

Chemical eye injuries: presentation and management difficulties.

BACKGROUND/PURPOSE: To review the pattern of presentation and management difficulty of patients with ocular chemical bums. METHOD: Retrospective study of all patients with ocular burns seen over 8-year period (March 1998-April 2006) in the eye clinic as well as the plastic and reconstructive surgery unit of our hospital. Case files were retrieved and relevant information extracted and analyzed. RESULTS: There were a total of 23 patients (n=33 eyes) seen in the period under review consisting of 19 males and 4 females. The age ranged from 6-52 years with mean age of 31.87years. The chemical injuries were accidental in 73.9% of the cases and of these 76.5% were work related. The remaining 26.1% resulting from assault were bilateral and led to blindness in all the patients. Main injurious agents were acid and alkali. CONCLUSION: Major cause of chemical injury was work related; although blindness and disability occurred more in the cases of assault. Occupational health issues need a revisit, preparedness of health institutions to take adequate care of people with ocular burns is presently poor.

The choice of ophthalmology as a career among Nigerian medical interns.

To determine the choice of ophthalmology as a career among Nigerian medical interns, structured questionnaire was administered to a set of medical interns at the University of Ilorin Teaching Hospital (UITH), Ilorin, Kwara State in the year 2003. The key information sought included the University attended, duration of undergraduate ophthalmology posting, perception of ophthalmology as a specialty, and the choice of postgraduate specialty in order of preference. Also included were improvements they would like to see in the undergraduate teaching of ophthalmology and whether they support the view that interns should have mandatory clinical rotation in other surgical subspecialties like Ophthalmology and Otorhinolaryngology. Seventy-six interns who graduated from seven Nigerian medical schools participated in the study. Average duration of their undergraduate posting in Ophthalmology was 4 weeks. (SD = 3.327). Fifty (67.6%) considered Ophthalmology as an interesting and important specialty, 6 (8.1%) regarded it as a boring specialty, while 18 (24.3%) considered it as just one specialty in their curriculum. Only 5 (6.6%) of the respondents chose Ophthalmology as first choice career while 16 (21%), 14 (18.4%), 13 (17.1%) and 10 (13.2%) chose Surgery, Paediatrics, Community Health and Obstetrics and Gynaecology respectively. 78% of the respondent suggested that interns should have clinical rotation in surgical subspecialties such as Ophthalmology. Other suggestions offered included the need to increase the duration of undergraduate Ophthalmology posting, provision of audiovisual aids and more equipment like Ophthalmoscope for teaching. The interns considered Ophthalmology posting as an important and interesting specialty even though only a few chose it as their future career. There is therefore an urgent need to improve the undergraduate teaching of Ophthalmology. The Medical and Dental Council of Nigeria (MDCN) should make rotation through Ophthalmology a part of the internship curriculum. These measures may increase the interest of medical students and interns alike in Ophthalmology as a career.