Health-Related Quality of Life and Its Determinants Among Hypertensive Patients in Rural Southwest Nigeria.

BACKGROUND: The health-related quality of life (HRQOL) of patients with hypertension is of particular concern to stakeholders because hypertension is a chronic disease. OBJECTIVES: To determine the pattern of HRQOL and its determinants among hypertensive patients in rural Southwestern Nigeria. SUBJECTS, MATERIALS AND METHODS: Ahospital-based crosssectional survey was conducted between June and October 2019 on 390 consented adult patients with hypertension on follow-up using systematic sampling technique. Respondents'blood pressure (BP), body mass index (BMI), waist circumference (WC), waist-hip ratio (W-HR) and other measurements were taken. Relevant data on socio-demographics and lifestyle behaviours were collected using an interviewer-administered questionnaire which incorporated validated instrument for assessment of HRQOL score using SF-12 survey. The data were analyzed using SPSS (version 21). Binary logistic regression was used to identify the determinants of HRQOL. RESULTS: The mean physical component summary (42.0 ± 8.44), mental component summary (40.6 ± 8.11), and mean overall quality of life score (41.3 ± 8.17) were all below the normal score of 50 ±10. However, of all the eight domains, the role emotional was the highest (47.61 ± 14.97). The odds of having overall good HRQOL were better with respondents with female gender (AOR=1.99, 95% CI: 1.05-3.88), tertiary education (AOR=3.22, 95% CI: 1.63-7.20), and controlled BP (AOR=3.01,95% CI: 1.04-15.79). CONCLUSION: The mean HRQOLscore of the respondents was below the mean score. The findings of this study would assist stakeholders in decision-making towards improved management of patients with hypertension.

CONTEXTE: La qualité de vie liée à la santé (HRQOL) des patients hypertendus est une préoccupation particulière pour les parties prenantes car l'hypertension est une maladie chronique. OBJECTIFS: Déterminer le modèle de la HRQOL et ses déterminants chez les patients hypertendus en milieu rural du sud-ouest du Nigéria. SUJETS, MATÉRIAUX ET MÉTHODES: Une enquête transversale hospitalière a été menée entre juin et octobre 2019 sur 390 patients adultes atteints d'hypertension en suivi, consentis, en utilisant une technique d'échantillonnage systématique. La pression artérielle (PA), l'indice de masse corporelle (IMC), la circonférence de la taille (CT), le rapport taillehanche (W-HR) et d'autres mesures ont été prises chez les répondants. Les données pertinentes sur les caractéristiques sociodémographiques et les comportements liés au mode de vie ont été collectées à l'aide d'un questionnaire administré par un enquêteur, intégrant un instrument validé pour l'évaluation du score HRQOL à l'aide de l'enquête SF-12. Les données ont été analysées à l'aide de SPSS (version 21). La régression logistique binaire a été utilisée pour identifier les déterminants de la HRQOL. RÉSULTATS: Le résumé de la composante physique (42,0 ± 8,44), la composante mentale (40,6 ± 8,11) et le score moyen de qualité de vie global (41,3 ± 8,17) étaient tous en dessous du score normal de 50 ± 10. Cependant, de tous les huit domaines, le rôle émotionnel était le plus élevé (47,61 ± 14,97). Les chances d'avoir une HRQOL globale satisfaisante étaient meilleures chez les répondants de sexe féminin (AOR=1,99, IC à 95 % : 1,05-3,88), ayant une éducation tertiaire (AOR=3,22, IC à 95 % : 1,63-7,20) et une PAcontrôlée (AOR=3,01, IC à 95 % : 1,04-15,79). CONCLUSION: Le score moyen de HRQOL des répondants était en dessous du score moyen. Les résultats de cette étude aideront les parties prenantes dans la prise de décision en vue d'une meilleure gestion des patients hypertendus. Mots-clés: Qualité de vie globale, Déterminants, Hypertension, Nigéria rural.

Effect of an Antidepressant on Medication Adherence among Type 2 Diabetic Patients with Depression Accessing Care in GOPC of FETHI.

Comorbid depression among diabetes mellitus (DM) patients is on the increase. This has been linked with poor glycaemic control, greater risk of complications, high burden of medical cost and health care utilisation, and worsening prevalence of other comorbidities resulting in decreased life expectancy. This study determined the antidepressant effect of amitriptyline on depression and glycaemic control among the depressed type 2 DM patients attending Federal Teaching Hospital, Ido-Ekiti (FETHI), Nigeria. It was an interventional study involving 51 depressed type 2 DM patients randomly screened using Patient Health Questionnaire-9 (PHQ-9). They had health education and oral amitriptyline 50mg at night for two months. Postintervention assessment was done using the same tool. Respondents' age ranged between 44 and 78 years with a mean age of 58±8.4 years. Post-intervention assessment showed improved depressive symptoms; 50% of the respondents had significantly improved glycaemic control with a statistically significant effect on depression (the median score of PHQ-9 reduced from 6.0 to 3.0).

La dépression comorbide chez les diabétiques est en augmentation. Elle a été associée à un mauvais contrôle de la glycémie, à un risque accru de complications, à une charge élevée en termes de coûts médicaux et d'utilisation des soins de santé, ainsi qu'à un taux de mortalité plus élevé chez les personnes souffrant de comorbidité. Cette étude a déterminé l'effet de l'antidépresseur (Amitriptyline) sur la dépression et le contrôle de la glycémie chez les patients dépressifs atteints de diabète de type 2 qui fréquentent l'hôpital universitaire fédéral d'Ido-Ekiti (FETHI). Il s'agit d'une étude interventionnelle portant sur 51 patients atteints de diabète de type 2 et déprimés, sélectionnés au hasard à l'aide du questionnaire sur la santé des patients 9 (PHQ-9). Ils ont bénéficié d'une éducation à la santé et ont pris 50 mg d'amitriptyline par voie orale pendant deux mois. L'évaluation post-intervention a été réalisée à l'aide du même outil. L'âge des personnes interrogées était compris entre 44 et 78 ans, avec un âge moyen de 58± 8,4 ans. L'évaluation postintervention a montré une amélioration des symptômes dépressifs, 50% des personnes interrogées ont eu un contrôle glycémique significativement amélioré avec un effet statistiquement significatif sur la dépression (le score médian du PHQ est passé de 6,0 à 3,0). Mots clés: Diabète sucré, dépression, contrôle glycémique, observance thérapeutique.

Pattern and awareness of complementary and alternative medicine usage for otorhinolaryngological problems among residents in Ekiti State.

Background: The use of complementary and alternative medicine (CAM) in the treatment of various ailments globally has called for more research. Aim: This study aimed to draw the attention of the stakeholders to the prevalence, pattern and awareness of CAM usage in otorhinolaryngological ailments and the need to safeguard the health of CAM users in Ekiti state, south - west Nigeria. Patients and Methods: This is a cross sectional descriptive study carried out over a 12-month period (January to December, 2019) among consented patients that attended ear, nose, and Throat (ENT) clinics in two tertiary health institutions in Ekiti state. All the participants are aged 18 years and above. A self-administered semi structured questionnaire was used to collect data from our respondents. Results: A total of 148 respondents were analyzed comprising of 56 (37.8%) males and 92 (62.2%) females given a male to female ratio of 1:1.6. Their age ranged from 20-79 years with a mean of 48.03 ± 15.11 SD. The highest response was in the age group 40-49 years representing 30.4% of the respondents. About half (51.4%) of our respondents were aware of the use of CAM for throat-related conditions. Few of the respondents (18.9%) are currently using CAM. About 33.1% of our respondents were satisfied with CAM. Only 4 (2.7%) of them experienced side effects to the use of CAM. For ear-related problems, Anointing/Olive (Olea europaea) oil was most commonly used in 34.5% of our respondents; Effinrin (Ocimum gratissimum), a local herb was commonly used in 29.7% for nose and local gin in 37.2% of our respondents for throat problems. Majority of them 44 (29.7%) got information about the various agents used through Vendors/traditional health practitioner. Conclusion: This study showed that the prevalent of CAM usage in ORL is quite low in our setting, which represent about one-fifth of the respondents. Although respondents claimed that the system was efficacious, awareness to its usage was very low and there was no evidence to prove that the diagnosis were known before using CAM. The use of Orthodox method in treating Otorhinolaryngological ailments is still the best. We therefore recommend empirical studies on CAM in future.

Attitude, practice orientation, benefits and barriers towards health research and publications among medical practitioners in Abia State, Nigeria: A cross-sectional study.

BACKGROUND: Health research is an essential component of medical training, education, and practice and is fundamental in establishing the scientific basis of health care. Aim: The study was aimed at describing the attitude, practice, benefits, and barriers towards health research and publications in a cross-section of medical practitioners in Abia State, Nigeria. MATERIALS AND METHODS: This was a cross-sectional descriptive study carried out on 210 medical practitioners in Abia State. Data collection was done using pretested, self-administered questionnaire that elicited information on attitude, practice, benefits, and barriers toward health research. Awareness of research misconduct, types of published research articles, and factors considered in selection of journals for publication of research were also studied. RESULTS: The age of the participants ranged from 26 to 77 years. There were 173 (82.4%) men. The overall attitude toward research was moderate (x = 5.02 ± 0.96). All the respondents (100%) were involved in undergraduate research projects while 72 (34.3%) had at least one journal publication with the most commonly published articles being descriptive studies. The commonest barriers to research were financial and time constraints while the greatest benefits of research were advancement of medical knowledge and keeping practitioners abreast with evidence-based medicine. The commonest research misconduct was plagiarism while the most common factor considered in selection of journals for publication was article publication charges. Middle age group and years of practice more than 10 years were significantly associated with publication of journal articles (P < 0.05). CONCLUSION: This study has shown that the study participants had moderate positive attitude toward research with all the participants previously involved in undergraduate research and only one third had at least one journal publications. The commonest barriers were financial and time constraints and greatest benefits of health research was advancement of medical knowledge and keeping practitioners abreast with evidence-based medicine. Choice of journal for publications is preeminently determined by article publication charges. The most common article published and research misconduct was descriptive studies and plagiarism, respectively.

Characterisation of phenolic components present in raw and roasted wattle (Acacia victoriae Bentham) seeds.

The effect of roasting on the phenolic components of Australian wattle (Acacia victoriae Bentham) seed was investigated. Wattle seeds were roasted at 200°C for 5-30min and ground to flour, which were then extracted with 70% acetone. The total phenolic and flavonoid contents of the extracts were determined, and the phenolic components were analysed by reverse phase-high performance liquid chromatography (RP-HPLC) coupled with an on-line post-column reaction system to determine the active antioxidant peaks. The major peaks were then purified by preparative HPLC and identified by gas chromatography-mass spectrometry (GC-MS) analysis. Roasting of wattle seeds resulted in significant increases in its soluble phenolic content. The concentration of total phenolics and flavonoids in the seeds roasted for 30min was more than nine and four times higher, respectively, than that in the raw seeds. The major phenolic acids present in wattle seeds were found to be succinic and gallic acids, the concentration of which increased by up to 10-fold as a result of roasting.

Glycosylation, amino acid analysis and kinetic properties of a major Kunitz-type trypsin inhibitor from Acacia victoriae Bentham seeds.

An Acacia victoriae trypsin inhibitor (AvTI) was purified from the seeds of prickly wattle (A. victoriae Bentham) by salt precipitation, ion-exchange and gel filtration chromatography, and its degree of glycosylation, amino acid composition, and kinetic properties were determined. Gel electrophoresis revealed at least four glycoprotein bands in the crude extract, salt-precipitated and ion-exchange protein fractions, while the purified AvTI showed only one band and a degree of glycosylation of 2.06%. Glutamate (13.3%), aspartate (10.3%), leucine (7.62%) and lysine (7.01%) were the major amino acids in AvTI while the contents of sulphur-containing amino acids, cysteine (1.38%) and methionine (0.75%), as well as of tryptophan (1.17%) were low. Its dissociation constant (Ki) for the inhibition of bovine trypsin was found to be 1.06×10(-8)M, indicating a high affinity between AvTI and this enzyme, and its role as a competitive inhibitor was confirmed by a double reciprocal plot. These results complement our earlier studies which indicated the presence of three isoforms of this Kunitz-type trypsin inhibitor in prickly wattle seed.

Relapse prevention in UK Stop Smoking Services: current practice, systematic reviews of effectiveness and cost-effectiveness analysis.

BACKGROUND: Reducing smoking is a chief priority for governments and health systems like the UK National Health Service (NHS). The UK has implemented a comprehensive tobacco control strategy involving a combination of population tobacco control interventions combined with treatment for dependent smokers through a national network of NHS Stop Smoking Services (NHS SSS). OBJECTIVES: To assess the effectiveness and cost-effectiveness of relapse prevention in NHS SSS. To (1) update current estimates of effectiveness on interventions for preventing relapse to smoking; (2) examine studies that provide findings that are generalisable to NHS SSS, and which test interventions that might be acceptable to introduce within the NHS; and (3) determine the cost-effectiveness of those relapse preventions interventions (RPIs) that could potentially be delivered by the NHS SSS. DATA SOURCES: A systematic review of the literature and economic evaluation were carried out. In addition to searching the Cochrane Tobacco Addiction Group register of trials (2004 to July 2008), MEDLINE, the Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, the Science Citation Index and Social Science Citation Index were also searched. REVIEW METHODS: The project was divided into four distinct phases with different methodologies: qualitative research with a convenience sample of NHS SSS managers; a systematic review investigation the efficacy of RPIs; a cost-effectiveness analysis; and a further systematic review to derive the relapse curves for smokers receiving evidence-based treatment of the type delivered by the NHS SSS. RESULTS: Qualitative research with 16 NHS SSS managers indicated that there was no shared understanding of what relapse prevention meant or of the kinds of interventions that should be used for this. The systematic review included 36 studies that randomised and delivered interventions to abstainers. 'Self-help' behavioural interventions delivered to abstainers who had achieved abstinence unaided were effective for preventing relapse to smoking at long-term follow-up [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.15 to 2.01]. The following pharmacotherapies were also effective as RPIs after their successful use as cessation treatments: bupropion at long-term follow-up (pooled OR 1.49, 95% CI 1.10 to 2.01); nicotine replacement therapy (NRT) at medium- (pooled OR 1.56, 95% CI 1.16 to 2.11) and long-term follow-ups (pooled OR 1.33, 95% CI 1.08 to 1.63) and one trial of varenicline also indicated effectiveness. The health economic analysis found that RPIs are highly cost-effective. Compared with 'no intervention'; using bupropion resulted in an incremental quality-adjusted life-year (QALY) increase of 0.07, with a concurrent NHS cost saving of 68 pounds; for NRT, spending 12 pounds resulted in a 0.04 incremental QALY increase; varenicline resulted in a similar QALY increase as NRT, but at almost seven times the cost. Extensive sensitivity analyses demonstrated that cost-effectiveness ratios were more sensitive to variations in effectiveness than cost and that for bupropion and NRT, cost-effectiveness generally remained. Varenicline also demonstrated cost-effectiveness at a 'willingness-to-pay' threshold of 20,000 pounds per QALY, but exceeded this when inputted values for potential effectiveness were at the lower end of the range explored. For all drugs, there was substantial relapse to smoking after treatment courses had finished. Quit attempts involving NRT appeared to have the highest early relapse rates, when trial participants would be expected to still be on treatment, but for those involving bupropion and varenicline little relapse was apparent during this time. LIMITATIONS: The qualitative research sample was small. CONCLUSIONS: Based on the totality of evidence, RPIs are expected to be effective and cost-effective if incorporated into routine treatment within the NHS SSS. While staff within the NHS SSS were largely favourably inclined towards providing RPIs, guidance would be needed to encourage the adoption of the most effective RPIs, as would incentives that focused on the importance of sustaining quit attempts beyond the currently monitored 4-week targets.

Isolation, characterization, and emulsifying properties of wattle seed (Acacia victoriae Bentham) extracts.

Extracts from either ground whole wattle seeds or uncoated cotyledons were obtained using water, alkali, or ethanol. These extracts were then analyzed for their protein molecular weight and electrophoretic profiles using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and capillary electrophoresis, respectively. Water extracts and those from the cotyledons gave higher material yield and contained significantly more proteins than other extracts. Furthermore, the proteins ranged in molecular weight from 6 to 92 kDa, with the highest concentration between 27 and 61 kDa. Water extracts, even at very low protein concentrations (0.17-1.12%), formed stable emulsions, containing up to 50% canola oil, and these emulsions were affected by pH (4-9), ionic strength (0.25-1% NaCl), and retorting (115 degrees C for 30 min). The study showed that water-soluble wattle extracts have great potential as emulsifiers and stabilizers for the food industry, especially at low pH levels.