Lifetime and 7-day alcohol consumption in the elderly, prevalence and correlates: Reports from the Ibadan Study of Aging.

INTRODUCTION: There is a dearth of information on alcohol consumption in the elderly in Africa. The aim of the study was to determine the prevalence of lifetime and 7 day alcohol consumption in a community sample of elderly Nigerians and the association of 7 day excessive alcohol consumption to several common health conditions. METHODS: Face-to-face interviews were carried out among 2,149 elderly persons aged 65 years and older, selected through a multistage stratified sampling method of households in the Yoruba-speaking areas of Nigeria (22% of Nigerian population). Using a daily inventory of drinking, lifetime and 7-day alcohol consumption estimates were derived. Excessive alcohol consumption was defined as use of more than 1 unit/day at a sitting or more than 7 units/week. Major depressive disorder was assessed with the WHO Composite International Diagnostic Interview; chronic general medical conditions were assessed by self reports. RESULTS: Majority (54.8%) of the respondents were lifetime abstainers. Past-week alcohol use was reported by 12.0% of men and 3.6% of women. Drinking rates declined with increasing age in both sexes (p < 0.05). Past week excessive alcohol consumption was less likely among persons residing in rural areas, OR = 0.41 95% CI (0.17-0.99) but more likely to be associated with chronic backache or neck pain OR = 2.04, 95% Cl, (1.0-4.59 and cognitive impairment OR=4.2, 95% CI, (1.21-15.1). CONCLUSION: Excessive consumption is relatively common among elderly males. Alcohol consumption in the elderly is associated with chronic pain, cognitive impairment and living in urban areas.

Prevalence of psychosis in tuberculosis patients and their nontuberculosis family contacts in a multidrug treatment-resistant treatment center in Nigeria.

OBJECTIVE: This study aimed at determining the prevalence of psychosis in tuberculosis (TB) patients in comparison to nontuberculosis control and its correlation with disease pattern. METHOD: One hundred and fifteen patients with TB and 112 family members visiting the multidrug treatment-resistant treatment center at University College Hospital Ibadan Centre were screened for psychological distress with the General Health Questionnaire (GHQ-12). Presence of a psychotic condition was determined by the Psychosis Screening Questionnaire and the Structured Clinical Interview for DSM-IV Axis I Disorder and was compared with severity of pulmonary TB. RESULTS: After adjusting for age, predictors of high/positive GHQ include the following: duration of TB ≥4years [odds ratio (OR)=4.02, 95% confidence interval (CI)=1.29-11.13], extrapulmonary TB (OR=3.45, 95% CI=1.02-14.11), severe disease extent (OR=5.27, 95% CI=1.05-13.01) and disease category 2 (OR=2.38, 95% CI=1.01-7.99), and predictors of psychosis are as follows: duration of TB ≥4years (OR=3.99, 95% CI=1.51-9.88), extrapulmonary TB (OR=3.88, 95% CI=1.55-9.98), severe disease extent (OR=9.55, 95% CI=2.15-18.05) and disease category 2 (OR=2.86, 95% CI=1.14-7.55). CONCLUSION: In view of high prevalence of psychological distress and psychosis in TB, care of TB patients should include consultative-liaison psychiatric care.

Quality of life in psychosis: prevalence and associated factors in a Nigerian clinical population.

Aim of the study was to assess sociodemographic and clinical determinants of quality of life in psychotic patients in a general hospital population in Nigeria. Information was obtained on demography, duration of untreated illness (DUI) and functioning among Schizophrenia (368), schizoaffective disorder (70), and 214 patients with affective psychosis. Functioning was assessed using GAF, severity of psychopathology with PANSS and quality of life using WHOQoL-BREF. In general, the differences in the QoL across the three psychotic disorders were small. Linear regression analysis, showed that high GAF p < 0.001, medication adherence, p = 0.007 were associated with good QoL in schizophrenia, low PANSS p < 0.001 and short DUI p = 0.001 in schizoaffective disorder and low PANSS, high GAF p < 0.001 respectively in affective psychosis. QoL and its determinants in psychosis are not absolutely different. More research is required in this area.

Burnout among doctors in residency training in a tertiary hospital.

The mental health of doctors is an issue of growing concern all over the world as it frequently interplays with their professional trainings and responsibilities. This study was done to determine the pattern and correlates of burnout among 204 doctors undergoing residency training. Eligible participants were interviewed using designed questionnaire, General Health Questionnaire (GHQ-12) and Maslach Burnout Inventory (MBI). The mean age of participants was 33.44±4.50. Ninety-three (45.6%) respondents reported burnout in the dimension of emotional exhaustion (EE), 118 (57.8%) in the dimension of depersonalization (D), and 126 (61.8%) in the dimension of reduced personal accomplishment (RPA). Factors that were significantly associated with all the dimensions of burnout were perceived heavy workload and presence of emotional distress (based on GHQ score of ≥3). The perception of call duty as being not stressful was negatively predictive of burnout in the emotional exhaustion subscale (odds ratio [OR]=0.52; 95%confidence interval [CI]=0.29-0.97; p=0.03), while emotional distress was a positive predictor (OR=6.97; 95%CI=3.28-14.81; p<0.001]. Absence of doctor-to-doctor conflict negatively predicted burnout in the depersonalization subscale (OR=0.36; 95%CI=0.17-0.76); p<0.01), while older age (OR=0.66; 95%CI=0.47-0.95; p=0.03) and adequate support from the management (OR=0.45; 95%CI=0.22-0.90; p=0.02) constituted negative predictors of burnout in the reduced personal accomplishment subscale. Burnout is highly prevalent among resident doctors. Evolvement of comprehensive mental health services, training supports, conflict de-escalation/resolution mechanisms, and periodic assessment are indicated to mitigate work related distress with burn out among resident doctors, while improving their productivity.

Tobacco smoking and medical co-morbidities among patients with schizophrenia in a Nigerian clinical setting.

BACKGROUND: Smoking is highly prevalent in patients living with schizophrenia and is associated with medical and psychiatric morbidities METHODS: In this descriptive, consecutive patients with schizophrenia (368) were interviewed at State Hospital Ibadan between January and December 2008. Information on demography and tobacco smoking, medication adherence and self reports of chronic common health conditions were obtained. The PANSS was used to determine level of psychopathology. Univariate associations were determined using Chi square statistics and multivariate analysis was used for further exploration of variables that were significant during univariate analysis. All analyses were performed using the SPSS (17.0). RESULTS: Prevalence of lifetime tobacco use was 198 (53.8%), current use 122 (33.1%). Current use was highest in respondents less than 25 years of age X2 = 11.8, p = 0.003 and reduced with increasing education, X2 = 21.6, p = 0.00, higher in non medication adherent patients, X2 = 19.9, p = 0.00 and was associated with health conditions such as haemopoetic diseases X2 = 6.8, p = 0.01 and respiratory diseases. Mean score of positive, negative, general psychopathology, total psychopathology subscales of PANSS were respectively significantly higher among current user, compared with abstainers, t = 6.7, p = 0.00, t = 5.1, p = 0.00, t 6.2, p.= 0.00, t 6.7, p = 0.00. Only general psychopathology subscale of PANSS, OR = 3.5, 95% CI (1.2-6.5), p = 0.02 remained associated with current tobacco use after adjusting for gender. CONCLUSION: The present study demonstrates high rate of tobacco use in patients with schizophrenia. Thus, such patients require additional screening for tobacco and tobacco cessation program.

Effects of Psychopathology, Functioning and Anti-psychotic Medication Adherence on Caregivers' Burden in Schizophrenia.

BACKGROUND: The aim of the study was to determine the effects of the level of psychopathology and anti-psychotic medication adherence on caregivers' burden in schizophrenia. MATERIALS AND METHODS: Three hundred and sixty-seven schizophrenia patient/caregiver dyads were interviewed. Caregiver's burden was assessed using the Yoruba version of the Family Burden Interview Schedule (FBIS) and 12-Item General Health Questionnaire (GHQ-12). Patients were assessed using the Global Assessment of Functioning (GAF) scale, Positive and Negative Symptoms Scale (PANSS), and medication compliance questionnaire. RESULTS: Mean age of the patients was 29.7 SD (8.6) years. About 82% of the 368 caregivers were parents of the patients with mean age of 58.1 years (SD 19.6). Total mean objective FBIS score was 22.69 (6.21), with 324 caregivers (85.3%) reporting total objective burden and 310 (84.2%) reporting subjective burden. FBIS scores were positively associated with PANSS scores but negatively with GAF P<0.001, respectively. Mean FBIS reduced with medication compliance categories A and B, P<0.01, respectively, but increased in category F, P<0.001. In all, 51.1% scored ≥3 on GHQ. CONCLUSION: Caregivers of schizophrenia patients experience enormous burden and are at risk for mental disorders. The severity of this burden is related to the level of psychopathology and medication adeherence, thereby adding to the available evidence pointing to the need for clinicians to optimize patients' management to prevent psychological distress in carers of such patients.

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.

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.

Outpatient pulmonary rehabilitation in severe chronic obstructive pulmonary disease.

OBJECTIVES: An outpatient programme for rehabilitation of patients with severe ventilatory impairment due to chronic obstructive pulmonary disease (COPD) was conducted. Its main purpose was to assess the feasibility of the programme for COPD patients. METHODS: Initial assessment included a shuttle walking test, administration of the chronic respiratory disease questionnaire (CRDQ), assessment of the hospital anxiety and depression scale (HAD) and sickness impact profile (SIP). The patients were entered into a 6-week outpatient programme between January 2007 to July 2007 during which they attended twice weekly for a 2 1/2 hour session. Assessment was repeated on completion of the study at three months and later at six months. RESULTS: The study included 44 (28 males) patients with COPD with a mean age 66 years. All patients had severe ventilatory impairment as defined by a forced expiratory volume in one second (FEV1) of less than 40% of predicted. The shuttle walking distance improved significantly and was maintained at the improved level for six months. The improvement in all four dimensions of the CRDQ was statistically significant (p < 0.05) and reached clinical significance for fatigue and for mastery. On entry, a notable level of depression was found in 32% of patients, and anxiety in 40 percent. There was a significant reduction in both of these that was maintained at six months (p < 0.05). There was no improvement in the SIP at three months, but significant improvement was found at six months (p < 0.05). CONCLUSIONS: This study shows that a successful outpatient programme can be conducted in patients with severe ventilatory impairment, and that benefits in physical ability and in health-related quality of life (HRQOL) can be achieved. The improvements were maintained at six months.

Attitudes towards community based residential care for people living with HIV/AIDS in Nigeria.

Community based care and support are important aspects of HIV/AIDS management in resource-poor African countries in view of increasing incidence of the disease and absence of a cure. A representative community sample (n = 2040) selected using a clustered stratified selection procedure was studied in Ogun, Oyo, and Osun states. A single item question which formed part of a larger survey of the stigma of mental illness was used to elicit information about the opinion of respondents regarding provision of a group home in their neighborhood for the care of persons experiencing a range of medical and social conditions which include HIV/AIDS, mental handicap, previous jail term, physical disability, mental illness, and drug abuse. Of the respondents, 906 (44.4%) were males and 1134(55.65) were females. The mean age was 43.5 (SD 19.72). Over 71% of the respondents disagreed or strongly disagreed with the location of a residential care for persons living with HIV/AIDS (PLWHA) in their neighborhood. This level of rejection was only comparable to that for drug addicts and alcoholics. PLWHA's were more likely to be rejected than ex-convicts for whom about 55% expressed rejection. Decreasing education (X2 = 32.55, p < 0.003) lower income (X2 = 21.25, p < 0.01), urban residence of the respondents (X2 = 15.11, p < 0.05) and female gender (X2 = 9.25, p < 0.05) were associated with a negative attitude to such a residential care for PLWHA. These results suggest a deep-seated prejudice against the provision of a group home for the PLWHA. A community-based enlightenment program anchored on the nature and course of HIV/AIDS should be part of a holistic management approach to the disease.