Burden of depressive symptoms and non-alcohol substance abuse; and their association with alcohol use and partner violence: a cross-sectional study in four sub-Saharan Africa countries.

In sub-Saharan Africa, there are limited data on burden of non-alcohol substance abuse (NAS) and depressive symptoms (DS), yet potential risk factors such as alcohol and intimate partner violence (IPV) are common and NAS abuse may be the rise. The aim of this study was to measure the burden of DS and NAS abuse, and determine whether alcohol use and IPV are associated with DS and/or NAS abuse. We conducted a cross-sectional study at five sites in four countries: Nigeria (nurses), South Africa (teachers), Tanzania (teachers) and two sites in Uganda (rural and peri-urban residents). Participants were selected by simple random sampling from a sampling frame at each of the study sites. We used a standardized tool to collect data on demographics, alcohol use and NAS use, IPV and DS and calculated prevalence ratios (PR). We enrolled 1415 respondents and of these 34.6% were male. DS occurred among 383 (32.3%) and NAS use among 52 (4.3%). In the multivariable analysis, being female (PR  =  1.49, p  =  0.008), NAS abuse (PR  =  2.06, p  =  0.02) and IPV (PR  =  2.93, p < 0.001) were significantly associated with DS. Older age [odds ratio (OR) = 0.31, p < 0.001)], female (OR = 0.48, p  =  0.036) were protective of NAS but current smokers (OR = 2.98, p < 0.001) and those reporting IPV (OR  =  2.16, p  =  0.024) were more likely to use NAS. Longitudinal studies should be done to establish temporal relationships with these risk factors to provide basis for interventions.

Internalized HIV stigma, bullying, major depressive disorder, and high-risk suicidality among HIV-positive adolescents in rural Uganda.

BACKGROUND: Studies conducted in sub-Saharan Africa suggest a high prevalence of depression and suicidality among adolescents living with HIV (ALWH). This is an important public health issue because depression is known to compromise HIV treatment adherence. However, the drivers of depression and suicidality in this population are unclear. We conducted a cross-sectional study to estimate the associations between internalized stigma, bullying, major depressive disorder, and suicidality. METHODS: We conducted a cross-sectional survey between November 2016 and March 2017, enrolling a consecutive sample of 224 ALWH aged 13-17 years. We collected information on demographic characteristics, internalized HIV-related stigma (using the six-item Internalized AIDS-Related Stigma Scale), bullying victimization (using the nine-item Social and Health Assessment Peer Victimization Scale), major depressive disorder [using the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID)], and suicidality (also using the MINI-KID). We fitted multivariable logistic regression models to estimate the associations between stigma, bullying, major depressive disorder, and suicidality. RESULTS: Thirty-seven participants (16%) had major depressive disorder, 30 (13%) had suicidality, and nine (4%) had high-risk suicidality. Ninety-one participants (41%) had high levels of internalized stigma, while 97 (43%) reported two or more bullying events in the past year. In multivariable logistic regression models, major depressive disorder had a statistically significant association with bullying (AOR = 1.09; 95% CI 1.00-1.20; p = 0.04); while suicidality (low, moderate, high risk) had statistically significant associations with both bullying (AOR = 1.09; 95% CI 1.01-1.17; p = 0.02) and stigma (AOR = 1.30; 95% CI 1.03-1.30; p = 0.02). CONCLUSIONS: Among ALWH in rural Uganda, stigma and bullying are strongly associated with major depressive disorder and suicidality. There is a need to incorporate psychological interventions in the mainstream HIV care to address these challenges for optimal management of HIV among ALWH.

A British Ophthalmological Surveillance Unit Study on metastatic endogenous endophthalmitis.

PurposeEndogenous endophthalmitis (EE) is a rare but serious ocular infection caused by the seeding of bacteria into the eye from a source elsewhere in the body. Studies suggest that EE accounts for 2 to 8% of all endophthalmitis.MethodsA prospective observational study was conducted using the British Ophthalmological Surveillance Unit reporting system. Questionnaires were sent to reporting Ophthalmologists in the UK to assess incidence, underlying aetiology, eye findings, management, and final outcomes in endogenous endophthalmitis over a 12-month period within the British Isles.ResultsSixty two cases reported with 48 initial questionnaires returned and 25 6-month follow-up questionnaires returned. The median age of patients affected was 57 years with youngest aged 2 years and oldest aged 85 years. Twenty three were male and 24 were female. The median visual acuity in the affected eye was 3 logMAR (range -0.1 to 5). Blood cultures were taken in 36 patients, 58% of which were positive. Vitreous biopsy was taken in 35 patients, 23% of which were culture positive. The visual function as assessed by visual acuity had significantly improved at 6 months with a median acuity of 0.18 logMAR (P=0.003).ConclusionsThe survey demonstrates the severe nature of endogenous endophthalmitis in patients with active infection or with risk factors for infection. Our study has demonstrated that at least half of the patients who were treated had significant vision improvement.

Equitable Access to Health Professional Training in Uganda: A Cross Sectional Study.

OBJECTIVE: We set out to assess inequalities to access health professional education, and the impact of an education improvement program supported by MEPI (Medical Education Partnership Initiative). Inequalities in the higher education system in sub-Saharan Africa remain despite some transformative policies and affirmative action. METHODS: We reviewed enrollment data from four universities for the period 2001-2014 for various health professional training programs, and conducted group discussions through an iterative process with selected stakeholders, and including a group of education experts. Two time periods, 2001-2010 and 2011-2014, were considered. In 2010-11, the MEPI education program began. Gender ratios, regional representation, secondary schools, and the number of admissions by university and year were analysed. We used SPSS version 17 software to analyse these data with level of significance p < 0.05. We collated qualitative data along predetermined and emerging themes. RESULTS: The overall male-to-female ratio among the student population was 2.3:1. In total, there were 7,023 admissions, 4,403 between 2001-2010 (440 per annum) and 2,620 between 2011-2014 (655 per annum) with p = 0.018. There were no significant increases in admissions in the central and western regions over the two time periods, 1,708 to 849 and 1,113 to 867 respectively, both p = 0.713 and p = 0.253. We propose improving the university admission criteria and increasing enrollment to health professions training schools. CONCLUSION: There were significant inequalities for higher education training in Uganda by gender, regional representation and school attended. Modifying the admission criteria and increasing enrollment may reduce these inequalities.

Multidisciplinary leadership training for undergraduate health science students may improve Ugandan healthcare

Background. Community-based education research and service (COBERS) is a platform for embedding progressive transformative leadership and research-related medical education in Uganda. The leadership development programme (LDP) developed at Mbarara University of Science and Technology (MUST); Uganda is a key component of COBERS. Health science students at MUST are equipped by means of the LDP with leadership knowledge and skills; and a positive attitude towards leadership and rural communities. The programme involves employing interactive learner-centred education techniques; with the opportunity to implement these skills in a community setting immediately after the training.Objective. To assess the students' self-reported perception and effectiveness of the precommunity placement LDP at MUST and its impact during the community clinical placement; and to measure the self-reported improvement of students' knowledge and their application of leadership skills in the community. The results of the evaluation will improve and build on this educational programme. The study also evaluated the effectiveness of the preplacement leadership training course for undergraduates at MUST; as reported by students.Methods. The programme evaluation of the LDP used quantitative pretest and post-test measures and qualitative data from focus group discussionsto enrich the evaluation. Data were collected from students before and after the 1-week leadership training course using the same self-administered questionnaire. Variables were then compared to evaluate the impact of the LDP.Results. Prior to the intervention; only 14% of the participants had ever attended a leadership training session. There was significant self-reported change in the task accomplishment skills; interpersonal relationship skills and quality of leadership.Conclusion. The results suggest that the LDP may increase leadership skills among health science students to improve healthcare in Uganda. Our study recommends that this leadership programme be considered for use by Ugandan medical training faculties and similar environments elsewhere

Comparing the 1CU accommodative, multifocal, and monofocal intraocular lenses: a randomized trial.

OBJECTIVE: To compare the binocular near vision performance in patients implanted with the 1CU accommodating intraocular lens (IOL) with a multifocal and monofocal IOL. DESIGN: Prospective, randomized, double-masked clinical trial. PARTICIPANTS: Ninety patients presenting for cataract surgery to the Department of Ophthalmology, Hillingdon Hospital were randomized to receive the 1CU accommodative IOL, a multifocal IOL, or a monofocal IOL (control group). METHODS: Patients underwent bilateral sequential phacoemulsification with implantation of 1 of the 3 IOL types and were assessed at 3 and 18 months after second-eye surgery. MAIN OUTCOME MEASURES: Logarithm of the minimum angle of resolution distance and near visual acuities (VAs) (unaided and distance corrected), contrast sensitivity, and accommodative amplitude (near point and defocusing) were measured at 3 and 18 months. Reading speed was assessed at 18 months, and glare symptoms and spectacle independence were compared using a standardized questionnaire. RESULTS: Mean unaided and distance-corrected binocular near VAs were similar in the 1CU and multifocal and were significantly higher than the control group's (P<0.02). There was no significant difference in reading speed between any of the groups, but critical print sizes were similar in the 1CU and multifocal groups and significantly better than the control group's (P = 0.02). The accommodative range was highest in the multifocal group and lowest in the control group, and there was no significant difference between the 1CU and control groups for defocus or near point at 18 months. Of the 1CU group and control group, 71.4% and 63.2%, respectively, experienced no glare at 18 months, compared with only 25% of the multifocal group (P = 0.01). Of the 1CU group and multifocal group, 19% and 27.3%, respectively, were completely spectacle independent at 18 months; none of the control group was (P = 0.05). CONCLUSIONS: The 1CU accommodating IOL provides improved near vision compared with a monofocal IOL. There is a discrepancy between the near function and accommodative amplitude measured in the 1CU. The multifocal provides excellent near acuity, but photopic phenomena remain a problem inherent in the lens design.

Phase II study of docetaxel in patients with liver metastases from breast cancer. UK study group.

BACKGROUND: Previous phase II studies of docetaxel have indicated that hepatic metastases from breast cancer respond well to first-line treatment with docetaxel. The objective of this prospective, open label phase II study therefore was specifically to evaluate the activity and safety of docetaxel in this indication. PATIENTS AND METHODS: The study recruited 47 women (mean age 50 years, range 33-66 years) with hepatic metastases from breast cancer who fulfilled the eligibility criteria. After premedication with steroids, patients received a one-hour intravenous infusion of docetaxel 100 mg/m2 at three-weekly intervals for up to eight cycles. Response to treatment during medication was assessed after three, six and where appropriate, eight cycles and every three month follow-up thereafter, until disease progression or death. RESULTS: The best overall response rate (ORR) for evaluable patients was 64.3% (95% CI: 48.0-78.5%). In terms of the primary efficacy parameters, the ORR at the sixth cycle of treatment was 62% (95% CI: 45%-80%) with 17% complete responses. The median duration of response was 139 days (95% CI: 111-216 days) and the median survival duration calculated on an intent-to-treat basis was 335 days (227-568 days, 95% CI). One (2%) toxic death was reported. CONCLUSIONS: Docetaxel is a highly effective cytotoxic agent in the treatment of patients with liver metastases from breast cancer.

Antibiotic beads in the treatment of diabetic pedal osteomyelitis.

Antibiotic-impregnated polymethylmethacrylate (PMMA) beads have improved the outcome of osteomyelitis treatment in both experimental models and clinical trials. The primary benefit of antibiotic-impregnated PMMA beads is that they provide high local concentrations of antibiotic while systemic levels of antibiotic remain low. Little has been written about the specific use of antibiotic-impregnated PMMA beads in the treatment of diabetic pedal osteomyelitis. The authors review antibiotic-impregnated PMMA beads and provide examples of their use in the treatment of diabetic pedal osteomyelitis.