Association between psychosocial factors and co-morbid cigarette smoking and alcohol use in a population experiencing homelessness.

The prevalence of combustible cigarette smoking in populations experiencing homelessness in the United States is five times that of the general population. The psychosocial well-being of persons who smoke and experience homelessness is poorer if such persons also use alcohol heavily. The PTQ2 study was a randomized clinical trial among persons experiencing homelessness who were also current smokers and heavy alcohol consumers. Secondary data analysis of the PTQ2 baseline data was conducted to examine associations among psychosocial variables (anxiety, depression, hopelessness, social network size), heaviness of smoking (cigarettes/day) and alcohol consumption (drinking days/month), and duration and frequency of homelessness. Among the 420 participants, the majority were male (75%), black (70%) and non-Hispanic (94%) with a mean age of 46.6 years (SD = 11.6).  Bivariate analyses show that heaviness of smoking was positively correlated with social network size (r = 0.16, p = .001). Heaviness of drinking was positively correlated with the MINI anxiety score (r = 0.13, p = .009) and marijuana use (median total number of drinks in past 30 days among those who used marijuana in past 30 days vs. did not use: 50 vs. 24, p < .0001), and associated with frequency of homelessness (median total number of drinks in past 30 days among those experiencing homelessness once vs. >1 time: 30 vs. 44, p = .022). The findings highlight the psychosocial factors that warrant consideration when addressing heavy smoking and alcohol consumption in persons experiencing homelessness.

Breast cancer knowledge and screening practices among undergraduates in a Nigerian tertiary institution, Southwest Region.

Introduction: Breast cancer is the most diagnosed female malignancy in Nigeria. This study aimed to assess the knowledge and practice of breast cancer screening among female undergraduates in a tertiary institution in Southwest Nigeria. Methods: This cross-sectional study recruited 350 female undergraduates of a public university in southwest Nigeria using a multi-stage sampling method involving simple random sampling. A structured self-administered questionnaire was used for data collection. Epi info 7 was used for data analysis, level of significance was set at 5% (p<0.05). Results: The majority, 316(90.3%) had poor knowledge of breast cancer and screening and 340(97.1%) had positive attitude towards screening. Only 185(52.9%) had done breast self-examination and 16(4.6%) had done clinical breast examination. The student's year of study was significantly associated with knowledge of breast cancer (p = 0.002) Marital status (p=0.039) and attitude towards breast cancer screening (p<0.001) were significantly associated with breast self-examination. Students in their third year were 6 (2 - 16) times more likely to have good knowledge of breast cancer (Adjusted Odds Ratio 5.87, Confidence Interval 2.17 - 15.86). Conclusion: Overall knowledge and practice of breast cancer screening were poor, but students' attitude towards screening was positive. Health education on breast cancer and screening is recommended.

Text messaging promoting physician-led brief intervention tobacco cessation: A before-and-after study among physicians in three tertiary hospitals in Nigeria.

Background: Physician-led smoking cessation services are suboptimal in Nigeria. Objectives: This study evaluated a text messaging intervention designed to increase the knowledge and practices of physicians in Nigeria to help smokers quit. Methods: Using a pre-post study design, all physicians (N = 946) in 3 tertiary care hospitals located in 3 geopolitical zones in Nigeria were sent 2-3 text messages weekly over a 13-week period to create awareness and improve cessation practices using the "Ask, Advise and Refer" (AAR) model. The primary outcomes were the awareness of AAR and the proportion of physicians who offered each of the components of the brief intervention (AAR) to at least half of eligible patients. Secondary outcomes included the attitudes and self-reported effects of the messages on motivation to offer AAR to patients who smoke. Results: Of the 946 eligible respondents, only 165 responded to both the before and after intervention surveys (17.4% participation rate). Participants were more likely to indicate awareness of the AAR approach after the intervention (60%) than before (21.2%). Overall, physicians' practice of each component of the AAR changed significantly after the intervention (P < .001; McNemar test). Of the participants, 71.5% reported reading the messages most/all of the time and 84.8% reported that the frequency of the messages was just adequate. Conclusions: A brief and low-cost text messaging intervention to physicians increased the awareness and practice of AAR in those who participated in the study. However, the relatively low participation rate highlights the importance of new research to improve and expand text messaging as an intervention among physicians to help them foster tobacco treatment among their patients.

Malaria in pregnancy: A community-based study on the knowledge, perception, and prevention among Nigerian women.

BACKGROUND: Malaria accounts for approximately 1 million deaths annually and about 300,000 deaths in Nigeria alone. Pregnant women and their unborn babies are particularly vulnerable to the adverse consequences of malaria. This study assessed the knowledge, perception, and preventive practices for malaria in pregnancy (MiP) among women in Lagos, Nigeria. MATERIALS AND METHODS: A cross-sectional, descriptive study design was adopted. A total of 422 respondents were selected using multistage sampling technique. Data were collected using a structured, interviewer-administered questionnaire in the first quarter of 2016. Analysis was done with Epi Info™ 7 software with level of significance set at P < 0.05. RESULTS: All respondents were aware of MiP, and almost all the respondents (96.2%) were aware that malaria is caused by infected mosquito bite. Majority (89.3%) of the respondents registered for antenatal care in their last pregnancy, but 56.6% did so in the second trimester. A little over half (55.5%) had good knowledge of MiP. There was poor knowledge of the complications of MiP in mothers, with 27% unaware of any complications. Majority (51.6%) of them did not know the complications of malaria in the fetus. Better educated respondents had statistically significant better knowledge of MiP (P = 0.001). Only two-fifths of the respondents (39.8%) agreed that MiP can lead to death of the fetus. Most (41.9%) used insecticide spray and coils in the prevention of MiP, whereas only 36.9% used intermittent preventive treatment. Only 24.1% used insecticide-treated nets and almost 20% used no form of prevention. CONCLUSION: Respondents' knowledge, perception, and preventive practices for MiP were not satisfactory. Public health education on MiP should be intensified at the community level in order to improve knowledge and prevention and also to correct misconceptions.

Occupational exposure, attitude to HIV-positive patients and uptake of HIV counselling and testing among health care workers in a tertiary hospital in Nigeria.

Health care workers (HCWs) are at risk of occupational exposure to HIV. Their attitude to HIV-positive patients influences patients' willingness and ability to access quality care. HIV counselling and testing (HCT) services are available to inform HCWs and patients about their status. There is little information about HCT uptake and attitude to HIV-positive patients among HCWs in tertiary health facilities in Nigeria. The aim of this study was to determine occupational exposure and attitude to HIV-positive patients and level of uptake of HCT services among HCWs in a tertiary hospital in Nigeria. A cross-sectional design was utilized. A total of 977 HCWs were surveyed using semi-structured, self-administered questionnaires. Nurses and doctors comprised 78.2% of the respondents. Their mean age was 35 ± 8.4 years. Almost half, 47.0%, reported accidental exposure to blood and body fluids (BBFs) in the preceding year. The main predictor of accidental exposure to BBFs in the last year was working in a surgical department, OR = 1.7, 95% CI (1.1-2.6). HCWs aged <40 years, OR = 5.5, 95% CI (1.9-15.9), who had worked for >5 years, OR = 3.6, 95% CI (1.4-9.3) and who work in nursing department, OR = 6.8, 95% CI (1.7-27.1) were more likely to be exposed to BBFs. Almost half, 52.9%, had accessed HCT services. Predictors for HCT uptake were age <40 years OR = 1.6, 95% CI (1.1-2.4), having worked for >5 years OR = 1.5, 95% CI (1.03-2.2) and working in medical department OR = 1.7, 95% CI (1.1-2.8). Respondents in nursing departments were more likely to require routine HIV test for all patients, OR = 3.9, 95% CI (2.4-6.2). HCWs in the laboratory departments were more likely to believe that HIV patients should be on separate wards, OR = 3.6, 95% CI (1.9-7.0). HCWs should be protected and encouraged to access HCT services in order to be effective role models in the prevention of HIV/AIDS.

Tobacco Cessation Interventions in Tertiary Hospitals in Nigeria: An Audit of Patient Records.

BACKGROUND: Patient medical records are an objective tool for the systematic identification and treatment of tobacco users. The aim of this study was to assess brief intervention tobacco cessation activities documented by physicians in some select tertiary hospitals in Nigeria. METHODS: We conducted a cross-sectional descriptive study using information obtained from 1588 randomly selected patient records in six teaching hospitals participating in a study to capacitate physicians to deliver brief advice. Trained data collectors collected data using a uniform checklist prior to the training of the physicians in these hospitals. RESULTS: Of the audited health records, 33.1% of patients had documentation of physicians' inquiry of their tobacco use mostly during out-patient clinics (37%) and by a resident doctor/medical officer (42.9%). Among identified tobacco users, it was documented that 12.9% were offered some form of tobacco cessation advice; readiness to quit was recorded in 2.6%; assistance with quitting was documented for 1.5% of tobacco users, while only 0.8% showed documentation of patient follow-up. Males and patients admitted to the hospital were 1.86 times and 2.14 times respectively more likely to have records of physicians' inquiry of their tobacco use. Patients who had tobacco-related morbidities and the unemployed were also more likely to have records of inquiry of their tobacco use. CONCLUSIONS: There was poor documentation of tobacco use by physicians in these hospitals and many opportunities for brief intervention activities were missed. Efforts to educate the physicians on the importance of documenting tobacco use in clinical notes are recommended. IMPLICATIONS: This study provides empirical evidence showing that there is poor documentation of tobacco use inquiry and brief intervention among physicians in tertiary hospitals in Nigeria. Records showing implementation of the 5A's were abysmally low and opportunities for brief intervention may have been missed. In line with the World Health Organization recommendations of Article 14 of the Framework Convention on Tobacco Control, efforts to promote brief intervention among physicians in tertiary hospitals in Nigeria should include an emphasis on appropriate documentation of tobacco control interventions in patient clinical notes.

Dental esthetics and oral health-related quality of life in young adults.

INTRODUCTION: Dental esthetics affects how people are perceived by society and how they perceive themselves, and this may also affect their oral health-related quality of life (OHRQoL). The aim of this study was to compare the impacts of self-perceived and normatively assessed dental esthetics on the OHRQoL of a young adult population. METHODS: This was a cross-sectional descriptive study involving 375 undergraduate university students, aged 18 to 30 years old. Data collection was carried out through oral examinations and self-administered questionnaires. Dental esthetics of the students was assessed using the esthetic component of the Index of Orthodontic Treatment Need. Two OHRQoL instruments were used: the shortened version of the Oral Health Impact Profile and the Psychosocial Impact of Dental Aesthetics Questionnaire. RESULTS: Statistically significant relationships (P <0.05) were recorded between both self-perceived and normatively assessed dental esthetics of the students, respectively, and 3 of the 4 Psychosocial Impact of Dental Aesthetics Questionnaire subscales: dental self-confidence (Kruskall-Wallis, P = 0.000; P = 0.000), psychological impact (P = 0.003, P = 0.047), and esthetic concern (P = 0.006, P = 0.003). The only exception was the social impact subscale, in which a significant relationship was recorded only with self-perceived dental esthetics (P = 0.040). For the shortened version of the Oral Health Impact Profile scale, marked differences were also observed between the impacts recorded for both self-assessments and normative assessments, respectively, particularly for the psychological disability domain (Fisher exact test, P = 0.021, P = 0.000; P = 0.064, P = 0.096). CONCLUSIONS: Differences exist between the impacts of self-perceived and normatively assessed dental esthetics on the OHRQoL of young adults, particularly in the psychosocial domains. These differences should be considered in orthodontic treatment planning for young adult populations.

Prevalence and Factors Associated with Intimate Partner Violence among Married Women in an Urban Community in Lagos State, Nigeria.

Violence against women is a major public health problem globally. A cross-sectional descriptive study was conducted in Ikosi Isheri LCDA of Lagos State among 400 married women. A multistage sampling method was used to select the respondents. The lifetime prevalence for physical violence, sexual violence and psychological violence were 50.5%, 33.8% and 85.0% respectively. Predictive factors for physical IPV include lower educational status of the women (AOR 3.22 95% CI: 1.54-6.77) and partner's daily alcohol intake (AOR: 1.84 95% CI: 1.05-3.23). The predictors of sexual violence include unemployment status of the partners (OR 5.89:1.39-24.84) and daily/weekly alcohol use (AOR 1.87 95% CI: 1.05-3.33). Predictors of psychological violence include respondents witness of parental violence (AOR 2.80 95% CI: 1.04-7.5) and daily alcohol use by partners (AOR 2.71 95% CI: 1.19-6.18). Preventive interventions such as increasing the educational status of women and reducing the intake of alcohol by men may help break the cycle of abuse.

PA21†Community participation in setting up palliative care clubs for chronically ill aids patients in lagos.

BACKGROUND: With the introduction of Highly Active Anti-retroviral Therapy, more HIV/AIDS patients live longer in our communities. AIM: This study was conducted to assess the willingness of people in Lagos to participate in setting up palliative care clubs for these patients. METHODOLOGY: Self administered questionnaires were completed by 261 respondents with age ranging from 21-61 years. SPSS version 16 data editor was used to analyse data. Univariate odds ratios and 95% confidence intervals (95% CI) were used to evaluate the correlates of willingness to participate (WTP). RESULTS: A total of 62% of the respondents reported that they will be willing to participate in palliative care for the HIV patients. Higher willingness was associated with prior contact with higher education (OR = 1.13, 95% CI: 1.02-1.53), present employment (OR = 1.65, 95% CI: 1.45-1.72) and a potential for financial incentives (OR = 1.59, 95% CI: 1.32-1.77). Decreased WTP was associated with concerns about social stigmatisation (OR = 0.35, 95% CI: 0.13-0.71) and possibility of rejection by the patients (OR = 0.83, 95% CI: 0.56-0.93). CONCLUSION: The high level of WTP indicates that such programmes would be better successful if organisers provide incentives as a part of the take-off of this program.

Exploring cigarette use among male migrant workers in Nigeria.

BACKGROUND: There is limited knowledge about the use of cigarettes by blacks outside the United States (U.S). Nigeria creates an opportunity to explore smoking behaviours, smoking cessation (nicotine dependence) and use of cigarettes in a country that has a large black population outside the U.S. METHODS: We conducted three Focus Group Discussions (FGDs) involving twenty-four male migrant workers who reported that they were current cigarette smokers. Interviews were audio-taped and transcribed. RESULTS: Four major themes namely: reasons for initiating and continuing to smoke cigarettes, factors affecting brand choice, barriers to quitting, effect of smoking mentholated cigarette brands were identified. CONCLUSION: This study provides insight into the use of mentholated and non-mentholated cigarettes and suggests the need for further studies to explore smoking behavior among Nigerians.

Knowledge and attitude toward smoke-free legislation and second-hand smoking exposure among workers in indoor bars, beer parlors and discotheques in Osun State of Nigeria.

BACKGROUND: One of the requirements of the Osun State smoke-free legislation is to ensure smoke-free enclosed and partially enclosed workplaces. This survey was conducted to assess the knowledge and attitude of workers in indoor bars, beer parlors and discotheques to smoke-free legislation in general and the Osun State smoke-free law in particular. METHODS: A convenience sampling of 36 hospitality centers was conducted. Interviewer-administered questionnaires were used to elicit responses about the objectives from non-smoking workers. The questionnaires had sections on knowledge of the Osun State smoke-free law, attitude toward the law and smoke-free legislation in general and exposure to second-hand tobacco smoke by the workers. Questions were also asked about the second-hand tobacco smoking status of these workers. The data were analyzed using SPSS version 15.0. RESULTS: We had 154 participants recruited into the study. There were 75 males (48.0%) and 79 females (52.0%). On the overall, respondents had a good knowledge of the effects of second-hand smoke on health (70.2%) with 75.0% of them being aware of the general smoke-free law and 67.3% being aware of the Osun State smoke-free law although none of them had ever seen a copy of the law. A high proportion (60.0%) was in support of the Osun smoke-free law although all of them think that the implementation of the law could reduce patronage and jeopardize their income. Attitude toward second-hand smoking was generally positive with 72.0% of them having no tolerance for second-hand tobacco smoke in their homes. Most participants (95.5%) had been exposed to tobacco smoke in the workplace within the past week. CONCLUSION: Despite the high level of awareness of the respondents about the dangers of second hand smoke and their positive attitude to smoke-free laws, nearly all were constantly being exposed to second hand smoke at work. This calls for policy level interventions to improve the implementation of the smoke-free law.

The ethical and legal regulation of HIV-vaccine research in Africa: lessons from Cameroon, Malawi, Nigeria, Rwanda and Zambia.

Ethical and legal frameworks are important for ensuring that the goals of scientific research are realised while at the same time the rights and welfare of human participants are adequately protected. A balance in attaining these two goals can be achieved if such frameworks provide for legally binding structures and processes to oversee, regulate, and monitor research on human participants according to accepted norms and standards. From 2007 to 2009, an ethical/legal audit, sponsored by the WHO/UNAIDS Ethics, Law and Human Rights Working Group of the African AIDS Vaccine Programme (AAVP ELH), was conducted in regard to five African countries (Cameroon, Malawi, Nigeria, Rwanda and Zambia) to determine whether these countries have adequate laws, ethical guidelines and policies in place to regulate HIV-vaccine research. This article discusses the findings of the audit with a view to highlighting key lessons that can be learnt from these countries. The article provides the context of the audit by highlighting its rationale, aims and methods. We discuss the general findings of the audit and the complex issues arising from HIV-vaccine research, specifically. Lastly, we propose specific ways in which the ethical/legal frameworks guiding research with human participants in these countries can be improved.

Assessment of the knowledge and beliefs of Finnish medical students regarding HIV infection and participation in AIDS vaccine trials.

This study sought to determine the level of general knowledge about HIV infection among Finnish medical students and their willingness to participate in AIDS vaccine trials. One hundred and sixty-two volunteer medical students at the University of Kuopio in the 2nd and 5th years of training filled self-administered questionnaires. The overall response rate among the 2nd year students was 77%, and among the 5th year students 70%. Knowledge was scored on a percentage scale. The mean score on general knowledge about HIV among 2nd year students was 75.6 (SD=0.23) while in the 5th year it was 87.8 (SD 0.18). Fifty-four students (77%) from the 5th year and 66 (72%) from the 2nd year indicated their willingness to participate (WTP) in AIDS vaccine trials (p=0.09). Medical curricula should be constantly revised to keep medical students up-to-date about recent advances in HIV/AIDS research.