Burnout: A predictor of oral health impact profile among Nigerian early career doctors.

There have been reported association of oral health disorders with burnout, stress, and mental health. Arguably, with these reported associations, and the current prevalence of burnout amongst Nigerian doctors, exploring the role of burnout on oral health amongst Nigerian doctors is timely. This study aims to determine the relationship between burnout and oral health-related quality of life amongst Early Career Doctors (ECDs) in Nigeria, while also identifying the role other possible predictors plays in this relationship. This was a cross-sectional study conducted amongst Nigerian ECDs as part of Challenges of Residency Training in Nigeria (CHARTING) II project. A total of 632 ECDs were recruited across thirty-one tertiary hospitals in the 6 geopolitical zones of the country using a multistage cluster sampling technique. A self-administered paper-based semi-structured questionnaire was given to each participant that consented. The tools used to assess burnout and Oral health-related quality of life (OHRQoL) were Copenhagen Burnout Inventory (CBI) and Oral Health Impact Profile (OHIP-14) respectively. Independent samples T-test, ANOVA and Multiple linear regression were used to draw inferences from the data collected. Overall mean OHIP-14 score of all participants was 11.12 (±9.23). The scores for the 3 dimensions of burnout were below 50% with CBI-Personal Burnout having the highest score of 49.96 (±19.15). Significant positive correlations (p < 0.001) were found between OHIP-14 and all the dimensions of burnout, as the burnout scores were increasing, there was a corresponding increase in the OHIP scores thus poorer OHRQoL. The regression model shows that the predictors of OHIP were CBI-PB (p = 0.003), use of fluoride paste (p = 0.039), use of tobacco (p = 0.005) and being a denture user (p = 0.047). This study shows a positive correlation between burnout and OHIP of ECDs. We found that as burnout was increasing, OHIP increased thus implying poorer oral health related quality of life amongst ECDs. The use of fluoride toothpaste, tobacco and denture are other factors we found that could affect the OHIP of ECDs.

Health, well-being, and burnout amongst Early Career Doctors in Nigeria.

BACKGROUND: Early Career Doctors (ECDs) in Nigeria are faced with many individual and systemic problems, which consequently adversely affect their health, well-being, patient care and safety. OBJECTIVE: This study, the second phase of the Challenges of Residency Training and Early Career Doctors in Nigeria (CHARTING II) Study, sought to examine the risk factors and contributors to the health, well-being and burnout amongst Nigerian ECDs. METHODS: This was a study of health, well-being and burnout amongst Nigerian ECDs. Outcome variables included burnout, depression, and anxiety, which were respectively assessed using the Copenhagen Burnout Inventory (CBI) and Oldenburg Burnout Inventory (OLBI), Patient Health Questionnaire (PHQ-9) depression scale, and Generalized Anxiety Disorder (GAD-7) scale. The quantitative data obtained was analysed using the IBM SPSS, version 24. Associations between categorical outcome and independent variables were assessed using chi square, with level of significance set at < 0.05. RESULTS: The mean body mass index (BMI), durations of smoking and alcohol consumption of the ECDs were 25.64 ± 4.43 kg/m2 (overweight range), 5.33 ± 5.65 years and 8.44 ± 6.43 years respectively. Less than a third (157, 26.9%) of the ECDs exercised regularly. The most common disease conditions affecting the ECDs were musculoskeletal (65/470, 13.8%) and cardiovascular diseases (39/548, 7.1%). Almost a third (192, 30.6%) of the ECDs reported experiencing anxiety. Male and lower cadre ECDs were more likely than female and higher cadre ECDs to report anxiety, burnout and depression. CONCLUSION: There is an urgent need to prioritize the health and well-being of Nigerian ECDs, so as to optimize patient care and improve Nigeria's healthcare indices.

An exploration of profile, perceptions, barriers, and predictors of research engagement among resident doctors: a report from CHARTING study.

Purpose/Aims: This research aimed to study the profile, perceptions, barriers, and predictors of Nigerian resident doctors' level of engagement in scientific research. Methods: This study was a descriptive cross-sectional quantitative survey of 438 resident doctors in Nigeria. This study forms a part of the big CHARTING Study, the protocol of which was published in "Nigeria Journal of Medicine 2019;28:198-205." Results: Three hundred and eighteen (72.8%) respondents were male and 119 (27.2%) were female. There were 229 (52.4%) registrars and 208 (47.6%) senior registrars, while residents in surgical versus nonsurgical specialties were 190 (44.5%) and 237 (55.5%), respectively. Three hundred and sixty-eight (85%) respondents had participated previously in research; 67 (15.6%) and 72 (16.6%) had their papers published in local or international journals, respectively; and only 46 (10.6%) had held first authorship positions in peer-reviewed journal publications. The significant barriers to research identified among them included lack of funding, lack of free time, inadequate training/knowledge on research methodology, and the onerous nature of clinical research. The independent predictor of previous engagement with research was years on current job (P = 0.007). This was similar to finding for the first authorship of a peer-reviewed article among the respondents (P = 0.017). Conclusion: This study concludes that publication and grantsmanship rates were very low among the surveyed resident doctors, despite their high rate of engagement in research projects. There is a need for increased research capacity building among resident doctors in Nigeria.

Profile and determinants of intention to migrate by early career doctors in Nigeria: A report from CHARTING study.

INTRODUCTION: Recently, there has been an upsurge in the migration of medical personnel, especially early career doctors (ECDs) from low- and middle-income countries, Nigeria inclusive, to high-income countries with wide-ranging consequences on the social and economic systems of the donor countries. This study assessed the profile and determinants of intention to emigrate by ECDs in Nigeria. METHODS: A cross-sectional study conducted among Nigerian ECDs from nine tertiary hospitals. Socio-demographic characteristics, intention & reasons to emigrate and willingness to return were collected using a self-administered semi-structured questionnaire. Data were analysed using Statistical Package for Social Sciences (SPSS) version 23. RESULTS: A total number of 763 ECDs participated in the study. The majority (88.2%) were less than 40 years of age and the male to female ratio was 2:1. Majority of the participants (69.4%) received monthly income ≤833 US Dollar. About two-thirds of ECDs had plans to emigrate and most to developed countries. Common reasons for intention to migrate were better quality of postgraduate training, improved quality of life and better remuneration. CONCLUSION: High proportion of Nigerian ECDs has intention to emigrate out with potential adverse effect on the fragile health system in the country.

Factors Driving the Acquisition of University Postgraduate Degrees among Resident Doctors in Nigeria.

The study examined the characteristics and factors driving the acquisition of postgraduate academic degrees among resident doctors in Nigeria. About 10% of the respondents had a form of university postgraduate degree with majority being master's degree. Having more than seven years of professional practice was the only factor predicting the acquisition of postgraduate academic degrees amongst the respondents [AOR: 0.243 (95% CI: 0.069,0.856; p = 0.028)]. The acquisition of postgraduate degree is not common among the surveyed resident doctors; and those that will acquire it do so in the later part of their career.

Impact of Covid-19 on Residency Training in Tertiary Health Institutions in Nigeria: A National Survey.

Background: The emergence of COVID-19 had a massive impact on the health system globally. While there are many kinds of literature reporting the impact on postgraduate medical training in other parts of the world, this cannot be said about Nigeria. Methodology: This was a national cross-sectional study among Resident doctors via an online google form survey for 8-months. Stratified cluster design where the entire country was stratified into the six geopolitical zones, and Tertiary Health Institutions (THI) were randomly selected from each of these zones. Data from the 47-item google form were analysed with Statistical Package for Social Science (SPSS) version 23, and internal consistency reliability was measured by Cronbach's alpha coefficient. Categorical variables were compared using chi-square, and the p-value was <0.05. Results: A total of 239 residents from THI in all six geopolitical zones completed the survey. The mean± standard deviation of the age of respondents, years in practice, and years in residency were 36.3±4.4); 10.2±7.6 years, and 4.2±2.6 years, respectively. The Cronbach's alpha coefficient was 0.95. Less than half had delayed the progression of residency (44.4%). The least strongly positive impacts were related to recruitments (4.2%), laboratory testing (4.2%), and ward rounds (4.2%); and the more strongly positive disruptive impact was on postgraduate seminars (9.2%), research (8.4%), professional examinations (8.0%) and residents' clinical schedules (8.0%). Conclusion: COVID-19 has caused a considerable delay in residents' training programs, and resident doctors have great concerns regarding the pandemic. This impact is perceived by them in almost all aspects of the training.

ThE profile of anthRopometRy and psyChosocial issuEs on campus (TERRACE) study: A study protocol and preliminary results.

Background: Obesity among the youth is a major public health problem. Globally, the burden of obesity has been on the increase, particularly among young persons, with associated psychosocial issues. This study aimed to present the rationale and design of ThE profile of anthRopometRy And psyChosocial issuEs on campus (TERRACE) Study and as well report some preliminary findings obtained on the anthropometric and psychosocial profile of young persons in some tertiary institutions in Oyo State, Nigeria. Methods: This study first described the methodology of the main study (TERRACE Study) and also provided a report of the preliminary data. The TERRACE study adopted a cross-sectional design of eligible and consenting adults between 16-35 years of age. A three-stage multi-stage sampling technique was used to recruit the participants. Questionnaire, weighing scales, and other tools were used to collect data on socio-demographic, cardiovascular profile, sleep, anthropometric, and psychological variables. Descriptive and inferential statistics were used for data analysis, using SPSS version 23 software. Result: The preliminary data were obtained from 225 participants recruited from three tertiary institutions in Ibadan metropolis, with mean age of 21.5 ±â€¯3.8 years. The majority were females (77.3%) and self-employed, with an average income less than 10,000 naira monthly (less than $25/month at an exchange rate of 400 naira/dollar). The males had higher systolic blood pressure compared to females and constituted a higher proportion of current smokers compared to females (was significant (p < 0.0001 and 0.011 respectively). A fifth (20.4%) of the population were underweight, while overweight and obese people accounted for 12%. They were mostly depressed, (183(87.9%) were moderate to severe depression), more of the females compared to males were anxious. Conclusion: The preliminary results revealed a high burden of underweight, obesity and psychosocial issues among the young people in Ibadan, Nigeria. Further findings to be obtained from the TERRACE Study would enhance the development of an effective public intervention in addressing anthropometric- and psychosocial-related health problems as well as provide baseline data for further studies among this population.

Evaluating the Relationship between Duty Hours and Quality of Life of Nigerian Early Career Doctors.

This study explored association between early career doctors (ECDs) duty hours and their quality of life (QoL). Information was collected on socio-demographics, duty hours and QoL of 391 Nigerian ECDs. Results showed median of 70 duty-hours weekly, 10 call-days monthly and 6 sleep-hours daily. Weekly duty-hours and daily sleep-hours were significantly negatively and positively correlated respectively with all four domains of WHOQoL. QoL potentially affects health of ECDs especially mental health. Policies targeted at improving ECDs workforce, working conditions should improve QoL and curtail the potential impact of brain drain and attrition among ECDs in Nigeria.

Exploring Issues and Challenges of Leadership among Early Career Doctors in Nigeria Using a Mixed-Method Approach: CHARTING Study.

(1) Background: leadership behaviour is a poorly explored phenomenon among early-career doctors (ECDs). Good leadership is vital in maximising the effective management of patients in a clinical setting. While a good number of studies, though with small sample surveys, have researched the role of leadership in clinical setting quantitatively, qualitative investigations are yet to be done in Nigeria. This study aims to explore the attitudes, skills, and experience of ECDs in Nigeria on issues pertaining to leadership in a medical setting, using a mixed-method approach. (2) Methods: we conducted two sessions of key informant focus group discussion (FGD) that involved 14 ECD leaders in Nigeria, exploring their leadership experience in a clinical setting. Furthermore, we used a self-administered questionnaire to quantitatively survey 474 ECDs from seven Nigerian teaching hospitals to explore their attitudes, skills, and experience on issues pertaining to medical leadership. (3) Results: taking on leadership roles is a common phenomenon (52.7%) among the surveyed ECDs; however, the medical leadership position can be very challenging for ECDs in Nigeria. Despite the fact that many (91.1%) of the surveyed ECDs perceived leadership skills as essential skills needed by a doctr, many (44.1%) of them were yet to be formally trained on medical leadership. About three out of every 10 (23.6%) of surveyed ECDs that have ever held leadership positions in a medical setting experienced major leadership challenges while in such office due to their lack of training on leadership skills. Leadership skill acquisition programmes are highly recommended to become an integral part of medical training programmes in Nigeria. (4) Conclusion: there is a need for a structured leadership skill acquisition programme for ECDs in Nigeria. This programme will help in the robust delivery of highly effective healthcare services in Nigeria, as effective leadership is crucial to patient care services.

Aggressive periodontitis: experience in a Nigerian teaching hospital

Objective: Aggressive periodontitis is a disease entity that can be classified as Stages III & IV and Grade C chronic periodontitis based on the 2017 classification of the American Association of Periodontology for periodontal diseases. It is a class of chronic periodontal disease that features clinically severe periodontal tissue destruction. The diagnosis of aggressive periodontitis in this environment is delayed because of some influencing factors such as lack of dental awareness, patients' poor attitude towards this disease entity and their low socio-economic status. The objective of this case series is to highlight the factors that influence the time of presentation and severity of periodontal tissue destruction of Stages III & IV and Grade C chronic periodontitis (aggressive periodontitis) in this environment. Cases Description: We present the summary of the history, clinical features and radiological findings of four (4) cases of early and delayed presentation of aggressive periodontitis patients aged 19-27 years and factors that influenced their time of presentation. Severe periodontal tissue destruction was a common feature in these four cases with eventual tooth/teeth loss in delayed presenters. They were all treated using standard periodontal debridement with normal saline and 0.2%chlorhexidine gluconate, scaling, root planning and systemic antibiotics therapy. The patients provided informed consents, ethical approval was obtained from the institutional ethical committee and the study was conducted in accordance with the Helsinki declaration of 1975 as revised in 2000.Results: The factors that influenced the time of presentation included dental awareness through dental education, missing and mobile teeth, fear of further loss of teeth in the future, replacement of missing teeth, social marginalization, believe in some traditional 'taboos' and socio-economic status. Conclusion: There is a need for aggressive dental education/enlightenment of the people in this environment especially on periodontal disease. Clinical Significance: Dental awareness through dental education generally influenced time of presentation which prevents severe destruction of the periodontium