Prevalence and Factors Associated with Stress, Anxiety and Depression amongst Primary Care Patients with Hepatitis B and C Infections in Nigeria.

BACKGROUND: Globally, more than 350 million people live with viral hepatitis, out of which over 20 million are in Nigeria. The prevalence of anxiety, depression and stress among patients with viral hepatitis in the primary care setting is not well established. OBJECTIVES: The objectives of this study were to determine the prevalence and factors associated with depression, anxiety and stress among hepatitis patients in a primary care clinic in North Central Nigeria using the Patient Health Questionnaire (PHQ2), Generalized Anxiety Disorder (GAD 2) and Kessler 6 scales respectively. METHODS: This cross-sectional study was carried out among Hepatitis B and C patients attending the Hepatitis Clinic of the Family Medicine Department, Federal Medical Centre Keffi. A total of 123 participants were recruited using a simple random sampling technique. Their sociodemographic and clinical data were collected after which they were screened for depression, anxiety and stress. Data collected was analysed using IBM SPSS. RESULTS: The mean age of study participants was 38.9±11.6 years. Most of them had hepatitis B infection (89.7%) and were on antiviral medications or liver supplements (45.2%). The prevalence of anxiety, depression and stress among them were found to be 18.9%, 25% and 77.6% respectively. Illness duration and medication use were found to be significantly associated with both depression and stress among them. CONCLUSION: The prevalence of anxiety, depression and stress is high among adult primary care patients with viral hepatitis in FMC Keffi.

CONTEXTE: À l'échelle mondiale, plus de 350 millions de personnes vivent avec les hépatites virales, dont plus de 20 millions au Nigeria. La prévalence de l'anxiété, de la dépression et du stress chez les patients atteints d'hépatite virale dans le cadre des soins primaires n'est pas bien établie. OBJECTIFS: Cette étude visait à déterminer la prévalence et les facteurs associés à la dépression, à l'anxiété et au stress chez les patients atteints d'hépatite dans une clinique de soins primaires dans le centre-nord du Nigeria en utilisant les échelles du Questionnaire de Santé Patient (PHQ2), du Trouble Anxieux Généralisé (GAD 2) et de Kessler 6 respectivement. MÉTHODES: Cette étude transversale a été réalisée parmi les patients atteints d'hépatite B et C fréquentant la clinique d'hépatite du département de médecine familiale du Centre Médical Fédéral de Keffi. Un total de 123 participants ont été recrutés à l'aide d'une technique d'échantillonnage aléatoire simple. Leurs données sociodémographiques et cliniques ont été recueillies, après quoi ils ont été dépistés pour la dépression, l'anxiété et le stress. Les données collectées ont été analysées à l'aide d'IBM SPSS. RÉSULTATS: L'âge moyen des participants à l'étude était de 38,9±11,6 ans. La plupart d'entre eux étaient atteints d'une infection par l'hépatite B (89,7 %) et prenaient des médicaments antiviraux ou des compléments hépatiques (45,2 %). La prévalence de l'anxiété, de la dépression et du stress parmi eux s'est avérée être respectivement de 18,9 %, 25 % et 77,6 %. La durée de la maladie et l'utilisation de médicaments ont été significativement associées à la dépression et au stress chez ces patients. CONCLUSION: La prévalence de l'anxiété, de la dépression et du stress est élevée parmi les patients adultes en soins primaires atteints d'hépatite virale au FMC Keffi. MOTS-CLÉS: Prévalence et facteurs, stress, anxiété, dépression, patients atteints d'hépatite B et C.

BATHE Consultation Model and Patients' Satisfaction: A Randomized Controlled Clinical Trial among Adults with Chronic Illness in a Tertiary Health Facility in North-Central Nigeria.

INTRODUCTION: BATHE is a consultation model mnemonic that stands for Background, Affect, Trouble, Handling, and Empathy. It is gaining fame in medicine because it offers person-centered care in time constrained setting and does not interfere with the physicians' ability to see large number of patients in a given day. We investigated the satisfaction scores of patients with chronic illnesses using BATHE model and the usual care (Subjective, Objective, Assessment and Plan, SOAP) model in a busy family medicine clinic. METHODS: It was a randomized control trial that involved 104 patients aged 18-65 years on follow-up for chronic illnesses. All consenting patients who met the inclusion criteria were selected and randomly allocated to each study arm of 52 participants. The control arm received usual care model only while the intervention arm received BATHE method in addition. RESULTS: Analyses revealed a higher patient's satisfaction among patients with BATHE consultation model than those in the Usual care model only (73.1% vs. 53.8%; p=0.042) at baseline. After eight weeks of the baseline, a follow-up trial using the two models still produced a higher patients' satisfaction in 'BATHE' consultation by a size of 28.8% (86.5%; 57.7%; p<0.001). CONCLUSION: The intervention model raised patients' satisfaction more than the control method. This study demonstrated a positive effect of BATHE consultation model on patients with chronic illness in spite of cultural differences. Hence, physicians should be encouraged to use BATHE technique in their consultations in order to improve patients' quality of care.

INTRODUCTION: BATHE est un modèle de consultation mnémotechnique qui signifie "Background, Affect, Trouble, Handling, and Empathy". Il gagne en popularité en médecine parce qu'il offre des soins centrés sur la personne dans un contexte de contrainte de temps et n'interfère pas avec la capacité des médecins à voir un grand nombre de patients dans une journée donnée. Nous avons étudié les scores de satisfaction des patients atteints de maladies chroniques en utilisant le modèle BATHE et le modèle de soins habituel (Subjective, Objective, Assessment and Plan, SOAP) dans une clinique de médecine familiale très fréquentée. MÉTHODES: Il s'agissait d'un essai contrôlé randomisé qui a impliqué 104 patients âgés de 18 à 65 ans en suivi pour des maladies chroniques. Tous les patients consentants qui répondaient aux critères d'inclusion ont été sélectionnés et répartis au hasard dans chaque groupe d'étude de 52 participants. Le bras de contrôle a reçu le modèle de soins habituels uniquement tandis que le bras d'intervention a reçu la méthode BATHE en plus. RÉSULTATS: Les analyses ont révélé une plus grande satisfaction des patients du modèle de consultation BATHE que de ceux du modèle de soins habituels seulement (73,1% vs. 53,8% ; p=0,042) au départ. Après huit semaines de référence, un essai de suivi utilisant les deux modèles a encore produit une plus grande satisfaction des patients dans la consultation 'BATHE' par une taille de 28,8% (86,5% ; 57,7% ; p<0,001). CONCLUSION: Le modèle d'intervention a augmenté la satisfaction des patients plus que la méthode de contrôle. Cette étude a démontré un effet positif du modèle de consultation BATHE sur les patients atteints de maladies chroniques, malgré les différences culturelles. Par conséquent, les médecins devraient être encouragés à utiliser la technique BATHE dans leurs consultations afin d'améliorer la qualité des soins des patients. MOTS CLÉS: Modèle de consultation BATHE, satisfaction du patient, maladies chroniques, modèle de soins habituels (SOAP).

The relationship between prostate volume and international prostate symptom score in Africans with benign prostatic hyperplasia.

OBJECTIVE: To determine the relationship between prostate volume and international prostate symptom score (IPSS) in Africans with benign prostatic hyperplasia (BPH). PATIENTS AND METHOD: This was a prospective study of 120 men aged between 45 to 85 years, who were referred to the urology outpatient facility for treatment of clinical BPH between July 2007 and October 2008 in Jos University Teaching Hospital. These patients were properly evaluated; a digital rectal examination was done to estimate the prostate size. The pre-treatment IPSS of the patient was also obtained. The prostate volume of each patient was then estimated by transabdominal ultrasound. RESULTS: The mean prostate volume was 72.79 +/- 44.38cm3. The mean values for the different diameters of the prostate were 5.63 +/- 1.17cm (longitudinal diameter), 4.48 +/- 0.95cm (anterior posterior diameter), 4.97 +/- 1.06cm (transverse diameter). The Pearson's correlation between pre-treatment International prostate symptom score and prostate volume was -0.0035 (P > 0.05). CONCLUSION: This study has shown that there is no significant relationship between international prostate symptom score and prostate volume in Africans. This is e with similar studies done in other parts of the world.

Surgical rescue and restoration of renal function in a post-hysterectomy anuric patient--a case report.

UNLABELLED: The recovery of renal function following release of urinary tract obstruction with advanced azotemia determines both the need for emergency dialysis in the early postoperative period and the long term planning for chronic kidney disease management. METHOD AND RESULTS: The case of a 60-year-old woman with a anuria following a Total Abdominal Hysterectomy done in a peripheral hospital presenting in the emergency unit two weeks after the surgery is presented. Her management and subsequent restoration of renal function are discussed. CONCLUSION: This report highlights the need to intervene early restore renal function in patients with bilateral urete obstruction.

Digital rectal examination for prostate cancer: attitude and experience of final year medical students.

OBJECTIVE: Prostate cancer which tends to take an aggressive course in black populations can be detected by digital rectal examination (DRE). There are concerns however that medical students are not acquiring the necessary DRE skills. We therefore studied their experience and attitude towards DRE for prostate cancer to assist us make any necessary adjustments in training. METHODS: This was a self-administered questionnaire based study of final year medical students two months to graduation carried out at the Jos University Teaching Hospital, location for clinical studies of the Medical Faculty ofthe University of Jos. RESULTS: There were 100 students in the study, with a male: female ratio of 3.6:1. The ages ranged from 24 to 35 with a mean of 28 years. Fifty-one percent and 94% agreed they had been taught DRE in class and on the ward/clinic respectively. Almost half (45%) had never performed a DRE and 43% performed it only 1-2 times. Sixty-two percent of the students had never confidently palpated a prostate; while 30% had palpated it 1 2 times. Eighty-six percent and 7% respectively have never felt a clinically malignant prostate or felt it 1 2 times. There was no statistically significant difference in the number of DREs performed by sex or age (p> 0.05). On supervision 43% were never supervised to do DRE while 23% were supervised all the time. Ninety-five percent believed DRE is an essential requirement for a medical practitioner and 96% believed they should have the skills before graduating. Only 36%, however, believed their teachers have been supportive, teaching them DRE (p value = .033). Ninety percent agreed that DRE is useful for screening for prostate cancer. The major reason for not performing DRE more than half the time was the student not feeling competent (54%). CONCLUSION: Students have received adequate teaching on DRE, have the right attitude and perspective, have adequate knowledge on DRE findings suggestive of prostate cancer but have not translated this knowledge into practice. This is mainly due to the students not feeling competent. Teachers need to intensify practical supervision to enable medical students acquire the necessary experience during clinical training.

The Management of Upper Urinary Tract Obstruction in Resource-Poor Settings

Objective: The management of upper urinary tract obstruction in the absence of modern facilities presents a major challenge to Urologic practice in developing countries. The aim of this study was to describe the etiology; presentation and treatment of upper urinary tract obstruction at the Jos University Teaching Hospital; Nigeria. Patients and Methods : This is a prospective analysis of 37 consecutive patients (18 males; 19 females) with a mean age of 35.5 years (range 3-55) who were managed for upper urinary tract obstruction at our department between January 2001 and December 2005. Two of them presented with a second pathology; so that we treated 39 pathologies in total. Flank pain was the most common clinical feature; being present in 35 patients (94.6). Other clinical features were gross hematuria in 12 (32.4); an enlarged kidney in 5 (13.5); renal impairment in 4 (10.8) and hypertension in 3 (8.1) patients. Diagnostic work-up consisted of plain radiography; abdominal ultrasound scan; intravenous urography and retrograde pyelography. Renal pelvic stones were the leading cause of obstruction (13 patients; 35.1); while congenital pelvi-ureteric junction (PUJ) obstruction was found in 7 (18.9) and ureteric stricture and vesical schistosomiasis in 4 (10.8) and 3 (8.1) patients; respectively. Two patients had bilateral obstruction from two different causes.Results: Twenty-nine open surgical procedures were carried out. They consisted of pyelolithotomy (n=12); pyeloplasty (n=6); ureteroureterostomy (n=4); ureteroneocystostomy (n=3); nephrectomy (n=2) and ureterolithotomy (n=2). Eight patients were treated non-surgically. Two patients are awaiting definitive surgical treatment. A total of 4 (13.8) complications following 29 operative procedures were encountered: two cases of migration of double-J ureteric stents ; one case of prolonged urine leakage and another case of wound infection. Conclusion : Upper urinary tract obstruction is not uncommon in our environment. In the absence of modern facilities; open surgery remains our main option of treatment; and it is relatively safe