Effect of attention-deficit–hyperactivity-disorder training program on the knowledge and attitudes of primary school teachers in Kaduna, North West Nigeria

BACKGROUND: There are indications that teachers have limited knowledge about attention deficit hyperactivity disorder (ADHD), despite its high prevalence in childhood and its long-term effects on students such as academic underachievement, reduced self-esteem, and social and behavioural difficulties. This study is therefore aimed at assessing the effect of an ADHD training program on the knowledge of ADHD among primary school teachers in Kaduna, Nigeria and their attitudes towards pupils with ADHD. METHODS: This was a randomized controlled trial involving 84 primary school teachers in the intervention group and 75 teachers in the control group. Participants in the intervention group received an initial 3-h training with a one-and-a-half hour booster session 2 weeks later using the World Health Organisation MhGAP-IG module on behavioural disorders focusing on ADHD. Outcome measures were knowledge of ADHD, attitude towards ADHD, and knowledge of behavioural intervention. RESULTS: Controlling for baseline scores, the intervention group had significantly higher post intervention scores on knowledge of ADHD, lower scores on attitude towards ADHD (i.e. less negative attitudes), and higher scores on knowledge of behavioural intervention compared with the control group respectively. The intervention showed moderate to large effect sizes. The booster training was associated with a further statistically significant increase in knowledge of ADHD only. CONCLUSIONS: The training program significantly improved the knowledge and attitudes of the teachers in the intervention group towards ADHD. Considerations should be given to incorporating ADHD training programs into teacher-training curricula in Nigeria, with regular reinforcement through in-service training

A structured approach to integrating mental health services into primary care: development of the Mental Health Scale Up Nigeria intervention (mhSUN).

BACKGROUND: The treatment gap for mental illness in Nigeria, as in other sub-Saharan countries, is estimated to be around 85%. There is need to prioritise mental health care in low and middle income countries by providing a strong body of evidence for effective services, particularly with a view to increasing international and government confidence in investment in scaling up appropriate services. This paper lays out the processes by which a programme to integrate evidence-based mental health care into primary care services in Nigeria was designed, including a research framework to provide evidence from a robust evaluation. METHODS: This paper forms the first step in the overall process evaluation of the mhSUN intervention, where standard research practice indicates that the intervention, and its development, is clearly documented prior to subsequent evaluation. The report covers the period of programme development and evaluation design, and study site and design was chosen to allow generalisability and practical conclusions to be drawn for service development in Nigeria. In order to design an intervention that was informed by evidence and took into account local context and input of stakeholders, a structured process was followed, including: (1) Engagement of relevant stakeholders for information gathering and buy-in; (2) Literature review and gathering of pertinent evidence; (3) Situation analysis at a national and local level; (4) Model development (using Theory of Change); (5) Ongoing consultation, recognising the iterative nature of Theory of Change, and need for ongoing refinement of complex interventions. RESULTS: The different sections of the structured approach resulted in outputs that built the necessary components (literature review, situation analysis) for informing the Theory of Change. A Theory of Change map is presented, which includes transparent documentation of the assumptions and logic behind the activities to drive the desired change. In addition, it documents the indicators necessary to measure fidelity and draw conclusions as to hypothesised effects of different mechanisms of action in subsequent evaluation. CONCLUSION: In addition to the details of ensuring robust evaluation design, there are a number of considerations that are particular to the context that must be taken into account in programme development, including the relationships between ultimate beneficiaries, implementers, host government and institutions, donors, and programme evaluators. Structured methods from existing frameworks can be drawn upon to use and collate relevant information to maximise the local applicability of a generic evidence base. Theory of Change, with its documented assumptions can form the basis of subsequent evaluation and iterative programme refinement, contributing to a more scientifically valid means of developing mental health programmes for scale up

Clinicopathological study of testicular tumors: an experience in a tertiary care hospital in Kashmir valley, Jammu and Kashmir, India

Background: Testicular and paratesticular neoplasia are rare type of tumors affecting adolescents and young adults in India, as observed by paucity of published data. This study was undertaken to analyze the patterns of testicular tumors at a tertiary level hospital in Kashmir valley, Jammu and Kashmir, India highlighting the patient’s demography, clinical presentation, diagnostic evaluation and pathological finding.Methods: This 5-year (retrospective and prospective) study was performed in the Department of Pathology, Government Medical College Srinagar, Jammu and Kashmir, India from January 2012 to December 2016. For the retrospective study, all cases of testicular tumors, their histopathological reports and required clinical details were searched from records maintained in the Department of Pathology, GMC Srinagar, Jammu and Kashmir, India. For the prospective study, the orchiedectomy specimens received in our department were subjected to routine histopathological processing followed by a detailed gross and microscopic examination. Tumour typing and subtyping was done according to WHO classification (2004).Results: A total of 37 cases of testicular and paratesticular neoplasia were included in present study with a mean age of 35.1 years. Out of these 37 cases, 31 (83.78%) were malignant and 6 cases (16.22%) were benign. Right testis was affected in 70.3% of cases. The most common clinical presentation was scrotal swelling. Germ cell tumor was the most common type accounting for 89.2% of tumors followed by lymphomas (8.1%).Conclusions:It is concluded that despite new techniques in imaging and tumor marker assay, the diagnosis of testicular tumors is dependent upon histopathological examination. The present study fairly provides an insight into the clinical presentations, prevalence and patterns of testicular tumors.

An evaluation of psychological distress and social support of survivors and contacts of Ebola virus disease infection and their relatives in Lagos, Nigeria: a cross sectional study − 2014

BACKGROUND: By September 2014, an outbreak of Ebola Viral Disease (EVD) in West African countries of Guinea, Liberia, Sierra Leone, Senegal and Nigeria, had recorded over 4500 and 2200 probable or confirmed cases and deaths respectively. EVD, an emerging infectious disease, can create fear and panic among patients, contacts and relatives, which could be a risk factor for psychological distress. Psychological distress among this subgroup could have public health implication for control of EVD, because of potential effects on patient management and contact tracing. We determined the Prevalence, pattern and factors associated with psychological distress among survivors and contacts of EVD and their relatives. METHODS: In a descriptive cross sectional study, we used General Health Questionnaire to assess psychological distress and Oslo Social Support Scale to assess social support among 117 participants who survived EVD, listed as EVD contacts or their relatives at Ebola Emergency Operation Center in Lagos, Nigeria. Factors associated with psychological distress were determined using chi square/odds ratio and adjusted odds ratio. RESULTS: The mean age and standard deviation of participants was 34 +/ - 9.6 years. Of 117 participants, 78 (66.7 %) were females, 77 (65.8 %) had a tertiary education and 45 (38.5 %) were health workers. Most frequently occurring psychological distress were inability to concentrate (37.6 %) and loss of sleep over worry (33.3 %). Losing a relation to EVD outbreak (OR = 6.0, 95 % CI, 1.2–32.9) was significantly associated with feeling unhappy or depressed while being a health worker was protective (OR = 0.4, 95 % CI, 0.2–0.9). Adjusted Odds Ratio (AOR) showed losing a relation (AOR = 5.7, 95 % CI, 1.2–28.0) was a predictor of “feeling unhappy or depressed”, loss of a relation (AOR = 10.1, 95 % CI, 1.7–60.7) was a predictor of inability to concentrate. CONCLUSIONS: Survivors and contacts of EVD and their relations develop psychological distress. Development of psychological distress could be predicted by loss of family member. It is recommended that psychiatrists and other mental health specialists be part of case management teams. The clinical teams managing EVD patients should be trained on recognition of common psychological distress among patients. A mental health specialist should review contacts being monitored for EVD for psychological distress or disorders

Unrecognized psychiatric disorders among adult patients admitted into a general hospital in Maiduguri, Northeastern Nigeria

Introduction: Patients with unrecognized psychiatric disorders in general hospitals, suffer economic and psycho-social difficulties. This study aimed to determine (i) prevalence and pattern of psychiatric  disorders, and (ii) prevalence of unrecognized psychiatric disorders among adult inpatients of a general hospital.Methods: In this two-stage, cross-sectional study, we used (i) General Health Questionnaire (GHQ) and Composite International Diagnostic Interview (CIDI) to assess the prevalence of psychiatric disorders, and (ii) Patient Encounter Form to determine unrecognized psychiatric disorders, among patients  admitted into a general hospital. Results: Of the 283 respondents, 174 (61.5%) had GHQ scores of ≥ 4. Eighty seven respondents (31%) had psychiatric disorders of which 85 (98%) were not recognized. The frequency of Depression and Anxiety disorders were 61.5% and 26.2% respectively. Unmarried (2.3, 1.2-4.3; p < 0.00), females (2.1, 1.1-4.05; p = 0.01) and patients with "unexplained symptoms" (≤ = 8.4, p< 0.00, df = 1) were more likely to have diagnosis of depression and anxiety disorder. Conclusion: We conclude that one-third of the patients in the general hospital, had co-morbid psychiatric diagnoses, mostly unrecognized by their physicians. Unmarried, females and respondents with  unexplained symptoms were associated with depression and anxiety disorders. We recommend the posting of psychiatric trainees to general hospitals, and training of general practitioners on the use of simple depression and anxiety screening instrumentsKey words: epression, anxiety disorders, prevalence, general practitioners, non-recognition, General hospita

Correlation of prothrombin time and activated partial thromboplastin time with serum immunoglobulin and M-band in newly diagnosed multiple myeloma patients

Background: Multiple myeloma is the second most frequent malignancy which constitute 13% of hematologic cancers. Thrombotic and hemorrhagic complications have been frequently observed in multiple myeloma patients. Methods: The study was conducted in the department of pathology, Government medical college Srinagar. A total of fifty (50) patients were recruited for the study. The patients were advised coagulation profile and complete myeloma profile. Results: Our findings indicate that prolonged PT is associated with high serum IgG levels. A mild to moderate correlation was seen with kappa-free light chains and an inverse correlation was seen between PT and lmbda-free light chains. Conclusions: Screening of multiple myeloma for hemostatic abnormalities at the diagnosis should improve prognosis in such cases

Prevalence and Correlates of Extrapyramidal Side Effects Among Patients with Schizophrenia Spectrum Disorders on Typical and Atypical Antipsychotics

Background: Antipsychotic medication for the treatment of schizophrenia spectrum disorders are associated with adverse effects with extrapyramidal side effects constituting one of the most notable effects associated with poor medication adherence and poor quality of life. Aims: The study aims to compare the prevalence of extrapyramidal side effects (EPSE), among patients with schizophrenia spectrum disorders on typical and atypical antipsychotic medications. The secondary aim is to determine the association of extra-pyramidal side effects with socio-clinical variables. Methodology: A cross-sectional hospital-based study with systematic random sampling recruitment of 340 participants and 303 completed the study. Variables with significant association on chi square analysis were subjected to logistic regression analysis. Results: The overall prevalence of extrapyramidal side effects among patients with schizophrenia spectrum disorder on antipsychotic medication was 42.6 %. The prevalence of tardive dyskinesia, parkinsonism and akathisia were 7.9 %, 38.6 and 3.6 %, respectively. The prevalence of extra-pyramidal side effects due to use of typical, atypical and combination drug was 44.4 %, 51.2 % and 34.5 %, respectively with haloperidol (59.4 %) and risperidone (71.4 %) having the greatest effect. Being elderly was associated with tardive dyskinesia, duration of treatment, severity of illness and type of illness with parkinsonism and severity of illness with akathisia. Conclusion: The findings of this study support the high prevalence of extrapyramidal side effects from either using typical and atypical antipsychotic medications. Therefore, Clinicians should discuss on these side effects and proffer possible solutions with their patients prior to commencement of antipsychotic medications in order to promote medication adherence

Analysis of the Metabolic Profile and Biological Activity of Hawthorn Species twigs: Crataegus azarolus and Crataegus monogyna

All parts of the hawthorn tree (Crataegus spp.), including fruits, flowers, and leaves, have been used as a source of bioactive compounds. Thus, in this investigation, the twigs of two species of hawthorn plant of Crataegus azarolus (C. azarolus) and Crataegus monogyna (C. monogyna) were evaluated for bioactive compositions and biological activity (antioxidant and antimicrobial activities). To evaluate bioactive compositions, high-performance liquid chromatography (HPLC) was applied, and for biological activity, biochemical assays were performed. C. monogyna revealed a higher amount of total phenolic, total flavonoid, and total tannin contents compared to C. azarolus. The HPLC results indicated the highest amount of kaempferol (14.40%), catechin (17.70%), and gallic acid (25%) in twigs of C. azarolus, while the maximum quercetin (72%) compound was present in C. monogyna. C. monogyna exhibited higher antioxidant activity by 1,1-dizarophenyl-2-picrylhydrazyl (DPPH) (86.13%) and 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid (ABTS) (92.93%) compared to C. azarolus for antioxidant activity-DPPH (81.86%) and -ABTS (87.47%) assay. In the case of antimicrobial activity, the twigs of both species (especially C. azarolus) have a capacity against Bacillus subtilis, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus. The results of this study revealed that the twigs of both species contained a high amount of phenolic metabolites and antioxidant activity, while they showed low antimicrobial activity

The rise of ransomware: a review of attacks, detection techniques, and future challenges

Cybersecurity is important in the field of information technology. One most recent pressing issue is information security. When we think of cybersecurity, the first thing that comes to mind is cyber-attacks, which are on the rise, such as Ransomware. Various governments and businesses take a variety of measures to combat cybercrime. People are still concerned about ransomware, despite numerous cybersecurity precautions. In ransomware, the attacker encrypts the victim's files/data and demands payment to unlock the data. Cybersecurity is a collection of tools, regulations, security guards, security ideas, guidelines, risk management, activities, training, insurance, best practices, and technology used to secure the cyber environment, organization, and user assets. This paper analyses ransomware attacks, techniques for dealing with these attacks, and future challenges

Protocol for process evaluation of integration of mental health into primary healthcare in two states in Nigeria: the mhSUN programme.

BACKGROUND: Current international recommendations to address the large treatment gap for mental healthcare in low- and middle-income countries are to scale up integration of mental health into primary care. There are good outcome studies to support this, but less robust evidence for effectively carrying out integration and scale-up of such services, or for understanding how to address contextual issues that routinely arise. AIMS: This protocol is for a process evaluation of a programme called Mental Health Scale Up Nigeria. The study aims are to determine the extent to which the intervention was carried out according to the plans developed (fidelity), to examine the effect of postulated moderating factors and local context, and the perception of the programme by primary care staff and implementers. METHOD: We use a theoretical framework for process evaluation based on the Medical Research Council's Guidelines on Process Evaluation. A Theory of Change workshop was carried out in programme development, to highlight relevant factors influencing the process, ensure good adaptation of global normative guidelines and gain buy-in from local stakeholders. We will use mixed methods to examine programme implementation and outcomes, and influence of moderating factors. RESULTS: Data sources will include the routine health information system, facility records (for staff, medication and infrastructure), log books of intervention activities, supervision records, patient questionnaires and qualitative interviews. CONCLUSIONS: Evidence from this process evaluation will help guide implementers aiming to scale up mental health services in primary care in low- and middle-income countries