Burnout Among Doctors and Nurses at The University of Uyo Teaching Hospital, South-South, Nigeria: A Comparative Study

BACKGROUND: Burnout remains a crucial occupational health challenge to healthcare professionals given its immediate and remote harmful effects. Doctors and nurses are highly susceptible to burnout due to the essence and demands of their services. The study aimed to determine and compare the prevalence of burnout among doctors and nurses working at the University of Uyo Teaching Hospital, Southern Nigeria. MATERIALS AND METHODS: A comparative, cross-sectional study of 553 doctors and nurses was conducted using a stratified random sampling technique. A pretested, self-administered MBI - Human Services Survey for Medical Personnel - MBI-HSS (MP) was used for data collection and analysis using IBM Statistical Product and Service Solutions (SPSS) software version 23. The Chi-square and Fisher's exact tests were applied with a statistical significance level set at α<0.05. RESULTS: The mean ages for doctors and nurses were 37.1 ± 5.3 and 39.0 ± 9.2 respectively (p=0.003). Burnout prevalence among doctors was 9.7% compared to 5.5% among nurses (p =0.062). Out of 553 respondents, 247 (46.7%) had high emotional exhaustion (EE), 70 (12.7%) had high depersonalization (DP), and 342 (61.9%) had low personal accomplishments (PA). Furthermore, 132 (47.3%) doctors had high EE, 43 (15.4%) had high DP and 159 (57%) had low PA. While 115 (42%) nurses had high EE, 27 (9.9%) had high DP and 183 (66.8%) had a low PA (p=0.041). Excessive workload (p=0.042) and lengthy years in a workplace position (p=0.002) were significantly associated with burnout among doctors compared to family size (p=0.045) and workplace support or community (p=0.005) among nurses. CONCLUSION: The study found burnout prevalence to be higher among doctors than nurses. Work-related factors contributed significantly to burnout development. Recreating and/or modifying workplace environments is essential to mitigating the adverse effects of burnout among healthcare workers.

CONTEXTE: Le burnout demeure un défi crucial pour la santé au travail des professionnels de la santé compte tenu de ses effets immédiats et à distance. Les médecins et les infirmières sont hautement susceptibles au burnout en raison de la nature et des exigences de leurs services. L'étude visait à établir et à comparer la prévalence du burnout parmi les médecins et les infirmières travaillant à l'Hôpital Universitaire de Uyo, dans le sud du Nigéria. MATÉRIEL ET MÉTHODES: Une étude comparative et transversale a été menée auprès de 553 médecins et infirmières à l'aide d'une technique d'échantillonnage aléatoire stratifié. Une enquête préalablement testée, auto-administrée, l'Inventaire d'épuisement professionnel humain pour le personnel médical (MBI-HSS [MP]), a été utilisée pour la collecte et l'analyse des données à l'aide du logiciel IBM Statistical Product and Service Solutions (SPSS) version 23. Les tests du Chi carré et de Fisher ont été appliqués avec un seuil de signification statistique fixé à α<0,05. RÉSULTATS: Les âges moyens des médecins et des infirmières étaient de 37,1 ± 5,3 et 39,0 ± 9,2 respectivement (p = 0,003). La prévalence de l'épuisement professionnel parmi les médecins était de 9,7 % par rapport à 5,5 % parmi les infirmières (p = 0,062). Sur les 553 répondants, 247 (46,7 %) présentaient un épuisement émotionnel élevé (EE), 70 (12,7 %) présentaient une dépersonnalisation élevée (DP) et 342 (61,9 %) présentaient un faible accomplissement personnel (PA). De plus, 132 (47,3 %) médecins avaient un EE élevé, 43 (15,4 %) avaient une DP élevée et 159 (57 %) avaient un PA faible. Tandis que 115 (42 %) infirmières avaient un EE élevé, 27 (9,9 %) avaient une DP élevée et 183 (66,8 %) avaient un PA faible (p = 0,041). Une charge de travail excessive (p = 0,042) et de nombreuses années passées à un poste de travail (p = 0,002) étaient significativement associées à l'épuisement professionnel parmi les médecins, par rapport à la taille de la famille (p = 0,045) et au soutien au travail ou à la communauté (p = 0,005) parmi les infirmières. CONCLUSION: L'étude a révélé une prévalence plus élevée du burnout parmi les médecins que parmi les infirmières. Les facteurs liés au travail ont contribué de manière significative au développement du burnout. Recréer et/ ou modifier les environnements de travail est essentiel pour atténuer les effets néfastes du burnout chez les travailleurs de la santé Mots-clés: épuisement professionnel, épuisement émotionnel, dépersonnalisation, accomplissement personnel, médecins, infirmières, hôpital Universitaire, Uyo, Nigéria.

Assessment of Oral Health Knowledge of Pharmacists in Two Tertiary Hospitals in Enugu, Nigeria.

Introduction: Oral health is defined as a state of being free of mouth and facial pain, oral infections and sores, and other diseases that limit an individual's capacity for biting, chewing, smiling, speaking, and psychosocial well-being. This study assessed the knowledge, barriers, and facilitators of oral health knowledge among Pharmacists in Enugu, Nigeria. Methods: This was a cross-sectional study of 163 pharmacists in two tertiary hospitals in Enugu, South East, Nigeria. Data on sociodemographic profiles, knowledge of oral health care, barriers, and facilitators of oral health knowledge was collected. Data were analyzed using SPSS version 26 and P < 0.05 was considered significant. Results: There were more female 96 (58.9%) than male pharmacists 67 (41.1%). Their mean age was 32.98 ± 8.33 years. The majority of respondents, 56 (34.4%) graduated between 2010 and 2019, and 44 (27%) had additional qualifications. Many of the pharmacists 88 (54%) believed that oral health is part of general health. Also, 107 (65.6%) of the respondents had a good knowledge of oral health while 56 (34.4%) had poor knowledge. There was a significant association between academic qualification (P = 0.04) and having good knowledge of oral health care among pharmacists with those with additional qualifications having better knowledge than the others. Poor creation of oral health awareness by dentists 106 (65.0%) was considered as the main barrier to having good oral health knowledge by the pharmacists. Conclusion: More than half of the pharmacists had good knowledge of oral health and academic qualification was associated with having a good knowledge of oral health care among pharmacists in the study population.

Tetanus and Diphtheria Seroprotection among Children Younger Than 15 Years in Nigeria, 2018: Who Are the Unprotected Children?

Serological surveys provide an objective biological measure of population immunity, and tetanus serological surveys can also assess vaccination coverage. We undertook a national assessment of immunity to tetanus and diphtheria among Nigerian children aged <15 years using stored specimens collected during the 2018 Nigeria HIV/AIDS Indicator and Impact Survey, a national cross-sectional household-based survey. We used a validated multiplex bead assay to test for tetanus and diphtheria toxoid-antibodies. In total, 31,456 specimens were tested. Overall, 70.9% and 84.3% of children aged <15 years had at least minimal seroprotection (≥0.01 IU/mL) against tetanus and diphtheria, respectively. Seroprotection was lowest in the north west and north east zones. Factors associated with increased tetanus seroprotection included living in the southern geopolitical zones, urban residence, and higher wealth quintiles (p < 0.001). Full seroprotection (≥0.1 IU/mL) was the same for tetanus (42.2%) and diphtheria (41.7%), while long-term seroprotection (≥1 IU/mL) was 15.1% for tetanus and 6.0% for diphtheria. Full- and long-term seroprotection were higher in boys compared to girls (p < 0.001). Achieving high infant vaccination coverage by targeting specific geographic areas and socio-economic groups and introducing tetanus and diphtheria booster doses in childhood and adolescence are needed to achieve lifelong protection against tetanus and diphtheria and prevent maternal and neonatal tetanus.

Prolonged blood coagulation time among occupationally exposed automobile technicians in Abeokuta, Nigeria.

Automobile technicians in resource-poor settings often work in poor environments and are exposed to chemicals that put them at risk of ill health and disease. These chemical exposures could affect blood coagulation, leading to bleeding disorders or thrombosis. The present study is aimed at assessing prothrombin test (PT) and activated partial thromboplastin test (aPTT) values, serum zinc (Zn) and copper (Cu) concentrations, and blood lead level (BLL) among occupationally exposed automobile technicians compared to unexposed controls. A total of 140 consenting participants comprising 70 automobile technicians and 70 unexposed controls were recruited for this case-control study. A 6-mL blood sample was drawn from each participant for estimation of BLL, serum Zn and Cu concentrations, and PT and aPTT values. Blood lead level, and serum Zn and Cu concentrations were determined using atomic absorption spectrophotometry, while PT and aPTT values were determined using Innovin PT and Actin FS Activated PTT reagents on the Sysmex CA-101 coagulation analyser. Data were analysed using t-tests, chi-square tests, and logistic and multiple linear regression analyses with statistical significance set at p < 0.05. The mean BLL, serum Zn concentration, and PT and aPTT values were significantly higher in automobile technicians compared to controls. Binary logistic regression showed that automobile technicians had higher odds of elevated PT value (OR = 21.769; p = 0.000), aPTT value (OR = 1.348; p = 0.018), BLL (OR = 1.261; p = 0.000) and serum Zn concentration (OR = 1.063; p = 0.005) than unexposed controls. Linear regression showed significant positive association of PT value with BLL and with serum Zn concentration. Higher PT and aPTT values reflect prolonged blood coagulation time among automobile technicians, which indicates impairment of extrinsic and intrinsic coagulation pathways associated with work-related exposures.

Aromaticity indices, electronic structural properties, and fuzzy atomic space investigations of naphthalene and its aza-derivatives.

The aromaticity and CDFT properties of naphthalene and its aza-derivatives were theoretically investigated using density functional theory (DFT) electronic structure method. The reactivity and chemistry of Azanaphthalene (1-AN), 1, 2-diazanaphthalene (1, 2-DAN), 1, 3-diazanaphthalene (1, 3-DAN), 1, 4-diazanaphthalene (1,4-DAN), 1, 5-diazanaphthalene (1, 5-DAN), 1, 6-diazanaphthalene (1, 6-DAN), 1, 7-diazanaphthalene (1,7-DAN) and 1, 8-diazanaphthalene (1, 8-DAN) were thoroughly explored and predicted focusing more on the fuzzy atomic space analysis, quantum chemical descriptors (CDFT), natural bond orbital (NBO), and structural electronic properties. The CDFT is focused on predicting the condensed Fukui function and dual descriptors along with condensed local electrophilicity and nucleophilicity investigation. From the aromaticity computational study, 1,7-DAN gave PDI, FLU, FLU- π , PLR, HOMA, BIRD and LOLIPOP values of approximately one (1) was found to be the most aromatic in the group, and strongest π -stacking ability. The aromaticity follows the trend: 1, 7-DAN > 1, 8-DAN > 1, 5-DAN > 1, 6-DAN > 1, 4-DAN > 1, 2-DAN > 1-AN > naphthalene. The second order perturbation energy NBO analysis revealed that the 3 highest stabilization energies in the molecules are C6-Na to C3-C4 ( π ∗ - π ∗ 236.90 kcal/mol) of 1, 6-DAN, C3-C4 to C1-C2 ( π ∗ - π ∗ 236.37 kcal/mol) of 1-AN and C7-N10 to C2-C4 ( π ∗ - π ∗ 235 kcal/mol) of 1, 3-DAN.

Multiple energy synchrotron biomedical imaging system.

A multiple energy imaging system that can extract multiple endogenous or induced contrast materials as well as water and bone images would be ideal for imaging of biological subjects. The continuous spectrum available from synchrotron light facilities provides a nearly perfect source for multiple energy x-ray imaging. A novel multiple energy x-ray imaging system, which prepares a horizontally focused polychromatic x-ray beam, has been developed at the BioMedical Imaging and Therapy bend magnet beamline at the Canadian Light Source. The imaging system is made up of a cylindrically bent Laue single silicon (5,1,1) crystal monochromator, scanning and positioning stages for the subjects, flat panel (area) detector, and a data acquisition and control system. Depending on the crystal's bent radius, reflection type, and the horizontal beam width of the filtered synchrotron radiation (20-50 keV) used, the size and spectral energy range of the focused beam prepared varied. For example, with a bent radius of 95 cm, a (1,1,1) type reflection and a 50 mm wide beam, a 0.5 mm wide focused beam of spectral energy range 27 keV-43 keV was obtained. This spectral energy range covers the K-edges of iodine (33.17 keV), xenon (34.56 keV), cesium (35.99 keV), and barium (37.44 keV); some of these elements are used as biomedical and clinical contrast agents. Using the developed imaging system, a test subject composed of iodine, xenon, cesium, and barium along with water and bone were imaged and their projected concentrations successfully extracted. The estimated dose rate to test subjects imaged at a ring current of 200 mA is 8.7 mGy s-1, corresponding to a cumulative dose of 1.3 Gy and a dose of 26.1 mGy per image. Potential biomedical applications of the imaging system will include projection imaging that requires any of the extracted elements as a contrast agent and multi-contrast K-edge imaging.

Profiling the immunity status of children with non-polio acute flaccid paralysis who had not received any doses of oral polio vaccine in the South-South region, Nigeria 2011-2014.

OBJECTIVES: To demonstrate the immunity status of children with non-polio acute flaccid paralysis (NP AFP) reported through the AFP surveillance system in the South-South region of Nigeria. STUDY DESIGN: A retrospective study was conducted using AFP surveillance data collected routinely between January 2011 and December 2014 by the Disease Surveillance Department of the regional health service and the World Health Organization (WHO)-accredited regional reference polio laboratory. All cases of AFP reported to the Disease Surveillance Network from all six zones during this period were included in the study. METHODS: In total, 5111 cases of AFP in children aged ≤15 years were reported between 2011 and 2014. These cases were investigated and verified by WHO surveillance officers using a standard questionnaire, which captured the number of doses of oral polio vaccine (OPV) received by the child. Two stool samples were collected for each case, 24-48 h apart, within 14 days of the onset of paralysis, and transported to the national polio laboratory under reverse cold chain storage. Data retrieved were stored in an AFP database hosted by the WHO server. EPIINFO software was used to query the database and extract the information required for analysis in this study. RESULTS: The percentage of children who had received at least three doses of OPV (which serves as a threshold to measure immunity status) decreased from 87% in 2011 to 82% in 2014. The percentage of children who had not received any doses of OPV decreased from 2% in 2011 to 1% in 2014. Forty-eight percent of the children who had not received any doses of OPV were aged <1 year. CONCLUSION: Given the decrease in OPV immunity status, the region risks re-introduction of poliovirus. Swift steps should be taken to improve the immunization coverage, which would boost immunity status in Nigeria.

Spectral K-edge subtraction imaging.

We describe a spectral x-ray transmission method to provide images of independent material components of an object using a synchrotron x-ray source. The imaging system and process is similar to K-edge subtraction (KES) imaging where two imaging energies are prepared above and below the K-absorption edge of a contrast element and a quantifiable image of the contrast element and a water equivalent image are obtained. The spectral method, termed 'spectral-KES' employs a continuous spectrum encompassing an absorption edge of an element within the object. The spectrum is prepared by a bent Laue monochromator with good focal and energy dispersive properties. The monochromator focuses the spectral beam at the object location, which then diverges onto an area detector such that one dimension in the detector is an energy axis. A least-squares method is used to interpret the transmitted spectral data with fits to either measured and/or calculated absorption of the contrast and matrix material-water. The spectral-KES system is very simple to implement and is comprised of a bent Laue monochromator, a stage for sample manipulation for projection and computed tomography imaging, and a pixelated area detector. The imaging system and examples of its applications to biological imaging are presented. The system is particularly well suited for a synchrotron bend magnet beamline with white beam access.

Poster - Thur Eve - 56: Verification of buildup region dose calculation of a treatment planning system.

Buildup region dose calculation of Pinnacle3 (version 9.0), a treatment planning system (TPS) commissioned using cylindrical ionization chamber measurements, have been verified experimentally. Dose values measured using Attix parallel plate ionization chamber were compared with those calculated by Pinnacle3 for a variety of clinical setups involving: 6 MV and 15 MV photon beams, open fields, enhanced dynamic wedges, physical wedges, block tray, 85, 100 and 120 cm source-to-surface distances, and square field sizes ranging from 3 × 3 to 30 × 30 cm2 . The dose difference (DD) and distance-to-agreement (DTA) techniques were used to evaluate the discrepancy between measured and calculated dose values. Based on the criteria of DD less than 2% or DTA less than 2mm, 93.7% of 1,710 dose points for the 6 MV and 96.1% of 2,244 dose points for 15 MV passed. Dose points that failed were mostly for open fields, block tray fields, and physical wedges (15 and 30 degrees) fields; this is attributed to high electron contamination (EC) associated with these fields. The levels of discrepancies between measured and calculated dose values were greatly reduced after remodeling the EC in Pinnacle3 using Attix chamber measurements, an indication that the EC equation in Pinnacle3 may be adequate for modeling EC in the dose buildup region, and the commissioning of a TPS using cylindrical ionization chamber measurements may not provide accurate buildup region dose calculation. Attix chamber measurements were validated using GafChromic EBT2 film; the disagreement was less than 3% for 89.9% of dose values compared.

Textile effluent induced genotoxic effects and oxidative stress in Clarias gariepinus.

Human and ecological disorder experienced in industrial settlements as a result of improper disposal of chemicals such as textile effluent calls for careful surveillance on the state of the environment. This study investigated the toxicity of textile effluent discharge using biochemical and cytogenetic responses to ascertain the acute and sub lethal effects on Clarias gariepinus. The 96 h LC50 of C. gariepinus exposed to the textile effluent was 8.203 ml L(-1). Fourteen day exposures to 1, 2, 4 and 6 ml L(-1) doses were conducted and several toxicological endpoints were evaluated. Sub lethal genotoxicity and biochemical study was also carried out for fourteen days. The genotoxicity studies utilized micronucleus test while the biochemical studies quantified serum anti-oxidant status Total Protein (TP), Catalase (CAT), Superoxide Dismutase (SOD) and Malondialdehyde (MDA) of the exposed fish. Toxicity factor indicates that the 96 h LC50 was significantly more toxic than the 24 h LC50 (p < 0.05). The textile effluent at the tested concentrations induced micronucleus and nuclear abnormalities in the peripheral blood of exposed fish. Micronucleus, notch and binucleated cell formation were significant (p < 0.05) compared to control while lobed and blebbed cells were insignificant (p < 0.05). SOD, TP and CAT significantly (p < 0.05) decreased compared to control group while MDA increased compared to control but was insignificant (p > 0.05). The results obtained from this study showed that textile effluent increase cytogenetic damage and altered anti-oxidant status in C. gariepinus. Chemicals in the effluent can be bioaccumulated and biomagnified in the aquatic organism hence affecting man.

Characterization and management of solid medical wastes in the Federal Capital Territory, Abuja Nigeria.

BACKGROUND: Medical establishment such as hospitals and research institutes generate sizable amount of hazardous waste. Health care workers, patients are at risk of acquiring infection from sharps and contamination of environment with multiple drug resistant microorganisms if wastes are not properly managed. OBJECTIVES: To characterize types and evaluate waste disposal techniques employed in the management of solid medical wastes in five selected hospitals in the Federal Capital Territory, Abuja. METHODS: This was a cross section study involving the use of questionnaires, in-depth interview, meetings, discussions and participant observed strategy. It also involved the collection, sorting (segregation), identification and characterization and weighing of waste types from wards and units in the selected hospitals. RESULTS: The average waste generation rate per bed/day was determined and found to be 2.78 kg of solid waste, 26.5% of the total waste was hazardous in nature. Waste segregation was found not to be practiced by any of the hospitals surveyed, 18.3% of the hospitals incinerated waste in a locally built brick incinerator; 9.1% bury; 36.3% burn waste in open pits while 36.3% dispose of a waste into municipal dumpsites. CONCLUSION: Waste management officers do not have formal training in waste management techniques; and hospital administrators pay very little attention to appropriate management of medical waste. Therefore, we must educate waste generators of their responsibility to properly manage the waste so that their staff, patients, environment and community is protected.

Effect of vitamin C on serum lipids and electrolyte profile of albino Wistar rats.

The effect of oral administration of vitamin C on serum lipids and electrolyte profile were investigated in albino rats of the Wistar strain. Eighteen (18) albino rats of opposite sexes weighing between 150-300 g were used for the study and randomly assigned on the basis of body weight and litter origin to three study groups of six animals each. The control group received via oral route a placebo (4 ml of distilled water), while test groups 1 and II received 100 mg/kg body weight and 200 mg/kg body weight of vitamin C in 2.5 ml and 5.0 ml of the vehicle via gastric intubation respectively. The administration of vitamin C for 30 days produced a significant [P < 0.05] decrease in total cholesterol (TC), very low-density lipoprotein (VLDL) and low density lipoprotein (LDL) in the test groups versus control but there was no change in triglycerides (TG) and High density lipoprotein (HDL) levels. Computed HDL:LDL ratio also increased in the treatments relative to the control. Except for computed HDL:LDL ratio all the other changes were dose dependent and there was a slight non-significant increase in all electrolytes (Na(+), K(+); and HCO3(-) ions. The study confirms the hypocholesterolaemic effect of vitamin C and that Vitamin C has no adverse effect on serum electrolytes. It is suggested that its administration in moderate to high doses may protect against atherosclerosis and hypertension.

The problems of indeterminate HIV results in blood transfusion services in Nigeria.

Five hundred sera samples were collected from individuals whose age range was 16-40 years, analysed using Murex 1 and 2 and Capillus HIV kit (Cambridge Biotechnology, Cambridge, UK), and confirmed with Western Blot technique (Biorad). Of these, 186 (37.2%) were repeatedly reactive, 90 (48.4%) were confirmed positive, 55 (29.6%) indeterminate (20 [10.7%] from blood donors) and 44 (22.0%) were negative. The data reveal a significant correlation between indeterminate results and confirmed positive sera (P < 0.05). This demonstrates the high incidence of indeterminate HIV results encountered in blood transfusion services.