Assessment of land use management and its effect on soil quality and carbon stock in Ebonyi State, Southeast Nigeria.

Evaluating soil quality (SQ) resulting from land management use impact is important for soil carbon (C) monitoring, land sustainability and suitability. However, the data in less developed regions of Africa like Nigeria is scarce, limiting our understanding at global scale. The study evaluated land management use on soil quality in Ebonyi State, Nigeria, a representative region of Africa. Soil samples were collected in 2021 and resampled in 2022 from regions including five land use managements (FS = forest soil; GLS = grass land soil; ACS = alley cropping Soil; SDS = sewage dump-soils; CCS = continuously cultivated soil). Soil physical and chemical properties were analyzed and discussed. The results shows that soil physical properties (bulk density, hydraulic conductivity, aggregate stability) were significantly (P < 0.05) influenced by land use management. Moderate to high bulk density, very low hydraulic conductivity (HC), and low aggregate stability were observed across land management, suggesting potential inhibition to root penetration, poor aeration, and water infiltration. Improved land management practices such as planting of cover crops either for re-grassing or addition of crop residues could be adopted as conservative options for increasing soil quality and encourage additional soil C. Soil pH decreased with the increase in soil depth in all land uses for both years. A higher soil pH of 6.78 (slightly acidic) was seen in SDS and lower mean 6.0 (moderately acidic) was obtained in CCS at 0-20 cm in 2021. The average mean nitrogen content was rated "very high" (0.81 g kg-1 and 0.69 g kg-1) in 2021 and 2022 respectively, suggesting nitrogen might not be a limiting factor for plant growth in the region. During the 2021 and 2022 study periods, the overall average mean C stock were 12.71 g kg-1 and 15.87 g kg-1 respectively suggesting 3.1 g kg-1 C stock increment in 2022. Soil inorganic C also increased by 9.86 g cm-2 in 2022. The study provided crucial information about how land management use affected soil physico-chemical properties including C stock and suggested that C stock could be improved by adopting appropriate land management use practices. The results fill a data gap in under-studied regions, but also facilitate potential land management practices.

Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India's NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

Adverse outcomes and short-term cost implications of bile duct injury during cholecystectomy.

BACKGROUND: Bile duct injury (BDI) is an uncommon but major complication of cholecystectomy that has a poorly defined magnitude of effect on hospital costs. This study sought to calculate the healthcare costs, length of stay, and discharge status associated with bile duct injury in patients undergoing cholecystectomy in the United States. METHODS: The Premier Healthcare Database, which comprises hospital-billing records from over 700 hospitals in the United States, was queried for all patients undergoing cholecystectomy between January 2010 and March 2018. BDI was defined by ICD-9-CM and ICD-10-CM codes. Patient demographics, clinical characteristics, and operative information were extracted. Hospital costs, length of stay, and discharge status were compared between BDI and non-BDI patients. Propensity score matching was used to minimize confounding factors. Multivariable regression models were used to estimate the association between BDI and the outcomes variables. RESULTS: A total of 1,168,288 cholecystectomies were identified. BDI occurred in 878 patients (0.08%). Laparoscopy was the most common approach (> 95%). The majority of BDI occurred during inpatient admissions (71.0%). BDI patients had higher index admission hospital costs ($18,771 vs. $12,345, p < 0.0001), increased rate of discharge to an institutional post-acute care facility (odds ratio 3.89, 95% CI 2.92-5.19, p < 0.0001), and increased risk of readmission within 30 days after discharge (odds ratio 1.86, 95% CI 1.52-2.28, p < 0.0001), compared to patients without BDI. Among inpatient cholecystectomies, BDI was associated with increased length of stay (8.6 days vs. 4.8 days, p < 0.0001). CONCLUSION: BDI is associated with significantly increased hospital costs, length of stay, 30-day readmission, and discharge to an institutional post-acute care facility.

Impact of a Clinical Pharmacist Intervention on Medicine Costs in Patients with Chronic Obstructive Pulmonary Disease in India.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, especially in low- and middle-income countries (LMICs) such as India. Medicine costs are a key issue in LMICs, with typically high patient co-payments. In addition, pharmacists are underutilised in LMICs, including India. However, pharmacist-led educational interventions may improve the care of patients with COPD, as well as reduce medicine costs. Consequently, the objective of this study was to assess the effectiveness of a pharmacist-led intervention in reducing medicine costs. METHODOLOGY: We assessed the impact of a pharmacist intervention on direct medicine costs in COPD patients (medicine costs and pharmacist time) in a randomised controlled study involving an intervention and control group, conducted at a tertiary care teaching hospital in India. RESULTS: The 6-monthly cost of medicines at baseline increased with disease severity, from a maximum of US$29.46 for those with mild COPD to US$63.28 for those with very severe COPD. Substantial savings in medical costs were achieved with the pharmacist-led programme, to a maximum of US$20.49 over 6 months for very severe patients. This equates to a reduction of 30.6% in medicine costs (p < 0.001), reduced to 26.1% when pharmacists' time (US$3.00/patient) was included. CONCLUSION: There could be a key role for pharmacists as educators for COPD patients in LMICs, to improve care and reduce costs, including patient co-payments.

Assessment of maternal risk factors associated with low birth weight neonates at a tertiary hospital, Nanded, Maharashtra.

BACKGROUND: To assess the maternal risk factors associated with low birth weight (LBW) neonates at a tertiary hospital, Nanded, Maharashtra. MATERIALS AND METHODS: This study was carried out in a tertiary care hospital in Nanded city of Maharashtra between January 2014 and July 2014 among 160 cases (LBW-birth weight ≤2499 g) and 160 controls (normal birth weight-birth weight >2499. Data collection was done by using predesigned questionnaire and also related health documents were checked and collected the expected information during the interview after obtaining informed consent from mothers. The data were analyzed by Epi Info 7 Version. RESULTS: The present study found the significant association among gestational age, sex of baby, type of delivery, maternal age, religion, education of mother and husband, occupation of mother and husband, type of family, maternal height, weight gain, hemoglobin level, planned/unplanned delivery, bad obstetric history, interval between pregnancies, previous history of LBW, underlying disease, tobacco chewing, timing of first antenatal care (ANC) visit, total number of ANC visit, and iron and folic acid (IFA) tablets consumption with LBW. No significant association was found among maternal age, residence, caste, consanguinity of marriage, socioeconomic status, gravida, birth order, multiple pregnancy, and smoking with LBW in our study. CONCLUSION: It was concluded that hemoglobin level, weight gain during pregnancy, gestational age, planned/unplanned delivery, bad obstetric history, and IFA tablets consumption during pregnancy were independent risk factors for LBW.

Justification of anthropometric empirical indicator (AEI) by digital chest and pelvic X-rays: a comparative scenario with DXA on obesity grounds.

BACKGROUND: Obesity is an abnormal accumulation of body fat directly proportional to reduced life expectancy. Treatment of this ailment should be preceded by proper and accurate assessment of the degree of obesity. OBJECTIVES: The main objective is the justification of anthropometric empirical indicator (AEI) by the utilization of chest and pelvic radiographs, so that precise measurement of obesity on economical grounds can be manifested. Also, the subsequent objective is to establish a comparative scenario between dual energy X-ray absorptiometry (DXA) and novel, portable, bioelectric impedance analysis (BIA)-based body composition analyzer, MI-105 (Meditech International Inc. India). MATERIALS AND METHODS: The cross-sectional design was adopted in the present study, in which 20 female participants from urban south India were involved. The measurements of body composition, anthropometry and chest (covering the region from neck to abdomen) as well as hip radiography of the studied population were acquired. RESULTS: The higher significant difference of ≤0.001 was evidenced in all female studied population in the main body composition parameters measured by DXA and low-cost BIA. The same framework of significance is applicable to AEI, AEI (image morphed) and AEI (image automatic). CONCLUSION: The novel-derived parameters: AEI (image morphed) and AEI (image automatic) can precisely gauge obesity and can be the effective alternatives for high-cost DXA. In addition, low-cost BIA-based body composition analyzer can also be the better substitute for DXA.

Risk assessment of heavy metals and their source distribution in waters of a contaminated industrial site.

Industrially contaminated sites with hazardous materials are a priority and urgent problem all over the world. Appropriate risk assessment is required to determine health risks associated with contaminated sites. The present study was conducted to investigate distribution of potentially hazardous, heavy metal (As, Cd, Cr, Cu, Ni, Pb and Zn) concentrations in surface and groundwater samples collected during summer (pre-monsoon) and winter (post-monsoon) seasons from an industrially contaminated site, Hyderabad, India, with potential source of metal contamination because of industrial effluents and usage of pesticides in agriculture. Heavy metal (HM) concentrations were analysed by using inductively coupled plasma-mass spectrometer and were compared with permissible limits set by the World Health Organisation. Data obtained was treated using multivariate statistical approaches like R-mode factor analysis (FA), principal component analysis, cluster analysis, geoaccumulation index, enrichment factor, contamination factor and the degree of contamination. Health risk assessment like chronic daily intake (CDI) and hazard quotient (HQ) were also calculated. Relatively high levels were noted in surface water with average concentrations during summer and winter seasons showing 16.13 and 11.83 for As, 7.91 and 1.64 for Cd, 88.33 and 32.90 for Cr, 58.11 and 28.26 for Cu, 53.62 and 69.96 for Ni, 173.8 and 118.6 for Pb, and 2,943 and 1,889 µg/L for Zn. While in groundwater, the mean metal levels during two seasons were 18.18 and 3.76 for As, 1.67 and 0.40 for Cd, 29.40 and 5.15 for Cr, 17.03 and 4.19 for Cu, 25.4 and 6.09 for Ni, 81.7 and 2.87 for Pb and 953 and 989 µg/L for Zn, respectively. FA identified two factors with cumulative loadings of F1-60.82 % and F2-76.55 % for pre-monsoon surface water and F1-48.75 % and F2-67.55 % for groundwater. Whereas, three factors with cumulative loadings of F1-39.13 %, F2-66.60 % and F3-81.01 % for post-monsoon surface water and F1-50.31 %, F2-66.18 % and F3-81.54 % for groundwater. The health risk assessment like CDI and HQ indices with increased levels of hazardous elements in the surface and groundwater were safe for drinking purposes provided some water treatment methodologies are adopted.

Compliance with iron-folic acid (IFA) therapy among pregnant women in an urban area of south India.

BACKGROUND: Anaemia is highly prevalent among pregnant women and iron deficiency is the most important cause. Like many other countries, India has policies to give pregnant women iron supplements. Non-compliance is one important challenging factor in combating anaemia. OBJECTIVE: To estimate the compliance for IFA tablets among pregnant women and to study the social factors influencing it. METHODOLOGY: This study included 190 pregnant women seeking ante-natal care in tertiary health Centres in the Mangalore city in South India. After Institutional Ethics Committee (IEC) approval, data was collected by personal interview. Missing ≥2 doses consecutively was considered non-compliance. The data was analyzed using SPSS (Statistical Package for Social Sciences) version 11.5. RESULTS: The mean age of the study population was 25.8 years (SD: 4.1). Majority of the subjects consumed mixed diet and 72.1% belonged to lower socioeconomic status. Overall, compliance with IFA tablets was 64.7%. Compliance increased with the increase in age, birth order and single daily dose. Forgetfulness and both perceived as well as experienced side effects of IFA therapy were the important factors for non-compliance. CONCLUSION: There was a moderate level of Compliance towards IFA tablets with key social and demographic factors playing important role.

Diagnosis and treatment of intracranial hemorrhage in children with hemophilia.

Intracranial hemorrhage (ICH) is a significant complication for children with hemophilia. Identifying risk factors may allow us to establish clinically relevant guidelines for the diagnosis and management of ICH. The purpose of this review is to nucleate evidence from the available literature on the incidence, risk factors, presentation, treatment, and outcomes of ICH that can be utilized to develop a clinically useful framework for the diagnosis and management of hemophiliac patients with the condition. An electronic MEDLINE and EMBASE literature search was undertaken using the key words 'intracranial hemorrhage and hemophilia' and setting limits as: Last 10 years and Review or Randomized Controlled Trial (RCT) or Clinical Trial, or Practice Guidelines. Following review of all articles using predetermined search words and criteria, 31 were retrieved with sufficient data to address our objectives. An algorithm is presented for the management of children (≥3 years-18 years) with hemophilia and suspected ICH. A standardized approach to ICH may reduce unnecessary exposure to radiation via computed tomography scan in a select group of children. Currently there is limited scientific evidence to recommend a diagnostic and therapeutic algorithm for neonates with hemophilia.

An initial safety assessment of hepatotoxic and nephrotoxic potential of intramuscular ketoprofen at single repetitive dose level in broiler chickens.

A study was undertaken to assess the hepatotoxic and nephrotoxic potential of ketoprofen in comparison with diclofenac upon short-term intramuscular (i.m.) administration in broiler chickens. Eighteen broiler chickens were randomly divided into 3 groups of 6 birds each. Group I served as the control and received normal saline (0.1 mL, i.m.), group II was the positive control and received diclofenac sodium (2.5 mg/kg, i.m.), and group III received ketoprofen (3 mg/kg, i.m.) daily at 24-h intervals for 5 consecutive days. Diclofenac sodium-treated birds showed severe clinical signs of toxicity with high mortality, a significant increase (P < 0.01) in serum concentrations of creatinine, uric acid, alanine aminotransferase, and aspartate aminotransferase, and these changes correlated well with gross and microscopic examination findings of kidney and liver. In contrast, ketoprofen-treated birds did not show any adverse clinical signs and no significant increase in concentration of creatinine, uric acid, alanine aminotransferase, and aspartate aminotransferase when compared with birds in group I. Gross and microscopic examination of kidney and liver showed normal organ architecture. Thus, based on the present findings, it was concluded that ketoprofen at the dose of 3 mg/kg administered intramuscularly daily for 5 d was nontoxic to broiler chickens.

Knowledge, attitude and practices of Indian dental surgeons towards tobacco control: advances towards prevention.

AIMS AND METHODS: We assessed the knowledge, attitude and practices of dental surgeons in the city of Bangalore, Karnataka, concerning use of tobacco in their patients. A self-administered questionnaire was administered to all dental surgeons prior to a sensitization program on nicotine dependence. RESULTS: The dental surgeons who responded (n=100) reported a need for increasing sensitization on the issue of tobacco especially among health professionals. Only 33% knew that nicotine is the most addictive drug and knowledge was poor about pharmacological as well as non pharmacological methods of treatment of nicotine dependence. Only 52% asked all their patients about tobacco use. However, almost all dental surgeons agreed that there should be a ban on public use of tobacco. IMPLICATIONS: The results of this study call for sensitizing health professionals on a larger scale on the issue of tobacco use and its treatment.

Are patient assistance programmes able to meet the needs of New York City women with breast cancer? Women's perspectives.

Women with breast cancer report needs that may interfere with their ability to obtain necessary treatments. High-quality community-based patient assistance programmes exist; however, their ability to identify and meet women's needs is unknown. We surveyed women with breast cancer attending such programmes to assess programmes' ability to identify and meet their needs. We surveyed 117 (42% minority) women utilizing nine programmes in the New York City area about expectations, needs and experiences. Ninety-two (89%) women wanted information, 102 (95%) psychosocial support and 15 (20%) practical assistance. Seventy-three per cent had all or most of their needs identified, and 74% had all or most of their needs met. Seventy per cent stated programmes met needs they were not previously aware they had. Needs identified and met were lower among minority women (57% vs. 84%; P = 0.003), those with lower income (46% vs. 79%; P = 0.02) and those in poor physical health (56% vs. 78%; P = 0.04), independent of the type of need. High-quality community-based patient assistance programmes effectively identify and meet the needs of women with breast cancer but traditionally at-risk women appear less likely to have needs identified and met. Programmes should enhance the systemization and sensitivity of needs assessments to improve women's experience with cancer.

Utilization pattern and cost of sedation, analgesia and neuromuscular blockade in a multidisciplinary intensive care unit / Patrón de utilización y costo de la sedación, analgesia y bloqueo neuromuscular en una unidad multidisciplinaria de cuidados intensivos

OBJECTIVES: To study the utilization pattern and the cost of sedatives, analgesics and neuromuscular blocking agents in a multidisciplinary intensive care unit (ICU) METHODS: A prospective observational study was conducted in the ICU of the Eric Williams Medical Sciences Complex, Trinidad and Tobago, for a period of twelve weeks. All patients admitted to the ICU were enrolled. No interventions were done. Data collected included demographics, diagnoses on admission, length of stay in the ICU, status of mechanical ventilation, patient outcome, quantity of sedatives, analgesics and neuromuscular blocking agents used in every patient and their cost. RESULTS: There were 333 patient-days encountered from 34 patients studied. Midazolam, fentanyl and cisatracurium were the most commonly used sedative, opioid and neuromuscular blocking agents respectively. The total cost of drugs used for sedation, analgesia and neuromuscular blockade was approximately US$ 19 600 per annum. Cost for this treatment alone accounted for more than 50% of the total ICU drug costs. The costs were significantly higher in patients who stayed more than two weeks in the ICU when compared to those who stayed less than two weeks (p < 0.001). CONCLUSIONS: The study highlights the utilization pattern and financial burden of sedation, analgesia and neuromuscular blockade in the delivery of critical care.

OBJETIVOS: Estudiar el patrón de utilización y costo de los sedantes, analgésicos, y agentes de bloqueo neuromuscular en una Unidad Multidisciplinaria de Cuidados Intensivos (UCI). MÉTODOS: Se llevó a cabo un estudio prospectivo en la UCI del Complejo de Ciencias Médicas Eric Williams, en Trinidad y Tobago, por un período de doce semanas. Todos los pacientes ingresados a la UCI fueron enrolados. No se realizaron intervenciones. Los datos recogidos incluyeron demografías, diagnósticos de ingreso, longitud de la estadía en la UCI, estatus de ventilación mecánica, evolución del paciente, así como la cantidad y el costo de los sedantes, analgésicos y agentes de bloqueo neuromuscular usados en cada paciente. RESULTADOS: Se encontraron 333 días-pacientes a partir de 34 pacientes estudiados. La midazolama, el fentanil y el cisatracurio fueron los agentes sedativos, opioides y de bloqueo neuromuscular más comúnmente usados. El costo total de los medicamentos usados para la sedación, la analgesia y el bloqueo neuromuscular fue de aproximadamente $19 600 USD por año. El costo sólo para este tratamiento representó más del 50% del total de los costos de medicamentos de la UCI. Los costos fueron significativamente más altos en pacientes que permanecieron más de dos semanas en la UCI, en comparación con aquellos que permanecieron menos de dos semanas (p < 0.001). CONCLUSIONES: El estudio pone de relieve el patrón de utilización de la carga financiera de la sedación, analgesia y bloqueo muscular a la hora de ofrecer atención crítica.

Utilization pattern and cost of sedation, analgesia and neuromuscular blockade in a multidisciplinary intensive care unit.

OBJECTIVES: To study the utilization pattern and the cost of sedatives, analgesics and neuromuscular blocking agents in a multidisciplinary intensive care unit (ICU). METHODS: A prospective observational study was conducted in the ICU of the Eric Williams Medical Sciences Complex, Trinidad and Tobago, for a period of twelve weeks. All patients admitted to the ICU were enrolled. No interventions were done. Data collected included demographics, diagnoses on admission, length of stay in the ICU, status of mechanical ventilation, patient outcome, quantity of sedatives, analgesics and neuromuscular blocking agents used in every patient and their cost. RESULTS: There were 333 patient-days encountered from 34 patients studied. Midazolam, fentanyl and cisatracurium were the most commonly used sedative, opioid and neuromuscular blocking agents respectively. The total cost of drugs used for sedation, analgesia and neuromuscular blockade was approximately US$ 19,600 per annum. Cost for this treatment alone accounted for more than 50% of the total ICU drug costs. The costs were significantly higher in patients who stayed more than two weeks in the ICU when compared to those who stayed less than two weeks (p < 0.001). CONCLUSIONS: The study highlights the utilization pattern and financial burden of sedation, analgesia and neuromuscular blockade in the delivery of critical care.

Assessing advertising content in a hospital advertising campaign: An application of Puto and Wells (1984) measure of informational and transformational advertising content.

The following is a report of a study designed to measure advertising content based on the cognitive and affective elements of informational (i.e., information processing) and transformational (i.e., experiential) content using the measure of advertising informational and transformational content developed by Puto and Wells (1984). A university hospital advertising campaign designed to be high in transformational content did not appear to affect perceived quality of local university hospitals relative to private hospitals or increase the likelihood of choosing a university hospital in the future. Further, experiences with university hospitals that seemed to be in direct contrast to the content of the advertisements based on subject perceptions affected how university hospital advertisements were perceived in terms of content. Conclusions and implications for hospital advertising campaigns are discussed.

Developing a tracking system for coagulation factor concentrates in southern Ontario.

BACKGROUND: In response to the transfusion- transmitted AIDS epidemic, Canadian authorities recommended the development of tracking systems and improved reporting of adverse events. This study describes the development of a verifiable and comprehensive regional tracking system for coagulation factor concentrates. STUDY DESIGN AND METHODS: The Hamilton- Niagara Regional Hemophilia Program received distribution and utilization data from Canadian Blood Services, 26 regional hospitals, and 70 individuals with bleeding disorders on home-based therapy. Purpose-specific software, the Canadian Hemophilia Assessment and Resource Management System (CHARMS), was used to store, monitor, analyze, and validate data. RESULTS: During a 1-year period (2001), all factor concentrates distributed in this region were accounted for. A higher proportion of FVIII and FIX concentrates (88 vs. 12%) was infused at home than in hospitals, and a higher proportion (63 vs. 28%) was used to prevent than to treat bleeds. During a period of shortage, a 5-percent reduction in utilization of both FVIII and FIX concentrates was documented. One recall was managed swiftly and efficiently. Two patients reported allergic skin reactions. CONCLUSION: A verifiable tracking system has been developed that can provide ongoing data for both clinical and administrative purposes. Data collection from patients needs to be made more efficient and real-time recording is an important future objective. Such a system can be instituted locally for less than 1.5 percent of the cost of the factor concentrate used.