Knowledge and Practice of the Referral System under the National Health Insurance Scheme among Medical and Dental Practitioners of A Large-Accredited Facility in Kano, Nigeria.

BACKGROUND: Studies on healthcare professionals' knowledge about the National Health Insurance Scheme (NHIS) are scarce. Therefore, we assessed the knowledge and practice of the NHIS referral system among Medical and Dental practitioners in a tertiary hospital in Northwest Nigeria. METHODS: This cross-sectional study involved 242 medical and dental practitioners randomly selected from nine departments for over 6-weeks. A structured self-administered questionnaire was used to collect data. Data were analyzed using descriptive and inferential statistics. RESULTS: The respondents' mean age was 35.7±6.0 years; they were predominantly males (64.9%). Their mean overall knowledge score was 58.9±23.0%, with 66.9% of respondents having inadequate overall knowledge of the NHIS referral system. Practice department (Fishers 2 exact, P=0.0019), perceived knowledge of the referral system (ꭓ =8.169, P=0.004), and having been referred as an enrolee (ꭓ2 = 6.358, P=0.012) were associated with overall-knowledge. Obstetrics-and-Gynaecology (odds ratio[OR]=0.29, 95% confident interval [CI] [0.88-0.98]), Dental and-Maxillofacial-Surgery (OR=0.08, 95%CI[0.01-0.98]), and Otorhinolaryngology (OR=0.18, 95%CI[0.04-0.80]) respondents were less likely to have adequate overall-knowledge.Although 56.2%, 50.4%, 20.7%, and 89.7% were enrolees, had received treatment as enrolees, had been referred as enrolees and treated other enrolees, respectively, an unimpressive proportion had sighted a referral letter (64.9%) or authorization code on the letter (25.2%), referred an enrolee from their department previously (51.2%) or used the NHIS referral form to write referrals (38.8%). CONCLUSION: The overall knowledge of the NHIS referral system was inadequate. The practice of the referral system was below expectation. Therefore, training medical and dental practitioners on the NHIS referral system is necessary. Training should target those who are least likely to have adequate overall knowledge.

CONTEXTE: Les études sur les connaissances des professionnels de la santé concernant le Régime d'assurance maladie national (NHIS) sont rares. Nous avons donc évalué les connaissances et la pratique du système de référence du NHIS parmi les médecins et dentistes d'un hôpital tertiaire du Nord-Ouest du Nigeria. MÉTHODES: Cette étude transversale a impliqué 242 médecins et dentistes sélectionnés de manière aléatoire dans neuf départements pendant plus de 6 semaines. Un questionnaire structuré auto-administré a été utilisé pour recueillir des données. Les données ont été analysées à l'aide de statistiques descriptives et inférentielles. RÉSULTATS: L'âge moyen des répondants était de 35,7 ± 6,0 ans ; ils étaient principalement des hommes (64,9 %). Leur score moyen global de connaissances était de 58,9 ± 23,0 %, avec 66,9 % des répondants ayant une connaissance globale insuffisante du système de référence du NHIS. Le département de pratique (test exact de Fisher, P=0,0019), la connaissance perçue du système de référence (ꭓ 2 =8,169, P=0,004) et avoir été référé en tant qu'adhérent (ꭓ 2 = 6,358, P=0,012) étaient associés à la connaissance globale. Les répondants en obstétrique-gynécologie (rapport des cotes [OR]=0,29, intervalle de confiance à 95 % [IC] [0,88-0,98]), en chirurgie dentaire et maxillo-faciale (OR=0,08, IC à 95 % [0,01-0,98]), et en oto-rhino-laryngologie (OR=0,18, IC à 95 % [0,04-0,80]) étaient moins susceptibles d'avoir une connaissance globale adéquate. Bien que 56,2 %, 50,4 %, 20,7 % et 89,7 % étaient adhérents, avaient reçu un traitement en tant qu'adhérents, avaient été référés en tant qu'adhérents et avaient traité d'autres adhérents, respectivement, une proportion peu impressionnante avait vu une lettre de référence (64,9 %) ou un code d'autorisation sur la lettre (25,2 %), avait référé un adhérent de leur département précédemment (51,2 %) ou avait utilisé le formulaire de référence du NHIS pour écrire des références (38,8 %). CONCLUSION: La connaissance globale du système de référence du NHIS était insuffisante. La pratique du système de référence était en deçà des attentes. Par conséquent, la formation des médecins et dentistes sur le système de référence du NHIS est nécessaire. La formation devrait cibler ceux qui sont moins susceptibles d'avoir une connaissance globale adéquate. MOTS-CLÉS: Connaissances et Pratiques, Professionnels de la santé, Régime national d'assurance maladie, Nigeria, Renvoi.

Knowledge and practice of prophylaxis of deep venous thrombosis: A survey among Nigerian surgeons.

BACKGROUND: Venous thromboembolism is a potentially dangerous condition that can lead to preventable morbidity and mortality among surgical patients. OBJECTIVES: We aimed to determine the knowledge and practice of surgeons practising in Tertiary Hospitals in Nigeria about prophylaxis of deep vein thrombosis (DVT). MATERIALS AND METHODS: Eight Tertiary Institutions were selected from institutions in the geopolitical regions of the country by simple random sampling using balloting method. A semi-structured questionnaire was administered, and the response was obtained from 105 out of 254 surgeons. RESULTS: The mean knowledge score was 5.81 ± 1.67, and only 33.3% have good knowledge about DVT prophylaxis. No statistical difference was observed between the different groups of surgeons. The mean practice score was 5.19 ± 1.8 and only 20% of surgeons have a good practice of DVT prophylaxis. The majority (90.5%) have encountered DVT whereas 83.5% have encountered pulmonary embolism in their practice. Most commonly encountered risk factors include prolonged immobility, advanced age, and pelvic surgery. Only 13.3% have used Well's score in the clinical evaluation of their patients. The prophylactic modality adopted varies, but most surgeons (77%) utilized both the pharmacological and mechanical methods. Low molecular weight heparin is the commonly used chemoprophylactic agent while a combination of early ambulation and limb physiotherapy is the most commonly preferred mechanical method of thromboprophylaxis. CONCLUSION: There is a deficiency in the knowledge and practice of DVT prophylaxis among surgeons in Nigeria. There is a need to improve both the knowledge and practice by introducing institutional guidelines or protocol for DVT prophylaxis for surgical patients.

Exploring the effect of cellulose nanowhiskers isolated from oil palm biomass on polylactic acid properties.

In this work, polylactic acid (PLA) reinforced cellulose nanowhiskers (CNW) were prepared through solution casting technique. The CNW was first isolated from oil palm empty fruit bunch microcrystalline cellulose (OPEFB-MCC) by using 64% H2SO4 and was designated as CNW-S. The optical microscopy revealed that the large particle of OPEFB-MCC has been broken down by the hydrolysis treatment. The atomic force microscopy confirmed that the CNW-S obtained is in nanoscale dimension and appeared in individual rod-like character. The produced CNW-S was then incorporated with PLA at 1, 3, and 5 parts per hundred (phr) resins for the PLA-CNW-S nanocomposite production. The synthesized nanocomposites were then characterized by a mean of tensile properties and thermal stability. Interestingly to note that incorporating of 3 phr/CNW-S in PLA improved the tensile strength by 61%. Also, CNW-S loading showed a positive impact on the Young's modulus of PLA. The elongation at break (Eb) of nanocomposites, however, decreased with the addition of CNW-S. Field emission scanning electron microscopy and transmission electron microscopy revealed that the CNW-S dispersed well in PLA at lower filler loading before it started to agglomerate at higher CNW-S loading (5phr). The DSC analysis of the nanocomposites obtained showed that Tg,Tcc and Tm values of PLA were improved with CNW-S loading. The TGA analysis however, revealed that incopreated CNW-S in PLA effect the thermal stability (T10,T50 and Tmax) of nanocomposite, where it decrease linearly with CNW-S loading.

Pyrolysis of low density polyethylene waste in subcritical water optimized by response surface methodology.

Pyrolysis of low density polyethylene (LDPE) waste from local waste separation company in subcritical water was conducted to investigate the effect of reaction time, temperature, as well as the mass ratio of water to polymer on the liquid yield. The data obtained from the study were used to optimize the liquid yield using response surface methodology. The range of reaction temperature used was 162-338°C, while the reaction time ranged from 37 min to 143 min, and the ratio of water to polymer ranged from 1.9 to 7.1. It was found that pyrolysis of LDPE waste in subcritical water produced hydrogen, methane, carbon monoxide and carbon dioxide, while the liquid product contained alkanes and alkenes with 10-50 carbons atoms, as well as heptadecanone, dichloroacetic acid and heptadecyl ester. The optimized conditions were 152.3°C, reaction time of 1.2 min and ratio of water solution to polymer of 32.7, with the optimum liquid yield of 13.6 wt% and gases yield of 2.6 wt%.

Isolation and characterization of cellulose nanowhiskers from oil palm biomass microcrystalline cellulose.

The objective of this study is to compare the effect of two different isolation techniques on the physico-chemical and thermal properties of cellulose nanowhiskers (CNW) from oil palm biomass obtained microcrystalline cellulose (MCC). Fourier transform infrared analysis showed that there are no significant changes in the peak positions, suggesting that the treatments did not affect the chemical structure of the cellulose fragment. Scanning electron microscopy showed that the aggregated structure of MCC is broken down after treatment. Transmission electron microscopy revealed that the produced CNW displayed a nanoscale structure. X-ray diffraction analysis indicated that chemical swelling improves the crystallinity of MCC while maintaining the cellulose I structure. Acid hydrolysis however reduced the crystallinity of MCC and displayed the coexistence of cellulose I and II allomorphs. The produced CNW is shown to have a good thermal stability and hence is suitable for a range of applications such as green biodegradable nanocomposites reinforced with CNW.

Properties of polylactic acid composites reinforced with oil palm biomass microcrystalline cellulose.

In this work, polylactic acid (PLA) composites filled with microcrystalline cellulose (MCC) from oil palm biomass were successfully prepared through solution casting. Fourier transform infrared (FT-IR) spectroscopy indicates that there are no significant changes in the peak positions, suggesting that incorporation of MCC in PLA did not result in any significant change in chemical structure of PLA. Thermogravimetric analysis was conducted on the samples. The T50 decomposition temperature improved with addition of MCC, showing increase in thermal stability of the composites. The synthesized composites were characterized in terms of tensile properties. The Young's modulus increased by about 30%, while the tensile strength and elongation at break for composites decreased with addition of MCC. Scanning electron microscopy (SEM) of the composites fractured surface shows that the MCC remained as aggregates of crystalline cellulose. Atomic force microscopy (AFM) topographic image of the composite surfaces show clustering of MCC with uneven distribution.

Bulk H analysis using neutrons for routine quality control of cassava and products.

Nuclear and related techniques are useful in addressing the issues of food security and safety facing the world today, via quality control of raw materials and products. In this work, experimental investigations were performed to assess the use of total hydrogen content in cassava and products as a quality control indicator of starch and cyanide contents. The work was carried out using a neutron reflection facility at the Centre for Energy Research and Training, Ahmadu Bello University, Zaria, Nigeria. Cassava samples and products were obtained from retail outlets of Ibadan, Umudike and Zaria, representing three major regions of Nigeria. In general, data obtained indicate a total hydrogen content range of 4.47±0.11-10.71±0.27wt% for the various samples, including raw, dry and processed cassava. Results show that samples having low hydrogen content are generally rich in cyanide compounds and demonstrate an inverse relationship between hydrogen content and cyanide content. The implication of this is that the neutron reflection facility can be used as a quality control setup for routine determination of hydrogen as an indicator of the cyanide content in cassava and products.

A morphometric study on the endometrium of rat uterus in hypothyroid and thyroxine treated hypothyroid rats.

Hypothyroidism increases the rate of pregnancy loss. Other manifestations include menstrual disorder, and infertility. Serum levels of gonadotropins are low in hypothyroid patients. Though studies of uterine ultrastructure are well established as approaches to investigating the pathophysiology of infertility, they have scarcely been extended to the study of hypothyroid related infertility. The present study investigates the effect of hypothyroidism on the ultrastructure of uterine epithelium. Three groups of Wistar rats were studied. Two groups were initially made hypothyroid using methimazole, and the third group was an untreated control. One hypothyroid group was given daily injections of thyroxine for six weeks. The uteri were removed in all three groups, and processed for transmission electron microscopy and morphometry. It was found that absolute epithelial cell volume was decreased in hypothyroidism. The volume of the nucleus had decreased though its relative volume in the cell had increased. The height of the luminal epithelium in hypothyroid rats also decreased by (33.8%) as compared with controls. Basement membrane thickness was significantly increased in hypothyroidism. The changes were all substantially abrogated by the administration of thyroxine. This study suggests that thyroid hormones might be importantly concerned in the maintenance of the normal structure of uterine epithelial cells.

QSAR modeling and transmission electron microscopy stereology of altered mitochondrial ultrastructure of white blood cells in patients diagnosed as schizophrenic and treated with antipsychotic drugs.

Treatment of patients diagnosed as schizophrenic with antipsychotic drugs (neuroleptics) is known to cause occasional unexplained depletion of white blood cells, especially neutrophil granulocytes. It has been known for many years that neuroleptics can interfere with the mitochondrial respiratory chain in vitro. Because there has been a growing interest recently in mitochondrial targeting of drugs, and since a quantitative structure-activity relationship (QSAR) model that predicts mitochondrial accumulation of neuroleptics has been published, we investigated the effects of neuroleptics on white blood cell mitochondria. Venous blood samples were collected from both patients undergoing treatment with neuroleptics and healthy volunteers. The samples were processed for transmission electron microscopy. The resulting images of white blood cells were analyzed using stereology to compare quantitatively mitochondrial morphology in the patient and control groups. We found that in patients, but not in controls, there was swelling of mitochondria and fragmentation of the mitochondrial cristae. There also were fewer mitochondria in patients than in controls, although due to the swelling of the organelles, the volume density of mitochondria in the two groups was not significantly different. Such changes are typical of a toxic insult. Consequently, it seems plausible that, since schizophrenia is not a disease considered to affect white blood cells per se, these changes probably are due to the medication.

Left Ventricle Myocardium Volume Densities in Spontaneously Hypertensive Rats (SHR) Following Combination of Exercise and ACE Inhibitor Treatment: A Stereological Study / Densidad de Volumen del Miocardio del Ventrículo Izquierdo en Ratas Espontáneamente Hipertensas (REH) Posterior a la Combinación de Ejercicios y Tratamiento Inhibidor de la ACE: Estudio Estereológico

This study was designed to test the possible effects of a combination of physical and pharmacological therapy intervention on myocardial structure of the left ventricle in spontaneously hypertensive rats (SHR). Twelve weeks old spontaneously hypertensive rats (n = 40) were divided into four groups of sedentary, (Sed) as controls, exercise only (Exer), lisinopril only 20mg/kg/day (Lis), and exercise + lisinopril (LisExer). Exercise training was performed on a treadmill (5m/min.) for 60 minutes/day, 5 days/week for 10 weeks. At the end of 10 weeks, all the rats were terminally anaesthetised, the heart was arrested in diastole by intravenous procaine and whole animal perfusion fixation through the abdominal aorta was carried out using Karnovsky's fixative (pH 7.24). The heart was removed and left ventricle plus the interventricular septum was serially sectioned at a thickness of 3 mm. One piece was randomly chosen, and embedded in JB4 resin. Six sections were obtained from each block, stained with toluidine blue:acid fucin. Measurement of volume fraction (Vf), of myocardium, capillaries and interstitium were carried out using a stereology software (Histometrix MIL6 Kinetic imaging Ltd.). Mean Vf of capillaries in Sed group was 0.114 ± 0.01 (SEM). This was significantly increased in LisExer group. The Vf of muscle in Sed group was 0.795 ± 0.02 (SEM). This was significantly decreased in Lis but unchanged in Exer group. Capillaries Vf was significantly higher in LisExer as compared to Lis or Exer groups (p<0.05). Muscle Vf was not different betweenLisExer and Lis groups. The outcome of these changes could well be a better enhancement of cardiac performance in hypertension by combined exercise and ACE inhibitor treatment than either of the interventions alone.

Este estudio fue diseñado para probar los posibles efectos de una combinación de ejercicios y una intervención de terapia farmacológica en las estructuras del miocardio del ventrículo izquierdo, en ratas espontaneamente hipertensivas (SHR). Ratas de 20 semanas espontáneamente hipertensas (n = 40) fueron divididas en cuatro grupos: sedentarias (Sed) y controles, solamente con ejercicio (Ejer), solamente con lisinopril con 20mg/kg/día (Lis), y ejercicios + lisinopril (LisEjer). Los ejercicios fueron ejecutados en una máquina de entrenamiento (5m/min.) por 60 minutos/día, 5 días/semana por 10 semanas. Al término de las 10 semanas, las ratas fueron sacrificadas bajo anestesia, el corazón fue detenido en diástole usando procaina intravenosa. Los animales fueron perfundidos a través de la parte abdominal de la aorta, usando solución de Karnovsky (pH 7.24). El corazón fue removido y tanto al ventrículo izquierdo como al septo interventricular se les realizaron cortes seriados de 3 µm. Una pieza fue seleccionados al azar, y sumergida en resina JB4. Fueron obtenidas 6 secciones de cada bloque y luego teñidas con azul de toluidina:fucsina ácida. Las mediciones de fracción volumétrica (Vf) del miocardio, capilares, e intersticio fueron obtenidas usando un software de estereología (Histometrix MIL6 Kinetic imaging Ltd.). El promedio Vf de capilares en el grupo Sed, fue 0.114 ± 0.01 (SEM). Éste fue significativamente mayor en el grupo LisExer. El Vf de músculo en Sed fue 0.795 ± 0.02 (SEM). Éste fue significativamente menor en Lis pero no varió en el grupo Ejer. Vf capilares fue significativamente alto en LisExjr, si es comparado con los grupos Lis o Ejer (p<0.05). En Vf músculo no hubo diferencias entre los grupos LisEjer y Lis. El resultado de estos cambios pudo deberse a un mejor funcionamiento cardiaco en ratas hipertensa,s producto de ejercicios combinados y tratamiento con inhibidor ACE, que en aquellos en que se efectó un solo procedimiento.

Congenital fiber-type disproportion myopathy with type I fiber predominance and type II fiber smallness and atrophy--a sterological analysis.

Congenital myopathy with fiber-type disproportion is an established disorder, where type I fibers predominate with smallness of the same type. We report a family with three siblings (12-year-old boy, 9-year-old girl, and 6-year-old boy) with clinical features of congenital myopathy, where muscle biopsy in the eldest sib showed fiber-type disproportion. Type I fibers predominated with small and atrophic type II fibers which is unusual, especially when the child did not have any other clinical or biochemical abnormality to account for this type of variation. Further, a stereological analysis highlighted the differences with regards to number, size and even volume of the fiber types. A 3-dimensional concept is proposed for this morphological abnormality.

Correlation between volume fraction and volume-weighted mean volume, and between total number and total mass of islets in post-weaning and young Wistar rats.

The aim of this study was to estimate the number and volume distribution of islets of Langerhans in post-weaning young Wistar rat pancreas and their variation with age. Four groups of six normal Wistar Kyoto rats, at 3, 6, 9 and 12 weeks of age, were used. The whole pancreas was weighed (W), fixed in buffered formaldehyde and embedded in JB4 resin, and 1.5-microm serial sections were obtained. A fraction of whole tissue was obtained in accordance with the multistage fractionator principle and used to estimate total number of islets (N(is)). Volume fraction (V(f)) of islets and volume-weighted mean volume (Vv) of islets were estimated using point-counting and point-sampled intercept methods, respectively. The numbers of islets increased steadily with age (P < 0.001), whereas the volume-weighted mean volume of individual islets was not significantly different among all age groups of rats (P > 0.05). There was a strong positive correlation between total islet number and islet mass (r = 0.96, P = 0.001), and between volume fraction and islet mass (r = 0.969, P = 0.001). However, there was a weak positive correlation between volume fraction and volume-weighted mean islet volume (r = 0.6, P = 0.002) in the age window investigated. These findings indicate that there was an increase in the number and volume fraction of islets with age in post-weaning young rats but that individual islet volume did not change significantly. It appears the mechanism of alteration in islet morphology in the rat is mainly by the formation of new islets while keeping their individual volume distribution unchanged.