bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimal Melatonin Dose in Older Adults: A Clinical Review of the Literature
Authors: Pierce Mackenzie , Linnebur Sunny A. , Pearson Scott M. , Fixen Danielle R.
Published: October 2021

OBJECTIVE: To review clinical studies evaluating melatonin doses and their effects on sleep in adults 65 years of age and older. DATA SOURCES: The MEDLINE databases were searched (1946 to October 10, 2018) using the following Medical Subject Heading terms: melatonin and:
sleep initiation and maintenance disorders, dyssomnia, sleep wake disorders, insomnia, sleep disorders intrinsic, and sleep disorders circadian rhythm. Sources were limited to English and human data. STUDY SELECTION/DATA EXTRACTION: An initial search resulted in 144 publications, with
25 included in this review. Studies were selected for full review based on design, mean age of participants, use of exogenous melatonin, and reports on any sleep-related outcome. DATA SYNTHESIS: Because of the side effect profiles of most prescription and nonprescription sleep aids,
safe and effective alternative therapies are necessary. Based on the current literature, no dose-related response to sleep improvement has been identified for melatonin in older adults. Variations in melatonin formulation and dosages, as well as available tools to measure sleep outcomes, make
it challenging to compare studies. CONCLUSIONS: This review evaluated a variety of melatonin doses, 0.5 mg to 10 mg, and their effects on sleep in older adults. The results varied, with some studies finding no difference in sleep outcomes when compared with placebo, while other studies
found statistically significant improvements in sleep outcomes. Doses of melatonin between 1 mg and 6 mg appear to be effective for improving sleep in older adults; however, further studies are needed to find the optimal minimum effective dose.
Music Therapy: A Novel Student Pharmacy Outreach to Manage Symptoms of Alzheimer's Dementia
Authors: Nagy Kayla , Hill Matthew , Kroustos Kelly Reilly , Sobota Kristen Finley
Published: October 2021

Patients with Alzheimer's dementia (AD) often present with behavioral and psychological symptoms of dementia (BPSD), which may include anxiety, depression, and agitation, leading to a decrease in quality of life. Nonpharmacologic methods are recommended as first-line therapy for reducing
BPSD. The student chapter of ASCP at Ohio Northern University Raabe College of Pharmacy has partnered with a local nursing facility to implement an active group music therapy (MT) outreach program to assist in management of BPSD. The program also evaluated the perceived effects of this outreach
on students. In addition to having a profound impact on the residents, this outreach has also provided an excellent educational outlet for students to establish and practice skills in working with the AD patient population. In this article, we share our experiences with MT and provide education
on how to implement MT outreach at your own institution or practice.
Osteoarthritis in Older Adults: Nonsteroidal Anti-Inflammatory Drugs Versus Opioids
Authors: Banks Callan , Hughes Krystal , Simpkins Cassandra , Elliott David P.
Published: October 2021

Persistent pain in older adults as a result of osteoarthritis (OA) has various treatment options, and all of them have significant risks. An oral nonsteroidal anti-inflammatory drug (NSAID) or an opioid can be considered as a treatment option when persistent pain is not controlled by
nonpharmacological interventions and regularly scheduled doses of acetaminophen. However, NSAIDs are nephrotoxic and may cause upper gastrointestinal bleeding. These risks can be mitigated through the initiation of a proton-pump inhibitor and careful monitoring of renal function and serum
electrolytes. A low-dose opioid taken as needed can be considered as a treatment option if the pain is not controlled by NSAIDs as long as the risks associated with central nervous system depression and dose escalation as a result of tolerance are monitored closely. The complete patient profile
must be taken into consideration when determining the best option.
Targeted Medication Deprescribing in the Elderly: Results of a Pharmacist-Driven Procedure in a Transitional Care Unit
Authors: Feldman Elizabeth A. , Noviasky John , Ulen Kelly R. , Miller Christopher D. , Barbagallo Deena , Seabury Robert
Published: October 2021

OBJECTIVE: Assess the impact of a pharmacist-driven deprescribing procedure on reduction of target medications at discharge among geriatric patients receiving care in a hospital-based transitional care unit.
 DESIGN: Retrospective, single-center chart review.

SETTING: Transitional care unit located within a hospital.
 PARTICIPANTS: Patients 65 years of age and older were included if they were admitted to the transitional care unit between June 1, 2017, and December 15, 2017, on one or more of the following target medication
classes: antihistamines, benzodiazepines, hypnotic sleep aids, proton-pump inhibitors, and skeletal muscle relaxants.
 INTERVENTIONS: Pharmacists performed a structured review of patient's medications upon admission and utilized the deprescribing procedure developed by our
institution to identify and deprescribe target medications in an attempt to optimize the patient's medication regimen prior to discharge.
 RESULTS: Overall, 129 patients on 198 target medications were included in the study. Patients were on an average of 1.5 ± 0.78
target medications at admission, which was reduced to 0.78 ± 0.73 at discharge (P < 0.001). Overall, a 50% reduction of target medications was achieved.
 CONCLUSION: A pharmacist-driven deprescribing procedure significantly reduced the quantity of target medications
that older patients were discharged on.
Pharmacy Services and the Novel Coronavirus
Authors: Alderman Chris
Published: October 2021

Pharmacists around the world can expect to be affected by the coronavirus, especially those who provide care for older people who are at a much higher risk for grave consequences from the virus. It is critical that pharmacists maintain awareness of the evolving pandemic and access reliable
information to remain familiar with developments.
Practical Insight Into Anticoagulation for an Aging Population
Authors: Bottorff Michael B. , Kim Michael H. , Essien Utibe R. , Worz Chad
Published: October 2021

Anticoagulation is almost always required as a part of treatment for atrial fibrillation, but it is also one of the most potentially dangerous pharmacologic strategies. Recently, a number of guidance documents have been released with respect to anticoagulation. Some elements of the
guidelines potentially create conflicting considerations for clinicians charged with selecting the safest and most effective anticoagulation protocol, especially for patients older than 75 years of age.
Amikacin Liposome Inhalation Suspension for Mycobacterium avium Complex Lung Disease
Authors: Golia Austin , Mahmood Brenden R. , Fundora Yaniset , Thornby Krisy-Ann , Chahine Elias B.
Published: October 2021

OBJECTIVE: To review the pharmacology, pharmacokinetics, pharmacodynamics, clinical efficacy, safety, administration, and role of amikacin liposome inhalation suspension (ALIS) in treatment of Mycobacterium avium complex (MAC) lung disease.
 DATA SOURCES:
A PubMed search using the terms "amikacin inhaled," "nebulized," and "liposome suspension" was performed. Selected infectious diseaseconference posters were also examined for relevant information. In addition, pertinent guidelines were reviewed.
 STUDY SELECTION/DATA EXTRACTION:
Guidelines for the management of nontuberculous mycobacterial infections from the American Thoracic Society/ Infectious Diseases Society of America and the British Thoracic Society were used to summarize guidelinebased therapy (GBT). A phase II and a phase III clinical trial were reviewed
to evaluate the role of ALIS in the treatment of MAC lung disease.
 DATA SYNTHESIS: ALIS is a new formulation of inhaled amikacin (AMK) indicated for the treatment of MAC lung disease refractory to GBT in adults who are not candidates for intravenous AMK. An ongoing clinical
trial has demonstrated that once-daily ALIS plus GBT results in higher rates of culture conversion compared with GBT alone by month 6 among patients with a mean age of 65 years. The most common adverse reactions associated with ALIS were dysphonia, cough, bronchospasm, hemoptysis, and ototoxicity.
Nephrotoxicity was uncommon.
 CONCLUSION: ALIS has been shown to increase culture conversion rates when added to GBT in adults with difficult-to-treat MAC lung disease. ALIS is associated with high rates of pulmonary and auditory adverse reactions and a low risk of renal adverse
reactions. ALIS may be an attractive treatment option for older adults who are at high risk for nephrotoxicity.
Newly Approved Novel Dosage Forms of Glucagon for Management of Severe Hypoglycemia
Authors: Borden Thomas J. , Baker Danial E. , Levien Terri L. , Gates Brian J.
Published: October 2021

The prevalence and clinical impact of diabetes mellitus (DM) continues to increase in the United States and throughout the world. Older adults are at increased risk for adverse outcomes associated with hypoglycemia, particularly in situations where a lack of awareness may arise because
typical symptoms are not necessarily present, serve to prompt medical intervention with oral glucose. Glucagon emergency kits that have been available to date require multiple-step reconstitution that may compromise timely and appropriate administration of lifesaving glucagon treatment during
episodes of severe hypoglycemia. In settings such as long-term care facilities, trained medical professionals may not be readily available, meaning that glucagon must be administered by laypersons. Novel dosage forms of glucagon that have recently been approved for marketing in the United
States allow glucagon to be delivered more easily, which may positively impact effective treatment of severe hypoglycemia among older people. Nasal glucagon and glucagon autoinjection "pens" are as effective as glucagon kits and increase the likelihood glucagon will be appropriately used by
patient caregivers. The safety, efficacy, and convenience of these new devices may improve outcomes and reduce health care costs of older people with diabetes.
Verifying Medication Orders in the Older Population: Are We Using Enough Caution?
Authors: Scrimenti Ali , Probst Luke A. , Miller Christopher D. , Ulen Kelly R. , Noviasky John , Seabury Robert W.
Published: October 2021

OBJECTIVE: To test the common hypothesis that pharmacists may use more caution and resources when processing pediatric versus geriatric medication orders in the hospital setting.
 DESIGN: A 26-item electronic survey was distributed to a sample of participating
academic medical-center pharmacy directors with the request to disseminate it to staff pharmacists. The survey was resent at two-week intervals on two occasions.
 MAIN OUTCOME MEASURE(S): To identify if pharmacists take more caution when processing geriatric or pediatric medication
orders, to characterize the frequency pharmacists use drug information resources when processing these orders, and to assess the level of importance pharmacists place on guidelines for medication error prevention when processing medication orders.
 RESULTS: A total of 173
out of 271 pharmacists completed the survey, resulting in a high final completion rate of 63.8%. Most were clinical, residencytrained pharmacists. A majority of respondents stated that they take more caution when verifying pediatric medication orders than they do for orders for older people
(125 out of 172, or 72.7%). Pharmacists report they were 4.2 times more likely to refer to a drug information resource for ≥ 50% of pediatric orders versus geriatric orders (pediatric: 118 out of 171, or 69.0% vs. geriatric: 59 out of 172, or 34.3%; P < 0.001, or 95% confidence
interval [CI] 4.156 [2.647-6.524]). Finally, pharmacists familiar with the guidelines for medication error prevention were 2.3 times more likely to state the pediatric guidelines were very important (pediatric: 51/171, or 29.8% vs. geriatric: 27/172, or 15.7%; P = 0.002, or 95% CI 2.28
[1.35-3.86]).
 CONCLUSION: This survey reveals evidence for attitudinal differences in work practices for pharmacists working with medication orders relating to different age groups. Given the challenges involved in drug treatment for the older patient population, a similar
level of caution, preparedness to refer to drug information, and to use guidelines should apply for both pediatric medication orders and those for older people, in order to provide safe and comprehensive care.
How Will COVID-19 Affect Long-Term Care?
Authors: Baldwin Paul
Published: October 2021

We hope to be ready for the next COVID-like crisis, but what if the next crisis is something completely different?
No Act of Kindness, However Small, Is Ever Wasted
Authors: Alderman Chris
Published: October 2021

The stress that pervades everyday professional practice in a pandemic has the potential to compromise the quality of our interactions with each other. Now is a good time to weave respect, consideration, and kindness into the way in which we interact with each other.
Vigilance of Drug-Drug interactions to Mitigate ADRs: Front and Center for Pharmacists
Authors: Beier Manju T
Published: October 2021

As the number of people taking multiple medications increases, differing approaches to address drug-drug interactions and adverse drug reactions have been debated—but not solved—despite excellent criteria to stop the use of potentially inappropriate medications.
Digital Therapeutics: Health Care Wired for the Future
Authors: Kaldy Joanne
Published: October 2021

Digital therapeutics (DTx)—treatment or therapy that uses digital health technologies to spur changes in patient behavior—increasingly are making their way into the health care environment. This evolution is especially apparent as health care moves to valuebased care, silos
between settings are breaking down, and data collection/analysis and teamwork play key roles. These technologies, whether they are apps, software programs, or sensors, are helping patients adhere to treatments and lifestyle changes, set and meet viable care goals, and avoid costly emergency
department visits and hospitalizations. At the same time, DTx are helping practitioners ensure the best possible outcomes; streamline costs; monitor patient progress; and receive, analyze, and share data.
A Review of Newly Approved Antibiotic Treatment for Community-Acquired Bacterial Pneumonia: Lefamulin
Authors: Wang Hongmei , Charles Creaque V.
Published: October 2021

Lefamulin is a novel systemic, semi-synthetic pleuromutilin class of antimicrobials that has been shown to be effective against common respiratory pathogens associated with community-acquired bacterial pneumonia (CABP). CABP, a common infection among older people, leads to an increase
in hospitalizations and mortality. Therefore, the use of lefamulin could be beneficial for CABP treatment in patients who are 65 years of age or older.
 The Food and Drug Administration (FDA) approved lefamulin for the treatment of CABP, which is available in both intravenous and
oral formulations. This medication offers the benefit of not having any cross-resistance to other antibiotics and is highly concentrated in lung tissues. Lefamulin is unique because it has an induced-fit mechanism of action which inhibits bacterial protein synthesis. The clinical efficacy
of lefamulin has demonstrated noninferiority to current standard-of-care for CABP, and patients, generally, have tolerated it well in clinical trials.
 Lefamulin does not require dosage adjustment in renal impairment. However, the drug does requires dosage adjustment in severe hepatic
impairment, based on Child-Pugh scores and clinical consideration in patients with severe hepatic impairment based on Child-Pugh scores. Though the benefit of adding lefamulin to a formulary is still in question; its potential to be a beneficial treatment for CABP is encouraging.
Failure to Thrive: The Perfect Storm
Authors: Antimisiaris Demetra , Niehoff Kristina
Published: October 2021

In this case, a 93-year-old woman declines rapidly following glossectomy surgery and experiences rapid weight loss. She becomes withdrawn and uncommunicative and is diagnosed as failure to thrive and potentially cognitively impaired. The eventual explanation for her decline is unexpected,
surprising—and counterintuitive. This case illustrates the importance of investigating every aspect of medication use related to outcomes including medication administration, therapeutics, and health system dynamics.
Oseltamivir-Induced Neuropsychiatric Event in an Older Person: A Case Report
Authors: Clifford Kalin M. , Feighner Lydia , McCarrell Jamie L. , Hong Peter
Published: October 2021

BACKGROUND: Oseltamivir is an effective agent for both the treatment and prevention of influenza, and its use is increasing. The package insert indicates that delirium and delirium-like events have been reported with the use of oseltamivir during postmarketing surveillance. The
reports of neuropsychiatric events associated with oseltamivir are mainly in younger patients. To our knowledge, this is the first reported case of oseltamivirassociated neuropsychiatric events occurring with oseltamivir prophylaxis in an older adult.
 CASE PRESENTATION: A
74-year-old male with a history of mild neurocognitive disorder was given oseltamivir prophylaxis in the setting of an influenza outbreak during his rehabilitation facility stay and developed newfound psychiatric symptoms after administration of oseltamivir for influenza prophylaxis because
of institutional outbreak. The patient recovered completely after cessation of oseltamivir.
 CONCLUSION: We hope that our case report highlights the importance of careful consideration when prescribing oseltamivir prophylaxis in older people with or without previous history
of neurocognitive disorder.
How Medicaid and Racial inequities Hinder Access to American Long-Term Care
Authors: Blagrove Madison
Published: October 2021

As America works towards more inclusive practices in aged care, we are learning more about how racial and ethnic disparities affect this sector. Furthermore, research has allowed for a more complete understanding of how wealth disparities along racial lines re-enforce gaps in access
to care. A 2017 report from the Board of Governors of the Federal Reserve System illustrates this clearly. It finds that the mean net worth of White Americans was $933,700, compared to the $138,200 mean net worth of Black Americans. These numbers include adults over age 65 and
the families that may assist them in covering their health expenses. Thus, these wealth disparities have profound implications in access to long-term care.
Safety and Efficacy Considerations of Gabapentin as Adjunctive Therapy to Opioids in the Perioperative Setting for Older Adults
Authors: Garcia Edgar , Reinert Justin P. , Veronin Michael
Published: October 2021

While opioids have historically been the initial choice of analgesic for both acute and chronic pain, legislative and deprescribing trends as a result of the opioid epidemic have demonstrated an increase in the use of adjunctive therapies. These adjunctive agents are being utilized
with increased frequency, especially in older adult patients, as a mechanism to mitigate any likelihood of dependency and in an effort to provide multimodal pain management. As this patient population can be more challenging because of comorbidities, the presence of polypharmacy, pharmacokinetic,
and pharmacodynamic changes, it is important to evaluate the risk of any relevant adverse effects for opioids and adjuncts that can lead to higher risk of opioid toxicities. Gabapentin is one of the most commonly added adjunctive medications; however, its safety and efficacy in conjunction
with opioids has not been exclusively considered in older adult patients in the perioperative setting. This report will summarize available evidence for gabapentin as an adjunctive therapy to opioids in older adult patients undergoing surgery.
Depression and its Treatment in Late Life
Authors: Hutchinson Amanda D. , Saredakis Dimitrios , Whelan Rochelle , Keage Hannah A.
Published: October 2021

Depression in late life is associated with poorer quality of life and higher mortality. Pain, chronic illness, loneliness, loss of physical abilities, grief, cognitive impairment, and socioeconomic disadvantage all increase the risk of depression in this age group. Treatment for depression
in late life includes antidepressant medications, cognitive behavior therapy, interpersonal therapy, and electroconvulsive therapy. The use of virtual reality is also proposed as a potential new treatment for depression that could be made available in aged care settings, and early evidence
holds promise. Differentiating between depression, dementia, and delirium plays an important role in diagnosis and treatment, and often relies on a comprehensive neuropsychological assessment. The prevention and treatment of depression in late life requires collaboration and cooperation between
families, carers, health professionals, and aged care providers.
Z-drugs and Falls: A Focused Review of the Literature
Authors: Ryba Nicole , Rainess Rebecca
Published: October 2021

OBJECTIVE: To provide a focused review of the literature related to the association between exposure to Z-drugs and the risk of falls, especially in the older population.
 DATA SOURCES: A literature search was conducted using Medline, PsychInfo, and the Cochrane
Library database for all clinical trials, case series, and case reports published in English up to May 2020. The search terms used consisted of each Z-drug, including "zolpidem," "zopiclone," "eszopiclone," and "zaleplon," matched with "falls."
 STUDY SELECTION: The search
yielded 295 studies. After review of abstracts, content and references were reviewed, and duplicates removed, a total of 9 articles met inclusion of exposure to at least 1 Z-drug and a primary outcome of falls.
 DATA EXTRACTION: The American Geriatrics Society 2019 Beers Criteria
Update for Potentially Inappropriate Medication Use in Older Adults recommends to avoid using nonbenzodiazepine hypnotics in this patient population because of the risk of adverse events.
 DATA SYNTHESIS: A majority of the literature suggests an increased risk of falls with
exposure to Z-drug use, especially zolpidem. Eight trials examined falls as a primary outcome in non-elderly (n=3) and elderly (n=5) patients in different settings, mostly in an inpatient setting (nursing facility or acute care hospital).
 CONCLUSION: Exposure to Z-drugs,
especially zolpidem, should be evaluated and counseled on continuously as these medications put patients at an increased risk for falls and other complications.
An Evaluation of Antimicrobial Prophylaxis for Dental Procedures at a Veterans Healthcare System; A Role for Senior Care Pharmacists?
Authors: DeRosa Alicia , Wattengel Bethany A. , Carter Michael T. , Sellick John A. , Mergenhagen Kari A.
Published: October 2021

OBJECTIVE: The primary objective of this study was to determine the prevalence of appropriate use of antibiotics before a dental procedure.
 DESIGN: Retrospective cohort study.
 SETTING: Veterans Healthcare Systems.
 PARTICIPANTS:
Veterans who filled outpatient prescriptions for antimicrobial dental prophylaxis at the Veterans Administration Western New York Healthcare System from December 1, 2017, through October 1, 2019.
 INTERVENTIONS: None.
 MAIN OUTCOME MEASURES: Use of antibiotic
dental prophylaxis was deemed appropriate if in accordance with guideline recommendations. Descriptive statistics were used to summarize data.
 RESULTS: A total of 130 veterans receiving antibiotics for dental prophylaxis were included in this evaluation. Of those who were
included, only 16.9% received appropriate antibiotic dental prophylaxis. Patients with a prosthetic joint were significantly more likely to be inappropriately prescribed antibiotics for dental prophylaxis. Approximately 87% of patients who were inappropriately prescribed antibiotic prophylaxis
had prosthetic joints (P < .0001).
 CONCLUSION: Most antibiotics for dental prophylaxis are prescribed inappropriately. The large amount of inappropriately used antibiotics in this study highlights the need for dental stewardship in our veteran population. Antibiotics
for dental prophylaxis therefore represent an important stewardship target in the outpatient setting. This may be an ideal opportunity for senior care pharmacists to intervene upon.
Government Resources on Mental Health
Authors: Baldwin Paul
Published: October 2021

State and federal governments collect massive amounts of data, both in their role as sponsors of research and as payers for an increasing share of health care services. The information available includes definitive clinical research as well as statistical information about disease prevalence
and contribution to health care costs.
Comparative yield of different active TB case finding interventions in a large urban TB project in central Uganda: a descriptive study
Authors: Kazibwe Andrew , Twinomugisha Fred , Musaazi Joseph , Nakaggwa Florence , Lukanga Disan , Aleu Phillip , Kiyemba Timothy , Nkolo Abel , Sebuliba Kirirabwa Nicholas , B Freitas Lopez Debora , Birabwa Estella , Dejene Seyoum , Zawedde-Muyanja Stella
Published: October 2021

Introduction: Systematic screening for TB among patients presenting to care and among high risk populations is recom- mended to improve TB case finding. We aimed to describe the comparative yield of three TB screening approaches imple- mented by a large urban TB project in central Uganda.

Methods: We abstracted data on the screening cascade from 65 health facilities and their surrounding communities (num- bers screened, with presumptive TB, receiving a diagnostic test and diagnosed with TB) from the different clinic and com- munity TB registers.

Results: From January 2018 to December 2019, 93,378 (24%) of all patients screened at health facilities had presumptive TB; 77,381 (82.9%) received a diagnostic test and 14,305 (18.5%) were diagnosed with TB. The screening yield (the number of patients diagnosed with TB out of all patients screened) was 0.3% and was three times higher among men than women (0.6% vs 0.2% p<0.01). During targeted community screening interventions, 9874 (21.1%) of all patients screened had presumptive TB; 7034 (71.2%) of these received a diagnostic test and 1699 (24.2%) were diagnosed with TB. The screening yield was higher among men, (3.7% vs 3.3% p<0.01) and highest among children 0-14 (4.8% vs 3.2% p<0.01).

Conclusion: Targeted community TB screening interventions improve access to TB diagnosis for men and children 0-14 years.

Keywords: Tuberculosis; screening; community; Uganda.
Challenges that healthcare practitioners experience in the comprehensive assessment of patients with non-communicable diseases: a preliminary investigation
Authors: Smith Lynn , Morris-Eyton Heather , Noorbhai Habib , Coopoo Yoga
Published: October 2021

Background: Resource allocation and access to comprehensive treatment in the public healthcare sector are always under pressure. This pressure takes the form of staff shortages, treatment models and the holistic care of patients, compromising basic healthcare in South Africa.

Objectives: The study’s aim was to determine the challenges that healthcare practitioners experience while assessing patients with non-communicable diseases, in private and public healthcare sectors in the Gauteng Province of South Africa.

Methods: The research design was exploratory and contextual. Qualitative data were collected through focus groups and semi-structured interviews among healthcare practitioners (n = 12). Data analysis took place using Atlas.ti 8.4 Windows (2020). Inter-rater reliability (r = 93.68%) was calculated to ensure the rigour and validity of the results.

Results: From the discussion, four themes emerged: 1) limited consultation time; 2) overwhelming economic impact and healthcare cost for facilities and patients; 3) holistic patient care encompassing physical, mental and socioeconomic compo- nents; and 4) lack of patient education due to time constraints experienced by healthcare practitioners.

Conclusion: Consultation times are reduced due to a shortage of medical staff, patient numbers, equipment, and poor working conditions. By improving these conditions, patients across all socioeconomic groups will be better assisted, treated, and educated, benefiting from equal access and quality healthcare.

Keywords: Healthcare practitioners; non-communicable diseases; qualitative research.
Preterm birth and its associated factors in Ethiopia: a systematic review and meta- analysis
Authors: Waltengus Sendeku Fikadu , Yenealem Beyene Fentahun , Arega Tesfu Azimeraw , Animen Bante Simachew , Gedefaw Azeze Getnet
Published: October 2021

Background: Preterm birth is a public health concern globally. In low- and middle-income countries, like Ethiopia, preterm birth is under reported and underestimated. Therefore, this systematic review and meta-analysis assessed the pooled preva- lence and associated risk factors for preterm birth in Ethiopia.

Methods: In this review the databases used were PubMed, Google scholar, EMBASE, HINARI and African journal online. Publication bias was checked using a funnel plot and Eggers test.

Results: A total of 30 studies were included in this systematic review and meta-analysis. The overall pooled prevalence of preterm birth in Ethiopia was 11.4% (95% CI; 9.04, 13.76). On pooled analysis, preterm birth was associated with pregnan- cy-induced hypertension being HIV-positive, premature rupture of membrane, rural residence, the mother having a history of abortion, multiple pregnancies, and anemia during pregnancy.

Conclusion: The national prevalence of preterm birth in Ethiopia was low. Early identifying those pregnant women who are at risk of the above determinants and proving quality healthcare and counsel them how to prevent preterm births, which decrease the rate of preterm birth and its consequences. So, both governmental and non-governmental health sectors work on the minimization of these risk factors.

Keywords: Prevalence; pre-term birth; determinants; systematic review; meta-analysis; Ethiopia.
Effect of massage therapy on preterm neonate's body temperature
Authors: Nyaga Emily , Esamai Fabian , Kyololo O'Brien
Published: October 2021

Background: Low-cost care strategies can be implemented to avert the morbidity and mortality associated with hypother- mia in preterm neonates.

Objective: To determine the effect of massage therapy on body temperature of preterm neonates.

Methods: A quasi-experimental design was conducted among 72 preterm neonates at a level II special care nursery in Western Kenya. Neonates were recruited on the third day of life and followed up for 10 days. Neonates in the intervention group were massaged three times a day for 15 minutes. Body temperature was monitored and recorded before, during and after each therapy session. Neonates in the control group received routine care: temperature monitoring three times a day, feeding and diaper change.

Results: Neonates who received massage had higher mean body temperature than the control group during therapy on day 6 (p = .019) and after therapy on day 6 (p = .017) and day 8 (p = .005). A comparison within massage group (before/during, during/after, before/after) showed an increase in mean body temperature during therapy compared to before therapy (p <.001) and after therapy compared to before therapy (p <.001).

Conclusion: Massage therapy increases body temperature in preterm neonates. Keywords: Body temperature; massage therapy; preterm neonates.
Predictors of intention to use modern contraceptives among female senior secondary school students in the Kpando Municipality, Ghana
Authors: D Der Amanda , A Anaman-Torgbor Judith , O Charles-Unadike Veronica , E Tarkang Elvis
Published: October 2021

Background: Improving the reproductive health of young women in developing countries requires access to safe and effec- tive methods of fertility control. Volta Region records one of the highest prevalence of teenage pregnancy and adolescents aged 15-19 years are the least acceptors of contraceptives in the Region. Guided by the Theory of Planned Behaviour, this study determined predictors of intention to use modern contraceptives among female Senior Secondary School students in the Kpando Municipality, Ghana.

Method: A cross-sectional design was adopted, collecting data among a multistage sample of 270 participants, using a pre- tested self-administered questionnaire and analysing them using Stata software Version 16 at the 0.05 level of significance.

Results: The mean age of the respondents was 16.78 ± 1.31. About 40.2% of the sexually experienced participants used a modern contraceptive during ther first sexual encounter. However, the majority (69.3%) had the intention to use modern contraceptives. Regarding subjective norms, the majority of the significant others (63.0%) were not supportive of modern contraceptive use and more than half of the respondents (59.3%) had a positive attitude towards modern contraceptive use, while 54.1% perceived that they had control over modern contraceptive use. The majority (69.3%) had the intention to use modern contraceptives. Perceived behavioural control was the only significant predictor of the intention to use modern contraceptives [AOR= 9.80 (C.I: 5.11, 18.77); p< 0.001].

Conclusion: Interventions to increase the perception of control over contraceptive use is of the essence. This will help increase their intention to use modern contraceptives.

Keywords: Modern contraceptive use; theory of planned behaviour; senior secondary school students; Ghana; Kpando Municipality.
Towards a better understanding of attitudes and beliefs held by traditional healers and recipients of traditional medicine concerning mental health conditions in post-conflict Liberia: a qualitative investigation
Authors: J Pullen Samuel , R Herman Augusta , CL Lange Brittany , Christian-Brathwaite Nicole , Ulloa Melissa , P Kempeh Michael , G Karnga Dyujay , P Fallah Mosoka , Menyongai Jeremiah , Harris Benjamin , Alonso Yadira , C Henderson David , PC Borba Christina
Published: October 2021

Background: A better understanding of attitudes and beliefs held by traditional healers and utilizers of traditional medicine concerning mental health conditions in Liberia is important as Liberia seeks to improve its delivery of mental healthcare in the context of scarce resources and recovery from civil war.

Methods: A qualitative research design was used to collect data from 24 Liberian traditional healers, and 11 utilizers of Liberian traditional medicine. Participants were queried about mental health problems in Liberia, treatments, and attitudes towards modern healthcare. Qualitative data were probed and aggregated using content analysis.

Results: Mental health problems described by study participants included: Open Mole, African Science, Epilepsy, Depres- sion and Mental Illness (trauma/substance use). Mental health problems were often associated with socioeconomic distress, and participants described their attitudes and beliefs concerning mental healthcare, traditional medicine, and modern health- care.

Conclusion: Traditional medicine is an important part of mental healthcare in Africa. Mental illness, social factors, and healthcare access were important problems in Liberia. Mental health problems blended local cultural beliefs with Western- ized nosology and social factors. Traditional healer’s attitudes towards Western medicine reflected ambivalence. There is a desire for collaboration with ‘modern’ health care providers, but this will require reciprocal trust-building.

Keywords: Traditional healer; mental healthcare; Liberia; qualitative research.
Association of trace elements abnormalities with thyroid dysfunction
Authors: M Al-Bazi Maha , A Kumosani Taha , L Al-Malki Abdulrahman , Kannan Kurunthachalam , S Moselhy Said
Published: October 2021

Background: The metabolic pathways can be affected by dysregulation in thyroid hormone levels which in turn can arise from environmental chemical exposure. This study investigated the association of selected trace elements with thyroid dis- orders in a Saudi population.

Methods: Urine samples collected from 100 participants (50 thyroid disorder patients and 50 controls) were analyzed to determine trace elements using inductively coupled plasma-mass spectrometer. Non-parametric Mann-Whitney Test, were used to examine the association between socio-demographic as well as clinical characteristics of thyroid profile levels (T3,T4 and TSH) and urinary trace element concentrations.

Results: Urine from patients with thyroid disorders had significantly higher concentrations of Ni, Cu, and Cd (p-values <0.0005). In contrast, urinary Cr and Zn (p-values <0.013 and 0.005) were low in thyroid patients compared to the control.

Conclusion: First study to report urinary trace element levels showed a possible link between thyroid disorders and trace element exposure which reflect the environmental pollution.

Keywords: Trace metals; heavy elements; thyroid dysfunction.
Public health implication of solid waste generated by households in Bekwarra Local Government area
Authors: Kwun Omang Donald I , Egbe John Godwin , Alain Inah Simon , Owan Bisong Jude
Published: October 2021

Background: This study was conducted in Bekwarra Local Government Area of Cross River State, Nigeria, to determine the public health implication of solid waste generated by households.

Methods: A cross sectional descriptive design was employed, using a semi-structured questionnaire together with an obser- vation checklist to elicit information from the respondents. Proportionate sampling was used to select 400 respondents of 18 years and above for the study area. Data collected were analysed using the Microsoft Excel 2007 and Statistical Package for Social Sciences (SPSS) software version 20.

Results: Respondents knowledge concerning solid waste disposal was assessed and the results showed that majority of the respondents 193 (63.7%) had high level of knowledge of solid waste disposal, while 170 (42.5%) had average level of knowl- edge of solid waste disposal. Wastes produced by households in the study include vegetables (95.5%), ash (94%), clothing/ rag (94.2%), wood (95%), and animal waste (86.2%) had the highest abundance. Diseases associated with these wastes pro- duced by households include cholera (18.2%), malaria (47.2%), lassa fever (10.7%) and diarrhea (23.9%) with malaria been the most prevalence infection.

Conclusion: The result shows solid waste posed a serious health hazard and lead to the spread of infectious diseases. These issues can be addressed through health education and enlightenment of the people on waste disposal.

Keywords: Municipal waste; public health; infection; health hazard; environmental pollution.
Summer temperature and all-cause mortality from 2006 to 2015 for Hyderabad, India
Authors: K Rathi Suresh , R Sodani Prahlad
Published: October 2021

Background: Studies have documented a significant association between temperature and all-cause mortality for various cities but such data are unavailable for Hyderabad City.

Objective: The objective of this work was to assess the association between the extreme heat and all-cause mortality for summer months (March to June) from 2006 to 2015 for Hyderabad city population.

Methods: We obtained the data on temperature and all-cause mortality for at least ten years for summer months. Descriptive and Bivariate analysis were conducted. Pearson correlation coefficient was used to study the relationship between heat and all-cause mortality for lag time effect.

Results: A total of 122,117 deaths for 1,220 summer days (2006 to 2015) were analyzed with mean daily all-cause mortality was 100.1±21.5. There is an increase of 16% and 17% per day mean all-cause mortality at the maximum temperature of ≥40oC and for extreme danger days (Heat Index >54oC) respectively. The mean daily all-cause mortality shows a significant association with maximum temperature (P < 0.001) and Heat Index from caution to extreme danger risk days (P < 0.0183). The lag effect of extreme heat on all-cause mortality for the study period (2006 to 2015) was at peak on same day of the maximum temperature (r = 0.273 at p<0.01).

Conclusion: The study concludes that the impact of ambient heat in the rise of all-cause mortality is clearly evident (16% mean deaths/day). There was no lag effect from the effect of extreme heat on all-cause mortality as the peak period was the same as the maximum temperature. Hence heat action plans are needed. However, extreme heat-related mortality merits further analysis.

Keywords: Heat wave; all-cause mortality; urban; humidity; heat index; India.
The use of low-cost ruggedized Android tablets to augment in-service training of community health workers in Mukono, Uganda: perspectives and lessons learned from the field
Authors: E Stiles Christina , O’Neil Jr Edward , Kabali Kenneth , O’Donovan James
Published: October 2021

Background: Despite potential for community health workers (CHWs) to effectively reduce morbidity and mortality in sub-Saharan Africa, they still face multiple barriers including access to on-going and refresher training. Digital technology offers a potential solution to improve the provision of ongoing training for CHWs.

Objectives: This report shares participant insights and experiences following the implementation of a mobile health (mHealth) assisted Integrated Community Case Management (iCCM) refresher training programme for CHWs in Mukono, Uganda. We seek to document benefits and challenges of such an approach.

Methods: CHWs were trained to recognize, treat and prevent childhood pneumonia via locally made videos preloaded onto low cost, ruggedized Android tablets. Subsequent interviews were compiled with key stakeholders including CHWs, CHW leaders and programme supervisors to better understand the strengths, barriers and lessons learned following the interven- tion.

Results: Success factors included the establishment of CHW leadership structures, the ability to use the tablets to learn on an “any pace, any place” basis and using the tablets to conduct community teaching and outreach. Barriers included appro- priate consideration of the implementation timeline and avoiding a “one size fits all” approach to digital literacy training.

Conclusions: The strength of the program stemmed from a grassroots approach that prioritized stakeholder input at all stages. Leadership at a local level, a history of local engagement and trust built up over a period time were also integral. As organizations aim to scale up digitally enhanced training initiatives, it is paramount that attention is paid to these human factors which are key for program success.

Keywords: Low-cost ruggedized Android tablets; in-service training; community health workers; Mukono.
Heavy metals in shell fishes of Ojo River, Lagos State, Nigeria
Authors: Oladunjoye R.Y. , Fafioye O.O. , Bankole S.T. , Adedeji A.H. , Edoh A.S.
Published: October 2021

The research examined the accumulations of six heavy metals including chromium (Cr), lead (Pb), iron (Fe), zinc (Zn), cadmium (Cd), and copper (Cu) in water as well as in three male and female species of crab (Cardisoma armatum, Callinectes danae, Callinectes ornatus) sampled from Ojo River in Lagos State of Nigeria. Physico-chemical parameters of the water samples from the River and heavy metal concentrations in the crab species obtained also from the River were examined using standard methods. The results showed that total dissolved solute (TDS), electrical conductivity (EC), salinity, dissolved oxygen, biological oxygen demand and chemical oxygen demand varied significantly along the River course, with TDS and EC being relatively high. Heavy metals detected in the crabs were Fe, Cu and Zn, with Cu being the highest in the species examined. The species C. ornatus presented the highest content of Cu followed by C. armatum and C. danae. The content of heavy metals (mg kg–1) among the crab species showed that Cu (23.47±0.10) > Zn (19.06±0.01) > Fe (16.85±0.01) in all the species except in C. armatum where Fe (1.26±0.44) was > Zn (1.19±0.02). Furthermore, Pb, Cd and Cr were not found in the crabs and this could be associated with the fact that the area consists mainly of residential houses, farms and a few industries. Notably, the content of the heavy metals was larger in the female than the male crabs. This study reported different levels of heavy metal accumulation in male and female species of crabs. Also, the shell fishes from Ojo River might be considered safe for consumption, but the need for continuous monitoring to prevent bioaccumulation is recommended.
Utilizing urban refuse wastes as soil amendment in sub-Saharan Africa: Prospects and challenges in the Nigerian context
Authors: Alhassan A.B. , Chiroma A.M. , Kundiri A.M. , Bababe B. , Tekwa I.J.
Published: October 2021

The challenge of effectively managing the huge wastes generated in most Nigerian cities raises serious environmental concerns with environmental pollution and ecological deterioration being the most serious concerns. Most municipal authorities responsible for evacuation of town refuse wastes lack the capacity to effectively manage the huge volumes of wastes generated on daily basis due to a number of reasons prominent of which include population explosion, urbanization, industrialization and economic growth. Application of urban refuse wastes (URW) to crop fields offers means of correcting many of the problems associated with collection and disposal of URW in Nigeria. Utilizing organic solid wastes on agricultural fields is an important way of effectively increasing soil organic carbon sequestration and supplying nutrients for crop plants. Proper sorting and composting of the URW has been shown to not only improve the quality of the wastes as organic amendment, but also help in correcting many of the health and environment related challenges associated with its direct application to agricultural lands. This review presents the results of research findings on utilization of URW as organic amendment and also highlights the constraints, prospects and the sustainability for utilizing URW as bio-fertilizer. It reveals that the average solid wastes generated in most Nigerian cities have a large fraction of organic materials that could easily be utilized as bio-fertilizer. Suggestions on ways to reduce some of the problems associated with land application of URW are proffered. Possible ways for improving the quality of URW intended for use as organic amendment are also suggested.
Petrography, geochemistry and industrial quality of the Etono limestone in Ugep Southwest, Southeastern Nigeria
Authors: Odey J.U. , Ugwu A.C. , Ekwueme B.N.
Published: October 2021

Petrographic and geochemical analyses were carried out on limestones occurring in Etono, Southwest Ugep, Southeastern Nigeria to determine their chemical composition, industrial uses and classification. Samples of limestone in the area were subjected to petrographic study and analyzed geochemically using Inductively Coupled Plasma Atomic Emission Spectrometry (ICP-AES) and X-Ray Fluorescence (XRF) techniques. The petrographic analysis reveals that the Etono limestone contains high percentage of carbonate materials with scanty organic remains and patches of iron. The bulk- rock composition of the limestone shows that the average SiO2 = 9.02%, Al2O3 = 1.95%, Fe2O3 = 2.08%, MgO = 0.39%, K2O = 0.47%, Na2O = 0.00%, CaO = 47.92%, SO2 = 0.24% and LOl = 37.37%. The limestone is classified based on their moderately high CaO, SiO2 and LOl and very low MgO. The mean CaO (47.92%) of Etono Limestone is high relative to the mean CaO of Agoi Ibami Limestone (43.83%) but low relative to the Mfamosing Limestone (55.30%) and the mean SiO2 values of 9.02% is high relative to Mfamosing Limestone (0.38%) but low relative to Agoi Ibami Limestone (13.93%). Results of the geochemical investigation reveal a shallow marine environment of deposition (EOD) for Etono Limestone. The higher values of CaO and LOl and lower values of SiO2 of the limestone suggest that it can be used for cement production, building stone, filler and agricultural purposes.