Faculty of Clinical Sciences

EFFECTS OF McKENZIE AND LUMBAR STABILISATION PROTOCOLS ON SEXUAL DYSFUNCTION IN PATIENTS WITH CHRONIC MECHANICAL LOW BACK PAIN

2017-08-01T00:00:00Z

EFFECTS OF McKENZIE AND LUMBAR STABILISATION PROTOCOLS ON SEXUAL DYSFUNCTION IN PATIENTS WITH CHRONIC MECHANICAL LOW BACK PAIN ADERIBIGBE, O. I. Chronic Mechanical Low Back Pain (CMLBP) has been associated with sexual dysfunction (SD). This problem is often not included in the management of individuals with CMLBP. McKenzie and Lumbar stabilisation are well established protocols for managing LBP. However, effects on SD have not been well elucidated. This study was designed to investigate the comparative effects of McKenzie and Lumbar stabilisation protocols on SD in patients with CMLBP. The quasi-experimental study involved 61 (males=23, females=38) individuals with CMLBP and associated SD consecutively recruited from the orthopaedic and general outpatient clinics. University of Ilorin Teaching Hospital. Participants were randomly assigned to either McKenzie Protocol Group (MPG; males=11; females=20) or Lumbar Stabilisation Protocol Group (LSPG; males=12; females=18). The MPG received McKenzie exercises (extension in prone lying, standing and side gliding exercises). The LSPG received lumbar stabilisation exercises (isometric co-contraction in prone lying, crook lying, kneeling, sitting positions, closed and open chain kinetic exercises). Both groups received treatment twice weekly for eight consecutive weeks. Sexual function questionnaire was used to assess sexual variables in females; (Sexual Desire female [SDf], Lubrication, Orgasm, Sexual Satisfaction [SSf] and SD Total female [SDTf]) and males; (Sexual Desire ma1e [SDm], Erectile Dysfunction [ED], Ejaculation [Ej], Sexual Satisfaction [SSm] and SD Total male [SDTm]. Participants were assessed at baseline, 4th and 8th week of the study. Reduction from baseline scores signifies improvement in sexual dysfunction. Data were analysed using descriptive statistics and Student t - test at ex. 0.05. The ages of MPG (49.3±12.8 years) and LSPG (52.3± 10.5 years) were comparable. At baseline, sexual variables were comparable in MPG and LSPG. In Females SDf (4.30±0.7 vs 4.5±0.8); SSf (7.9±1.6 vs 8.12±1.3); Lubrication (9.3±2.2 vs 9.7±2.7); Orgasm (11.6±2.4 vs 11.8±2.1); SDTf (33.1±5.6 vs 34.1± 5.6); and for Males: SDm (3.6±1.3 vs 4.08±0.8); SSm (7.3±1.7 VS 7.46±1.3); ED (7.2±1.2 VS 7.5±2.2); Ej (7.7±2.2 VS 6.7±2.4); SDTm (25.7±3.9 VS 26.8±6.0) for MPG and LSPG respectively. At week four sexual variables were comparable in MPG and LSPG respectively: for Females SDf (3.7±0.8 vs 3.3±1.0); SSf (7.3±1.9 vs 8.4±7.0); Lubrication (8.0±2.2 vs 7.00±2.1); Orgasm (1.4±1.7 vs 10.1±1.8); SDTf (29.4±5.3 vs 28.8±9.0); for Males: SDm (2.9±1.1 vs 3.2± 1.0); SSm (6.0± 1.6 vs 5.6± 1.1); ED (6.1 ±1.0 vs 5.8±1.7; Ej (7.3±2.2 vs 6.0± 1.3) for MPG and LSPG. At week 8, LSPG had significant greater reduction in sexual dysfunction than MPG in SDf and SSf in females: SDf (3.4±0.8 vs 2.3± 1.2); SSf (6.2± 1.5 vs 5.1 ±1.2) respectively. However, MPG and LSPG had comparable effects on Lubrication; Orgasm and SDTf at week eight: Lubrication (6.7± 1.5 vs 6.3±2.0); Orgasm (9.6± 1.5 vs 9.0± 1.8) and SDTf (25.9±4.3 vs 22.8±5.8) for females. In Males, LSPG had a significant greater reduction in all the sexual variables than MPG at week 8, SDm (2.90± 1.0 vs 2.2±0.7); SSm (5.9±1.1 vs 4.3±0.8); ED (6. 1±1.2 vs 4.6± 1.1); Ej (7.3±1.9 vs 5.0±1.1); and SDTm (22.2±3.5 vs 15.9±3.5) respectively. This study observed that Lumbar stabilisation protocol resulted in greater improvement than McKenzie protocol in sexual dysfunction, sexual desire, sexual satisfaction and erectile dysfunction in patients with chronic mechanical low back pain. A Ph,D thesis in the department of Physiotherapy. Faculty of Clinical Science, College of Medicine, University of Ibadan.

NURSE-LED HEALTH EDUCATION AND SUPPORTIVE SUPERVISION OF HOME MANAGEMENT AND PREVENTION OF MALARIA AMONG UNDER-FIVES' MOTHERS IN EGBEDORE LOCAL GOVERNMENT, OSUN STATE NIGERIA

2015-11-01T00:00:00Z

NURSE-LED HEALTH EDUCATION AND SUPPORTIVE SUPERVISION OF HOME MANAGEMENT AND PREVENTION OF MALARIA AMONG UNDER-FIVES' MOTHERS IN EGBEDORE LOCAL GOVERNMENT, OSUN STATE NIGERIA ADEYEMO, M.O.A Malaria contributes significantly to under-five mortality in Nigeria. Home management and prevention of malaria are key interventions for its control. However, effectiveness of these interventions require mothers's adequate knowledge and appropriate skills. The 2011 Disease surveillance and notification report of Osun state showed that the under-five malaria burden in Egbedore Local Government Area (LGA) was more than one third of the total in the state for all age groups in 2008, 2009 and 2010. This study was designed to assess effects of nurse-led health education and supportive supervision on knowledge and practice of home management and prevention of malaria by mothers of under-fives in the LGA. The study utilised quasi-experimental design. A four-stage sampling technique was used to select 837 mothers of under-fives in seven out of ten wards of the LGA .The mothers were randomly assigned into one Control Group (CG) and two intervention groups: Health Education Group (HEG) and Health Education and Supportive Supervision Group (HESSG). The study instruments were 11-item observation checklist to assess the structure of home environment and a 46-item structured questionnaire on knowledge and practice of home management and prevention of malaria. Data collection was at pre- (P1) and post-interventions at one month (P2), three months (P3) and six months (P4). Minimum and maximum scores obtainable for knowledge were 0 and 86 while practices were 0 and 58 respectively. Data were analysed using descriptive statistics, Chi square test and ANOVA at p = 0.05. Mothers' ages (years) were 31.9±5.6 (CG), 32.2±10.0 (HEG) and 31.2.±7.0 (HESSG). Married respondents per group were 91.0%, 92.5% and 94.6% for CG, HEG and HESSG respectively. There were no significant differences in their age, household size and number of under-fives across the study groups. The home environment significantly influenced home management and prevention of malaria. At PI, that were significant differences in overall knowledge scores of the study groups (CG: 38.34±4.4, HEG: 37.8± 5.0 and HESSG: 40.1±6.4). At P2, the differences in overall knowledge scores for the groups were significant (CC; 45.3±7.7, HEG:66.9±6.3 and HESSG: 73.3±5.1). At P3, the scores were significantly different (CG: 45.9±7.7, HEG: 74.6±4.7 and HESSG:73.6±5.8). At P4, there were also significant differences in the overall scores within the groups (CG: 45.8±7.7, HEG: 71.0±6.7 and HESSG: 74.1±5.8). The overall practice scores at P1 for the respondents were significantly different (CG: 18.6±4.2, HEG: 18.9±4.7 and HESSG: 20.9±4.6). At P2, the scores were significantly different (CG: 25.2±5.6, HEG: 34.9±4.1 and HESSG: 39.8±5.6). At P3, there were significant differences in the scores within the groups (CG: 25.2±5.6, HEG: 40.7 ± 6.1, and HESSG: 40.5±6.4). At P4, scores were also significantly different (CG: 25.1±5.6, HEG: 38.9±5.6 and HESSG: 40.8±5.0). Nurse-led health education and supportive supervision improved knowledge and practice of home management and prevention of malaria in Egbedore LGA. These approaches are therefore recommended. A Thesis in the Department of Nursing, submitted to the Faculty of Clinical Sciences, College of Medicine in partial fulfillment of the requirements for the Degree of Doctor of Philosophy of the University of Ibadan

EFFECTS OF BANEF MODEL-BASED PERSONAL PROTECRIVE EQUIPMENT EDUCATION PROGRAMME ON KNOWLEDGE ATTITUDE AND PRACTICE OF RESPIRATORY PROTECTION AMONG SAWMILL WORKERS IN IBADAN

2017-05-01T00:00:00Z

EFFECTS OF BANEF MODEL-BASED PERSONAL PROTECRIVE EQUIPMENT EDUCATION PROGRAMME ON KNOWLEDGE ATTITUDE AND PRACTICE OF RESPIRATORY PROTECTION AMONG SAWMILL WORKERS IN IBADAN JAIYESIMI, A.O Sawmill Workers (SW) are exposed to occupational hazardsthat may impact on their respiratory health. They have been reported to have poor knowledge on occupational hazards, safety measures andpractices. The Belief, Attitude, Subjective Norms and Enabling Factors (BASNEF) model of Health Education had been used to improve workers knowledge, attitude and safety practices in other countries. However, its effects on sawmill workers in Nigeria have not been adequately reported. This study investigated the effects of BASNEF model-based personal protective equipment education programme on the knowledge, attitude and practice (KAP) of respiratory protection among sawmill workers in Ibadan. The respiratory health of these workers was also assessed. Four hundred SW recruited consecutively from four randomly selected sawmills in Ibadan metropolis and 400 NSW (controls) participated in the study’s cross-sectional survey phase. The second phase was a two-group quasi-experimental pre-test-post-test study with the sawmills randomly divided into two training and two non-training centres using the fish-bowl method. Forty-five participantseach were randomly selected from the training centres (Training Group, TG) and non-training centres (Non-Training Group, NTG). Outcomes assessed were KAPusing Personal Protective Equipment Knowledge, Attitude and Practice Questionnaire (PPE-KAPQ), LFI – forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), peak expiratory flow rate (PEFR) and FEV1/FVC%) using the Micro Medical spirometer and respiratory health using the Respiratory Health Questionnaire (RHQ). The PPE-KAPQ was administered to both TG and NTG pre and four weeks post-intervention. Knowledge scores were classified as high (13-16), moderate (10-12) or low (00-09), attitude scores as positive (26-32), neutral (19-25) or negative (00-18) and practice scores as good (> 7), fair (3 – 7) or poor (<3). The TG received a 6-session health education intervention utilising the Basic Training Course in Personal Breathing Protection materials using the BASNEF concept.Data were analyzed using descriptive statistics, independent and paired t-test, Chi square and Pearson and Spearman correlation at α0.05. The SW and NSW were comparable in age (38.77±11.11 vs37.35±10.94yrs) and weight (65.82±12.10vs65.78±9.55kg) but the NSW were significantlytaller (1.69±0.11vs1.63±0.08m). The SW had mean knowledge, attitude and practice scores of 65.4±14.4%, 61.6±11.9% and 15.6±22.8% respectively. The TG and NTG pre-training knowledge (62.9±16.0 vs 63.2±14.4%), attitude (60.3±12.8 vs 62.0±12.0%), and practice (15.3±17.9 vs 14.7±16.7%) scores respectively were comparable. The 28.5%, 23.4% and 76.0% improvements in knowledge (62.9±16.0 vs 91.4±3.6%), attitude (60.3±12.8vs 83.7±8.4%) and practice (15.3 vs 91.3±9.7%) scores respectively for the TG were significantly higher than 2.2%, 0.9% and 2.2% for the NTG. The SW had significantly lower LFI than the NSW – FVC (2.52±0.60Lvs3.35±0.70L), FEV1, (1.73±0.49Lvs2.64±0.60L), FEV1/FVC (0.69±0.10 vs0.79±0.06), PEFR (270.77±91.02L/min vs402.43±94.18L/min). Sawmill workers in Ibadan had poorer respiratory health profile than non-sawmill workers. The Belief, Attitude, Subjective Norms and Enabling Factors model-based personal protective equipment education programme was effective in improving knowledge, attitude and practice of respiratory protection among the sawmill workers. It is recommended for the training of workers who are exposed to wood dust on occupational hazard and safety practices. A Ph.D thesis in the department of Physiotherapy, faculty of clinical sciences, college of medicine, University of Ibadan

EPIDERMAL GROWTH FACTOR IN MAN AND MOUSE: PHYSIOLOGICAL, CLINICAL AND EXPERIMENTAL STUDIES

1989-04-01T00:00:00Z

EPIDERMAL GROWTH FACTOR IN MAN AND MOUSE: PHYSIOLOGICAL, CLINICAL AND EXPERIMENTAL STUDIES DAGOGO-JACK, S. E. Epidermal growth factor (EGF), which was first isolated from the mouse submaxillary gland and later from human urine belongs to a new class of polypeptides collectively known as growth factors. These growth factors regulate cell growth, tissue differentiatIon and maturation. EGF has interesting interactions with the endocrine system particularly in the thyroid gland, where it stimulates proliferation and inhibits differentiated thyrocyte function in vitro. The synthesis of EGF in mouse submaxillary gland is, in turn, regulated by hormones such as thyroxine and testosterone. Ever since its discovery, attempts have been made to assign a role to EGF in normal physiology or in the causation of disease. The results have so far proved inconclusive. The aim of the present study was to investigate the significance of EGF in man and mouse by using radioligand binding assays to measure EGF levels in a number of physiological, clinical and experimental situations. Specific and sensitive radio immunoassays and radioreceptor assays were developed for both human and mouse EGF. Methodologies for the extraction of EGF from human and mouse tissues were validated. The human (h) EGF radioimmunoassay was optimised for use in saliva, urine and thyroid tissue homogenates and applied to populations of healthy subjects and patients with various diseases. The concentration of (m) EGF in homogenates from mouse thyroid and other tissues was measured by the homologous mEGF radioimmunoassay. The biological activities of both hEGF and mEGF detected by the radioimmunoassays were assessed in separate radio receptor assays and their molecular integrity, by gel chromatography. The main findings in this work were as follows: hEGF was found to be normally present in saliva of healthy subjects from the different racial groups without significant racial variations. The mean salivary hEGF concentration (pmol) was 368.55 ± 30.00 in Pakistanis, 457.25 ± 54.21 in Black Africans, 414.00 ± 31.20 in Chinese and 450.00 ± 58.22 in white Britons, p > 0.05. The mean salivary hF concentration in 27 pregnant famales and 23 healthy age - matched controls were similar (713.19 ± 56.10 vs 665.22±51.66 pmol/1); there was no correlation between salivary hEGF and gestational age among the former. Significant increases in salivary hEGF levels were observed In patients with goitrous thyrotoxicosis and in those with terminal renal failure. Declining urinary excretion of hEGF was observed in diabetic patients with worsening proteinuria. hEGF was found measurable in every human thyroid gland examined and increased concentrations were found in glands from patients with uncorrected thyrotoxicosis. Studies using immunochemistry localized hEGF to the cytoplasm of the follicular cells in frozen human thyroid sections. Studies in the mouse demonstrated for the first time the presence of mEGF within murine thyroids. The mean mEGF concentration in thyroid homogenates was 26.10 ±6.00 ng/mg protein (range 5.50 - 68.00 ng/mg). This was equivalent to 1.5 ng/mg wet weight and was of the order of 20 to 150 times the mEGF concentration previously reported in mouse testes, brain or pituitary. Extracts from the mouse submaxillary gland expectedly contained abundant mEGF (600 - 1220ng/mg wet weight) but there was no correlation between thyroid and submaxillary mEGF content; Sialoadenectomy augmented thyroid mEGF content. Exposure of mice to various hormonal and metabolic manipulations indicated that mouse thyroid and submaxillary mEGF was responsive to thyroid hormone status, androgen status and to changes in dietary iodine. Further studies in newborn mice revealed that their thyroids had begun to t elaborate appreciable amounts of mEGF while the growth factor remained undetectable in their submaxillary glands. In conclusions these mouse indicate that EGF is a normal constituent of human saliva, human urine and of both human and murine thyroid tissues with differinig levels relating to different disease states such as thyrotoxicosis, diabetic nephropathy and end - stage renal failure. Furthermore, evidence has been presented to implicate the thyroid gland as a probable site of EGF synthesis in both man and the mouse. A Thesis in the Department of Medicine, submitted to the Faculty of Clinical Sciences and Dentistry in partial fulfillment of the requirements for the Degree of Doctor of Medicine of the University of Ibadan

EFFECTS OF A TWELVE-WEEK ARM ERGOMETRY TRAINING ON SELECTED HEALTH INDICES OF LOWER LIMB PARALYTIC POLIOMYELITIS SURVIVORS

2014-07-01T00:00:00Z

EFFECTS OF A TWELVE-WEEK ARM ERGOMETRY TRAINING ON SELECTED HEALTH INDICES OF LOWER LIMB PARALYTIC POLIOMYELITIS SURVIVORS ATOWOJU, A. A. Reduced mobility consequent to motor paralysis is associated with Secondary Health Conditions (SHC) among Lower Limb Paralytic Poliomyelitis Survivors (LLPPS). Arm ergometry, an effective aerobic exercise, can be used to improve the overall health of LLPPS with SHC, but no clinical trial has comprehensively and concurrently assessed its potential benefit in this population using a Randomised Clinical Trial (RCT) design. The study investigated the effects of a twelve-week arm ergometry training on selected health indices or LLPPS with SHC. The RCT involved 60 LLPPS from eleven local government centres in Ibadan, Oyo State. They were randomly selected from the 252 who had SHC as determined using Tate SHC Questionnaire in a Cross-Sectional Survey. Participants were randomly assigned into Exercise Group (EG) and Control Group (CG). The EG received thrice-weekly arm ergometry training for twelve consecutive weeks in addition to flexibility exercises which was received by the CG. Participants' Resting Heart Rate (RHR), Resting Systolic Blood Pressure (RSBP), Resting Diastolic Blood Pressure (RDBP), Percent Body Fat (PBF), and Body Mass Index (BMI) were assessed using standard methods, while Cardio -Respiratory Fitness was assessed using Six-Minute Walk Test (6-MWT). The General Health Status (GHS), Quality of Life ( QoL) and Depressive Symptoms (DS) were assessed using Dartmouth COOP Health Chart (higher scores indicate reduced activity), Ferrans and Powers QoL measure and Beck Depression Inventory respectively. Assessments were carried out at baseline and end of 4TH 8th and 12th weeks. Data were analysed using ANOVA independent t- test and Mann Whitney-U at p = 0.05. Twenty eight participants in EG (15 males, 13 females) and 26 in CG(11 males, 15 females) completed the study. Twenty six participants had bilateral, while 28 had unilateral lower limb affectation. Twelve were independently ambulant while 42 used assistive devices. Most participants were unmarried and had only secondary school education. They were predominantly traders and artisans with average monthly income of 4,556 naira. The mean ages of EG (38.43±6.97) and CG (38.08 ±5.75 years) were not significantly different. The common SHC observed were hypertension, depression, obesity, back pain and spinal deformities. At baseline, the health indices of EG and CG were not significantly different. At twelfth week, CG had significantly higher R SBP (126.69 ±7.18 vs 121.50 ± 6.29) and PBF (30.52±6.01 vs 23.43±11.24) than the EG respectively. The CG had significantly higher scores than EG in daily activities (at 4th/8th, 0/8th, 4th/12th and 0/12th weeks) and social activities (at week 8th/ 12TH) domains of GHS, Groups were not significantly different in QoL, and DS. Within-group comparison showed significant decreases in EG's RHR (F=I6.33), RSBP (F= 8.99), RDBP (F=14.37), PBF (F=20.78). DS (Xr2= 19.61) and increases in 6-MWT (F=33.45) and QoL (xr²=23.53). CG had significant increase in PBF (F= 20.78) and decrease in pain (xr²13.67) and Feelings (xr²=8.01) domains of GHS. No gender variation was observed in all the variables. Twelve-week arm ergometry training improved the health indices of lower limb paralytic poliomyelitis survivors with secondary health conditions. Arm ergometry should be incorporated into the rehabilitation programme of these individuals. A Thesis in the Department of Physiotherapy, submitted to the Postgraduate School,University of Ibadan in partial fulfillment of the requirements for the Degree of Doctor of Philosophy (Physiotherapy) of the University of Ibadan, Ibadan, Nigeria

EFFECTS OF AEROBIC EXERCISE ON BLOOD PRESSURE CARDIOVASCULAR HEALTH INDICES AND QUALITY OF LIFE OF INDIVIDUALS WITH UNCONTROLLED HYPERTENSION ON TWO ANTIHYPERTENSIVE DRUGS

2014-01-01T00:00:00Z

EFFECTS OF AEROBIC EXERCISE ON BLOOD PRESSURE CARDIOVASCULAR HEALTH INDICES AND QUALITY OF LIFE OF INDIVIDUALS WITH UNCONTROLLED HYPERTENSION ON TWO ANTIHYPERTENSIVE DRUGS MARUF, F. A Studies have indicated that poor drug compliance and uncontrolled hyperiension arc common among Nigerian patients on three or more antihypertensive drugs. Blood Pressure (BP) lowering effect of Aerobic. Exercise Training (AFT) has been documented but it is uncertain that combining Ail- with two antihypertensive drugs would achieve BP control in individuals with uncontrolled hypertension, This study investigated the effects of AET on BP, 5elected cardiovascular health indices and Quality of Lire ( L) or individuals with uncontrolled hypertension on two antihypertensive drugs, This randomized-controlled trial involved 120 individuals newly diagnosed with essential hypertension placed on combined 50 mg or hydrochlorothiazide and 5 mg of hydrochloride amiloride and 5 or 10 mg of amlodipine for 4-6 weeks with poor control (BP ≥140/90 mmhg). Doses of the antihypertensive drugs were similar in both groups throughout the study. Participants were consecutively recruited and randomly assigned equally into Exercise Group (E0) and Control Group (CG). Only. EG underwent AE T for 12 weeks. Body Mass Index BP, Percent Body Fat (%BF), waist circumference and exercise capacity were measured using standard methods. Blood lipids were assessed using enzymatic colorimetric method and QoL was assessed using the World Health Organization QoL-Bref (four domains). All variables were measured pre- and post-stud. Data were analysed using independent t-test. Chi square, paired t-test. Mann-Whitney -U test, Wilcoxon test and analysis of covariance at p = 0.05. Mean ages of EG and CG were 50.8113 and 54,8+8,6 years (p-value-0.012) respectively. Baseline variables were comparable in both groups except age. BM1 and %BF. More participants in EG (53.3%) than in CG (35.0%)had BP control post-study. Mean Systolic BP (SBP) decreased significantly in EG (154.8±.10.3 to 136.0±15.3 mmhg) and CG (156.6±I2.5 to 147.8±18.3 mmHg); mean Diastolic BP (DBP) decreased significantly in EG (92.7±9.0 to 83.8±10.8 mmHg) and CG (93.3±11.0 to 87.7±10.5 mmHg) post-study. Only EG had significant reductions in mean low-density-lipoprotein cholesterol (120.1±33.4 to 110.5±31.7 mg/dl), mean triglyceride (117.5±45.1 to 100.6±35.4 mg/dl) and mean BMl (27.4±.5.0 to 27.1±5.0 kg/m²), and improvement in exercise capacity ( 1.1±0.3 to 1.3±0.2 ml/kg/ min) post-study. There were significant improvements in physical-health. Psychological-health and social-relationship domains of QoL in both groups and in environment domain in EG post-study. The EG had significantly lower SBP (135.5±2.1 versus 146.8±2.1 mmHg), DBP (83.1±1.3 versus 88.4±I.3 mmHg) and DMI (26.2±0.1 versus 26.6±0.1 kg/m²2) and better improvement in exercise capacity (1.2±0.0 versus 1.1±0.1 ml/kg/min) physical-health (52.8 versus 36.3),psychological-health (51.5 versus 36.5) and environment (54.0 versus 34.9) domains ofQ01., than CO post-study. The combination of aerobic exercise training and ma antihypertensive drugs achieved more reductions in blood pressure and body mass index, better blood pressure control, improved exercise capacity and quality of life than two antihypertensive drugs alone in individuals with uncontrolled hypertension. Aerobic exercise should be recomended as an adjunctive treatment option in the management of uncontrolled hypertension. Key words: Adiposity, Aerobic exercise training, blood pressure control, Exercise capacity, Quality of Life Word Count: 465 A thesis in the Department of Physiotherapy submitted to the postgraduate school, University of Ibadan, in Partial fulfilment of the requirements for the degree of Doctor of Philosophy of the University of Ibadan

DEVELOPMENT AND EVALUATION OF EFFECTS OF A PRIMARY HEALTH CARE-BASED PHYSIOTHERAPY PROTOCOL ON SELECTED INDICES OF STROKE RECOVERY

2013-01-01T00:00:00Z

DEVELOPMENT AND EVALUATION OF EFFECTS OF A PRIMARY HEALTH CARE-BASED PHYSIOTHERAPY PROTOCOL ON SELECTED INDICES OF STROKE RECOVERY OLALEYE, O. A Stroke rehabilitation is traditionally carried out in various hospital and rehabilitation settings. Evidence is accruing that post-stroke patients can also benefit from treatments based in the community or at primary health care centres. There is however dearth of Primary health Care-based Physiotherapy Protocol (PHCPP) for enhancing recovery post- stroke. This study was designed to develop, and evaluate the effects of a PHCPP on selected indices of stroke recovery. The physiotherapy evidence database was used to identify treatment approaches and modalities with proven efficacy. These established treatment approaches were synthesised to develop the PHCPP. The PHCPP was then used in a quasi-experimental research involving 56 consenting individuals with first incident stroke, consecutively recruited and randomly assigned into either the Primary Health are Group (PHCG, n⁼29) or the Home Group (HG. n⁼27). Fifty-two individuals comprising 25 PHCG and 27 HG participants completed the study. Participants in the PHCG and HG were treated at a primary health centre and their homes respectively, twice weekly for 10 consecutive weeks using PHCPP. Motor function ability, postural balance and community reintegration were assessed using the Modified Motor Assessment Scale (MMAS, obtainable score 0 to 48), Short Form of Postural Assessment Scale for Stroke (SEPASS, obtainable score 0 to 15) and Reintegration to Normal Living Index (RNLI, obtainable score 0 to 100%) respectively, before intervention and thereafter fortnightly, Walking Speed and quality or life were assessed using a stopwatch and Health Related Quality of Life in Stroke Patients (HRQLISP, obtainable score 0 to 100%) respectively. before and at week 10 of intervention. Data were analysed using descriptive statistics, t-test and general linear model for repeated measures at p⁼ 0.05. The MPHCG (60,6±10.2 years) and HG (61.7±8.4 years) were comparable in age. Within- subjects multivariate analysis, after controlling for gender, showed a significant increase in the MMAS scores for the PHCG (22.9+15.1) and HG (19.9±16.4) at pre-intervention to 34.7+11.7 and 36.6±10.3 respectively at week I0. There was a significant increase in SFPASS scores of the PHCG (8.6±5.0) and HG (7.1±5.6) at pre-intervention to12.3±3.2 and 12.3±3.3 at week 10 respectively. The HRQLISP scores significantly increased from 70.4±4.9 pre-intervention to 75.2±5.4 in the PHCG and from 69.7+51 to 74.845.9 in the HG. Similarly, walking speed significantly increased from 0.30±0.20 m/s pre-intervention to 0.60±0.40 m/s at week 10 in the PHCG and from 0.30±0.40 m/s to 0.50±0.40 m/s in the HG. The groups were comparable in each of the MM AS, RNLI, SFPASS, walking speed and overall HRQLISP scores pre-intervention and at week 10. However, the PHCG had a significantly higher spiritual interaction score (77.6±9.3) on the HRQLISP measure than the HG (14.2±8.3 ). The primary health care-based physiotherapy protocol improved motor function ability, walking speed, postural balance and quality of life among post-stroke patients. This protocol can be used for stroke rehabilitation at home and primary health centres which are closer to the community. Keywords: Stroke rehabilitation; Primary health care, Physiotherapy protocol word Count: 472 A thesis in the department of Physiotherapy submitted to the Faculty of Clinical Sciences in partial fulfilment of the requirements for the degree of Doctor of Philosophy of the University of Ibadan

EFFECTS OF MOBILE HEALTH NURSING INTERVENTION ON MATERNAL HEALTH SERVICES UPTAKE AMONG ANTENATAL CLINIC ATTENDEES IN OYO SOUTH SENATORIAL DISTRICT, OYO STATE

2014-08-01T00:00:00Z

EFFECTS OF MOBILE HEALTH NURSING INTERVENTION ON MATERNAL HEALTH SERVICES UPTAKE AMONG ANTENATAL CLINIC ATTENDEES IN OYO SOUTH SENATORIAL DISTRICT, OYO STATE ODETOLA, T. D. Compliance with Antenatal Care (ANC) and Postnatal Care (PNC) regimen is a known determinant of pregnancy outcomes. In most developing countries, access to Skilled Birth Delivery (SBD) and Childhood Immunisation (CIm), socio-cultural beliefs, physical and financial barriers significantly influence perinatal health outcome. Mobile health (M.Health) is an emerging strategy for improving healthcare utilisation and compliance but the extent to which it may influence uptake of available maternal and infant welfare services in Nigeria is not documented in literature. Nurses are the fulcrum for maternal healthcare but their knowledge and roles in the use of M-Health are not known in Nigeria. This study was designed to assess the effects of M-health Nursing intervention (MHNI) on uptake of maternal health services in Oyo South Senatorial District. This quasi-experimental study involved four out of nine local government areas randomly selected and allocated into Experimental (EG) and Control (CG) groups [a semi-urban and an urban each]. All the 12 Primary Health Care facilities which had nursing personnel were purposively selected. Forty-eight nurses (EG: 21 nurses; CG:27 nurses) and 383 literate pregnant women (EG:191 women; CG:192 women) at gestational age of 4-6 months, registered at the PHC were recruited consecutively. Experimental group nurses were trained on M-health and mobile telephones were given to nurses and registered pregnant women to facilitate communication. Over an 8-month period, pregnant women received free voice calls and health promotion text messages from nurses. At baseline, 3-month and 6-month, nurses' knowledge about MHNI was assessed in EG and CG using a non-weighted 42-item pretested questionnaire. Outcome evaluation checklist was used to document utilisation and completion of the following six indices among pregnant women: ANC, PNC attendance, SBD, Intermittent Preventive Treatments in pregnancy (IPTp), Tetanus Toxoid (TT), and CIm within 6 weeks of birth. Data were analysed using descriptive statistics, Chi-square, repeated measures ANOVA and logistic regression at p= 0.05. In the EG, knowledge score significantly increased from 21.9±4.5 at baseline to 23.6±4.6 and 23.2±5.6 at three-month and six-month respectively while there was no significant difference in knowledge score among CG over the study period. Comparing EG with CG, significant differences were documented ANC attendance (66.8% versus 53.1%; OR:1.7, Cl: 1.2-2.7), uptake of IPTp (47.6% versus 18.4%; OR:1.7, CI: 1.2-2.7), Clm (62.6% versus 46.9%; OR:I.9, Cr: 1.3-2.8) and TT (64.5% versus 54.1%; OR:1.02, CI: 0.5- 1.9). SBD (69.8% versus 36.3%; OR: 1.0, CI: 0.6-1.6), PNC (69.0% versus 51.0%; OR :2.1, Cl: 1.4-3.2). Significantly more women in the EG who completed ANC had IPTp (OR: 14.9, CI: 6.3-35.7);TT (OR: 8.2 CI: 1.7-39.9) and SBD (OR: 2.3. CI: 1.2-4.5) than those who did not. Likewise in CG, more women who completed ANC had IPTp (OR: 21.9, CI: 5.1-94.1) and SBD (OR: 2.0, CI: 1.1-3.8). Mobile health nursing intervention improved uptake of maternal health services among pregnant women. Policy makers need to consider the adoption of mobile health to enhance uptake of maternal health services and improve pregnancy outcome. A Thesis in the Department of Nursing submitted to the Faculty of Clinical Sciences in partial fulfillment of the requirement for the Degree of Doctor of Philosophy of the University of Ibadan

EFFECTS OF EDUCATIONAL INTERVENTION FOR NURSES ON WOMEN'S KNOWLEDGE AND WILLINGNESS TO UPTAKE CERVICAL SCREENING SERVICES IN SELECTED HEALTH FACILITIES IN IBADAN

2014-06-01T00:00:00Z

EFFECTS OF EDUCATIONAL INTERVENTION FOR NURSES ON WOMEN'S KNOWLEDGE AND WILLINGNESS TO UPTAKE CERVICAL SCREENING SERVICES IN SELECTED HEALTH FACILITIES IN IBADAN NDIKOM, C. M. Cervical cancer (CC) is a major cause of cancer mortality among women especially in developing nations. Low uptake of Cervical Cancer Screening (CCS) has been implicated. Countries with established screening programmes have recorded reduction in CC. Uptake of CCS depends largely on information available to women and nurse are in vantage position to provide this information. Few CCS pregames have been developed in Nigeria: however, the effects of educational interventions directed at nurses on women's uptake of screening have not been assessed. This study evaluated the effects of an educational intervention (EI) for nurses on women's knowledge and willingness to uptake CCS services. This quasi experimental study was conducted in purposively selected four primary and four secondary health facilities in Ibadan. These were randomly divided into four different facilities each in intervention and control groups. A total of 133 consented nurses who had more than a year experience [60 in the Intervention Group (IG) and 73 in the Control Group (CG) participated. Nine hundred and four women attending antenatal clinics in the facilities were also selected using systematic random sampling as baseline and same number at Post-Intervention (PI). Baseline data were collected from nurses and women using different validated structured questionnaires. Five modules El were conducted for the four in the IG at weekly intervals for three weeks. The nurses were followed up monthly, for six months and activities related to information dissemination for women were observed. Post-test questionnaires were administered to the nurses and women in IG and CG. Data were analysed using Chi square, t-test and logistic regression at p=0.05. Nurses' mean age was 41.6± 9.1 years while those of the women were 27.9±5.8 years at baseline and 28.0±5.3 )ears at PI. Majority of the women, IG; 94.9%; CG: 94.6% were married at baseline. The nurses' knowledge scores for the IG (11.8±3.3) and CG ( 11.7±3.3) were comparable at baseline. Post intervention knowledge score was significantly higher among nurses in the IG (14.6±3.1) than those in CG (12.7±3.5). The women's mean knowledge score was comparable at baseline IG (2.9±1.3) and CG (2.9±1.9). Post intervention knowledge score was significantly higher among women in the IG (3.4±3.2) than CG (2.0±3.1). Willingness to utilise CCS services also significantly increased from 75.0% (IG) and 70.0% (CG) bawline to 90.0% (IG) and 85.3% (CG) at PI. Uptake of CCS increased from 1.4% at baseline to 3.6% in the IG and 2.1% to 2.3% in the CG. The major factors that influenced uptake among women despite their willingness at PI were non-availability of CCS services (OR=0.481, CI=0.353-0.659) and lack of information on CCS (OR=1.919, CI=1.149-2.477). Cervical cancer screening uptake was low but improved slightly with the intervention. Educational intervention is a useful tool for improving knowledge and uptake of Cervical Cancer Screening. Nurses at all levels of healthcare should be trained to provide this information to women. Government and health related agencies should provide information and empower nurses to render cervical cancer services at all levels. A Thesis in the Department of Nursing submitted to the Faculty of Clinical Sciences in partial fulfillment of the degree of Doctor of Philosophy of the University of Ibadan.

THE NOSOLOGICAL STATUS OF SCHIZOPHRENIA: A MULTIDIMENSIONAL VALIDITY STUDY

1993-01-01T00:00:00Z

THE NOSOLOGICAL STATUS OF SCHIZOPHRENIA: A MULTIDIMENSIONAL VALIDITY STUDY OYEWUSI, GUREJE In spite of many years of research, schizophrenia remains a medical puzzle. Even though modern classificatory systems have revolutionized its clinical diagnosis by improving reliability, its validity as a distinct disorder remains controversial. Schizophrenia has many characteristic signs and symptoms but no pathognomonic ones: it has clinical features which overlap those of a number of other disorders. Many workers have been unable to demonstrate a distinct bimodality between schizophrenia and affective psychoses when these disorders have been studied with regard to clinical phenomenology. A number of neurobiologic features have been associated with schizophrenia but most of these are non-specific as they have been demonstrated in patients with other disorders. The course of the iliness is unpredictable and varied. Given this array of unknown, it is no wonder that the Search for its aetiology remains largely exploratory. It is therefore now widely accepted that further significant progress in the study of schizophrenia. especially progress In the identification of aetiological factors and in the possible formulation of preventive measures, will only be made after the problems associated with the clinical heterogeneity of the disorder have been successfully addressed. Over the years, a number of investigators have suggested various ways of subdividing the iliness. These have shown different degrees of success. The challenge of the present time is to use various clinical and neurobiologic domains to determine the most empirically useful way to achieve this subdivision. This study was designed to determine the validity of schizophrenia in a sample of Nigerian patients and to explore which procedure for subdividing it has the potentials for defining broadly homogenous groups of patients. A multidimensional approach was employed such that aspects of the clinical phenomenology, historical and familial antecedents, and neurobiologic correlates of the subjects were Study 60 consecutively admitted patients with schizophrenia diagnosed according to the Research Diagnostic Criteria. Control groups consisted of 53 randomly selected normal subjects, 35 consecutively admitted patients with mania, and 11 with psychotic depression. Study subjects were identical to controls with respect to gender, age, social class, and educational attainments. Patient were made up of non-institutionalized young subject s with relatively short duration of illness. Using standardized procedures, the patient groups were evaluated for a history of perinatal and childhood head trauma, premorbid functioning, psychiatric disorder in first degree relatives, and clinical features of iliness . All the subject had neurobiologic assessment consisting of examination for the presence of neurologic soft signs, determination of cerebral dominance using a battery of sensor motor tests, and evaluation of performance on a number of neuropsychologic tests designed to reflect the functioning of specific brain areas. Assessment procedures anc measurement techniques were shown to be generally reliable. Analyses consisted of comparisons of study and control groups, and of putative subtypes of schizophrenia using univariate statistical methods such as the t-test, chi square, simple correlation, and analysis of variance as appropriate. Multivariate techniques such as various forms of multiple regression analysis were used to determine strengths of associations after potentially confounding factors had been controlled for. Family history data provided support for the view that schizophrenia was a heritable disease. While the first degree relatives of schizophrenics showed an elevated risk for the illness, there was no suggestion that. such relatives showed a similar risk for affective psychoses. Schizophrenics were significantly more likely to have experienced obstetric complications and childhood head injuries than patients with affective psychoses. On the other hand, no evidence was found for a more impaired premorbid functioning, a higher prevalence of neurologic soft signs, or deviant cerebral dominance among schizophrenics than among patients with affective psychoses. Compared with normal and non-schizophrenic controls, patients with schizophrenia showed a relatively consistent pattern of impaired performance on neuropsychological tests, especially on those tests requiring frontal lobe integrity. In a discriminant function analysis, 8 variables consisting of symptomatic features of illness, age at onset of illness, cumulative score of left-sided soft signs, and performance on the Similarities subtest of weschier Adult intelligence test correctly classified 81% of the schizophrenics and 76% of the patients with affective psychoses. Exploration of different subtyping schema revealed that even though the diagnosis of the traditional hebephrenic, catatonic, mixed (or undifferentiated), and paranoid subtypes could be made reliably, these classic subtypes of schizophrenia have little to support their validity in this sample of early onset schizophrenics. There was also no evidence to suggest that subdivisions based on putative aetiolgical factors of familiality or early brain insult have practical utility as only very few patients could be classified in these ways. On the other hand, characterizing patients with the use of positive and negative symptoms profile has empiric validity. However, using factor analytic techniques, a three- rather than a two level typology of syndromes best described the patients. The three syndromes could be termed negative, disorganized, and positive based on their constituent symptom configurations. The results suggested that while the negative syndrome may be characterized by its association with poor premorbid functioning, especially during adolescence, the disorganization syndrome was characterized by its association with widespread impairment of cognitive functioning, particularly of frontal lobe functioning. The positive syndrome generally showed no strong association with the assumed variables. This study has shown that while schizophrenia is a disorder that can be reliably and validly distinguished from normality and for affective psychoses, its clinical heterogeneity often blurs this distinction. Using a multidimensional approach, it was shown that the illness consists of three relatively independent but coexisting syndromes. These schizophrenia were shown to be valid by demonstrating that they bore differential association with historical and neurobiologic correlates. The validity of this approach at subdividing the illness suggests that future research into various aspects of schizophrenia, especially aspects of the aetiology and biological substrate of the illness, are more likely to be rewarding if the disorder is seen as consisting of these three overlapping syndromes. A Thesis in the Department of Psychiatry, submitted to the Faculty of Clinical Sciences and Dentistry in partial fulfillment of the requirements for the degree of Doctor of Philosophy, University of Ibadan.