Family Practice Clinic Research Articles

Depression and sleep problems in a Nigerian family practice setting

Depressive symptoms in family practice clinics are often undetected, despite the fact they are associated with sleep disorders. There is paucity of data on the association between depression and sleep disorders in a Nigerian family practice setting, hence the need for this study. This was a hospital based study. Systematic sampling method was used in recruiting the patients. The PHQ-9 was administered to the respondents to screen for depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to measure the quality and patterns of sleep in the respondents. One hundred and seventy eight (44.5%) out of the four hundred respondents were found to have one form of depression or other, out of which one hundred and seventy two (96.6%) had sleep disturbance, 39 (21.9%) stayed more than 60 minutes before falling asleep, 85 (47.7%) had poor subjective sleep quality, forty eight (36.9%) had taken medication (prescribed or over the counter) to assist in sleeping. These were statistically significant (p-values = 0.001, 0.000, 0.000 and 0.000) respectively. One hundred and fifty three (85.9%) were poor sleepers. One hundred and sixty one (90.4%) had habitual sleep efficiency greater than 85%, while 60 (33.7%) had trouble staying awake while driving, eating meals or engaging in social activities. Depression is common in primary care patients and is associated with sleep disturbance, sleep latency, poor subjective quality and medication before sleep. Sleep evaluation should be part of routine assessment of the new patients presenting at a family practice setting

Randomized study of probiotics in primary care

Objectives Several studies have demonstrated that probiotics can be helpful in preventing antibiotic-associated diarrhoea in hospitalized patients. However, the extent to which probiotics may benefit healthy adults taking a course of antibiotics has not been investigated in primary care. Furthermore, patient willingness to take a probiotic supplement concomitantly with antibiotics has not been explored. We aimed to conduct an exploratory study using probiotics in adults requiring an acute course of antibiotic therapy. Methods Patients prescribed antibiotics for treatment of acute infections in an outpatient family practice setting were randomized to receive either a probiotic or placebo concurrently. Patients completed adherence diaries and daily symptom checklists to assess gastrointestinal and vaginal (women) symptoms and collect information about adherence. Key findings During 179.5 h in which patients were actively recruited, 952 individuals sought care at the family practice clinic. Of these individuals, 124 were prescribed oral antibiotics; ultimately, 51 individuals met eligibility criteria, consented to participate and were randomized. Forty participants (78.4%) returned symptom diaries. No adverse effects were reported from probiotic use; however, adherence was better with the prescribed antibiotic regimen than with the study supplement (P = 0.0033). Conclusion In our pilot study, probiotics were well tolerated, although no differences were detected in any gastrointestinal or vaginal symptoms between probiotic or placebo.

A Pediatric Office-Based Quality Improvement Project in a Rural Health Clinic: Retrospective Evaluation

Purpose: An office-based pediatric quality improvement project was implemented to increase the number of well-child health visits and increase the documentation of pediatric quality measures in a Midwest rural clinic. Project Description: The Bright Futures framework provided the structure for the project and a retrospective evaluation was performed six months after the initiation of practice changes, reminder letters, and public service announcements. Chart review was performed with a convenience sample of children ages 0 to 47 months from the database of the organization that supports the family practice clinic and emergency department. The descriptive analysis included change in proportions and percentages and chi-square analyses. Outcomes: There was an increase the number of well-child visits by 65% in the six month period with a wider range of ages being seen. There was a 40% response rate of visits within two months of the reminder letters. Documentation increased in four out of nine quality measures with two measures remaining at 100%. Validated developmental and behavioral assessment tools were used consistently. A dialogue with the local health department was established to coordinate immunization and well-child visits. Conclusions: The practice changes were found to be sustainable and consistent with quality pediatric care. DOI : http://dx.doi.org/10.14574/ojrnhc.v14i1.280 Keywords: rural pediatric, office-based, quality improvement

Factors associated with intimate partner violence against women in a mega city of South-Asia: multi-centre cross-sectional study.

OBJECTIVES. To assess the proportion of women subjected to intimate partner violence and the associated factors, and to identify the attitudes of women towards the use of violence by their husbands. DESIGN. Cross-sectional study. SETTING. Family practice clinics at a teaching hospital in Karachi, Pakistan. PARTICIPANTS. A total of 520 women aged between 16 and 60 years were consecutively approached to participate in the study and interviewed by trained data collectors. Overall, 401 completed questionnaires were available for analysis. Multivariate logistic regression analysis was used to identify the association of various factors of interest. RESULTS. In all, 35% of the women reported being physically abused by their husbands in the last 12 months. Multivariate analysis showed that experiences of violence were independently associated with women's illiteracy (adjusted odds ratio=5.9; 95% confidence interval, 1.8-19.6), husband's illiteracy (3.9; 1.4-10.7), smoking habit of husbands (3.3; 1.9-5.8), and substance use (3.1; 1.7-5.7). CONCLUSION. It is imperative that intimate partner violence be considered a major public health concern. It can be prevented through comprehensive, multifaceted, and integrated approaches. The role of education is greatly emphasised in changing the perspectives of individuals and societies against intimate partner violence.

Impact of Otitis Media Severity on Children's Quality of Life

Children with otitis media (OM) suffer sleep disturbances, loss of appetite, earache, and behavioral problems. Our objective was to quantitate the average burden of OM and to compare the associated impact of tympanostomy tubes on infant health related quality of life (HR-QoL). Multi-institutional prospective cross-sectional study. Otolaryngology, family practice, and pediatric clinics. Children ages 6 to 24 months of age with or without recurrent OM. Patient history, the PedsQL Infant QoL survey, and the 6-item child with OM survey (Otitis Media 6 [OM-6]) were collected from providers and parents. Data from 1208 patients were analyzed. Mean age was 14.7 months, and 54% were male. The mean OM-6 score of children with recurrent OM was 3.3, whereas similarly aged well-children had a mean OM-6 score of 2.5. The mean PedsQL Infant scores of recurrent OM patients were significantly worse than those of children from well-child visits. Worse OM-6 scores were correlated with poorer PedsQL Infant scores, Pearson r = -0.581 (1-12 months) and -0.558 (13-24 months), P < .001. Otolaryngology patients who were recommended to undergo ear tube placement had significantly poorer OM-6 scores and worse PedsQL Infant scores, whereas patients with prior tube placement had significantly better OM-6 and PedsQL Infant scores. Children with recurrent OM had significantly worse HR-QoL than similarly aged healthy children. Increased burden of OM strongly affected HR-QoL, and recommendation for tube placement was associated with increased disease burden and poorer HR-QoL. The presence of tympanostomy tubes was associated with better OM-6 and PedsQL Infant scores.

Potential Screening Benefit of a Colorectal Imaging Capsule That Does Not Require Bowel Preparation

Check-Cap is a capsule device that images the colon using low-dose radiation (total dose equivalent to a plain abdominal radiograph) and does not require bowel preparation. Check-Cap is in development for colorectal cancer imaging. : To survey patients in a primary care setting for their preferences for Check-Cap versus fecal occult blood testing (FOBT), including among patients who decline colonoscopy. Patients aged 50 and older presenting to the general medicine and family practice clinics of Indiana University Health sites within a 3-month period were approached during clinic visits. A total of 502 patients who agreed to participate were given the opportunity to complete an anonymous survey (Supplementary Appendix 1, http://links.lww.com/JCG/A71) regarding their preferences for colon cancer screening. The survey presented procedure descriptions and projected accuracies for colonoscopy, FOBT, and Check-Cap. For Check-Cap, projected sensitivity was 80% for cancer and 50% for large polyps. The mean age of the subjects was 61.6 years, 39% were males, 44% white, 62% of patients had prior colonoscopy, and 26% had prior polypectomy. We defined 3 groups of patients-those that had never had a colonoscopy (NC)-38%, those who had a colonoscopy but no polypectomy (CNP)-36%, and those who had a colonoscopy and polypectomy (CP)-26%. Overall, 284 patients (57%) were willing to undergo a future colonoscopy. Patients with prior colonoscopy and polypectomy were more willing to get another colonoscopy than the other 2 groups (CP:CNP:NC=78%:64%:38%; P<0.0001). Willingness to undergo colonoscopy decreased with age in all the 3 groups. Among those not willing to undergo colonoscopy, 30% were willing to undergo Check-Cap, 20% were willing for FOBT), 25% were willing to do both, and 24% were not willing for either test. Among those who declined future colonoscopy, 40% reported Check-Cap as their preferred screening test versus 22% for FOBT; P=0.0002. Our survey suggests that an imaging capsule like Check-Cap could contribute to screening adherence among patients who decline colonoscopy, provided that it can achieve projected sensitivities of 80% for cancer and 50% for large polyps.

Association between Depression and Social Demographic Factors in a Nigerian Family Practice Setting

Objectives: Although depression is one of the more common illnesses in outpatients’ clinic, it is often overlooked. Besides accurate identification and treatment is challenging. As pertinent as demographic factors are in explaining the variability of depressive symptoms, there is paucity of data in Nigeria in particular, and West Africa in general, hence the need to bring into lime light the association between depression symptoms and socio-demographic factors in a General Outpatients Clinic in Nigeria, West Africa. Methods: Following institutional ethics committee approval, four hundred newly registered patients who attended the General Out Patients Department (GOPD) of Kwara State Specialist Hospital, Ilorin, Nigeria, were selected by systematic random sampling and studied. The Patients Health Questionnaire-9 (PHQ-9) specifically developed for use in primary care with acceptable reliability, validity, sensitively was used. Association between each socio-demographic factor and depression was sought. Results: One hundred and seventy eight (44.5%) out of the four hundred respondents were found to have one form of depression or the other. There was minimal depression in 119 (29.8%), mild in 54 (13.4%), moderate in 2 (0.5%), and severe in 3 (0.8%). There was strong statistical association between depression and age group, sex, marital status, level of education, occupation and monthly income, p-values 0.008, 0.000, 0.000, 0.003, 0.000, 0.001 respectively. However, religion (p = 0.541) and ethnicity (p = 0.567) were of no statistical importance. Conclusion: The prevalence of depressive symptoms among patients attending family practice clinics was high. There was also strong association between depression and socio-demographic factor. Family physician should have high index of suspicion to patients with vague somatic complaints and the aforementioned socio-demographic factors. Early detection of depression can be enhanced by screening patients for this disorder, when they attend the hospital for other reasons.

Management of Prediabetes

Purpose: To compare the management of prediabetes between a family practice clinic and internal medicine/endocrinology practice. Methods: A randomized, retrospective evaluation of the medical history in 168 eligible patients with a diagnosis of prediabetes or abnormal blood glucose (BG) at a family practice clinic (n = 78) and an internal medicine/endocrinology practice (n = 90). Results: The internal medicine/endocrinology practice provided more counseling regarding lifestyle modifications (91.1% vs 76.9%, P = .039), specific physical activity recommendations (26.7% vs 7.7%, P = .003), and recommended more patients receive 150 minutes/week of moderate exercise (8.9% vs 1.3%, P = .038). The family practice clinic provided more written dietary information (16.9% vs 13.3%, P = .044) and specific weight loss goals (20.5% vs 6.7%, P = .015). The internal medicine/endocrinology practice initiated pharmacological therapy in more patients (51.1% vs 3.8%, P< .001) and had a significant decrease in fasting BG from baseline compared to the family practice clinic (−9.0 vs −5.6 mg/dL, P< .001). Conclusion: Providers are likely to initiate nonpharmacological therapy but may not provide specific education recommended by the American Diabetes Association. The integration of a multidisciplinary team to provide guideline-based nonpharmacologic counseling may be beneficial in improving outcomes in the management of prediabetes.

Nonmydriatic Fundus Photography for Teleophthalmology Diabetic Retinopathy Screening in Rural and Urban Clinics

To evaluate the relative diagnostic value of nonmydriatic fundus photography (nFP) among patients screened for diabetic retinopathy in remote rural medical clinics and an urban academic medical center for nonadherence to recommended annual dilated eye examination. A retrospective cross-sectional study was performed among diabetic patients seen in primary outpatient clinics between 2006 and 2011 who were screened for diabetic retinopathy with nFP for history of nonadherence to recommended annual dilated eye examination. A single nonstereoscopic, 45°, 10-megapixel digital image of the disc and macula of both eyes was obtained locally and transmitted electronically to a retinal specialist for remote review. The results from remote rural Native American Indian reservations were compared with those from an urban academic family practice clinic. The proportion of subjects diagnosed with diabetic retinopathy and the quality of fundus images were compared. Among 872 patients (1,744 eyes) screened from rural sites and 517 subjects (1,034 eyes) screened from an urban site, images were of good quality for evaluation in 82.4% and 85.7% of subjects, respectively. Diabetic retinopathy was noted in 12.6% of rural subjects and 29.6% of urban subjects (p<0.001). nFP can be a useful tool in both rural and urban settings to screen for diabetic retinopathy in patients who are nonadherent to the recommended dilated annual eye exam. In our study population, a surprisingly higher percentage of diabetic subjects screened from the urban clinic had retinopathy compared with subjects screened in rural clinics.

Effectiveness of Physical Therapists Serving as Primary Care Musculoskeletal Providers as Compared to Family Practice Providers in a Deployed Combat Location: A Retrospective Medical Chart Review

A medical records review to compare efficiency and effectiveness of a physical therapist (PT) functioning as a musculoskeletal primary care provider (PCP) compared to family practice (FP) physicians functioning as musculoskeletal PCP. (1) Use of medication/imaging studies will be significantly less with a PT as PCP compared to FP as PCP. (2) Return-to-duty (RTD) rate will show significant increases when patients with musculoskeletal conditions are seen by PT as compared to FP. One PT practicing in a deployed combat location collected data on patients that presented directly to the PT clinic or FP clinic for care of musculoskeletal complaints. Treatment patterns of two Air Force physicians were accessed regarding patients with musculoskeletal conditions. Fifty-four patients were randomly selected for the PT group and 95 patients for FP group. AHLTA was searched for cases reported from June 2009 to January 2010. Data regarding age, gender, medication, imaging use, and return to duty (RTD) rate were collected. Of the study population, 126 (84%) were males, 23 (16%) were females (age range: 19-54, mean 29). RTD rate was 50% greater for PT. Rate of medication and imaging use for PT was 24% and 11%, whereas FP was 90% and 82%, respectively (p < 0.01). Using PT as the musculoskeletal PCP was shown to be an effective and efficient practice model to assess and treat patients with musculoskeletal complaints.

Caregiver Quality of Life Is Related to Severity of Otitis Media in Children

Objectives: Otitis media (OM) in children is the most frequent reason for physician visits in developed countries and burdens caregivers and society, as well as the child. Our objective was to describe the impact of OM severity on caregiver quality of life (QoL). Methods: Multi-institutional prospective cross-sectional study. Setting: Otolaryngology, family practice, and pediatrics clinics. Children 6-24 months old with and without a primary diagnosis of recurrent OM and their caregivers. Physicians provided patient history, and parents/caregivers completed a Family Information form, the PedsQL Family QoL survey, the PROMIS survey, and the 6-item child with OM QoL survey (OM-6). Results: A total of 2414 patients were enrolled. The average age was 16 months, and 58% were male. The mean OM-6 score was 3.26, slightly more severe than the reported 2.8 for the average child with OM. The mean PedsQL Family score was 68.63, worse than the reported mean of 81.00 of parents with children with chronic disease in a convalescent hospital. Higher OM-6 scores correlated significantly with worse PedsQL Family scores, Pearson r -0.502, P &lt; 0.01. Similarly, more severe OM-6 scores strongly correlated with increased parental anxiety, depression, fatigue, and decreased satisfaction, all P &lt; 0.01. Conclusions: Parents of children ages 6-24 months with OM had mean PedsQL scores similar to parents of chronically ill children requiring full time home care. Worse PedsQL Family scores were highly correlated with elevated OM-6 scores, suggesting that severity of OM significantly affects parental QoL.

Impact of Otitis Media Severity on Children's Quality of Life

Objectives: Children with otitis media suffer sleep disturbances, loss of appetite, earache, and psychosocial and behavioral problems. Our objective was to describe the impact of otitis media severity on infant quality of life (QoL). Methods: Study Design: Multi-institutional prospective cross-sectional study. Setting: otolaryngology, family practice, and pediatric outpatient clinics. Subjects: Children 6-24 months of age with and without a primary diagnosis of recurrent otitis media. Data were collected from providers and parents, including relevant patient history, a Family Information Form, the PedsQL Infant quality of life survey, and the 6-item child with OM QoL survey (OM-6). Results: A total of 2414 patients were enrolled. The average age was 16 months, and 58% were male. The mean OM-6 score was 3.26, slightly more severe than the reported 2.8 for the average child with OM. The mean PedsQL Infant scores were 77 for children less than 1 year old, and 79 for children &gt;1 year. These values indicate worse QoL compared to the reported average scores for healthy and acutely ill infants, 82.47 and 79.46, respectively. Higher OM-6 scores were significantly correlated with worse PedsQL Infant scores, Pearson r values -0.602 and -0.563, P &lt; 0.01. Other factors that correlate with QoL in this population will be discussed. Conclusions: Children 6-24 months of age with recurrent OM had a mean PedsQL score significantly worse than similarly aged healthy children. Worse PedsQL Infant scores were highly correlated with elevated OM-6 scores, suggesting that severity of OM significantly affects child QoL.

Counseling About Medication-Induced Birth Defects with Clinical Decision Support in Primary Care

We evaluated how computerized clinical decision support (CDS) affects the counseling women receive when primary care physicians (PCPs) prescribe potential teratogens and how this counseling affects women's behavior. Between October 2008 and April 2010, all women aged 18-50 years visiting one of three community-based family practice clinics or an academic general internal medicine clinic were invited to complete a survey 5-30 days after their clinic visit. Women who received prescriptions were asked if they were counseled about teratogenic risks or contraception and if they used contraception at last intercourse. Eight hundred one women completed surveys; 27% received a prescription for a potential teratogen. With or without CDS, women prescribed potential teratogens were more likely than women prescribed safer medications to report counseling about teratogenic risks. However, even with CDS 43% of women prescribed potential teratogens reported no counseling. In multivariable models, women were more likely to report counseling if they saw a female PCP (odds ratio: 1.97; 95% confidence interval: 1.26-3.09). Women were least likely to report counseling if they received angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Women who were pregnant or trying to conceive were not more likely to report counseling. Nonetheless, women who received counseling about contraception or teratogenic risks were more likely to use contraception after being prescribed potential teratogens than women who received no counseling. Physician counseling can reduce risk of medication-induced birth defects. However, efforts are needed to ensure that PCPs consistently inform women of teratogenic risks and provide access to highly effective contraception.

Prevalence of low back pain and associated risk factors amongst adult patients presenting to a Nigerian family practice clinic, a hospital-based study

BackgroundLow back pain (LBP) is a common health problem with concomitant disability which has assumed a public health importance in our setting.ObjectivesThe aim of this study was to determine the prevalence of LBP and associated risk factors amongst adult patients attending the General Outpatients’ Clinic of the University College Hospital in Ibadan, Nigeria.MethodThis was a cross-sectional study of 485 respondents. A semi-structured questionnaire was used to obtain information on socio-demography, lifestyle, occupation and other risk factors associated with LBP.ResultsThere were 288 (59.4%) female and 197 (40.6%) male respondents. The point prevalence of LBP was 46.8%. Occupational activities, previous back injury and tobacco smoking were significant associated factors for the total population. For the female respondents, logistic regression analysis showed that a waist circumference of 88 cm or more, dysmenorrhea, previous back injury and being engaged in an occupation were the most significant factors associated with LBP. However, previous back injury was the most significant factor associated with LBP for the male respondents.ConclusionThe prevalence of LBP amongst adult patients in our setting is high, with preventable and treatable predisposing factors. Public health efforts should be directed at educating people on occupational activities and lifestyle habits.

Social Media and Clinical Care

It is an exciting time to practice medicine during our digital “coming of age.” Social media, the freely available Web-based platforms that facilitate information sharing of user-generated content, such as social networking sites, media-sharing sites, blogs, microblogs, and wikis, have transformed the way we communicate as a society. Through community building, message amplification, rapid dissemination, and engagement, social media has changed our interactions with others and, by direct consequence, our relationships. For health care, this represents a veritable social revolution. 1 Indeed, medicine is constantly evolving to adapt to new technologies. These advances have led to new therapies, diagnostic tools, and ways of communicating. As physicians and lifelong learners, it has been imperative to embrace the new when it has meant better and more efficient patient care while holding on to the stable tenets of medicine that root our profession: humanism, integrity, ethics, professionalism, and trust. Patients have been active on social media to find health information, find support through discussion groups and forums, and chronicle their illness journeys.2 Naturally, they are also interested in using social media to facilitate communication between themselves and their providers. In a survey of patients of an outpatient family practice clinic, 56% wanted their providers to use social media for appointment setting and reminders, diagnostic test results reporting, health information sharing, prescription notifications, and answering general questions.3 For those patients who do not use social media, many would start if they knew that they could connect with their providers there.3 Physicians are also exploring ways to use social media, both personally and professionally, although personal use is more common.4–6 Some physicians use social media professionally to find and share health information, communicate/network with colleagues and trainees, disseminate their research, market their practice, or engage in health advocacy. In …

Ask-Advise-Connect

Several national health care-based smoking cessation initiatives have been recommended to facilitate the delivery of evidence-based treatments, such as quitline (telephone-based tobacco cessation services) assistance. The most notable examples are the 5 As (Ask, Advise, Assess, Assist, Arrange) and Ask. Advise. Refer. (AAR) programs. Unfortunately, rates of primary care referrals to quitlines are low, and most referred smokers fail to call for assistance. To evaluate a new approach--Ask-Advise-Connect (AAC)--designed to address barriers to linking smokers with treatment. A pair-matched, 2-treatment-arm, group-randomized design in 10 family practice clinics in a single metropolitan area. Five clinics were randomized to the AAC (intervention) and 5 to the AAR (control) conditions. In both conditions, clinic staff were trained to assess and record the smoking status of all patients at all visits in the electronic health record, and smokers were given brief advice to quit. In the AAC clinics, the names and telephone numbers of smokers who agreed to be connected were sent electronically to the quitline daily, and patients were called proactively by the quitline within 48 hours. In the AAR clinics, smokers were offered a quitline referral card and encouraged to call on their own. All data were collected from February 8 through December 27, 2011. Ten clinics in Houston, Texas. Smoking status assessments were completed for 42,277 patients; 2052 unique smokers were identified at AAC clinics, and 1611 smokers were identified at AAR clinics. Linking smokers with quitline-delivered treatment. Impact was based on the RE-AIM (Reach, Efficacy, Adoption, Implementation, and Maintenance) conceptual framework and defined as the proportion of all identified smokers who enrolled in treatment. In the AAC clinics, 7.8% of all identified smokers enrolled in treatment vs 0.6% in the AAR clinics (t4 = 9.19 [P < .001]; odds ratio, 11.60 [95% CI, 5.53-24.32]), a 13-fold increase in the proportion of smokers enrolling in treatment. The system changes implemented in the AAC approach could be adopted broadly by other health care systems and have tremendous potential to reduce tobacco-related morbidity and mortality.

Evaluating the Effectiveness of a Smoking Warning Label on Raising Patient Awareness of Smoking and Bladder Cancer

We assessed the knowledge of patients with regard to the association between smoking and bladder cancer, and examined the impact of a novel smoking warning label on raising awareness of this issue. We conducted a prospective cross-sectional study involving patients who presented to urology and family practice clinics. A questionnaire was used to assess knowledge regarding the association between smoking and various diseases. Participants were also asked to evaluate a novel smoking warning label for bladder cancer. A total of 291 (97%) patients responded to the questionnaire including 143 (95.3%) at urology clinics and 148 (98.7%) at family practice clinics. Overall only 45.2% of respondents were aware of the association between smoking and bladder cancer compared to 97.4% who knew that there was an association between smoking and lung cancer. There were no significant differences in knowledge between those at urology and family practice clinics. After viewing the warning label, 58.1% of respondents stated that it had changed their opinion on smoking and bladder cancer, and 74.8% felt that this label would be an effective tool to raise awareness of the issue. Patients who changed their opinion had statistically significantly less initial knowledge about the association between smoking and bladder cancer (36.7% vs 57.5% for those who did not change their opinion, p <0.001). Awareness of the link between smoking and bladder cancer remains low. The use of a smoking warning label may help raise awareness of this important public health issue.

Health Related Quality of Life of Patients with Chronic Liver Disease Attending Family Practice Clinic , Suez Canal University Hospital , Ismailia , Egypt

Health Related Quality of Life of Patients with Chronic Liver Disease Attending Family Practice Clinic , Suez Canal University Hospital , Ismailia , Egypt

Magnitude of knee osteoarthritis and associated risk factors among adult patients presenting in a family practice clinic in Nigeria

Background: Knee osteoarthritis is a chronic medical condition of public health importance in this setting. It is mostly diagnosed when preventive measures are no longer practicable due to reliance on the radiological diagnosis. Objectives: To determine the magnitude and risk factors associated with knee osteoarthritis among adult patients presenting at the University College Hospital, Ibadan, Nigeria. Materials and Methods: This cross-sectional study used a semi-structured questionnaire to interview 400 respondents. Knee osteoarthritis was diagnosed clinically using the American College of Rheumatology (ACR) criteria. Results: The point prevalence of knee osteoarthritis was 11.5%. Increasing age, female gender, marital status, low educational status, financial dependency, poor income, obesity, previous knee injury, epigastric pain, peptic ulcer disease, varus deformity of the knee, and poor health status were significantly associated with knee osteoarthritis. Logistic regression analysis showed increasing age (OR = 2. 874, CI = 1. 294-6.381), history of epigastric pain (OR = 57. 044, CI = 1. 693-192.24) and varus deformity of the left knee (OR = 3. 012, CI = 1. 063-8.547) to be the most significant factors associated with knee osteoarthritis.Conclusion: The magnitude of clinical knee osteoarthritis is high among respondents in this hospital-based study. Doctors in primary care should screen patients at first-contact to detect osteoarthritis early and manage appropriately.

Prescription pattern of antihypertensive drugs in Family Practice Clinics at Jordan University Hospital

The present study represents the current prescribing trend for antihypertensive drugs in family medicine clinics at Jordan University Hospital in Jordan. The study sample involved 416 male and female hypertensive Jordanian patients. Our results demonstrate that 2 hypertensive patients were not receiving any antihypertensive therapy at the time of evaluation, 192 patients were on a single antihypertensive therapy, 157 patients were on two antihypertensive drugs, 52 patients were on triple antihypertensive therapy and 13 patients were on four or more drugs. The most frequent classes of antihypertensive drugs used or prescribed to patients either as a single therapy or in combinations include angiotensin converting enzyme inhibitors, I²-blockers, calcium channel blockers, diuretics and angiotensin receptor blockers. Among the mono-therapy prescriptions, angiotensin converting enzyme inhibitors were the most commonly prescribed and diuretics were least used. In combined therapy, diuretics were the most prescribed antihypertensive drugs, followed by I²-blockers. Combinations consisting of diuretics and I²-blockers were the most commonly seen. With respect to overall use, angiotensin converting enzyme inhibitors were the most prescribed agents. Despite an observed significant reduction in blood pressure between first and last visits to the family clinics, most of the patients did not achieve recommended blood pressure control according to the international guidelines.