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A case of thyrotoxic paralysis caused by consumption of Iodocaseine

Antonio Villa, Gabriella Nucera

box-doi   https://doi.org/10.19204/2019/csft2

Published Online: April 15, 2019

Abstract

Acute hypokalaemic paralysis is a rare but treatable cause of acute limb weakness. Thyrotoxic paralysis is an uncommon, potentially life-threatening endocrine emergency and it is a rare complication of hyperthyroidism. The most common causes of hyperthyroidism include Graves’ disease, multinodular goiters or solitary thyroid nodule, and iodine-induced thyrotoxicosis (Jod- Basedow syndrome). Thyreotoxicosis factitia, which is caused by the excessive ingestion of exogenous thyroid hormone or iodine derivatives administration, has been rarely reported as a cause of thyrotoxic paralysis. We describe the case of a young Caucasian male with flaccid paralysis of all four limbs and severe hypokalaemia after inappropriate iodine derivatives (iodocasein) intake to show, in conclusion, how critical care physicians need to be aware of this rare but curable condition.

Towards the Universal Health Coverage in Ghana: An exploratory, cross-sectional study on the National Health Insurance Scheme

Richard Boateng, Alfred Edwin Yawson

box-doi   https://doi.org/doi10.19204/2019/twrs3

Published Online: April 15, 2019

Abstract

Introduction: a universal health care system created in 2003 to guarantee the right of care for all.
Method: A cross-sectional survey was conducted in 2017 on 300 adult participants, who were recruited by a convenience random sampling from subscribers of the formal and informal sectors, living in Accra, Ghana. A questionnaire ad hoc was administered to study subscribers’ perceived quality of healthcare services delivered by NHIS and their perception about UHC and two discrete indicators of healthcare system performance such as Universal Healthcare Access (UHA) and Financial Risk Protection (FRP). Data analysis was conducted through SPSS 21 and AMOS 21, employing basic analysis such as reliability, principal component and model fit analysis. Additionally, the structural model analysis was conducted to examine the relationship between antecedent and outcomes variables.
Results: In our study, positive perception of NHIS services enjoyed during the last year was predictive of FRP (CR = 5.324, P < 0.001), UHA (CR = 3.736, P < 0.001) and UHC (CR = 4.159, P < 0.001) of NHIS. In addition, UHA and FRP were found to be good predictors in the relationship between perceived quality of healthcare services delivered by NHIS and UHC (CR =5.823, P < 0.001 and CR = 2.097, P < 0.05, respectively).
Discussion and Conclusion: Findings of our study showed that perceived quality of healthcare services delivered by NHIS may play a certain role on the attainment of UHC both directly and by mediating effects of UHA and FRP. Therefore, good healthcare services provided by NHIS can promote universal healthcare access and financial risk protection as major catalysts towards the attainment UHC in Ghana.

The neoliberal roots of modern vaccine hesitancy

Chris Sanders, Kristin Burnett

box-doi   https://doi.org/doi10.19204/2019/thnl4

Published Online: April 15, 2019

Abstract

Popular resistance to vaccines is not a new phenomenon and has been widely documented by medical historians. The latest iteration of this resistance, however, is popularly referred to as the ‘vaccine hesitancy’ and reflects a host of beliefs and social and institutional influences. While it may be tempting to dismiss the views of those who resist vaccines, immunization policies and practice cannot be devised in isolation from the contemporary political and social landscape. Understanding the socio-political meanings that lay people assign to vaccines and the manner in which they communicate these concerns via media is essential for public health practitioners to consider when formulating immunization policy and education praxis. One such meaning that, to date, has received relatively less attention is the socio-political ideology of neoliberalism. We argue that the undercurrent of neoliberal sensibilities expressed in media stories points to another key social factor that must be considered when seeking public health solutions to the growing vaccine hesitancy movement.

Correlates of physical activity behaviour among nursing professionals: A systematic search and literature review

Amanda H Wilkerson, Hunter O Thomas, Vinayak K Nahar

box-doi   https://doi.org/10.19204/2019/crrl5

Published Online: April 15, 2019

Abstract

Introduction: Physical activity (PA) has been shown to protect against adverse health outcomes, and factors influencing physical activity vary among different populations. Previous research suggests nurses have an increased risk of being physically inactive, which may contribute to increased risk of musculoskeletal disorders. The purpose of this investigation was to use a systematic search process to determine previously identified correlates of nurses’ physical activity.
Methods: The study utilized a systematic search process to identify studies for the review. The search was performed using three electronic databases: MEDLINE, CINAHL Complete, and Web of Science. The authors extracted and synthesized information regarding physical activity levels, significant correlates of physical activity, and measures of physical activity using a narrative approach.
Results: Twelve articles were included in this review. All had predominately female samples and reported statistically significant findings. The majority determined nurses’ physical activity using self-report methods (n = 11) and explored the relationship between nurses’ physical activity and individual-level variables (n = 7). Few studies explored the difference between leisure-time and work-related physical activity, and many did not assess muscle-strengthening physical activity.
Discussion and Conclusions: Demographic and non-modifiable work-related factors were the most frequently assessed correlates of behaviour. The reviewed studies showed that demographic variables, such as age and BMI, were significantly associated with nursing professional’s PA. There is a need for more studies to assess factors influencing nursing professionals’ PA beyond the individual level, using theoretical designs, and including objective measures of PA. Future studies should also include assessments of nursing professionals’ muscle-strengthening PA and involve adequate representation of the United States nursing population. Practitioners and researchers working to improve nurses’ physical activity behaviour should target efforts to those more likely to engage in less physical activity, such as those with greater BMI, older age, and working night shifts, in order to tailor intervention efforts to high-risk groups.

Health effects of the National Health Insurance Scheme (NHIS): A study among federal civil servants in Bayelsa State, Nigeria

Endurance Uzobo, Aboluwaji D Ayinmoro

box-doi   https://doi.org/10.19204/2019/hlth10

Published Online: January 29, 2019

Abstract

Introduction: This study aimed to analyze the level of satisfaction and health effects of the National Health Insurance Scheme (NHIS) among federal civil servants employed in Bayelsa State, Southern Nigeria.
Methods: A cross-sectional survey was adopted using simple random sampling to recruit 337 federal employees living in the state. A structured questionnaire was used as data collection instrument to elicit socio-demographic information and types of services enjoyed under the scheme by the participants. Satisfaction levels and self-rated health were measured as continuous variables. Data was analysed using analysis of variance (ANOVA), multiple linear regression, and χ2 statistics. The level of statistical significance was set up at P < 0.05.
Results: Satisfaction levels and self-rated health differed significantly by demographic variables and types of services enjoyed by the participants (P < 0.05). Our findings showed that malaria treatment (β = 0.737, P < 0.05), prescriptions of drugs (β = 0.187, P < 0.05) and vaccinations (β = 0.422, P < 0.05) were good predictors of satisfaction levels and self-rated health status. Malaria treatment had the highest satisfaction level (β = 0.737, P < 0.05) compared to other services enjoyed under the scheme.
Discussion and Conclusion: In spite of the fact that most of the services under the scheme were associated with good self-reported health status and high satisfaction level by the participants, there are still some issues concerning supply of drugs and health facilities for federal employees living in Bayelsa State. The government and key stakeholders should ensure that NHIS provide adequate provisions of drugs, skilled health professionals and equipped healthcare facilities, as proper referral systems could mitigate the effects of health conditions affecting federal civil servants and promote the quality of health-care system.

Key health impacts and support systems for informal carers in the UK: A thematic review

Susanna Abraham Cottagiri, Peter Sykes

box-doi   https://doi.org/10.19204/2019/kyhl11

Published Online: January 29, 2019

Abstract

Introduction: The economic contributions made by informal carers in the UK per year mount up to £132 billion. This is equivalent to the total amount of the health care costs, yet the health and wellbeing of carers are often not prioritised. This review paper aims to determine the key health impacts of informal caregiving and evaluate support/control methods in the UK.
Methods: This thematic review was conducted in accordance with an adapted version of the PRISMA guidelines for systematic reviews. Of the 6,482 articles identified through Pubmed/Medline, CINAHL, SpringerLink, Summon, and grey literature, 38 studies were included in the review.
Results: The key health impacts of being an informal carer were identified as musculoskeletal disorders and psychological issues (such as depression, stress and anxiety), which were categorized as ‘high-risk impact’ areas. The review further identified cardiovascular disease and early mortality as ‘low to moderate risk impact’ areas and a thematic area that revolves around positive impacts on health of informal carers. Financial help, proper respite care, availability and accessibility of information and advice, provision of equipment in a timely manner and adequate support networks were found to be key factors useful in minimising musculoskeletal and psychological disorders.
Discussion and Conclusions: There is a need for policy makers and program implementers to recognize and accommodate the ever-changing role of carers on different stages of caring. There is also a need to review key health policy documents to include informal carers’ needs and improve support systems available. The lack of evidence-based research on the psycho-physical impacts of caring and the lack of evaluation of services that impact the health of carers also needs to be addressed with priority. 

Role of epigenetics in aetiology and therapies for Type 1 Diabetes Mellitus: A narrative review

Yahaya O. Tajudeen, Ufuoma B. Shemishere

box-doi   https://doi.org/10.19204/2019/rlfp12

Published Online: January 29, 2019

Abstract

Introduction: Some studies have demonstrated the possibility of using epigenetic modifications to manage or treat some cases of Type 1 diabetes mellitus (T1DM) in the near future. However, there are diverse opinions on the strategies suggested, necessitating this study to review epigenetic mechanisms and their possible therapeutic applications for T1DM.
Results and Discussion: Through enzyme-mediated DNA methylation, histone post-transcriptional modifications and microRNAs (miRNAs) gene expression, environmental factors may program the epigenomes of several cells during intrauterine life. In the β-cells, these biological processes may lead to altered expressions of certain insulin genes along with their promoter regions, resulting in dysfunctional insulin biosynthesis, hyperglycemia and T1DM. By inhibiting the enzymes modulating these pathways, epigenetic changes can be reversed and normal functions of the affected genes restored, culminating in improved insulin production.
Conclusions: Epigenetic programming during intrauterine life may be responsible for the pathogenesis of some cases of T1DM. Fortunately, epigenetic mechanisms are reversible, so when detected early, could be used to prevent some cases of T1DM. It can also be used to formulate treatment procedures for T1DM.