Northern Nigeria is a region that contradicts its natural endowments. Despite the existence of many economic resources such as tin, kaolin, a variety of agricultural products and a huge fertile land, the people remain in abject poverty leading to plethora of crisis in forms of insurgency, electoral violence and crime. Out of the six geopolitical zones in Nigeria, three are in the northern part of the country and they have the worst indices of poverty compared to the other zones. The Northwest with 77.7 per cent, North-central having 67.5 per cent and Northeast with 76.3 per cent, northern Nigeria becomes a hub of joblessness, crime, illiteracy, maternal mortality, early marriage and, recently, terrorism. This article uses content analysis to unravel the link between the present turmoil in northern Nigeria and the poverty indices that triggered the lingering crisis. This article shows that ineffectiveness of poverty alleviation programmes, poor resource utilisation, lack of private initiative and overdependence on scarce public jobs are the factors that caused and sustained poverty in northern Nigeria to serve as the foundation of the turbulence in all sectors of society. It recommends, inter alia, the strengthening of the private sector to provide jobs for the jobless, adherence to prudence, transparency and accountability in poverty alleviation programmes.
The world is facing an unprecedented global economic crisis, with many countries needing to reconsider their level of health care spending. This paper explores the many consequences of the global economic turndown on Pakistan's health, including reduced government and donor spending and increased poverty with the consequent diversion of funds away from health. Nevertheless, these challenges may provide opportunities not only to mitigate the adverse effects of the economic crisis but also to institute some muchneeded reforms that may not receive political support during more affluent times. Our suggestions focus on setting priorities based on the national disease burden, prioritizing prevention interventions, demanding results, curbing corruption, experimenting with innovative funding mechanisms, advocating for increased funding by presenting health spending as an investment rather than an expense and by selected recourse to civil society interventions and philanthropy to bridge the gap between available and needed resources. RÉSUMÉ Le monde fait face à une crise économique sans précédent. En conséquence, de nombreux pays doivent réviser leur niveau de dépenses de santé. Le présent article étudie les nombreux effets de la récession économique mondiale sur la santé au Pakistan, notamment les réductions des dépenses du gouvernement et des bailleurs de fonds et l'augmentation de la pauvreté en raison de l'important détournement des fonds du secteur sanitaire. Toutefois, ces difficultés sont l'occasion non seulement de limiter les dégats de la crise économique, mais aussi d'instaurer des réformes indispensables qui ne recevraient pas d'appui politique lors d'une période prospère. Nos suggestions sont axées sur l'établissement de priorités en fonction de la charge de morbidité nationale ; la sélection des interventions prioritaires ; l'obligation de résultats ; la lutte contre la corruption ; l'expérimentation de mécanismes de financement innovants ; le plaidoyer pour une hausse des fonds en présentant les dépenses de santé comme un investissement plutôt que comme une dépense ; et un recours occasionnel à des interventions de la société civile et à la philanthropie pour combler le fossé entre les besoins et les ressources disponibles.
FIBRIN GLUE MESH FIXATION UNDER LOCAL ANAESTHESIA FOR THE TREATMENT OF INGUINAL HERNIA IN ELDERLY PATIENTS R LionettF, A Cesaro 1 , E NapolitanoI, L Caruso 1 , B Neola1, M Rutigliano1, 0 P Ferulano1 iDpt. Specialistic Surgeries and Nephrology Policlinic Federico II, Naples, ITALY \ud Introduction: Inguinal hernia repair is one of the most common operations performed in general surgery, especially among elderly patients, due to age-related loss of muscle mass and increase of co-morbidities associated with high intra-abdominal pressure. The purpose of our trial was to assess the safeness and the impact on quality of life of tension free, sutureless hernia repair technique with the use of fibrin glue under local anesthesia in elderly patients. Methods: From January 2010 to December 2012,53 male patients aged 70 and above (mean age 73.9 years) were enrolled; complicated, recurrent, scrotal hernia and ASA IV patients were excluded. Furthermore diabetic patients with glycated hemoglobin level 7% or more were ruled out for presumable neuropathy. Informed consent and data from SF36 questionnaire were collected preoperatively. The Visual Analogue Scale (VAS) for postoperative pain and a new SF36 questionnaire for overall satisfaction at one year, were administered postoperatively. Chronic pain was classified according to Cunningham's criteria. Operative time, length of hospitalization, postoperative use of nonsteroidal anti-inflammatory drugs, complications and recurrences were also assessed. Results: All patients were operated under local anaesthesia (2% Mepivacaine Cloridrate and 7,5mg!ml Ropivacaine) with light sedation; in all cases partially absorbable mesh and plug (polypropylene! polyglecaprone 25) have been implanted and fixed with I ml of fibrin glue. 50 out of 53 patients completed the 2 years follow-up, one died for not related comorbidity. Mean operative time was 54.8 minutes; 46 patients were discharged at home the same day, 5 the following day, 2 patients had to stay one more day for postoperative complications (I haematoma, I urinary retention), no major complications were observed; at two years follow-up, 2 recurrences (4%) have been observed; mean VAS score for post-operative pain, assessed at 6, 12, 24 hours and 7 days after surgery, was 4 or less for 50 (94,3%) patients, only 3 (5,6%) patients referred a score> 4. At one year follow up only 2 (4%) patients suffered of chronic postoperative pain (I mild and I moderate), no severe chronic postoperative pain has been reported. Data from pre and postoperative SF36 questionnaires, analysed by using the Student's t test, showed significant increase of the score both in the Physical Component Summery (PCM) and in the Mental Component Summary (MCS) with a p-value < 0.0001. Conclusion: Inguinal hernia repair with use of fibrin glue and partially absorbable prosthesis under local anaesthesia is a safe technique in elderly patient
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