Cooking with dirty-burning fuels is associated with health risk from household air pollution. We assessed the prevalence of and factors associated with the use of cooking fuels, and attitudes and barriers towards use of liquefied petroleum gas (LPG). This was a cross-sectional, population-based survey conducted in 519 households in Lagos, Nigeria. We used a structured questionnaire to obtain information regarding choice of household cooking fuel and the attitudes towards the use of LPG. Kerosene was the most frequently used cooking fuel (n = 475, 91.5%; primary use n = 364, 70.1%) followed by charcoal (n = 159, 30.6%; primary use n = 88, 17%) and LPG (n = 86, 16.6%; primary use n = 63, 12.1%). Higher level of education, higher income and younger age were associated with LPG vs. kerosene use. Fuel expenditure on LPG was significantly lower than for kerosene (horizontalstrikeN (Naira) 2169.0 ± 1507.0 vs. horizontalstrikeN2581.6 ± 1407.5). Over 90% of non-LPG users were willing to switch to LPG but cited safety issues and high cost as potential barriers to switching. Our findings suggest that misinformation and beliefs regarding benefits, safety and cost of LPG are important barriers to LPG use. An educational intervention program could be a cost-effective approach to improve LPG adoption and should be formally addressed through a well-designed community-based intervention study.

The aim of this study was to evaluate an automated trigger algorithm designed to detect potentially adverse events in children with Attention-Deficit/Hyperactivity Disorder (ADHD), who were monitored remotely between visits. We embedded a trigger algorithm derived from parent-reported ADHD rating scales within an electronic patient monitoring system. We categorized clinicians’ alert resolution outcomes and compared Vanderbilt ADHD rating scale scores between patients who did or did not have triggered alerts. A total of 146 out of 1738 parent reports (8%) triggered alerts for 98 patients. One hundred and eleven alerts (76%) required immediate clinician review. Nurses successfully contacted parents for 68 (61%) of actionable alerts; 46% (31/68) led to a change in care plan prior to the next scheduled appointment. Compared to patients without alerts, patients with alerts demonstrated worsened ADHD severity (β = 5.8, 95% CI: 3.5–8.1 [p < 0.001] within 90 days prior to an alert. The trigger algorithm facilitated timely changes in the care plan in between face-to-face visits.

The use of outcome measures for assessing progress in the management and treatment of cerebral palsy (CP) is widely recommended. This study was, therefore, carried out to determine awareness and use of standardized outcome measures among physiotherapists managing CP in Nigeria. Barriers to and facilitators for the use of outcome measures were also investigated. This was a descriptive study involving 138 physiotherapists from selected hospitals in southwestern Nigeria. A self-administered questionnaire was used to obtain relevant information on socio-demographics, awareness, use, barriers to, and facilitators for the use of seven standardized outcome measures. The Gross Motor Function Measure was the most recognized (78.9%) and commonly used (58%) outcome measure, while the Paediatric Outcomes Data Collection Instrument (23.2%) and the Paediatric Evaluation of Disability Inventory (10.9%) were the least recognized and least used, respectively. The greatest perceived facilitators were familiarity (87.7%), positive attitude (87.7%), and that outcome measures allow for a balanced clinical assessment (89.1%). The greatest perceived barriers identified were the need for extra accommodation to apply outcome measures (63%) and time consumption on the part of patients (44.2%). Many physiotherapists in this study identified the standardized outcome measures, but fewer used them irrespective of educational status and years of work experience. Generally, there was a positive attitude toward the use of outcome measures. The use of outcome measures should be promoted among physiotherapists in Nigeria, through training programs and translation into the native languages, to effectively assess, manage, and monitor the progress of patients with CP, putting into consideration barriers and facilitators.

We aimed to describe the acute seizure care pathway for pediatric patients and identify barriers encountered by those involved in seizure care management. We also proposed interventions to bridge these care gaps within this pathway. Methods:We constructed a process map that illustrates the acute seizure care pathway for pediatric patients at Boston Children's Hospital (BCH). The map was designed from knowledge gathered from unstructured interviews with experts at BCH, direct observation of patient care management at BCH through a quality improvement implemented seizure diary and from findings through three studies conducted at BCH, including a prospective observational study by the pediatric Status Epilepticus Research Group, a multi-site international consortium. We also reviewed the literature highlighting gaps and strategies in seizure care management.Results: Within the process map, we identified twenty-nine care gaps encountered by caregivers, care teams, residential and educational institutions, and proposed interventions to address these challenges. The process map outlines clinical care of a patient through the following settings: 1) pre-hospitalization setting, defined as residential and educational settings before hospital admission, 2) BCH emergency department and inpatient settings, 3) post-hospitalization setting, defined as residential and educational settings following hospital discharge or clinic visit and 4) follow-up BCH outpatient settings, including neurology, epilepsy, and primary care provider clinics. The acute seizure care pathway for a pediatric patient who presents with seizures exhibits at least twenty-nine challenges in acute seizure care management.Significance: Identification of care barriers in the acute seizure care pathway provides a necessary first step for implementing interventions and strategies in acute seizure care management that could potentially impact patient outcomes.