BACKGROUND:Due to exhaustive working climate, health-care professionals (HCPs) are highly exposed to emotional strain and work-related stress that leads to burnout syndrome (BOS).AIM:We aimed to explore the prevalence of BOS among HCPs and delineate the factors that contribute to developing this emerging threat in HCPs working in Gondar University Hospital (GUH).METHODS:A cross-sectional study was conducted among HCPs using a self-administered validated questionnaire containing sociodemographic and job characteristics, symptoms of burnout using Astudillo and Mendinueta questionnaire, and Maslach Burnout Inventory scale. The prevalence of BOS was assessed by summation of answers to all 19 items with a range of 0–57. HCPs who scored >23 were considered as burned out. Pearson's correlation analysis and multivariate logistic regression were used to assess the relationship between BOS and job factors. Data were analyzed using descriptive and inferential statistics.RESULTS:A total of 250 HCPs were approached out of which 248 responded (response rate –99.2%). The overall prevalence of burnout was 13.7% and majority of the respondents experienced debility (52.8%), self-criticism (56%), and depressive symptoms (46%). BOS symptoms were significant with age (P = 0.008), number of patients treated per day (P < 0.001), and HCPs working in shifts (P < 0.001). Higher mean levels of emotional exhaustion (5.4 ± 1.2) and inefficacy (5.1 ± 1.7) were noticed than cynicism (4.8 ± 2.0). Male HCPs, being single and years of experience, were determinant factors for all the three dimensions of BOS, whereas profession was significantly determinant for emotional exhaustion (P < 0.01).CONCLUSION:The prevalence of BOS among HCPs working in GUH was 13.7%. Being male, unmarried, and years of experience were significant risk factors for all the three dimensions of BOS. Pragmatic measures are recommended to prevent stressful challenges for the physical and mental well-being of the HCPs in GUH.

Background. There was limited published data on target organ damage (TOD) and the effect of nonadherence to practice guidelines in Ethiopia. This study determined TOD and the long term effect of nonadherence to clinical guidelines on hypertensive patients.Methods. An open level retrospective cohort study has been employed at cardiac clinic of Gondar university hospital for a mean follow-up period of 78 months. Multivariate Cox regression was conducted to test associating factors of TOD. Results. Of the total number of 612 patients examined, the overall prevalence of hypertensive TOD was 40.3%. The presence of comorbidities, COR = 1.073 [1.01-1.437], AOR = 1.196 [1.174-1.637], and nonadherence to clinical practice guidelines, COR = 1.537 [1.167-2.024], AOR = 1.636 [1.189-2.251], were found to be predicting factors for TOD. According to Kaplan-Meier analysis patients who were initiated on appropriate medication tended to develop TOD very late: Log Rank [11.975 ( = 0.01)]. Conclusion. More than forty percent of patients acquired TOD which is more significant. Presence of comorbidities and nonadherence to practice guidelines were correlated with the incidence of TOD. Appropriate management of hypertension and modification of triggering factors are essential to prevent complications.

BackgroundDiabetic ketoacidosis is an acute life-threatening complication of diabetes mellitus. There was limited data on level of in-hospital mortality, hospital stay and factors associated with length of hospital stay among diabetic patients admitted to diabetic ketoacidosis at Debretabor General Hospital.ObjectiveThe aim of the study was to determine the length of hospital stay and in-hospital mortality of diabetic ketoacidosis patients and to assess determinants of long hospital stay among diabetic patients admitted with Diabetic ketoacidosis at Debretabor General Hospital.MethodA retrospective study was conducted at Debretabor General Hospital from June 1to 30, 2018. Participants included in the study were all diabetic patients with diabetic ketoacidosis admitted to the hospital from August 2010 to May 31, 2018 whose medical records contained complete pertinent data. The primary outcome was to determine the length of hospital stay and in-hospital mortality of diabetic ketoacidosis patients. All the statistical data was carried out using Statistical Package for Social Sciences (SPSS). Descriptive statistics was presented using means with standard deviation and percentages.ResultA total of 387 patients’ medical records contained pertinent complete information included in this study. Mean age of the patients was 33.30± 14.96 years. The majority of patients were females 244 (63.0%). The mean length of hospital stay was 4.64(±2.802) days. About twenty percent 79(20.41%) patients had long hospital stay (>7days). The majority 370 (95.60%) of patients improved and discharged and 17 (4.40%) patients died in the hospital. patients who had mild DKA; AOR: 0.16 [0.03-0.78] and patients between the age of 35-44years, AOR: 0.125[0.017-0.92] had reduced length of hospital stay. further, patients with DKA precipitated by infection were 4.59 times more likely to have long hospital stay than patients with DKA precipitated by unknown causes; AOR 4.59[1.08-19.42].ConclusionsIn the current study, the mean length of hospital stay was around five days. About twenty percent patients had long hospital stay. Nearly ninety five percent of patientsimproved and discharged. The presence of infection, frequent rebound hyperglycemia and severity of DKA were the major determinants of long hospital stay.

Objectives: PARADIGM-HF, a phase III trial conducted in patients with heart failure and reduced ejection fraction (HFrEF), showed that sacubitril/valsartan, a first-inclass angiotensin receptor-neprilysin inhibitor, provided incremental cardiovascular and overall survival benefit compared to enalapril. This analysis aimed to quantify the number of potential all-cause deaths that could be avoided with optimal usage of sacubitril/valsartan for the treatment of HFrEF in Costa Rica. MethOds: Data from Instituto Nacional de Estadística y Censos was used to identify patients with HFrEF for whom sacubitril/valsartan could be indicated. A literature review was conducted to determine the prevalence of HF, and the proportion of HFrEF patients classified as NYHA Class II-IV, in Latin America. The number needed to treat (NNT) to avoid one all-cause death, standardized to 12 months, was derived from the PARADIGM-HF trial. The potential number of all-cause deaths prevented or postponed with sacubitril/valsartan treatment was estimated using multi-way sensitivity analysis. The main outcome measure was all-cause mortality. Results: The entire 2017 population (≥ 20 years) was estimated at 3,435,930 and the estimated prevalence of HF was 1.0%. Physician interviews indicated that 60% of patients with chronic HF are diagnosed, yielding approximately 20,616 patients. Half of diagnosed patients had HFrEF, 80% of whom were classified as NYHA Class II-IV, equating to 8,246 patients with HFrEF NYHA II-IV. The absolute reduction in all-cause mortality in PARADIGM-HF was 2.8% over an average follow-up of 27 months with a NNT of 80.3, standardized to 12 months. Thus, optimal usage of sacubitril/valsartan therapy was estimated to prevent 103 deaths each year. cOnclusiOns: This analysis suggests that a significant number of all-cause deaths could potentially be prevented with optimal implementation of sacubitril/valsartan therapy into routine clinical practice in Costa Rica. However, one limitation of this analysis is the lack of current epidemiology data available specific to HF prevalence in Costa Rica.

Background: Hypertension drives the global burden of cardiovascular disease and its prevalence is estimated to increase by 30% by the year 2025. Nonadherence to chronic medication regimens is common; approximately 43% to 65.5% of patients who fail to adhere to prescribed regimens are hypertensive patients. Nonadherence to medications is a potential contributing factor to the occurrence of concomitant diseases.Objective: This systematic review applied a meta-analytic procedure to investigate the medication nonadherence in adult hypertensive patients.Methods: Original research studies, conducted on adult hypertensive patients, using the 8-item Morisky medication adherence scale (MMAS-8) to assess the medication adherence between January 2009 and March 2016 were included. Comprehensive search strategies of 3 databases and MeSH keywords were used to locate eligible literature. Study characteristics, participant demographics, and medication adherence outcomes were recorded. Effect sizes for outcomes were calculated as standardized mean differences using random-effect model to estimate overall mean effects.Results: A total of 28 studies from 15 countries were identified, in total comprising of 13,688 hypertensive patients, were reviewed. Of 25 studies included in the meta-analysis involving 12,603 subjects, a significant number (45.2%) of the hypertensive patients and one-third (31.2%) of the hypertensive patients with comorbidities were nonadherent to medications. However, a higher proportion (83.7%) of medication nonadherence was noticed in uncontrolled blood pressure (BP) patients. Although a higher percentage (54%) of nonadherence to antihypertensive medications was noticed in females (P < 0.001), the risk of nonadherence was 1.3 times higher in males, with a relative risk of 0.883. Overall, nearly two-thirds (62.5%) of the medication nonadherence was noticed in Africans and Asians (43.5%).Conclusion: Nonadherence to antihypertensive medications was noticed in 45% of the subjects studied and a higher proportion of uncontrolled BP (83.7%) was nonadherent to medication. Intervention models aiming to improve adherence should be emphasized.Abbreviations: BP = blood pressure, CHD = coronary heart disease, CVD = cardiovascular disease, MMAS = Morisky medication adherence scale, PRISMA = Preferred Reporting Items for Systematic review and Meta-Analysis, STROBE = Strengthening the Reporting of Observational Studies in Epidemiology.

Background: Adverse drug reactions (ADRs) to antiretroviral medications remained important reasons of concern that may compromise the effectiveness of the ART programs. In health communication, pictograms has a comprehensive place to aid attention, memory recall and promote adherence. In this study, we sought to assess whether this intervention would help to identify and improve ADR reporting in an ART clinic serving HIV patients in Northwest Ethiopia. Methods & Materials: A cross-sectional study on ART-naïve HIV-positive patients was conducted from July 15, 2015 to January 15, 2016. The patients were randomly categorized into two groups. The first group (group A) were subjected to receive pictorial medication information and pictograms-enhanced tool to identify and report ADRs, while the second group (group B) did not receive any pictogram-enhanced tool to identify the medications and to report ADRs. Results: Bivariate analysis showed that sociodemographic characteristics, age, sex, education, employment, and marital status were predictors of identifying and reporting ADRs. Males were twice more likely to identify ADRs than females. Univariate analysis revealed, intervention group showed a statistically significant association with the ability to identify ART medications using pictograms. Intervention group patients were more likely to identify 3TC [OR (95% CI) = 7.536 (4.042-14.021), p = 0.000], TDF [(OR (95% CI) = 6.250 (2.855-13.682), p = 0.000], NVP [(OR (95% CI) = 5.320 (1.954-14.484), p = 0.001], EFV [(OR (95% CI) = 3.929 (1.876-8.228), p = 0.000], and AZT [(OR (95% CI) = 3.570 (1.602-7.960), p = 0.002] using pictograms. Compared to group B, group A showed 4.3 times more likely to identify diarrhea as an ADR using pictogram. Conclusion: It was found that the use of pictogram-based intervention for ART medications resulted in increased identification of ADRs and improved ADR reporting among naïve HIV-positive patients with limited literacy in Northwest Ethiopia. This intervention provided promising innovation with the potential implications to improve ADR reporting and promote patients safety, particularly for HIV-positive patients with limited educational levels.

Objective: The aim of this study was to assess the pattern of cardiovascular diseases (CVDs), their clinical characteristics, and associated factors in the outpatient department of the chronic illness clinic of Gondar University Referral Hospital. Method: A retrospective cross-sectional study was conducted among patients on follow-up at the outpatient chronic illness clinic of the hospital from October 2010 to October 2015. The source population for the study included patients with a diagnosis of CVD whose medical records have the required socio-demographic information during the study period. The data were collected from August 2015 to December 2015. Chi-square and binary logistic regression tests were performed to test the significance of difference among predictive variables and CVDs. Results: Of 1105 patient medical records, 862 fulfilled the inclusion criteria. The majority of the patients were females (65%) and living in urban areas (62.7%). Hypertension accounted for the majority (62.3%) of CVDs followed by heart failure (HF) (23.9%). Headache was the leading chief complaint among the patients (37.7%) upon diagnosis and was the prominent clinical feature in more than half of the patients during their course of follow-up. Higher proportions of dyslipidemia (85.7%), hypertension (72.8%), and ischemic heart disease (IHD) (73.2%) were associated with urban residency (P<0.01). Conclusion:Hypertension was found to be the most frequent CVD followed by HF, and hypertensive heart disease was the leading cause of cardiac diseases. Most of the patients had improved assessment in the last follow-up, but patients from rural regions and those with comorbidty had higher likelihood of poor cardiovascular outcome.

A933system for logistic control of medicines of the Brazilian National STD/Aids Program. Despite its administrative nature, this system contains specific information about antiretroviral dispensation providing a unique data source for adherence assessment. This study aimed to assess HAART adherence among patients followed up in a public outpatient facility located in Rio de Janeiro city, Brazil, using pharmacy refill data obtained from SICLOM. Methods: All patients that initiated HAART in 2011 were included and followed up until December 2013. Data about dispensed medicines, including amounts and dates, and demographic data was obtained from SICLOM. Therapy adherence was estimated using the medication possession ratio (MPR) calculated as the ratio between the number of days covered by a refill and treatment duration in days. The number of days without medication (gaps) was also calculated. Results: The analysis included 82 patients. The average age was 36.2 ±10.1 years old and 85.4% were male. Most of the patients (65.9%) were followed up at public facilities. The medians of the gaps and MPR were 66.5 days (28.75-130) and 94.6% (87.9-97.4) respectively. MPR was lower than 95% for 54.9% of the patients. ConClusions: According to the World Health Organization, HIV patients should take more than 95% of antiretroviral prescribed doses. However, the fact that 54.9% of the patients presented a MPR lower than 95% suggests a high prevalence of HAART non-adherence. SICLOM showed to be a powerful data source for adherence studies that could provide useful information in order to improve HAART effectiveness.