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TEXILA INTERNATIONAL JOURNAL OF PUBLIC HEALTH
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Table of Contents - Issue
Health programs are often instituted to prevent diseases and to restore or promote health. In many cases, there are gaps between anticipated and attained goals. A case in point is the Nigerian Midwives Service Scheme, where the concept of providing 24 hour coverage of the primary health centers by skilled birth attendants is currently failing to meet the desired targets in certain parts of Nigeria, predominantly the North Eastern and North Western Zones.
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Bridging the Gap between Concept and Reality in the Nigerian Midwives Service Scheme
Author: Inegbenebor, Ute
[ABSTRACT] [Full-Text PDF] [REFERENCES]
This is in spite of adequate funding and organization. This article discusses the barriers to effective implementation of the program and suggests that the gap between goals anticipated during program conceptualization and goals attained after program implementation can be bridged by optimizing innovative health communications to the target audience and applying social marketing techniques to health care delivery in the affected zones. This is in addition to inter-sectoral coordination and collaboration between relevant government ministries and stakeholders.
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[2.] Ajumobi, F Underage Marriage: Playing games with child's rights. Sunday Vanguard. 45-47 www.vanguardngr.com accessed 29/07/2013.
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[4.] Cheng, H, Kotler, P, and Lee, N. R. Building Partnerships. Social Marketing for Public Health: An Introduction. Jones and Barlett Publishers. LLC. 2009; 8.
[5.] Cheng, H, Kotler, P, and Lee, N R Edutainment. Social Marketing for Public Health: An Introduction. Jones and Barlett Publishers. LLC.2009; 12
[6.] Ekwempu CC The influence of antenatal care on pregnancy outcome. Tropical Journal of Obstetrics and Gynecology.1988; I: 67-71.
[7.] Ezekwem, U Social Practices harmful to women in Nigeria. Tropical Journal of Obstetrics and Gynecology. 2002; 19 S (1): S22-25.
[8.] Harrison K A Maternal mortality in Nigeria: the real issues. Afr. J. Reprod Health. 1997; 1(1):7–13
[9.] Harrison, KA The influence of maternal age and parity on childbearing with special reference to primigravidae aged 15 years and under. British Journal of Obstetrics and Gynecology. 1985; 92(S5) 23-31.
[10.] Hogan, M C, Foreman, K J, Naghavi, M., Ahn, SY Maternal Mortality for 181 Countries, 1980- 2008; a systematic analysis of progress towards Millennium Goal 5. The Lancet.2010; 375 (9726): 1609-1623.
[11.] HealthNewsNG.com . Nigeria records reduction in infant and maternal mortality rates. http://www.healthnewsng.com/2013/12/nigeria-records-reduction-in-infant-and.html. Accessed on 18/04/2014
[12.] Inegbenebor, U. Conceptual model for the prevention of maternal mortality in Nigeria Tropical doctor. 2007; 2(37):104-106. PMID: 17540095.
[13.] Kotler. P Satisfying Both Employees and Customers. Selling Services for Profit. Marketing Management: Analysis, Planning, Implementation, Control.. Ninth Edition. Prentice Hall of India. New Delhi. 1999; 482.
[14.] Nylander, PPS and Adekunle, AO Antenatal care in developing countries. Hall, MH ed. Antenatal Care. Bailliere's Clinical Obstetrics and Gynecology. London: Bailliere Tindall, 1990; 4(1):169-186.
[15.] Osakwe , F. Maternal mortality figure not accurate, says SOGON. National Mirror. http://nationalmirroronline.net/new/maternal-mortality-figure-not-accurate-says-sogon/ Accessed on 18/04/2014.
[16.] Osubor, K, Fatusi, A, Chiwuzie, J Maternal Health Seeking Behavior and Associated Factors in a Rural Nigerian Community. Maternal and Child Health Journal. 2006; 10 (2); 159-169.
[17.] Park, K. Maternal and Child health problems. Preventive Medicine in Obstetrics, Pediatrics and Geriatrics. Park's Textbook of Preventive and Social Medicine. 19th Edition. Prem Nagar Jabalpur. M/s banarsidas Bhanot Publishers. 2007; 415-417.
[18.] Park, K Models of health education. Communications for health Education. Park's Textbook of Preventive and Social Medicine. 19th Edition. Prem Nagar Jabalpur. M/s banarsidas Bhanot Publishers.2007; 712-713.
[19.] Thaddeus S, Maine D Too far to walk: maternal mortality in context. Soc Sci. Med 1994; 38(8):1091-1110. http://dx.doi.org/10.1016/0277-9536 (94)90226-7
[20.] WHO, UNICEF, UNFPA and the World Bank. Trends in maternal mortality: 1990 to 2010. 2012; Accessed on 22/08/2013.
[21.] UNESCO High level International Round Table on Literacy "Reaching the 2015 Literacy Target: Delivering on the promise." National Literacy Action Plan for 2012 -2015. Nigeria. 2012; Accessed on 22/08/2013.
[22.] Yusuf, MA, Ladan, B, Idris, UA, Halilu, A Comparative Study of the State of Literacy in Nigeria and Cuba. European Scientific Journal. 2013; 9(19): ISSN: 1857 – 7881 (Print) e - ISSN 1857- 743
Current Levels of Lead in Paint Sold in Nigeria
Author: Ahamefuna N.C.
Serious health effects of lead poisoning have elicited global campaign to eliminate lead use in paint. The major challenge is the dearth of data on lead levels in paints from developing countries. Thus lead levels of paints manufactured and sold in Nigerian market were studied. Lead concentrations from 59 paint samples involving 10 different shades were determined using flame atomic absorption spectrophotometer (AAS).
It was found that 83 % of the enamel paints had higher than the approved levels of lead in some countries which are 90jg/g and 600jg/g. The lead concentrations in the paint obtained ranged from 22.5jg/g to 74175jg/g, with mean value of 6442.88jg/g and median value of 1685jg/g. The concentration of lead was very high in almost all the enamel paints which make up over 80 % of the paint samples.
Plastic paints (emulsion paint)generally contained low lead levels (22.5 jg/g -80.5 jg/g). Analysis shows that there is no significant difference between the concentration of lead and the colours of the paint sampled. Thus all the paint manufacturers are still using lead containing pigment in their paint production. Efforts should be made by regulatory authority to spearhead campaign to phase out lead use in paint.
[1.] Adebamowo, E.O., Clark, C.S., Roda, S., Agbede, O.A., Sridhar, M.K.C., et al 2007.Lead content of dried films of domestic paint currently sold in Nigeria. Science of the Total Environment 388: 116–120.
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[3.] American Public Health Association (APHA), 2007.Policy Number: LB-07-01 lead exposure, child health and development, environmental health calling for a global ban on lead use in residential indoor and outdoor paints, children's products, and all nonessential uses in consumer products adopted at Annual Meeting .Available online at www.apha.org/APHA/CMS_Templates/Policy (Accessed April 7,2010).
[4.] Canfield et al.2003.Intelligent impairment in children with blood lead concentration below 10jg per deciliter.New England Journal of Medicine16:1517-1526.
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[6.] CNN,2010.Aid groups say lead poisoning has killed 400 children in Nigeria.Avalaible online at www.articles.CNN..com/2010-10-05/world/nigeria.lead piosoning_1_poisoning-death-toll-nigeria(Accessed 30/12/2010).
[7.] Gibson,L.1904.A plea for painted railings and painted walls as a source of lead poisoning among Queensland children. Australas Med Gazette 23:149-153
[8.] International Labour Office ,ILO 1921. Convention 13 concerning the use of white lead in painting. ILO Publication No.13. ILO Publications, Geneva.
[9.] Jacobs, D.E., Clickner, R.P., Zhou, J.Y., Viet, S.M., Marker, D.A., et al. 2002. The prevalence of lead-based paint hazards in U.S. housing. Environ.Health Perspect. 110: A599–A606.
[10.] Kumar,A..,and Gottesfeld,P.2008.Lead content in household paints in India. Science of the Total Environment 407:333–337.
[11.] Kumar,A.2009.Lead levels in New Decorative Paints.A global paint Study
[12.] Kuruvilla,A.,Pillay,V.V.,Venkatesh,T.,Adhikari,P.,Chakrapani,M.,et al.2004.Portable lead analyzer to locate sources of lead. Indian Journal of Pediatrics 41:495–499.
[13.] Lawlib.2010.Lead-based paint. Available online at
[14.] http://www.state.ma.us/subject/about/lead.html(accessed 30/12/2010). 14) Lin, G.Z., Peng, R.F., Chen, Q., Wu, Z.G., and Du, L.2009.Lead in housing paints: an exposure source still not taken seriously for children lead poisoning in China. Environ Res.109(1):1-5
[15.] 15) Markowitz, G.2000.The role of the lead industry in a public Health Tragedy, 1900-1955.American
[16.] Journal of Public Health 90.1:36-46. 16) Meyer, P.A., McGeehin, M.A., Falk, H., 2003. A global approach to childhood lead poisoning prevention. International Journal of Environment and Health 206: 363–369.
[17.] Montgomery, M.and Mathee, A.2005.A preliminary study of residential paint lead concentrations in Johannesburg. Environmental Research 98:279–283.
[18.] Needleman, H. L 2004.Lead poisoning. Annual review of medicine 55:209-222.
[19.] Nriagu, J. 2009. History in lead and lead poisoning in history :Ingestion of Lead from Spent Ammunition: Implications for Wildlife and human Eds. R. T. Watson, M. Fuller, M. Pokras, and W. G. Hunt .The Peregrine Fund, Boise, Idaho, USA. Pg 10-408
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[23.] Reuters. 2009. China to move residents from lead smelter base-report. Available online at http://www.reuters.com article/rbss Industry Materials Utilities News/id USPEK Retrieved 15th June 2010.
[24.] The Nigerian Guardian,June 2010
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[26.] US Environmental Protection Agency (US EPA), 2001b. Standard Operating Procedures for Lead in Paint by Hotplate or Microwavebased Acid Digestions and Atomic Absorption or Inductively Coupled Plasma Emission Spectroscopy. EPA, PB92-114172, September 1991.
[27.] US Environmental Protection Agency (US EPA),2013.Learn about Lead.(http://www2.epa.gov/lead/learn-about-lead,accesses April 24th 2013).
[28.] Watts, J .2009. Lead poisoning cases spark riots in China. Lancet 374 .9693: 868.
[29.] WHO,2010.Global Alert and response.Nigeria:mass lead poisoning from mining activities,zamfar state.www.who.int/csr/don/2010_07_07/en/index.html(accessed 30/12/2010).
[30.] Wilson,J.,Pivetz,T.,Ashley,P.,Jacobs,D.,Strauss,W.,et al.2006.Evaluation of HUD-funded lead hazard control treatment at 6 years post-intervention. Environmental Research102:237–248.
[31.] Wright, N .J. Thacher, T. D., Pfitzner, M .A. Fischer, P. R and . Pettifor, J. M. 2005. Causes of lead toxicity in a Nigerian city. Arch Dis Child 90:262-266
Knowledge Attitude and Practices of Persons Diagnosed with Type Ii Diabetes Mellitus with Regards to Nephropathy as a Complication
Author: Cummings E
Diabetes mellitus (DM) is the most common disorder of the endocrine glands caused by an inability to produce or use insulin. It is the fourth leading cause of death in the World according to World Health Organization., in Guyana it is among the leading cause of death. (MOH Bulletin)
[1.] Anon, article date: 01 Mar 2010 - 6:00 PST;Think Globally, Act Locally To Reduce Burden Of Diabetic Kidney Disease, Diabetes; Urology / Nephrology; http://www.medicalnewstoday.com/articles/180714.php, Retrieved 22/8/2010).
[2.] Atkins RC, Zimmet P.; Diabetic kidney disease: Act now or pay later. Saudi J Kidney Dis Transpl 2010;21:217-21; http://www.sjkdt.org/article.asp; Retrieved 19/8/10.
[3.] Belle TR, Fraser HS, Adomakoh SA, Walrond ER; April 2002; Economic cost of managing diabetes mellitus in Barbados [conference presentation]; Caribbean Health Research Council, 47th Annual Council and Scientific Meetings, Georgetown, Guyana; http://revista.paho.org; Retrieved 20/8/2010
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[5.] Butt Saud, Hall Phillip, Saul Nurko; Diabetic Nephropathy; http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/diabetic-nephropathy/; Retrieved 18/8/2010
[6.] Correa-Rotter et al.; (Kidney International (2005) 68, S69–S75; doi:10.1111/j.1523-1755.2005.09813.x); Early detection and prevention of diabetic nephropathy: A challenge calling for mandatory action for Mexico and the developing world; http://www.nature.com/ki/journal/v68/n98s/full/4496442a.html; Retrieved 22/8/10
[7.] UpadhyayDinesh K, et al.; November 26, 2007; Knowledge, Attitude and Practice about Diabetes among Diabetes Patients in Western Nepal; http://www.rmj.org.pk/rmj_jan_jun_2008/original_articles/dm_attitude/pdf.pdf; Retrieved 29/8/10
[8.] EHE Newsletter, Volume 9, Number 5, March 3, 2009, Kidney disease; http://www.eheintl.com/newsletter.jsp; Retrieved 8/26/2010
[9.] GINA;July18, 2008; Diabetes registry established - will allow for easy patient follow, http://www.gina.gov.gy/archive/daily/b080718.html, Retrieved 22/8/2010
[10.] Gordon Serena; Tuesday, Dec. 29 (HealthDay News); Diabetics Less Prone Now to End-Stage Kidney Disease; http://www.medicinenet.com/script/main/art.asp; Retrieved 22/8/10
[11.] Gower Timothy; How Diabetes Affects the Kidneys; http://health.howstuffworks.com/how-diabetes-affects-the-kidneys1.htm; Retrieved 9/23/10
[12.] Holly Kramer, MD1 and Mark E. Molitch, MD2;Screening for Kidney Disease in AdultsWith Diabetes; http://care.diabetesjournals.org; Retrieved 8/22/10
[13.] Ian H. de Boer and Michael W. Steffes; March 14, 2007; Glomerular Filtration Rate and Albuminuria: Twin Manifestations of Nephropathy in Diabetes; J Am Soc Nephrol 18: 1036-1037, 2007; Last Reviewed: February 27, 2009; http://nkdep.nih.gov/patients/kidney_disease_testing.htm; Retrieved 8/22/10
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[15.] Janet Worsley, Norwood and Charles B. Inlander; Diabetic Complications;The Factors Behind Complications of Diabetes;Excerpt from: Understanding Diabetes; http://www.diabetesinfocenter.org/View.aspx?url=diabetic_complications; Retrieved8/18/10.
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Estimates of Health Care Professional Shortages in Sub-Saharan Africa by 2015: a Critical Review
Author: Talkmore Maruta
The article by Richard M Scheffler; et all titled; Estimates Of Health Care Professional Shortages In Sub-Saharan Africa By 2015 published in the Health Affairs Journal volume 28, issue 5 of 5 2009 is reviewed. The review considers how the article is written in terms of structure, content and its effectiveness on addressing the issue of shortage of human resources in public. The issue of human resource shortage and brain drain especially in the developing world has been widely discussed, therefore, the relevancy, accuracy, objectivity, clarity of this article with respect to this subject area will be reviewed.
[1.] Yohannes Kinfu, Mario R dal Poz, Hugo Merce and david B Evans. 2008. The health worker shortage in Africa: are enough physicians and nurses being trained. Bulletin of the WHO 2009; 87:225-230.
[2.] Shortage of healthcare workers in developing countries - Africa
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[4.] Health Worker Shortages and inequalities: The Reform of united States Policy.
[5.] WHO, "About the Global Health Atlas," http://apps.who.int/globalatlas. Accessed 09 February 2013.
Knowledge, Attitude and Practices towards Voluntary Counselling and Testing for HIV among Rural Dwellers in Kogi State
Author: Okebugwu Andrew Nwachimere-eze
One of the indispensible components in the war against HIV/AIDS is the voluntary counseling and testing and this has acquired global recognition. This study was done to ascertain the knowledge, attitudes and practices of VCT among rural dwellers in Kogi State Nigeria. Data were obtained through questionnaires administered to 250 participants who were selected through quota and convenience sampling and were analyzed manually. Finding shows that the awareness of VCT in this area is 79% with the highest source of information as mass media (79%). 52% agreed to receive VCT if offered.. 14% have accessed VCT services before this study.
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[3.] Charles MP, Kweka EJ, Mahande AM, Barongo LR, Shekalaghe MJ (2009). Evaluation of uptake and attitude to voluntary counseling and testing among health care professional students in Kilimanjaro region, Tanzania. BMC Public Health, 9:128 doi: 10.1186/1471-2458-9-128.
[4.] Denison JA, Lungu N,Dunnet-Dagg WA, McCanley M, Sweat MD(2006). Social relationships and adolescents HIV counseling and testing decisions in Zambia. Horizons Research Summary. Washington DC Population council
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[6.] Holmes CN, Preko PO, Bolds R, Baidoo J, Jolly PE (2008). Acceptance of voluntary counseling testing and treatment for HIV among pregnant women in Kumasi, Ghana.
[7.] Ikechebelu IJ, The knowledge, attitude and practice of voluntary counseling and testing for HIV AIDS among undergraduates in a polytechnic in south east Nigeria . Niger J. med.2006 Jul- Sept;15(3):245-9
[8.] Kalichman SC, Simbayi LC, (2003). HIV testing attitudes, AIDS stigma and voluntary HIV counseling and testing in a black township in Cape Town South Africa. Sex Transm Infect 2003,79:442-447,doi:10.1136/sti.79.6.442
[9.] Manirankuda L, Lovs J, Alo TA, Colevinders R, Nostlinger C (2009l. "It is better not to know". Perceived barriers to HIV voluntary counseling and testing among sub-Saharan migrant in Belgium. Aids Educ. And Prevention, 21(6):582-593
[10.] Morin SF, Khumale Sekutuwa G, Charlebois ED, Routh J, Fritz K, Lane T, Vaki T, Fiamma A, Coates TJ (2006). Removing barriers to knowing HIV status: same day HIV testing in Zimbabwe. Acquired Immune deficiency syndrome, 41 (2):218-224.
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National Health Insurance Scheme in Ghana: Health Care Providers and Clients Perceptions and Experiences in the Upper East Region of Ghana
Author: Francis Abugri Akum
The Ghana National Health Insurance Scheme (NHIS) is to assure equitable and universal access for all residents of Ghana to an acceptable quality package of essential health care services without out-of pocket payment. The objective of this study is to examine the perceptions and experiences of health care providers and clients in the Upper East Region of Ghana regarding the NHIS. The study was cross-sectional and Patient exit interviews, in-depth interviews and focus group discussions (FGDs) were used to collect data. The NHIS was seen by all participants of the study to be beneficial. It led to an increase in the utilization of health care services for the insured and mobilized health resources for facilities. Insured clients reported verbal abuse, long waiting times, not being physically examined and discrimination in favour of the uninsured and the rich. Providers think that the insured were abusing their services by frequenting the facilities, and sometimes faking illness to collect drugs for their uninsured relatives. The biggest challenge was the delay in reimbursement of claims as a result; providers were not able to purchase drugs and non-drug supplies threatening the sustainability of the NHIS.
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[2.] Arhinful, D. (2003). The solidarity of self-interest: social and cultural feasibility of rural health insurance in Ghana. In Research report 71. Leiden, Netherlands: African Studies Centre.
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[5.] Boateng, A.R. National health insurance Authority. (2008). Mobilising the private sector to develop a sustainable health care economy in Africa.
[6.] Bruce, E., Narh-Bana, S. and Agyepong, I. (2008). Community satisfaction, equity in coverage and implications for sustainability of the dangme west health insurance scheme.In Technical Report Series No 9. [Accra Ghanaian Dutch Collaboration for Health Research and Development]
[7.] De Allegri, M., Sanon, M., and Sauerborn, R. (2006). "To enrol or not to enrol?": A qualitative investigation of demand for health insurance in rural West Africa.SocSci Med, 62(6):1520-1527. PubMed Abstract | Publisher Full Text
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[9.] Franco, I.M.et al. (2008). Effects of mutual health organizations on use of priority health-care services in urban and rural Mali: a case–control study. Bull World Health Organ, 86(11):830-838. PubMed Abstract | Publisher Full Text | PubMed Central Full Text
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[12.] Gnawali, D.P. (2009). The effect of community-based health insurance on the utilization of modern health care services: Evidence from Burkina Faso. Health Policy Plan, 90:214-222.
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[14.] James CD, Hanson K, McPake B, Balabanova D, Gwatkin D, Hopwood I, et al.: To retain or remove user fees? Reflections on the current debate in low- and middle-income countries.Appl Health Econ Health Policy 2006, 5:137-153. PubMed Abstract | Publisher Full Text
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[19.] Zebilla District Health Insurance Scheme. (2012). Annual Report. Zebilla.
Obesity and Health - a Review
Author: OGBU C E
Obesity is an urgent and growing global health problem of critical concern. The causes of this epidemic are complex and multifactorial, but fundamentally lead to an excess calorie intake and inadequate energy expenditure. Modern lifestyles, incorporating altered eating patterns, access to cheap, highly palatable, energy-dense yet nutritionally-poor foods, sedentary life-style and labour-saving devices which reduce physical activity have hugely accelerated the problem during the latter part of the 20thcentury. Obesity is a complex condition, with serious social and psychological dimensions, affecting virtually all ages and socioeconomic groups . The health consequences range from increased risk of premature death, to serious chronic conditions that reduce the overall quality of life. Of special concern is the increasing incidence of childhood obesity. The literature has been extensively reviewed to give an overview of the causes, the health problems associated with this disorder, the mode of assessment of the degree of obesity, its consequences, various methods of managing obesity with particular emphasis on dieting, exercise and the possible use of drugs (anorexiants) as well as surgery.
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Relationship between Socio-Economic Status and out-of-Pocket Expenses on Healthcare in Rural Nigeria
Author: Oluwakemi Tomori Edet-Utan
The socio-economic status of individuals, households and community play a key role in their health status especially for those in rural areas amongst which the pauper dwells. The fact that out-of-pocket(OOPs)expenses especially amongst the rural poor leads to more poverty/impoverishment, indebtedness and or death calls for strategic and highly efficient health financing measures to resolves issues around OOPs. This study thus, seeks to understand the relationship between the socio-economic status of rural dwellers in Ejigbo LGA and out-of-pocket expenses made on their healthcare.
This cross sectional study was carried out Utilizing an interviewer administered questionnaire to 1280 respondents who were selected using stratified random sampling of respondents in structures and households. SPSS version 21 was used to analyse the data obtained. Level of Educational attainment, income/earnings per month and occupation were scaled and cumulated to obtain the socio-economic scale/status
Majority of respondents belong to the lower socio-economic class, and had up to secondary level education. More than half of the rural dwellers earn between ₦10,000 ($62.5 US). In this study, 64.4% of respondents spent ₦5,000 ($31.25 US) or less on their health through out-of-pocket spending (OOPs) in 3 months consequently about ₦1,666.66 ($10.41 US) in a month.
A statistically significant correlation was found between SES of respondents in rural area and their OOPs on healthcare. An increase in SES revealed an increase in OOPs. A significant relationship was found between the SES of respondents and the OOPs on healthcare which was a reflection of educational status, occupation and income/earnings of community members. This survey also reveals that the poorer the people, the less they spend on their healthcare owing to the fact that they have low earnings/income. Hence, there is need for more efficient risk pooling mechanisms in order to assure equity in healthcare service delivery.
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[2.] Dr. Suni Pal Singh's Socio-Economic classification presentation on (Slide share forum a web based forum)
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[4.] Shankar Reddy Dudala and Arlappa N. (2013). An Updated Prasad's Socio Economic Status Classification for 2013. Int Journal of Research and Development of Health. April 2013; Vol 1(2)
The Theoretical Approach to the Discourse on Sexuality in Ghana: Law, Power, and Cultural Resistance: the Case of Minority Groups (Homosexuals)
Author: Elijah Tukwarlba Yin
This paper presents a critical discourse on sexuality in Ghana. It examines the religious, constitutional and legal arguments on sexuality. It also examines the issue of sexuality (Homosexuality) as a normal or an abnormal behaviour, private or public matter, as well as the place of morality in sexual matters. All these were examined in respect of power relations and law. The study used a letter written by the Christian Council of Ghana, internet news sources, and some responses that were gathered via informal discussions.
The study used various theoretical tools such as perspectives of queer theorists, Foucault, and Brock's writing on sexuality to interpret and interrogate the data. The paper explores the clashes in the legal orders i.e. it shows how the Ghana Criminal Code and other traditional norms criminalize 'Unnatural Carnal Knowledge' intercourse whilst at the same time the constitution and other international laws guarantee the right to freedom from discrimination. These legal ordersbring into sharp focus issues of legal pluralism as the normative orders contradicts a statutory order whilst at the same time the statutory orders clash each other. The study also shows that whilst the dominant group considers homosexuality as an abnormal sexual behaviour homosexuals through the theoretical perspectives consider their sexual orientation as one of the terrain towards sexual citizenship.
The study further shows how 'power' permeate the whole sexual discourse as to who even determines morality. The paper concludes by settling on recommending a balanced approach to dealing with homosexuality rather than adopting an abusive approach.
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Understanding the Risk of Exposure to Occupational Hazards and Safety Measures for Nigerian Workers
Author: OKECHUKWU EDITH CHINENYE
To have a vibrant and productive economy in any nation, it becomes imperative that the health and safety of her workers must be given priority attention by the worker himself, employer and the government. Because of the increasing industrialization, infrastructural developments and modernization taking place in developing countries particularly like Nigeria. These factors have not only increased the job opportunities in and around the country but at the same time increased the incidence of morbidity and mortality of workers.
And so it is important that the worker has an in depth knowledge and understanding of the nature of the job with regards to the health hazard exposures peculiar to the job and the safety measures to be undertaken even before accepting the job. More so, safety officers, factory and industrial managers etc. need to appreciate the need to know all that is involved in the job in order to make the workplace a safe and conducive one for the worker and achieve high productivity.
This paper attempts to highlight a lot of occupational hazards that occur among both the formal and informal Nigerian workers, reasons for their occurrences, safety measures, lapses on the part of the employer and reveals the laxity on the part of government to enact and enforce occupational safety and health laws.
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How Condom Social Marketing is Effective Tool to Improve the Health of Vulnerable
Author: Neeraj Sharma
In response to the HIV/AIDS epidemic, social marketing programmes have made condoms accessible, affordable and acceptable to low-income populations and high-risk groups. Corporate marketing is used for social purpose then it's called social marketing. In some areas this has become successful but in other few areas it given negative effect. This primary study has been done to First measure the effect of social marketing and second if social marketing, specially what type of media, would be an effective way to disseminate the information of HIV/AIDS, RTI/STI and condoms to the vulnerable population.
This has been done on truckers (n=200), MSM (n=30), FSW (n=30). Questionnaire was made and FGDs were conducted. It was found that career is the priority of truckers & FSW and friends were priority of MSM. Truckers have radio as source of information. MSM and FSW were having Cellular phone to get information of their clients and friends. Approximately 78% truckers, 70% MSM, 48% FSW were aware about condom through social marketing (See Table 1). Only 63% truckers, 47% MSM, 12% FSW were aware of HIV/AIDS, and 58% trucker, 41% MSM, 5% FSW were using condom for prevention of HIV/AIDS, rest were for any other purpose.
Social marketing programmes do not operate in air; government support is a key component of a successful programme. So government should support to MSM, FSW in legal. There is urgent need to have more social marketing of female condom & its use, and public private partnership model to improve health of vulnerable group. Corporate sector should provide support to Government as their Corporate Social Responsibility (CSR).
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Improving Health Systems in Nigeria
Author: NWUBA CHIOMA ONYINYE
Nigeria, with a population of 140 million people accounting for 47% of the population of West Africa, has a moral responsibility to lead the continent towards achieving the Millennium Development Goals (MDGs). Yet its health system is ranked 187th of 191 WHO member states. Lending credence to this ranking are health indices such as an infant mortality rate of 101 per 1000; maternal mortality rates ranging from 500 per 100,000 in the South West to 800 per 100,000 in the North East, perinatal mortality rate of 48 per 1000 and child mortality rate of 205 per 1000.
There is thus an urgent need to foster effective collaboration and partnership with all relevant stakeholders to improve the health systems in Nigeria.
This paper explores challenges and possible solutions relating to health systems strengthening in Nigeria including health policies, governance, organization and financing of health services, health workforce production and health service delivery.
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Screening Of Primary School Children For Refractive Error In An Urban School In Lagos State
Author: IMADE PRISCILIA UHUANMWEN
A cross sectional study on screening for refractive error in school children was carried out in a primary school in Ikeja Local Government Area of Lagos State between November and December, 2012. The study population were school age children from primary 1-6 and the pupils age was 5–11 years. Near acuity was done at 40cm and distance visual acuity for each eye was assessed by an intern Optometrist at 6 meters distance. Those with visual acuity of 6/12 or less were presented with a pinhole and the test repeated. Improvement of visual acuity with pinhole was considered refractive error. Penlight examination was carried out to check for external examination and opthalmoscopy was done under dim illumination to check the internal status of the eye. The isihara chart was used to assess the color vision.
A total of 580 (340 females and 240 males) Pupils were examined. Of these, 506 pupils (87.24%) had no refractive error but 74 pupils ( 12.76%) had refractive errors including amblyopia and color vision defects. Myopia was found to be highest refractive 51.35%, followed by hyperopia 29.73%, astigmatism 10.81%, amblyopia 2.70% and color vision 5.41%.
A significant refractive errors was observed among primary school children aged 5-11years at a prevalence of 12 .76%. Refractive errors can affect a child academic performance in school and could lead to permanent visual disabilities in adult life if not detected and treated early. Therefore, there is a need to have regular and timely vision screening in primary school children at least at the commencement of school so as to defect those who may suffer from visual impairment. Eye health education and regular vision screening are very crucial in the prevention of visual impairments among school age children.
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Causes and Consequences of Air Pollution in Nigeria
Author: Ukemenam Obianuju Sarah
Air pollution is a significant cause of morbidity and mortality. The greatest health impacts from air pollution worldwide occur among the poorest and most vulnerable populations. The amount of exposure in terms of the number of people, exposure intensity and time spent exposed is far greater in the developing world (Smith, 1993); approximately 76% of all global particulate matter air pollution occurs indoors in the developing world
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Texila International Journal


An update is available for the new Turbo Game Engine beta.
Added high-resolution depth buffer (additional parameter on CreateContext()).
Subscribers can download the new version here.
Can confirm working fine for me now (AMD R51600X CPU + RX480 GPU).
I tried to find the information on forums, but I couldn't, so I have to ask here. Will Leadworks license works on Turbo game engine? Or that is gonna be a separate engine, with separate license?
Will Leadworks license works on Turbo game engine? Or that is gonna be a separate engine, with separate license?
You will need to purchase it separately. I believe there was talk of a possible discount for Leadwerks owners.


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Paracetamol ili acetaminofen, u SAD) je često korišteni analgetik i antipiretik. On je učinkovita zamjena za aspirin, često se koristi za smanjenje tjelesne temperature, ublažavanje glavobolja i drugih slabijih tegoba i bolova. Međutim, za razliku od aspirina nije dobar antiupalni lijek. Jedan je od osnovnih sastojaka za brojna farmaceutska sredstva koja služe za prehladu i gripu. U kombinaciji s opioidnim analgeticima, paracetamol se može koristiti i za ublažavanje jačih bolova poput postoperativnih bolova te za pružanje palijativne njege kod pacijenata s uznapredovalim rakom. Njegovo analgetičko djelovanje počinje otprilike 11 minuta nakon oralnog uzimanja., a njegovo biološko poluvrijeme eliminacije iznosi od 1 do 4 sata. Iako se paracetamol koristi za ublažavanje upalnih procesa, on općenito nije svrstan u obitelj NSAID jer pokazuje samo vrlo slabe antiupalne aktivnosti.

Iako je općenito siguran za korištenje u preporučenim dozama (od 1 000 mg po dozi do najviše 4 000 mg dnevno za odrasle osobe), akutno predoziranje paracetamolom može uzrokovati možda smrtonosno oštećenje jetre, a kod rijetkih slučajeva, i normalna doza može učiniti isto; rizik se povećava učestalom i prekomjernom konzumacijom alkohola. Otrovnost paracetamola je najčešći razlog akutnog zatajenja jetre u zapadnim zemljama, i uzrok je najvećeg broja predoziranja lijekovima u SAD-u, Velikoj Britaniji, Australiji i Novom Zelandu.

Paracetamol je aktivni metabolit fenacetina, nekad popularnog kao analgetik i antipiretik, ali za razliku od fenacetina i njegovih kombinacija, paracetamol se ne smatra kancerogenim u terapeutskim dozama. Pojmovi acetaminofen (koristi se u SAD, Kanadi, Japanu, Južnoj Koreji, Hong Kongu i Iranu) i paracetamol (u ostalim zemljama) su nastali iz kemijskog naziva za ovaj lijek: para-acetilaminofenol i para-acetilaminofenol. U nekim kontekstima, koristi se i kratica kao APAP za acetil-para-aminopfenol.

Medicinska uporaba

Groznica

Paracetamol je potvrđeni lijek za ublažavanje groznice kod osoba svih uzrasta. Svjetska zdravstvena organizacija (WHO) preporučuje da se paracetamol koristi samo za ublažavanje groznice kod djece ako je njihova tjelesna temperatura veća od 38,5 °C. Efikasnost paracetamola samog po sebi kod djece s groznicom je upitna, a meta-analiza je pokazala da je manje efikasan od ibuprofena. Uloga paracetamola u pedijatrijskoj medicini je izrazito izražajna kao učinkovit analgetik i antipiretik.

Bolovi

Paracetamol se koristi za ublažavanje bolova povezanih s mnogim dijelovima tijela. On posjeduje analgetičke osobine usporedive s onima kod aspirina, dok su njegovi antiupalni učinci daleko slabiji. Općenito se bolje podnosi od aspirina kod pacijenata kod kojih je utvrđena obilna sekrecija gastritične kiseline ili se strahuje od produženja krvarenja. Pošto je dostupan u prodaji bez liječničkog recepta, sve više je postao uobičajeni lijek u brojnim kućanstvima. Paracetamol može ublažiti bolove pri blagom artritisu ali nema učinak na upalu, crvenilo i nateknuće zgloba koji su povezani s artritisom. Za ublažavanje bolova pri osteoartritisu koljena, on je učinkovit poput ibuprofena.

U vezi komparativne farmakološke efikasnosti, studije su pokazale zbunjujuće i suprotne ishode kada se paracetamol usporedi s nesteroidnim antiupalnim lijekovima (NSAID). Slučajne nadzirane studije kronične boli prouzrokovane osteoartritisom kod odraslih su pokazale slične koristi od paracetamola i ibuprofena.

Efikasnost paracetamola kada se koristi u kombinaciji sa slabim opioidima (poput kodeina) je upitna zbog podataka iz nedavnih studija; zbog male količine podataka koji su dostupni teško je donijeti bilo kakav zaključak. Kombinacijski lijekovi paracetamola i snažnih opioida poput morfina su pokazali da smanjuju korištenu količinu opioida i poboljšavaju analgetski učinak kao i da sputavaju predoziranje opioidima zbog možebitno otrovnog učinka paracetamola. Slučajne nadzirane studije akutne muskuloskeletalne boli kod djece su pokazale da obični tržišni ibuprofen u normalnoj dozi bolje smanjuje bol od standardne doze paracetamola.

Neželjeni učinci

U preporučenim dozama, neželjeni učinci paracetamola su blagi ili ih nema. Za razliku od aspirina, on nema antikoagulacijske osobine (ne razrjeđuje krv) pa ga zbog toga mogu koristiti pacijenti koji imaju problema s koagulacijom. Pored toga, paracetamol ne vrši iritaciju želučane sluznice. U usporedbi s ibuprofenom - koji ima neželjene učinke poput dijareje, povraćanja i abdominalnih bolova - paracetamol se relativno dobro tolerira s manje popratnih učinaka. Produženo dnevno korištenje povećava rizik od komplikacija na gornjim probavnim organima poput krvarenja u želucu, a može prouzrokovati i oštećenje bubrega ili jetre. Paracetamol se metabolizira u jetri i hepatotoksičan je; neželjeni učinci mogu biti slični kao kod kroničnog alkoholizma ili kao kod pacijenata s oštećenjem jetre.

Sve do 2010. godine, za paracetamol se vjerovalo da je siguran za korištenje u trudnoći (da ne utječe na zatvaranje ductus arteriosus kod fetusa kao što je to slučaj kod NSAID lijekova). Međutim, u studiji objavljenoj u listopadu 2010. godine, povezan je s neplodnošću u odrasloj dobi kod još nerođenih beba. Poput NSAID lijekova a za razliku od opioidnih analgetika, za paracetamol nije pronađeno da prouzrokuje euforiju ili mijenja raspoloženje premda su nedavna istraživanja dala određene dokaze da paracetamol može umanjiti psihološku bol. Za razliku od aspirina, siguran je za korištenje kod djece, pošto on nije povezan s rizikom od Reyevog sindroma kod djece s virusnim oboljenjima. Paracetamol koji se koristi za ublažavanje groznice u prvim godinama života je bio povezan s povećanom pojavom simptoma astme u uzrastu od 6 do 7 godina, i takva uporaba paracetamola, kod djece u prvim godinama života kao i kod djece od 6-7 godina, je također povezana i s povećanom opasnošću od rinokonjunktivitisa i ekcema. Autori studije priznaju da je na njihovo "otkriće utjecali usputni i drugi pokazatelji", odnosno da ta povezanost ne može biti uzročna nego zbog činjenice da je bolest tretirana paracetamolom te potom naglašavaju da je neophodno dodatno istraživanje. Pored toga, objavljeni su brojni komentari, dopisi, odgovori i kritike u časopisu The Lancet koji se odnose na metodologiju i zaključke te studije. Britanska agencija za regulaciju lijekova (Medicines and Healthcare products Regulatory Agency) također je ispitala ovo istraživanje i objavila brojne kritike o načinu interpretacije dobijenih podataka te ponudila savjet za farmaceute, roditelje i širu javnost: "Ishodi ove nove studije nužnu ne mijenjaju bilo koje trenutne upute za upotrebu paracetamola kod djece. Paracetamol ostaje siguran i pogodan izbor analgetika kod djece. Nema dovoljnih dokaza iz ovog istraživanja za promjenu uputstava u vezi korištenja antipiretika kod djece." Kronični korisnici paracetamola mogu biti izloženi riziku razvoja leukemije.

Predoziranje

Hepatotoksičnost paracetamola je daleko najčešći uzrok akutnog zatajenja jetre u SAD-u kao i u Velikoj Britaniji. Podaci pokazuju da predoziranje paracetamolom može dovesti do brojnih poziva u kontrolne centre za zaštitu od trovanja u SAD, više nego trovanje bilo kojom drugom farmakološkom supstancom. Znaci i simptomi otrovnosti paracetamola mogu isprva biti vrlo blagi ili nikakvi. Netretirano predoziranje može dovesti do zatajenja jetre i smrti u toku nekoliko dana. Tretman takvih slučajeva je usmjeren ka uklanjanju paracetamola iz tijela i zamjenom glutationa. Aktivni ugalj se može koristiti za povećanje adsorpcije paracetamola ako se pacijent javi na tretman u kratkom vremenu nakon predoziranja. Dok protuotrov acetilcistein (poznat i kao N-acetilcisteil ili NAC) djeluje kao prekursor za glutation, on pomaže tijelu da se regenerira u dovoljnoj mjeri da spriječi oštećenje jetre, premda ako dođe do ozbiljnijih oštećenja jetre, nužno je provesti i njenu transplantaciju. Na tržištu postoje i tablete (u UK poznate pod nazivom Paradote) koje kombiniraju paracetamol s protuotrovom (metionin) radi zaštite jetre u slučaju predoziranja.

U lipnju 2009. godine, savjetodavni odbor Američke agencije za nadzor hrane i lijekova (FDA) dao je preporuku da se na uporabu paracetamola izda novo ograničenje unutar SAD-a koje će pomoći ljudima upozoravajući ih na potencijalne otrovne učinke. Najveća doza u bilo koje vrijeme smanjena je s 1000 mg na 650 mg, dok je istodobno zabranjena kombinacija paracetamola i narkotičkih analgetika. Članovi odbora osobito su bili zabrinuti činjenicom da je trenutno najveće ograničenje doze paracetamola pokazalo kako može načiniti promjene u hepatičkoj funkciji. Dana 13. siječnja 2011. godine, FDA je zatražila od proizvođača kombinacijskih lijekova u kojima je sadržan paracetamol, ograničiti količinu paracetamola u takvim lijekovima na ne više od 325 mg po tableti ili kapsuli i počela tražiti od proizvođača ažurirati oznake na tim proizvodima kako bi upozorili na potencijalni rizik od teškog oštećenja jetre. Proizvođači će imati rok od tri godine ograničiti količinu paracetamola na 325 mg po dozi.

U studenom 2011. godine Britanska regulatorna agencija za lijekove i medicinsku njegu također je revidirala doziranje tekućeg paracetamola za djecu.

Klasifikacija

Paracetamol je dio skupine lijekova poznatijih kao "anilin analgetici"; on je jedini takav lijek koji je i danas još uvijek u uporabi. On se ne smatra NSAID jer ne iskazuje antiupalnu aktivnost u značajnijoj mjeri (ali jeste slabi inhibitor ciklooksigenaze). Usprkos tome, paracetamol i lijekovi iz skupine NSAID imaju neke slične farmakološke osobine.

Mehanizam djelovanja

Do danas, mehanizam djelovanja paracetamola još uvijek nije u potpunosti razjašnjen. Smatra se da je osnovno djelovanje putem inhibicije ciklooksigenaze (COX), a nedavna otkrića sugeriraju da je visoko selektivan za ciklooksigenazu-2 (COX-2). Dok su njegove analgetičke i antipiretičke osobine usporedive s onim kod aspirina i drugih NSAID lijekova, njegove periferalne antiupalne osobine i aktivnosti su obično ograničene brojim čimbenicima, jedan od njih je i visoka razina peroksida koji su prisutni u upalnim lezijama. Međutim, u nekim slučajevima, promatrane su i neke periferalne antiupalne aktivnosti koje se mogu usporediti s ostalim NSAID lijekovima. Članak u časopisu Nature Communications koji su objavili znanstvenici iz Londona i Lunda (Švedska) u studenom 2011. godine ukazuje na analgetičke mehanizme paracetamola (acetaminofena), tako što metaboliti acetaminofena poput NAPQI djeluju na TRPA1-receptore u kralježničnoj moždini onemogućiti provođenje signala iz najviših vanjskih slojeva kralježnične moždine što dovodi do neosjetljivosti na bol.

Zbog svoje selektivnosti za COX-2, on ne inhibira u značajnijoj mjeri proizvodnju tromboksana koji podstiče zgrušavanje krvi.

COX obitelj enzima odgovorna je za metabolizam arahidonske kiseline do prostaglandina H2, nestabilne molekule koja se pretvara u brojne proupalne spojeve. Klasični antiupalni preparati poput NSAID lijekova blokiraju ovaj korak. Samo kada je odgovarajuće oksidiran, COX enzim je tada iznimno reaktivan. Paracetamol smanjuje oksidirani oblik COX enzima, onemogućavajući mu da gradi proupalne spojeve. Ovo dovodi do smanjene količine prostaglandina E2 u središnjem živčanom sustavu i time smanjujući hipotalamsku točku u središtu za reguliranje tjelesne temperature.

Paracetamol također modulira endogeni kanabinoidni sustav. Paracetamol se metabolizira do AM404, spoja koji djeluje na nekoliko načina; najvažniji način je da on inhibira ponovno uzimanje endogenog kanabinoida/vaniloida anandamida od strane neurona. Ponovno uzimanje anandamida bi ishodovalo smanjenjem sinaptičkih razina i manje aktivacije glavnog receptora za bol (nociceptora) u tijelu, TRPV1 (stariji naziv: receptor vaniloida). Pošto inhibira ponovno uzimanje anandamida, razine u sinapsama ostaju visoke tako da se mogu umrtviti TRPV1 receptori kao što se postiže djelovanjem kapsaicina. Pored toga, AM404 inhibira kanale natrija, kao što to radi i anestetici lidokain i prokain. Bilo koja od ovih akcija sama po sebi dokazano smanjuje bol i smatra se kao mogući mehanizam djelovanja za paracetamol. Međutim, dokazano je da nakon blokade receptora kanabinoida putem sintetičkih antagonista, dolazi do prestanka analgetičkih efekata paracetamola, što ukazuje da njegovo analgetičko djelovanje uključuje endogeni kanabinoidni sustav. Dokazano je da spinalni TRPA1 receptori također imaju antinocicepitivne reakcije na paracetamol kod miševa.

Aspirin je poznat da izaziva inhibiranje ciklooksigenaze (COX) obitelji enzima te, pošto djelovanje paracetamola je djelomično slično djelovanju aspirina, izvršena su brojna istraživanja koja su fokusirana na tezu inhibira li i paracetamol također COX. Danas je razjašnjeno da paracetamol djeluje putem najmanje dva ciklusa.

Točan način na koji je COX inhibiran u različitim okolnostima je još uvijek predmet rasprave. Zbog razlika u aktivnosti paracetamola, aspirina i drugih lijekova iz obitelji NSAID, postavljena je teorija da postoje i neke druge inačice ciklooksigenaze. Jedna teorija smatra da paracetamol djeluje tako što inhibira COX-3 izoformu, jednu od varijanti COX-1 unutar COX obitelji enzima. Ako se promatra njegovo djelovanje kod pasa, ovaj enzim dijeli veliku sličnost s drugim COX enzimima, proizvodeći proupalne spojeve a također je selektivno inhibiran od strane paracetamola. Međutim, neke studije sugeriraju da kod ljudi i miševa, enzim COX-3 ne pokazuje značajno upalno djelovanje te njegova blokada putem paracetamola nije beznačajna u svojoj funkciji u ljudskom organizmu. Druga mogućnost je da paracetamol blokira ciklooksigenazu (kao i aspirin), ali tako da visoko oksidacijsko stanje paracetamola onemogućava njeno djelovanje u upalnom okruženju gdje je koncentracija
peroksida visoka. Ova ideja bi značila da ne postoje izravni učinci na mjestu upalnog procesa, nego da djeluje u CNS gdje okolina nije oksidacijska, snižujući temperaturu itd. Točan način djelovanja za koji se vjeruje da paracetamol utječe na COX-3 još je predmet rasprave.

Struktura i reaktivnost

Paracetamol se sastoji iz jezgre benzenovog prstena, substituiranog jednom hidroksil skupinom i atomom dušika od amidne skupine u para (1,4) shemi. Amidna skupina je acetamid (etanamid). On je ekstentivno konjugirani sustav, jer su usamljeni parovi na atomu hidroksil kisika, benzenov pi oblak, dušikov usamljeni par, p orbitala na karbonilnom atomu ugljika i usamljeni par na karbonilnom atomu kisika, svi konjugirani. Prisustvo dvije aktivne skupine također daje benzenovom prstenu visoku reaktivnost prilikom elektrofilnih aromatskih substitucija. Kao substituenti, sve pozicije u prstenu su više ili manje jednako aktivirani. Konjugacija je značajno smanjuje bazičnost kisika i dušika, dok u isto vrijeme hidroksilna kiselost kroz delokalizaciju naboja se razvija na fenoksidom anionu.

Sinteza

U laboratorijskim uvjetima, paracetamol se može vrlo lako pripremiti putem nitracije fenola s natrijevim nitratom, odvajajući željeni p-nitrofenol od orto sporednih proizvoda, i reducirajući nitro skupinu s natrijevim borohidridom. Ishod p-aminofenol se zatim acetilira s acetatnim anhidridom. U ovoj reakciji fenol je jako aktivirajući reagens, tako da reakcije zahtjeva samo blage uvjete (npr. nitraciju benzena). Sličan je i industrijski proces, ali se umjesto redukcije natrij borohidrida koristi hidrogenacija.

Jednostavnija sinteza koju je razvila kompanija Hoechst-Celanese uključuje izravnu acilaciju fenola s acetatnim anhidridom uz HF kao katalizator, zatim se provodi konverzija ketona do ketoksima s hidroksilaminom, a nakon toga Beckmannovo preuređenje katalizirano s kiselinama, čime se dobiva amid.

Potražnja za paracetamolom u SAD je procijenjena na 30 000 do 35 000 tona godišnje u 1997. godini, što odgovara cjelokupnoj potražnji za njim u ostatku svijeta.

Metabolizam

Paracetamol se primarno metabolizira u jetri u neotrovne proizvode. Značajna su tri metabolička puta:
Smatra se da na glukuronidaciju otpada od 40% do dvije trećine metabolizma paracetamola.
Na sulfaciju (konjugacija sulfata) se može odnositi 20–40%.
N-hidroksilacija i preuređivanje, zatim GSH konjugacija, može zauzimati manje od 15%. Hepatički sustav citohrom P450 enzima metabolizira paracetamol, dajući malo ali važnog alkaliranog metabolita poznatog kao NAPQI (N-acetil-p-benzo-kvinon imin). NAPQI je zatim nepovratno konjugirana sa sulfhidrilnim skupinama glutationa.

Kod sva tri metabolička puta daju završne proizvode koji su neaktivni, neotrovni te se na kraju izlučuju renalno. Međutim, u trećem nabrojenom metaboličkom putu, kao međuproizvod javlja se NAPQI koji je otrovan. NAPQI je primarno odgovoran za otrovne učinke paracetamola; što se smatra jednim od primjera toksikacije.

Nastajanje NAPQI se primarno zbiva zbog djelovanja dva izoenzima citohroma P450: CYP2E1 i CYP1A2. Međutim, gen P450 je izrazito polimorfan, a do pojedinačnih razlika u otrovnosti paracetamola dolazi zbog trećeg izoenzima, CYP2D6. Genski polimorfizmi u CYP2D6 mogu doprinijeti do značajno različite brzine proizvodnje NAPQI. Dalje, pojedine osobe mogu biti razvrstane po fenotipskoj varijabilnosti na "obilne", "ultra brze" i "slabe" metabolizere (proizvođače NAPQI), što ovisi o njihovim razinama izraza CYP2D6. Iako CYP2D6 metabolizira paracetamol u NAPQI u manjem obujmu od drugih P450 enzima, njegovo djelovanje može doprinijeti da se otrovnost paracetamola poveća kod "obilnih" i "ultrabrzih" metabolizera, i kada se paracetamol uzima u velikim dozama. U uobičajenim dozama, kod "slabih" metabolizera, NAPQI je brzo neutralizira putem konjugacije. Ako dođe do predoziranja, a moguće je i kod "obilnih" i "ultra brzih" metabolizera, ovaj neutralizacijski metabolički put postaje zasićen, a kao posljedica toga nagomilava se NAPQI.

Reakcije

p-Aminofenol se može dobiti putem amidne hidrolize paracetamola. p-aminofenol dobiven na ovaj način, a povezan je s Metolom koji je dostupan na tržištu, koristi se za amatersko razvijanje fotografija. Ova reakcija se također koristi i za dokazivanje paracetamola u uzorcima urinaa: nakon hidrolize s hidroklornom kiselinom, p-aminofenol reagira u rastvoru amonijaka s fenolnim derivatima npr. salicilnom kiselinom dajući boju indofenol zbog oksidacije na zraku.

Povijest

Acetanilid je bio prvi derivat anilina slučajno otkriven da ima analgetičke i antipiretičke osobine, i vrlo brzo je ušao u medicinsku praksu pod imenom antifebrin 1886. godine od strane A. Cahna i P. Heppa. Međutim, njegovi neprihvatljivi toksični učinci, od kojih je najopasnija bila cijanoza zbog methemoglobinemije, doveli su do potrage za manje opasnim derivatima anilina. Onodobni američki kemičar Harmon Northrop Morse je već sintetizirao paracetamol 1877. godine na Sveučilištu Johns Hopkins putem redukcije 4-nitrofenola s kositrom u smrznutoj acetatnoj kiselini, ali je to ostalo nepoznato sve do 1887. godine dok klinički farmakolog Joseph von Mering nije isprobao paracetamol na pacijentima. Godine 1893. von Mering objavio je rad o kliničkim ishodima paracetamola s fenacetinom, drugim derivatom anilina. Von Mering je tvrdio da, za razliku od fenacetina, paracetamol ima veću tendenciju izazvati methemoglobinemiju. Nakon toga, paracetamol je vrlo brzo zanemaren u korist fenacetina. Prodaja fenacetina je dovela Bayer do položaja vodeće ljekarničke kompanije. Iako ga je djelomično zasjenio aspirin, uveden od strane Heinricha Dresera 1899. godine, fenacetin je bio popularan desetljećima, dijelom široko reklamiran kao "sredstvo protiv glavobolje" dostupno bez recepta, sadržeći najčešće fenacetin, aminopirinski derivat aspirina, kofeina i ponekad barbiturate.

Tvrdnje Von Meringa su ostale neopovrgnute gotovo pola stoljeća, sve dok dva tima znanstvenika iz SAD-a nisu raščlanjivala metabolizam acetanilida i parcetamola. Godine 1947. biokemičari David Lester i Leon Greenberg su otkrili jake dokaze da je paracetamol bio osnovni metabolit acetanilida u krvi ljudi, a naknadne studije su pokazale kako velike doze paracetamola koje su se davale albino štakorima nisu uzrokovale methemoglobinemiju.  Tri znanstvena rada koja su objavljena u rujnu 1948. godine u Žurnalu za farmakologiju i eksperimentalne terapije (Journal of Pharmacology and Experimental Therapeutics), biokemičari Bernard Brodie, Julius Axelrod i Frederick Flinn su potvrdili koristeći specifične metode da je paracetamol doista osnovni metabolit acetanilida u krvi, te se potvrdilo da je također efikasan kao analgetik kao i spojevi koji mu prethode. Oni su također sugerirali da je methemoglobinemija koja se javlja kod ljudi uglavnom uzrokovana zbog drugog metabolita, fenilhidroksilamina. Naknadni radovi Brodieja i Axelroda iz 1949. godine su pokazali da se fenacetin također metabolira do paracetamola. To je postupno dovelo do ponovnog otkrića paracetamola.

Paracetamol je prvi put pušten na tržište SAD-a 1953. godine od strane kompanije Sterling-Winthrop Co., koja ga je promicala kao zamjenu za aspirin pošto je sigurniji od njega za djecu i osobe s ulkusima. Danas, najpoznatije tržišno ime za paracetamol u SAD je Tylenol, kojeg je 1955. godine ponudila McNeil Laboratories započinjući prodaju paracetamola kao sredstva za ublažavanje bolova i povišene temperature kod djece pod imenom Tylenol Children's Elixir, riječ "tylenol" je zapravo skraćeno ime od para-acetilaminofenol.

Dostupni oblici

Paracetamol je dostupan u svim farmacijskim oblicima: tabletama, kapsulama, tekućim otopinama, supozitorijama, intravenznim i intramuskularnim oblicima. Najčešća doza za odrasle osobe kreće se od 500 do 1000 mg. Najveća preporučena dnevna doza za odrasle osobe je 4000 mg. U preporučenim dozama, paracetamol je općenito siguran za djecu i dojenčad kao i za odrasle osobe, iako je bilo rijetkih slučajeva akutnih oštećenja jetre koji su bili povezani za količinama manjim od 2500 mg dnevno.

Panadol, koji je dostupan na tržištima Afrike, Azije, Europe, Srednje Amerike i Australije, je najrašireniji dostupni oblik i brend paracetamola, a prodaje se u preko 80 zemalja. U Sjevernoj Americi, paracetamol se prodaje u generičkom obliku (obično označen kao acetaminofen) ili pod brojim trgovačkim imenima, naprimjer, Tylenol (McNeil-PPC, Inc.), Anacin-3, Tempra, Datril i Ofirmev. Iako je u UK-u dostupan paracetamol pod trgovačkim imenima (naprimjer Panadol), mnogo uobičajenije je da se on prodaje nebrendiran ili kao generički lijek. Trgovačko ime za paracetamol, Acamol, se proizvodi u Izraelu, a proizvodi ga Teva Pharmaceutical Industries, te je najviše korišteni oblik paracetamola u toj zemlji. Na Filipinima, najviše prodavani brend paracetamola je Biogesic, kojeg proizvodi United Laboratories. Godišnje se na Filipinima proda gotovo milijardu tableta Biogesica, ne računajući paracetamol u tekućim suspenzijama. To trgovačko ime dostupno je i u zemljama ASEAN-a gdje je kompanija United Laboratories također prisutna. U Europi najčešća trgovačka imena paracetamola su Efferalgan i Doliprane. U Indiji je najčešći Crocin kojeg proizvodi Glaxo SmithKline Asia. U Bangladešu najpopularnije trgovačko ime je Napa kojeg proizvodi Beximco Pharma.

Izvori

Vanjske poveznice

 Kemijski podaci
 Informacijski centar za paracetamol
 Uputstvo za paracetamol, Bosnalijek
 TylolHot, Nobelfarma
 bh-news.com: paracetamol_kao_jako_opasna_tableta

Lijekovi

redpajama_set_name: RedPajamaWikipedia


When deciding whether to approve an employer for self-insurance, WorkSafe can contact other organisations to get more information. The process is outlined here.
Anyone can see who is applying to be a self-insurer on the WorkSafe website, and make a submission to WorkSafe about your application if they have information they think is relevant.
This document shows what those submissions can contain, how WorkSafe assesses them, and your right to respond.


Vivekanand College for Advanced Computer and Information Science, Surat was established in 2011. Vivekanand College for Advanced Computer and Information Science, Surat is affiliated to Veer Narmad South Gujarat University, Surat And approved by University Grants Commission (UGC).
Vivekanand College for Advanced Computer and Information Science, Surat offers various graduate courses as well as Post Graduate courses.
Vivekanand College for Advanced Computer and Information Science, Surat is affiliated to Veer Narmad South Gujarat University, Surat.
List of facilities available at Vivekanand College for Advanced Computer and Information Science, Surat for students.


Jawbone ERA™ is equipped with military-grade NoiseAssasin® 3.0,the latest version of Jawbone's industry-first noise and wind cancelling technology. Originally developed for use by tank commanders and helicopter pilots, NoiseAssassin 3.0 eliminates background noise better than any other headset. It also auto-adjusts inbound call volume and intelligibility to your environment.
Music, video and calls never sounded better. With its 10mm wideband speaker podcasts, Pandora® tunes, YouTube® videos, driving direction sand more come vibrantly to life in full-spectrum, HD-quality sound. Jawbone ERA is also the most convenient way to enjoy all your mobile media and calls in one place. No more clunky headphones, no more tangled cords.
Jawbone ERA is the first headset with a built-in accelerometer and patented MotionX™ technology. Out of the box, you can double ShakeShake® Jawbone ERA into pairing mode or TapTap® to answer phone calls. And because Jawbone ERA is completely integrated with the online MyTALK platform, it will continue to gain functionality as we develop new motion applications.
Jawbone ERA gets better with time when synced with Jawbone's industry first MyTALK platform. Download apps, customize new features like Caller ID by Name (exclusive to Jawbone ERA), set different voices or language options, even program Jawbone ERA to send emails and text messages using your voice. Keep tabs on battery.
To check battery status, glance at the battery meter that automatically displays in the status bar of your iPhone® (BlackBerry® and others available at MyTALK). Or just press the TALK button on Jawbone ERA to hear an update: "About 5 hours of talk time remaining". When your battery is running low, you'll hear a reminder to charge up whispered in your ear.
PERFECT FIT - Every Jawbone ERA comes with eight earbuds and anoptional binaural earloop, ensuring the perfect fit in either ear, no matter what your size. It's so light and comfortable, you'll probably forget you're even wearing it. Jawbone ERA also includes Jawbone's innovative Spoutearbud, a breakthrough design that channels audio directly into your ear,providing the clearest sound.REFINED DESIGN - With its layered, architectural surface exterior andfaceted body, Jawbone ERA's sophisticated form reflects the advancedtechnology within. Available in four striking designs.ECO-FRIENDLY - Our packaging is 100% recyclable and made fromonly two materials: recycled paper and PET plastic. The total volume ofJawbone's headset packaging has also been reduced by over 50% fromprevious years.


Sliding glass doors are beautiful and helps gives that elegance and taste you have in or architectural design. Sliding glass doors can be used both at homes and in offices. It is an open secret and inescapable that you would need to repair your sliding glass doors after they have served you for a few good years. It is not abnormal that these doors develop crack, the rollers get stuck in their tracks, become unhinged or simply have their glasses shattered. When this happens you may find that the beauty of the sliding doors is lost and the operation becomes a hassle as it gets harder having to lose or open the doors.
Sliding doors come in a lot of variety – shapes, sizes, designs – and there are various ways they get damaged after years from use. If you are in the Pembroke park are in Florida, and you are tired of the hassles of having to go through the difficulty of opening and closing your sliding glass door and need to have it fixed or replaced, or you just want to change the design to something of your taste, then you should contact American Sliding Doors Inc. and you can be sure that a professional service of high quality is guaranteed. We have multi skilled professional with expertise in any and every kind of sliding glass doors. And we would ensure to repair, replace or provide maintenance on your sliding doors speedily and effectively to make them last longer and function better.


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Nigeria, major world economies consolidate progress on trade and investment facilitation
Sam Smith News 12 October 2017
Source: APO Africa NewsroomVisit website
Photo credit: FMITI Nigeria | APO
The group of WTO Friends of Investment Facilitation for Development (FIFD) pledged support for the success of the High-Level Investment Forum taking place in Abuja on the 3rd and 4th of November
Nigeria, Brazil, China, the European Union (EU) and a host of other leading economic powers on 10 October 2017 made tremendous progress on Investment Facilitation Initiative for Development, in Marrakech, Morocco, during the World Trade Organisation (WTO) Mini-Ministerial meeting.
In a breakthrough for Nigeria, the group of WTO Friends of Investment Facilitation for Development (FIFD) pledged support for the success of the High-Level Investment Forum taking place in Abuja on the 3rd and 4th of November, co-hosted by the Ministry of Industry, Trade and Investment and the Economic Community of West Africa (ECOWAS) Commission in partnership with FIFD.
Investment Facilitation for Development is an initiative by some WTO members including Nigeria as a core member to constructively and progressively drive trade and investment with concrete deliverables in mind.
This WTO Investment Coalition is made of Nigeria, Argentina, China, Australia, Brazil, Chile, Colombia, Hong Kong, Japan, Korea, Mexico, Pakistan, Russia, Singapore, Switzerland, Canada and the European Union.
A draft declaration is being negotiated for finalization at the WTO in Geneva, Switzerland, as part of the deliverables for the Buenos Aires, Argentina, Ministerial Conference in December.
The Objectives of the Investment Coalition are:
Place investment facilitation as a priority for the WTO Ministerial MC11 in Buenos Aries, Argentina.
Achieve coherence between the trade and investment policy communities and position the WTO to be more pro-development with actual deliverables for its members.
Seek active investment opportunities in their countries.
"Nigeria is part of this coalition because we see investment and trade facilitation as a positive and pro-development agenda, and ensure that the WTO is better responsive to domestic economic priorities," said the Minister of Industry, Trade and Investment Dr. Okechukwu
"This Investment Facilitation Initiative is potentially significant to position WTO better to respond to the investment needs of developing countries, in general and African countries in particular," he added.
In his remarks, the Director General/Chief Negotiator of the Nigerian Office for Trade Negotiations (NOTN) Ambassador Chiedu Osakwe expressed delight at the progress made so far, saying: "This is for economic growth and recovery, creation of employment opportunities and connection to global value chains."
The Abuja event titled "High-Level Forum on Trade and Investment Facilitation for Development" is expected to bring together African Investment and Trade decision makers as well private sector representatives to share perspectives on leveraging trade and investment opportunities on the continent. It seeks to connect actual investors within and outside the continent with African policy makers in order to produce concrete outcomes.
At the concluding session of the WTO Ministerial in Marrakech, Edward Yau, Hong Kong China Trade and Industry Secretary, in reporting to the Ministerial Meeting, invited the WTO to ensure the success of the Abuja event on trade and investment facilitation.
Constance C. Ikokwu
Strategy and Communications Adviser to Minister
Distributed by APO on behalf of Federal Ministry of Industry, Trade & Investment, Nigeria.
Tags World Trade OrganisationInvestment policyTrade facilitation Global trade governance Trade Law and Regulation
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redpajama_set_name: RedPajamaCommonCrawl


A typically charming country house is usually imagined with a spacious and prettily furnished veranda, terrace or porch. Though shaded terraces were usually built to protect visitors from the rain and sun in bygone days, today, such verandas are ideal spots for relaxing outdoors and enjoying a drink with family or friends.
So today, we've collated 11 beautiful country homes to inspire you—and all come with lovely verandas! If you're after some simple home and garden inspiration, these porches will be just the ticket.
A large and gently sloping brown roof protects the dark green walls of this Japanese home, simultaneously shading the spacious L-shaped wooden terrace. This roof, along with the neat wooden railings, offers ample privacy and comfort to the terrace.
The pretty white wooden porch and the staircase that leads to it, complement the bright lemon walls of the house for a cheerful and cosy feel. It is also spacious enough for relishing casual chats and lazy afternoon teas. Credit for this creation goes to the architects at Kanda Arquitectos.
Light-hued wood arranged horizontally and in a criss-cross manner makes this Greek-style terrace a classy affair. Neat steps leading to the porch, beautiful plants and quaint furniture make the veranda seem like a European cafe.
This house belongs to a family of avid surfers, and the spacious porch with pretty white railings offers them a fabulous spot for unwinding and socialising without dirtying the interiors. The elegant stone steps leading to the porch look inviting, too.
Wide stone steps flanked by natural stone balustrades lead you to a gorgeous L-shaped wooden porch. The simple yet chic wooden fence and vibrant pink blossoms add oodles of charm to the spot.
Built symmetrically, the classical architecture and design of this residence is reflected in the welcoming porch with its pretty railings. Slender white columns add a quaint touch, while the bright green entrance door complements the lush greenery outside.
Situated in a forested area, this house combines an elegant grey roof with white columns and railings to make the porch look beautiful and timeless. The floors are wooden, lending warmth to the terrace.
Rendered almost entirely in wood with natural grey stone for its foundation, this expansive villa comes with multiple terraces which are shaded and cosy. Wood lends warmth to the verandas, while glass windows ensure a modern feel.
A roof lined with bright red tiles not only makes the house look pretty, but also lends an extra edge to the white and grey porch. Set amidst lush greens, the terrace with its latticed windows and cute fence looks very American and peaceful.
White concrete paired with earthy bricks and slate grey roofs make this large house elegant and warm. To top it all, there's a large white terrace with a simple neat railing and slender columns.
The small, quaint and shaded porch lends a lot of personality to this house, if not tons of outdoor space. Bright flowers in pretty planters make the whole house look inviting and lively.
Which of these verandas would you pick for your home?


Villaz Dental is located at North Avenue and Addison in a strip center in front of HOBO. You will find us between Dunkin Donuts and Chipolte. We have convenient parking right in front of our office.
We provide dental services to Villa Park, Addison, Elmhurst and Lombard.


Welcome to Black Dog Chimney Sweeps Suffolk. We are a small family run business covering Beccles, South Norfolk and North Suffolk with our sweeping services. Pete is our qualified and fully insured chimney sweep. He is a registered member of the Institute of Chimney Sweeps and also undertakes mentoring and testing of sweeps for them. His eye-catching van can regularly be seen in Gorleston, Lowestoft, Beccles, Bungay and Southwold areas.
We sweep all varieties of chimneys, including open fires, wood or multifuel burners, inglenooks and more. We hold an Environment Agency license to remove the debris and soot from the property and ensure that it is disposed of properly. We can carry out CCTV surveys of chimneys to see the cause of any blockages or build ups, and provide reports if required for insurance companies. We also perform smoke tests and can fit Carbon Monoxide and Smoke Alarms if required.
If you have any queries or require more information on our services call us today.
We can test your Carbon Monoxide Alarm with a specialist gas to check if the sensor is working. Ideal for landlords, as this service comes with certification. Ask for more details.
As a leading chimney sweep in Beccles and Suffolk Pete has worked hard to establish himself as a professional and reliable sweep. He strives to continuously improve the services he offers. We can sweep using the traditional way, but Power Sweeping is our regular method of sweeping. This is much more efficient at soot and tar build up removal, and gentle on both chimneys and flue liners. Call us and book your appointment today.
We offer a safe, reliable and full chimney sweeping service to all our customers. Our work is backed by the Institute Of Chimney Sweeps. The removal and disposal of soot from your property (as required by the Environment Agency) is included in the price of your sweep. We can fit Smoke and Carbon Monoxide Alarms.
Pete is a trained, fully qualified, and insured chimney sweep. A registered member of The Institute Of Chimney Sweeps.
We offer 7 days a week chimney sweeping service, at competitive prices to suit our customers. No more taking time off work just to get your chimney swept. The issue of a Certificate Of Sweeping, is included in the price of your sweep.
Black Dog was a recommendation to me and I can not praise the service enough. In my opinion there is no competition in this field locally. Very Professional, knowledgeable and affordable. Excellent service. Thank you.
Very good company . excellent clean work very pleasant attitude reliable and punctual used for many years very trustworthy would have no trouble recommending to anyone .
Pete, the sweep, came to our house at the time given. Swept our chimney fully. Got loads of soot down, created no mess, left no mess and offered loads of advice. Really friendly, will definitely use again next year!