Browsing by Author "Yorke, E."

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Body composition and ankle-brachial index in Ghanaians with asymptomatic peripheral arterial disease in a tertiary hospital
(2016-05-13) Yeboah, K.; Puplampu, P.; Yorke, E.; Antwi, D.A.; Gyan, B.; Amoah, A.G.B.
Abstract Background Ankle-brachial index (ABI) and indices of obesity are both use to indicate cardiovascular risk. However, association between body composition indices and ABI, a measure of peripheral arterial disease, is inconsistent in various study reports. In this study, we investigated the relationship between ABI and general and central indices of obesity in Ghanaians without history of cardiovascular diseases. Method In a case–control design, ABI was measured in a total of 623 subjects and categorised into PAD (ABI ≤ 0.9, n = 261) and non-PAD (ABI > 0.9, n = 362) groups. Anthropometric indices, BMI, waist circumference (WC), waist-hip ratio (WHR) and waist-height ratio (WHtR) were also measured. Results PAD subjects had higher mean BMI (29.8 ± 8.7 vs. 26.5 ± 7.6 kg/m2, p = 0.043) and waist circumference (95 ± 15 vs. 92 ± 24 cm, p = 0.034) than non-PAD subjects. In multivariable logistic regression models, having BMI ≥ 30 kg/m2 increased the odds of both unilateral [OR (95 % CI): 2 (1.14–3.51), p < 0.01] and overall PAD [2 (1.22–3.27), p < 0.01]. Conclusion In indigenous Ghanaians in our study, PAD participants had higher BMI and waist circumference than non-PAD participants. Also, halving BMI ≥ 30 kg/m2 was associated with twofold increase in the odds of PAD.
A case of Cushing Syndrome due to accidental intake of dexamethasone: a call for enforcement of regulatory laws
(Ghana Med J, 2021) Asamoah, K.T.; Akpalu, J.; Atiase, Y.; Yorke, E.
Cushing syndrome could be a complication of long-term steroid use, resulting in a wide range of clinical presentations. Whereas some patients take medically prescribed doses of conventional medicines, including steroids for various ailments, others inadvertently consume unspecified doses by adulterating traditional medicines with these orthodox medications to increase their therapeutic appeal. Furthermore, some individuals with access to conventional medica tions may sell them in unlabelled packages as traditional medicines (TMs) to unsuspecting customers. This may lead to undesirable side effects and safety concerns. The case report highlights the problem of poorly regulated access to medications and makes suggestions to protect patrons' health of traditional medicines.
Challenges in the Management of a Patient with Myxoedema Coma in Ghana: A Case Report
(Ghana Medical Journal, 2017-03) Akpalu, J.; Atiase, Y.; Yorke, E.; Fiscian, H.; Kootin-Sanwu, C.; Akpalu, A.
Myxoedema coma is a rare life-threatening disease, and it is essential that it is managed appropriately to reduce the associated high mortality. However, in the setting where efficient healthcare delivery is hampered by inadequacies, the management of such cases may pose a significant challenge. We present the case of a middle-aged woman diagnosed with myxoedema coma and severe hyponatremia. The case report highlights some of the challenges that may be encountered during the management of myxoedema coma in similar settings and outlines the management strategies undertaken to overcome them in the absence of national guidelines. It also brings to the fore the need for clinicians to look out for clinical features suggestive of hypothyroidism particularly among high risk individuals for early diagnosis and treatment.
Co-Morbid Hypothyroidism and Liver Dysfunction: A Review
(Clinical Medicine Insights: Endocrinology and Diabetes, 2024) Yorke, E.
The liver and thyroid hormones interact at multiple levels to maintain homoeostasis. The liver requires large, adequate amounts of thyroid hormones to execute its metabolic functions optimally, and deficiency of thyroid hormones may lead to liver dysfunction. Hypothyroidism has been associated with abnormal lipid metabolism, non-alcoholic fatty liver disease (NAFLD), hypothyroidism-induced myopathy, hypothyroidism-associated gallstones and occasionally, interferon-induced thyroid dysfunction. NAFLD remain an important association with hypothyroidism and further studies are needed that specifically compare the natural course of NAFLD secondary to hypothyroidism and primary NAFLD. Hepatic dysfunction associated with hypothyroidism is usually reverted by normalizing thyroid status. Large-scale studies geared towards finding new and effective therapies, especially for NAFLD, are needed. The clinician must be aware that there is overlapping symptomatology between liver dysfunction and severe hypothyroidism, which may delay the diagnosis and treatment of hypothyroidism; this requires a high index of suspicion
Comparison of neurocognitive changes among newly diagnosed tuberculosis patients with and without dysglycaemia
(BMC Psychiatry, 2020-04-03) Yorke, E.; Boima, V.; Dey, I.D.; Ganu, D.; Nkornu, N.; Acquaye, K.S.; Mate-Kole, C.C.
Background: Diabetes often occurs together with tuberculosis (TB) and both may affect each other negatively. Diabetes may be associated with neurocognitive dysfunctioning in affected patients and may negatively impact treatment adherence and outcomes. This study compared the neurocognitive status between newly diagnosed smear positive tuberculosis patients with dysglycaemia and those with normoglycaemia. Methods: The current study was a cross-sectional study involving one hundred and forty-six (146) newly diagnosed smear positive TB patients. Oral glucose tolerance test (OGTT) was performed and the results were categorized as either normoglycaemia, impaired glucose tolerance (IGT), impaired fasting glucose (IFG) or diabetes. Neurocognitive functioning among study participants was assessed at the time of TB diagnosis using Cognitive Failure Questionnaire (CFQ), Montreal Cognitive Assessment tool (MoCA), California Verbal Learning Test (CVLT), Brief Symptom Inventory (BSI) and the Spitzer Quality of Life Index (QLI). Results: The mean age of the participants (n = 146) was 38.7 years with 78.8% being males and 21.2% females. Using the fasting blood glucose test, the prevalence of impaired fasting glucose and diabetes were 5.5 and 3.4% respectively, both representing a total of 13 out of the 146 participants; whilst the prevalence of impaired glucose tolerance and diabetes using 2-h post-glucose values were 28.8 and 11.6% respectively, both representing a total of 59 out of the 146 participants. There were no significant differences in the mean scores on the neurocognitive measures between the dysglaycaemia and normoglycamic groups using fasting plasma glucose (FPG). However, there were significant differences in the mean scores between the dysglycaemia and normal groups using 2-h postprandial (2HPP) glucose values on Phobic Anxiety (Normal, Mean = 0.38 ± 0.603; dysglycaemia, Mean = 0.23 ± 0.356; p = 0.045), and Montreal Cognitive Assessment (MoCA) scores (17.26 ± 5.981 vs. 15.04 ± 5.834, p = 0.037). Conclusion: Newly diagnosed smear positive patients with dysglycaemia were associated with significantly lower mean cognitive scores and scores on phobic anxiety than those with normoglyacaemia. The latter finding must be further explored.
Coping strategies and resilience among patients with hypertension in Ghana
(Frontiers in Psychology, 2023) Boima, V.; Yorke, E.; Ganu, V.; Gyaban-Mensah, A.; Ekem-Ferguson, G.; Kretchy, I.A.; Mate-Kole, C.C.
Background: Hypertension is associated with high morbidity and mortality and this has been linked to poor treatment and control rates. To optimize drug treatment, patient-centered strategies such as coping, resilience, and adherence to medication may improve control rates and decrease the morbidity and mortality associated with hypertension. This study, therefore, assessed coping skills and resilience among patients with hypertension in Ghana. Methods: A cross-sectional study was conducted at Korle Bu Teaching Hospital. 224 consented patients with a diagnosis of hypertension were consecutively selected from the outpatient clinic. Questionnaires comprising socio-demographic characteristics, clinical parameters, Adult Resilience Measure, and the Africultural Coping Systems Inventory were administered. Data were analyzed using Stata version 16.1 and significance level was set at p-value of ≤ 0.05. Results: The mean age of participants was 62.03 ± 11.40 years and the majority were female (63%). The overall coping strategy mean score was 43.13 ± 13.57. For resilience, median relational and personal resilience (PR) scores were 32 (IQR-7) and 39 (IQR-9), respectively. Increased systolic BP significantly increases the overall coping strategy score. Collective coping strategy and systolic BP significantly increased coping scores (95%CI = 0.05–3.69 vs. 95%CI = 0.58–5.31). Overall coping strategy significantly increased personal and relational resilience (RR) domain scores by 0.004 (95%CI = 0.002–0.01) and 0.005 (95%CI = 0.003–0.006) units, respectively. This study demonstrated that Cognitive and emotional debriefing coping strategy was mostly used by patients with hypertension. Conclusion: Coping strategies had a positive and significant correlation with personal and RR, specifically collective and cognitive debriefing had a significant positive association with resilience among study participants. There is a need to actively put in measures that can improve the coping strategies and resilience among patients with hypertension to adjust to the long-term nature of the illness and treatment as this will promote better treatment outcomes.
Depression and glycaemic control among type 2 diabetes patients: a cross-sectional study in a tertiary healthcare facility in Ghana
(BMC Psychiatry, 2018-11) Akpalu, J.; Yorke, E.; Ainuson-Quampah, J.; Balogun, W.; Yeboah, K.
Background Diabetes and depression are both chronic debilitating conditions, and their coexistence has been associated with adverse outcomes. In this study, we investigated the association between glycaemic control and depression in type 2 diabetes (T2DM) patients attending a tertiary healthcare facility in Ghana. Methodology In a cross-sectional study design, Patient Health Questionnare-9 (PHQ-9) was used to assess depression in 400 T2DM, aged 30–65 years. Anthropometric characteristics and blood pressure were measured. Venous blood was collected to measure the levels of glycated haemoglobin (HbA1c). Results The prevalence of depression was 31.3% among T2DM patients. Female gender, being unmarried, frequent intake of alcohol, previous smoking status and insulin use were associated with increased odds of depression, whereas being educated above basic school level was associated with a decreased odds of depression. In a multivariable logistic regression model, being unmarried and poor glycaemic control were associated with an increase in odds of depression after adjusting for age, gender, and social factors. The association between depression and glycaemic control was attenuated when clinical factors were introduced into the model. Conclusion In our study population, we found that depression is common among Ghanaians with T2DM, and not associated with poor glycaemic control in a fully multivariable-adjusted model.
Depression and quality of life in patients on long term hemodialysis at a nationalhospital in Ghana: a cross-sectional study
(Ghana medical journal, 2018-03) Ganu, V.J.; Boima, V.; Adjei, D.N.; Yendork, J.S.; Dey, I.D.; Yorke, E.; Mate-Kole, C.C.; Mate-Kole, M.O.
The study examined quality of life and prevalence of depressive symptoms in patients on long term hemodialysis. Further, it explored the impact of socio-demographic characteristics on depression and quality of life. Design Study design was cross-sectional. Setting Study was conducted in the two renal dialysis units of the Korle-Bu Teaching hospital in Accra, Ghana. Participants and study tools One hundred and six participants on haemodialysis were recruited for the study. The Patient Health Questionnaire and the World Health Organization Quality of Life instrument were used to assess depression and quality of life. Results Forty five percent of participants screened positive for symptoms of depression. Approximately 19% obtained low scores on overall quality of life. There were significant negative correlations between the following: Depression and overall QoL, Depression and duration of dialysis treatment and Depression and income level. There was positive correlation between overall QoL and duration of dialysis, treatment and income. Conclusion Depressive symptoms were common amongst patients on long term hemodialysis. Haemodialysis patients who obtained low scores on quality of life measures were more likely to screen positive for depressive symptoms. Screening for depressive symptoms among these patients is critical as early treatment may improve their general wellbeing.
Determinants of Willingness To Accept Kidney Transplantation Among Chronic Kidney Disease Patients in Ghana
(BMC Nephrology, 2021) Boima, V.; Amissah-Arthur, M. B.; Yorke, E.; Dey, D.; Fiagbe, D.; Yawson, A.E.; Nonvignon, J.; Mate-Kole, C.C.;
Background: The burden of chronic kidney disease in Africa is three to four times higher compared to high- income countries and the cost of treatment is beyond the reach of most affected persons. The best treatment for end stage renal disease is kidney transplantation which is not available in most African countries. As kidney transplantation surgery is emerging in Ghana, this study assessed factors which could influence the willingness of patients with chronic kidney disease to accept it as a mode of treatment. Methods: This cross-sectional survey was carried out among patients with chronic kidney disease in Korle-Bu Teaching Hospital. A consecutive sampling method was used to recruit consenting patients. A structured questionnaire and standardized research instruments were used to obtain information on demographic, socio- economic characteristics, knowledge about transplantation, perception of transplantation, religiosity and spirituality. Logistic regression model was used to assess the determinants of willingness to accept a kidney transplant. Results: 342 CKD patients participated in the study of which 56.7% (n = 194) were male. The mean age of the participants was 50.24 ± 17.08 years. The proportion of participants who were willing to accept a kidney transplant was 67.3% (95%CI: 62.0–72.2%). The factors which influenced participants’ willingness to accept this treatment included; willingness to attend a class on kidney transplantation (p < 0.016), willingness to donate a kidney if they had the chance (p < 0.005), perception that a living person could donate a kidney (p < 0.001) and perceived improvement in quality of life after transplantation (p < 0.005). The barriers for accepting kidney transplantation were anticipated complications of transplant surgery and financial constraints. Conclusion: More than two-thirds of CKD patients were willing to accept a kidney transplant and this is influenced by multiple factors. Government health agencies must consider full or partial coverage of kidney transplantation through the existing national health insurance scheme. Further, efficient educational programmes are required to improve both patients’ and physicians’ knowledge on the importance of kidney transplantation in the management of end stage renal disease in Ghana.
Health-seeking behaviour, referral patterns and associated factors among patients with autoimmune rheumatic diseases in Ghana: A cross-sectional mixed method study
(PLOS ONE, 2022) Amissah-Arthur, M-B.; Gyaban-Mensah, A.; Boima, V.; Yorke, E.; Dey, D.; Ganu, V.; Mate-Kole, C.
Background Challenges exist in the diagnosis and management of autoimmune rheumatic diseases in low and middle income countries due to factors, such as poverty and under-resourced healthcare infrastructure. Furthermore, other contributory factors such as societal, cultural and religious practices influence health seeking behaviour which has a bearing on access and delivery of healthcare. Objectives To examine the health seeking behaviour and referral patterns of Ghanaian patients with autoimmune rheumatic diseases and assess the associated factors that influence these. Method A cross-sectional study using an explanatory sequential mixed method design was carried out in a Rheumatology clinic at a national referral centre. 110 participants were purposively recruited for the quantitative phase. The qualitative phase comprised 10 participants for indepth interviews and 10 participants for a focus group discussion. Analysis using descriptive statistics, t-tests and logistic regression models were performed. Transcripts generated from the interviews and focused group discussion were analysed using thematic analysis. Results Median duration from onset of symptoms until seeking help was 1 week (IQR = 12); from seeking help until obtaining a final diagnosis was 12 months (IQR = 33). Multiple factors determined the choice of first facility visited, X2 (12, N = 107) = 32.29, p = .001. Only twenty-one participants (19.6%) had knowledge of their disease prior to diagnosis. Education predicted prior knowledge [OR = 2.6 (95% CI = .66–10.12), p < .021]. Unemployed participants had increased odds of seeking help after a month compared to those who were employed [Odds ratio = 2.60 (95% CI = 1.14–5.90), p = .02]. Knowledge of autoimmune rheumatic diseases was low with multiple causative factors such as biomedical, environmental and spiritual causes determining where patients accessed care. Forty (36.4%) participants utilised complementary and alternative treatment options. Conclusion We observed that knowledge about autoimmune rheumatic diseases among Ghanaian patients was low. Patients sought help from numerous medical facilities, traditional healers and prayer camps often contributing to a delay in diagnosis for most patients. This was influenced by individual perceptions, cultural beliefs and socioeconomic status. Active awareness and educational programmes for the public and healthcare workers are required, as well as strategic planning to integrate the biomedical and traditional care services to enable earlier presentation, accurate diagnosis and better clinical outcomes for the patients.
High BMI: an important health risk factor among older adults in Ghana
(Public Health Nutrition, 2021) Yorke, E.; Tetteh, J.; Boima, V.; Yawson, AE.
Objective: We examined BMI as a health risk factor for self-reported diabetes mellitus, angina, strokes and arthritis among older Ghanaians aged 50 years and above. Design: We analysed the individual-level data from the World Health Organization Study on global AGEing and adult health Ghana Wave 2 (2014/2015). The influence of BMI on self-reported chronic conditions including diabetes, angina, stroke and arthritis was examined. Setting: Households from all the administrative regions of Ghana. Participants: Included 3350 adults aged 50 years and older. Results: The prevalence of overweight and obesity among participants was 22·8 % (95 % CI 20·6, 25·2) and 13·2 %, respectively (95 % CI 11·5, 15·1). With respect to individual chronic conditions, arthritis emerged with the highest prevalence rate of 7·3 (95 % CI 5·3, 9·9), while the prevalence rate of diabetes, angina and stroke was 2·8 % (95 % CI 2·0, 3·9), 1·7 % (95 % CI 1·1, 2·6) and 1·3 % (95 % CI 1·0, 1·8), respectively. The risk of diabetes among overweight and obesity was over three and two times, respectively, higher compared with participants with normal weights. Overweight and obesity were significantly more than two and three times likely to experience angina, respectively, compared with participants with normal weight. Obesity significantly influences arthritis with approximately two times increased odds compared with normal weight participants. Conclusion: Prevalence of obesity and overweight in Ghana is high and increasing, which poses a health risk at the individual and population levels. Inter-sectorial and multidisciplinary measures in line with the national non-communicable disease policies aimed at curbing this trend are imperative.
Hyperthyroidism and Liver Dysfunction: A Review of a Common Comorbidity
(SAGE, 2022) Yorke, E.
Deranged liver enzymes due to hyperthyroidism rather than intrinsic liver pathology are not uncommon. The reported prevalence of liver biochemical abnormalities in patients with untreated thyrotoxicosis varies widely ranging from 15% to 76%. The suggested causes of liver dysfunction include direct hepatocyte injury, co-morbid heart failure, associated autoimmune conditions (especially in the setting of Graves’ Disease), preexisting liver disease and drugs including antithyroid medications. Although, some patients may have a pattern of mild liver injury, about 1% to 2% can have fulminant hepatitis. Liver enzymes can return to normalcy in as many as 77% to 83% of patients once the initiations of thionamides are started in a timely fashion, which can help forestall complications and prevent or minimize multi-organ dysfunction. Clinicians should maintain a high index of suspicion for underlying hyperthyroidism in patients presenting with unexplained liver dysfunction or unexplained jaundice.
Impact of structured education on glucose control and hypoglycaemia in Type-2 diabetes: a systematic review of randomized controlled trials
(Ghana medical journal, 2018-03) Yorke, E.; Atiase, Y.
Evidence for the use of structured education in diabetes management is accumulating and has shown positive influence in the management of Type-2 diabetes. Objective To assess the impact of structured education on glucose control and hypoglycaemia in the management of Type-2 diabetes. Methods A systematic review was done using Medline via Ovid and EMBASE databases of published English literature between 1980 and 2014. Included studies were randomized control trials that assessed the impact of structured education on glucose control and hypoglycaemia. Results Out of the 12,086 full text articles were identified, 36 full text articles were finally considered for this review after applying both inclusion and exclusion criteria, of which 34 were exclusively on the effect of structured diabetes education on glucose control whilst 2 were studies on the effects of structured diabetes education on glucose control and hypoglycaemia. Majority of the studies included a predominant Caucasian population. There was heterogeneity in the included studies such as intervention methods and intensity as well as follow up periods. Group based education was preferred over individual education by most studies. Overall, most of the studies showed a significant positive effect on glycaemic control compared with control groups. One study showed a significant impact of structured education on hypoglycaemia. Conclusion Structured education has positive impact on glucose control and hypoglycaemia in Type-2 diabetes and must be incorporated in routine care.
Knowledge and Willingness to Donate Kidneys for Transplantation in Ghana: A Cross-Sectional Survey
(Transplantation Proceedings, 2020-05-10) Boima, V.; Ganu, V.; Yorke, E.; Dey, D.; Amissah-Arthur, M.B.; Agyabeng, K.; Yawson, A.; Lartey, M.; Mate-Kole, C.C.
Background. The main treatment modalities for chronic kidney disease (CKD) are dialysis and kidney transplantation. While kidney transplantation provides better survival and quality of life outcomes, it is a new treatment option in Ghana. Finding kidney donors for transplant may be a major challenge due to varied views of the public. Methods. This cross-sectional study was carried out in 5 purposively selected communities in the Greater Accra region in Ghana. Structured questionnaires and standardized instruments were used to assess sociodemographic characteristics, spirituality, and perception of kidney transplantation. Results. The mean age of the 480 participants was 29.60 10.65 years. The proportion of men was 51%. The average score for knowledge of participants on kidney donation was 4.8 2.6. The level of spirituality score was 25.4 3.89. Approximately 48%(231/480) of participants were willing to donate a kidney while still alive. Willingness to donate when dead was 72% (344/480). Willingness to donate a kidney when deadwas significantly lower among the participants in the older age groups.High level of knowledge about kidney transplantation, being employed, basic formal education, and never married were associated with willingness to donate kidney (P < .05). Conclusion. Our results suggest that participants have a low level of knowledge regarding kidney transplantation, while about two-thirds are willing to donate only after death. Continuous public education is key to raise public awareness of the need for kidney transplants. This will support the Ministry of Health in their efforts to institute a kidney transplant program in Ghana.
Management of recurrent pheochromocytoma in pregnancy in a young Ghanaian
(Ghana Medical Journal, 2022) Akpalu, J.; Ampong, C.; Atiase, Y.; Yorke, E.; Takyi, C.; Cole-man, J.
The co-existence of pheochromocytoma and pregnancy is rare, with poor maternal and foetal outcomes. This is a case report of a young Ghanaian woman with a pre-existing diagnosis of recurrent pheochromocytoma who became preg nant and experienced elevated blood pressure in the third trimester with proteinuria and abnormal liver function. She was managed as an in-patient and delivered a live baby via caesarean section at 34 weeks after detecting intra-uterine growth restriction. Management of such cases by a multidisciplinary team is recommended for optimal outcomes.
The mediating role of quality of life on depression and medication adherence among patients with type 2 diabetes mellitus: A cross‐sectional study
(Health Sci. Rep., 2023) Yorke, E.; Boima, V.; Ganu, V.; et al.
Background and Aim: Patients living with diabetes mellitus have a high burden of psychological distress such as depression and anxiety as well as impaired quality of life, which may negatively impact their adherence to medications, glucose control, and health‐related costs. This study assessed the impact of quality of life and depression on medication adherence among patients with type 2 diabetes (type 2 diabetes mellitus [T2DM]) in a tertiary care setting in Ghana Methods: The study was a cross‐sectional study involving 238 patients with diabetes aged 18 years and above. Validated tools were used to assess medication adherence, depressive symptoms, and quality of life. Structural Equation Modeling was adopted to examine the mediation effect of quality of life on the relationship between depression and medication adherence among participants. Results: The mean age of the participants was 58.82 ± 13.49, and 169 (71.0%) out of a total of 238 respondents were females. Depression had a significant direct relationship with the quality of life of respondents [aβ (95% confidence interval, CI) = −0.20 (−0.03, −0.00), p < 0.05; −0.21 (−0.41, −0.01) p < 0.05, respectively] and indirect relationship with quality of life [aβ (95% CI) = −0.01 (−0.02, −0.004) p < 0.001]. Educational status and religion both showed a significant indirect relationship with quality of life [aβ (95% CI) = 0.06 (0.07, 0.12), p < 0.05; 0.18 (0.01, 0.35) p < 0.05, respectively]. The mediating effect of quality of life on the relationship between depression and medication adherence was significant (Sobel = −3.19, p < 0.001). Conclusion: Depression, medication adherence, and quality of life were higher among older adults with T2DM. Depression was also found to have a strong negative association with both medication adherence and quality of life. Interventions to screen for depression and to improve the quality of life in patients living with diabetes are also recommended and this should go beyond the provision of standard treatments to explore further the mechanisms of this relationships.
The mediating role of quality of life on depression and medication adherence among patients with type 2 diabetes mellitus: A cross‐sectional study
(Health Science Reports, 2023) Yorke, E.; Ganu, V.; Tetteh, J.; et al.
Background and Aim: Patients living with diabetes mellitus have a high burden of psychological distress such as depression and anxiety as well as impaired quality of life, which may negatively impact their adherence to medications, glucose control, and health‐related costs. This study assessed the impact of quality of life and depression on medication adherence among patients with type 2 diabetes (type 2 diabetes mellitus [T2DM]) in a tertiary care setting in Ghana Methods: The study was a cross‐sectional study involving 238 patients with diabetes aged 18 years and above. Validated tools were used to assess medication adherence, depressive symptoms, and quality of life. Structural Equation Modeling was adopted to examine the mediation effect of quality of life on the relationship between depression and medication adherence among participants. Results: The mean age of the participants was 58.82 ± 13.49, and 169 (71.0%) out of a total of 238 respondents were females. Depression had a significant direct relationship with the quality of life of respondents [aβ (95% confidence interval, CI) = −0.20 (−0.03, −0.00), p < 0.05; −0.21 (−0.41, −0.01) p < 0.05, respectively] and indirect relationship with quality of life [aβ (95% CI) = −0.01 (−0.02, −0.004) p < 0.001]. Educational status and religion both showed a significant indirect relationship with quality of life [aβ (95% CI) = 0.06 (0.07, 0.12), p < 0.05; 0.18 (0.01, 0.35) p < 0.05, respectively]. The mediating effect of quality of life on the relationship between depression and medication adherence was significant (Sobel = −3.19, p < 0.001). Conclusion: Depression, medication adherence, and quality of life were higher among older adults with T2DM. Depression was also found to have a strong negative association with both medication adherence and quality of life. Interventions to screen for depression and to improve the quality of life in patients living with diabetes are also recommended and this should go beyond the provision of standard treatments to explore further the mechanisms of this relationships.
Older adults with hypertension have increased risk of depression compared to their younger counterparts: Evidence from the World Health Organization study of Global Ageing and Adult Health Wave 2 in Ghana
(Journal of Affective Disorders, 2020) Boima, V.; Yorke, E.; Archampong, T.; et al.
Background: Depression and hypertension interact through a complex interplay of social, behavioral and bio logical factors. Despite the huge burden of hypertension in the African sub-region, very little information exists on depression among hypertensive patients. This study assessed the prevalence and factors associated with depression among young and older adult hypertensive patients in Ghana. Method: Data from the World Health Organization Study on Global AGEing and Adult Health wave 2 (2014/ 2015) for Ghana was used. Depression was estimated among participants with blood pressure 140/90mmHg and above. Weighted descriptive statistics and logistic regression with adjusted predictions were carried out. The analysis was performed using Stata 15. Result: The overall prevalence of depression was 6.3%. Older hypertensive patients had almost twice the pre valence of depression compared with younger patients (8.4% vs 4.5%). The factors which predicted depression among hypertensive patients were educational level, marital status, religion, region of residence, work status, self-rated health (SRH), and unhealthy lifestyle. Participants with no religion were more than 7 times likely to be depressed compared with Christians [aOR(95%CI)=7.52(2.11-26.8)]. Those in the Volta region were more than 8 times likely to be depressed compared to those in the Greater Accra region [aOR(95%CI)=8.58(2.51-29.3)]. Conclusion: Older adult hypertensive patients were more likely to experience depressive symptoms. Multiple factors predicted depression in both young and old hypertensive patients; thus a comprehensive care package including psychological support for patients with hypertension is essential for optimum clinical management.
Pachydermoperiostosis in a patient with chronic hepatitis B virus infection referred as acromegaly: a case report
(Journal of Medical Case Reports, 2018-03) Atiase, Y.; Yorke, E.; Akpalu, J.; Opoku-Asare, B.; Adjei, P.; Amissah-Arthur, M.B.; Akpalu, A.
Background Primary hypertrophic osteoarthropathy also known as pachydermoperiostosis is a rare genetic disorder that has often been confused with acromegaly because of similar clinical features. Vascular endothelial growth factors which have been implicated in the clinical features of pachydermoperiostosis, have also been shown to be present in chronic hepatitis and implicated in the malignant transformation of hepatitis B infection to hepatocellular carcinoma. To the best of our knowledge there is one reported case of pachydermoperiostosis with chronic hepatitis B infection. We do not imply a causal relationship between pachydermoperiostosis and hepatitis B infection because pachydermoperiostosis is a genetic disorder; however, the question is raised whether hypertrophic osteoarthropathy is one of the many extrahepatic manifestations of chronic hepatitis B infection. Case presentation A 21-year-old African (Ghanaian) man with chronic hepatitis B infection was referred to our Endocrine unit as having acromegaly with changing facial features, enlarging hands and feet, and large knee joint effusions which affected activities of daily living. He was finally diagnosed as having pachydermoperiostosis when acromegaly, rheumatological disorders, as well as cardiopulmonary disorders were ruled out. He improved with arthrocentesis, a tapering regime of steroids, non-steroidal anti-inflammatory drugs, and proton pump inhibitors. Conclusions The possible role of hepatitis B in hypertrophic osteoarthropathy, that is, secondary hypertrophic osteoarthropathy, needs to be explored; however, with digital clubbing in his father our patient is likely to have pachydermoperiostosis.
Predictors and outcome of systemic lupus erythematosus (SLE) admission rates in a large teaching hospital in sub-Saharan Africa
(Lupus, 2018-02) Dzifa, D.; Boima, V.; Yorke, E.; Yawson, A.; Ganu, V.; Mate-Kole, C.
Although it was previously believed that systemic lupus erythematosus was uncommon among Africans, it has become increasingly apparent that the incidence is higher, and socioeconomic challenges such as physician shortages, poor medical facility access, and poor health literacy may worsen prognosis. This retrospective study examines characteristics and outcomes of hospitalized systemic lupus erythematosus patients over a two-year period and serves as a baseline for comparison for future studies to examine the outcomes with the provision of more dedicated care. There were 51 patient admissions over a two-year period, with a mean duration from start of illness to admission of approximately two years. Duration of admission ranged from one to 140 days with a mean period of 26.12 days (SD ± 26.6). There were 22 deaths (43.1% of admissions), which were mainly due to infections and renal complications. Factors associated with risk of death in regression analysis were: infections, fever, disease flare, musculoskeletal involvement, amenorrhea, depression, a clinical finding of hepatomegaly, and chest infection. Understanding the effect and outcome of systemic lupus erythematosus across different countries can elucidate the role of genetic, environmental, and other causative factors in the progression of the disease.