Applying the ICF codes, flag model and C-OAR-SE in the development of return-to-work assessment scale for stroke survivors.

BACKGROUND: The Return-to-Work Assessment Scale (RAS) was developed in 2021 by Ibikunle et al. to assess return-to-work among post-stroke survivors. OBJECTIVE: The aim of this study was to describe how the conceptual (flag model and ICF) and theoretical framework (C-OAR-SE) were used in developing the RAS. METHOD: The development of the RAS consisted of three phases: (i) Initial item generation (ii) Face and content validity (iii) Psychometric testing. With each phase embracing the flag model, international classification of functioning, disability and health (ICF) and the C-OAR-SE an acronym for the six aspects of the theory: 'C' [construct definition], 'OAR' [object representation, attribute classification, and rater entity identification], and 'SE' [selection of item type and answer scale, as well as, enumeration]. RESULTS: A triangulated approach drawn on three separate theories and models. Phase one was developed by using the flag model which provided the semi-structured open ended questions that materialized into the draft instrument while phases two and three were developed using the ICF and the C-OAR-SE. The scale consists of two sections, A and B. Section A comprises general information about post-stroke survivors, which would not be scored, while section B includes three parts that are important to consider when deciding to return-to-work. CONCLUSION: An instrument called RAS was developed, an excellent, internally consistent, as well as reliable tool that has demonstrated good group and structural validity.

Diversity training for health professionals: Preparedness to competently address intellectual disability in the Western Cape Province, South Africa.

Diversity training for health professionals in South Africa has traditionally been conceptualized as differences in gender, race or ethnicity, culture and sexual orientation. More recently physical disability and mental illness was included as a dimension. Intellectual disabilities received lip service as a diversity concern. This paper reports on health professionals' perceptions of the extent to which diversity training prepared them to competently deal with intellectual disabilities. This explorative study included a purposive sample of 18 health care professionals experienced in intellectual disability services. Two focus groups were facilitated over three sessions. Transcripts were analysed thematically. Health professionals felt inadequately prepared to consider intellectual disabilities as a diversity issue. They could not effectively advocate for reasonable accommodation. There was a differential familiarity with issues related to diversity and intellectual disability with profession constituting an additional intersecting dimension of diversity. Health professions did not perceive their diversity training to prepare them to deal competently with intellectual disabilities.

Validation of content and structure of the Return-to-work assessment for post-stroke survivors.

Background: Validation of an instrument consist of three main types: content, criterion and construct. Content validity needs to be determined in order for an instrument to be acceptable for use, validity establishes the fact that an instrument measures exactly what it proposes to measure. The Return-to-work assessment scale (RAS) was developed to measure three aspects of return to work: (Personal factors and/or issues, work issues and contextual factors) in 2021. Objective: To report on the processes followed in establishing the face and content validity of the RAS. Method: Twenty participants took part in our study, they were selected purposively and conveniently from a pool of professionals and post stroke survivors. The Delphi survey technique was used to arrive at consensus and professional opinion on the items included in the RAS. Consensus was sought on the items, domains and subdomains included in the RAS that was used to assess return-to-work after a stroke. Our study was concluded after the third round. Result: One item was remove out of the original 86, three (3) domains made up of eleven (11) subdomains were retained. The RAS had consensus of 100% after three rounds of scrutiny for all items. Conclusion: The RAS was found to be valid, thereby establishing its face and content validity. Clinical implication: The RAS is valid and was recommended for psychometric testing which was the next stage after face and content validity.

An exploration of the impact of COVID-19 on mental health in South Africa.

In response to the COVID-19 pandemic, South Africa implemented a strict stay-at-home order. The mental health effects of the pandemic and related containment measures are minimally documented in this region. This study examines the association between COVID-19 related stressors and mental health during a strict stay-at-home order in South Africa. A total of 860 self-selected participants residing in the Western Cape province completed an online survey from 20-31 May 2020. This sample consisted mainly of higher socioeconomic and higher educated segments of the population. Structural equation modelling was used to assess how sociodemographic factors, membership of vulnerable groups and COVID-19 related stressors were associated with PHQ-9 (depression) and GAD-7 (anxiety) scores. 46.0% and 47.2% of participants met the diagnostic threshold of anxiety and depressive disorder, respectively. Considerable daily life repercussions were linked to these scores. Among these participants, less than 20% consulted a formal practitioner and this was 12% for participants without a pre-existing mental health condition. Distress related to containment measures and distress about being infected were significantly associated with more anxiety and depressive symptoms. Having a pre-existing mental health condition was associated with poorer mental health, but being an active health worker was not. Younger age, being female, and living in a non-rural area were associated with poorer mental health. Our findings suggest a considerable mental health impact of this pandemic and related containment measures, but low attendance of mental health services. The accessibility to tailored mental health support is essential under these circumstances, especially for vulnerable groups.

Structural validity and reliability of the return to work assessment scale among post stroke survivors.

BACKGROUND: Return to work (RTW) after injury or illness is a behavior influenced by physical, psychological and social factors. This study aims to determine the structural validity and reliability of a return to work assessment scale using internal consistency and factor analysis. METHOD: A cross sectional survey research design was adopted for this study involving 101 Post stroke survivors. The return to work assessment scale, which was developed by Ibikunle et al. in 2019, was subjected to structural validity and reliability. RESULT: The results reveal that 58 (57.4%) were males and 43 (42.2%) females with mean ages of 53.88±10.68 years. Internal consistency was high with a Cronbach's alpha coefficient of 0.81 for Domain 1, 0.93 for Domain 2 and 0.76 for Domain 3.Test-retest reliability analysis gave an ICC of 0.85(p = 0.001) for Domain 1, Domain 2 an ICC of 0.91 (p = 0.001) and Domain 3 an ICC of 0.99 (p = 0.001). The Kaiser-Meyer-Olkin measure of sampling adequacy (KMO) value for Domain 1 was X2  = 0.63 and that of Bartlett's test of sphericity value was significant (P = 0.000), Kaiser-Meyer-Olkin measure of sampling adequacy for Domain 2 was 0.84 and the Bartlett's test of sphericity value was significant (P = 0.000), the Kaiser-Meyer-Olkin measure of sampling adequacy for Domain 3 was 0.66 while the Barlett's test of sphericity was significant (p = 0.001). Therefore the factor analysis was appropriate. CONCLUSION: The return to work assessment scale is a good, internally consistent and reliable tool that has demonstrated good group and structural validity.

Non-cognitive Support for Postgraduate Studies: A Systematic Review.

Retention of postgraduate students is a complex problem at higher education institutions. To address this concern, various forms of academic support are offered by higher education institutions to nurture and develop the pipeline of postgraduate students. The support provided to postgraduate students tends to emphasize academic support at times at the expense of psychosocial or non-academic support. Non-cognitive skills were underscored as integral to determining academic and employment outcomes and thus, may need to be investigated more. This manuscript reports on an attempt to filter and consolidate the literature reporting on interventions for postgraduate students that include the development of non-cognitive skills. A systematic review was conducted, because it enabled rigorous and replicable process of consolidating literature. Covidence software was used as a digital platform for the systematic review. The review was conducted at four levels as per the PRISMA guideline namely, identification, screening, eligibility and final summation. The filtration process attempted to answer the following research questions: (1) How are non-cognitive factors or skills defined? (2) Which non-cognitive skills were included in support for postgraduate (Masters and Doctoral) students in the higher education setting?, and (3) How have non-cognitive skills been included in support interventions provided to retain postgraduate students? Descriptive and theory explicative metasynthesis was used for the summation and data extraction. The primary finding was that the term non-cognitive was not used explicitly in the included studies to describe skills or factors supporting student retention. The discourse centered around support and social support as non-academic factors and skills. This suggested that non-cognitive skills were constructed as co-curricular and not integrated into the postgraduate academic project or core learning outcomes. The findings highlighted the distinction between non-cognitive skills and factors and illustrated how skills and factors operate at different levels with different spheres of influence. The formats of support provide an intersectional space where skills and factors are combined.

Ellisras Longitudinal Study 2017: patterns of physical activity in an urban and rural setting among black South African adults (ELS 23).

BACKGROUND: Understanding patterns of physical activity among adults can lead to targeted approaches to improve activity levels in the African population. This study aimed to determine whether age, gender, location and employment status could predict physical activity among rural and urban South African adults, and to determine the participants' risk of developing cardiovascular disease (CVD). METHODS: A cross-sectional design was conducted on 319 participants of mean age 57 ± 10.43 years. Participants were sampled using a stratified random-sampling procedure from an urban township in Langa, Western Cape Province, and a rural township in Mt Frere, Eastern Cape Province, South Africa. A researcher-generated questionnaire was used to collect sociodemographic and physical activity data. Linear regression analysis was used to test predictive relationships. RESULTS: Gender and geographical location were significant predictors (p = 0.001) of physical activity. Rural participants engaged more in physical activity (91.5%) than urban participants (84.2%) and were more likely to meet the physical activity recommendations to promote cardiovascular fitness (p = 0.000). The most frequent physical activities in rural participants were walking (15.4%), household chores (18.8%) and household chores + gardening (15.4%). The most frequent physical activities in urban participants were household chores (34.2%), and household chores + walking (33.7%). In terms of duration of physical activity, rural participants spent longer periods engaging in activities lasting up to two hours (21.4%), compared to 5.9% in urban participants (p = 0.000). CONCLUSIONS: Gender and geographical location were significant predictors of physical activity among black South African adults. Overall, rural adults engaged in more physical activity than urban-dwelling adults. Males also engaged in more physical activity and at a higher intensity than females. Most rural participants met the American College of Sports Medicine recommendations for cardiovascular fitness and therefore were at minimal risk for developing CVD compared to their urban counterparts.

Motor and functional recovery after stroke: a comparison between rehabilitation settings in a developed versus a developing country.

BACKGROUND: Recovery post stroke is well documented in the field of stroke rehabilitation. The structure and process of rehabilitation are different between developed and developing countries. The aim of the present study was to compare the motor and functional recovery of stroke patients in Germany versus stroke patients receiving rehabilitation in South Africa. METHODS: This study used secondary data analysis of patient protocols collected in two independent studies conducted in Germany and South Africa respectively. A total of 73 patients from the two separate studies were matched for age at stroke onset, gender, and initial motor functioning. Motor and functional recovery were assessed at baseline, two and six months post stroke using the Rivermead Motor Assessment Scale and the Barthel Index (BI) respectively. Significant differences in motor and functional recovery were found, using the Wilcoxon rank sum test on admission to the centre, and at two and six months after stroke. A generalized linear mixed-methods model (GLIMMIX) was used to compare the recovery patterns between the participants from the two settings over time. RESULTS: The results of the GLIMMIX revealed a significant difference in favour of the German participants for gross motor (RMA-GF) and upper limb (RMA-A) recovery, while no significant difference was found for lower limb (RMA-LT) and functional (BI) recovery patterns between the participants of the two settings. No significant differences existed in RMA-A and BI-scores on admission to the CHC/SRU. At two and six months after stroke, both the RMA-A and BI-scores were significantly lower in the South African than the German sample. CONCLUSION: The results of this study provide empirical evidence for differential recovery patterns for patients in developed and developing countries. A detailed exploration of the factors to which this difference in recovery patterns can be attributed was beyond the scope of the present study, and is recommended for future research.

PCBs: amenaza real o mediática?

Analiza que si bien la peligrosidad de los bifenilospoliclorados es un hecho probado, sostiene que existe cierto fundamentalismo que debiera evitarse para poder mantener la objetividad que corresponde al tratamiento serie del tema. Que a la hora de discutir sobre la oportunidad de su utilización, debe conocerse tanto las tecnologías de tratamiento y disposición como las regulaciones vigentes, cuya adecuada aplicación reducen de manera singular la presencia de contingencias negativas

Infección por hantavirus. Nuevo desafío / Infection for hantavirus. New challenge

La Cooperativa Médica de Canelones, asistió entre los meses de febrero y junio de 1999, tres pacientes jóvenes, dos procedentes de medio rural y uno de zona urbana con diagnóstico de infección por Hantavirus con las características del Sindrome Pulmonar por Hantavirus. Su clínica y paraclínica fueron consideradas fundamentales para el diagnóstico de esta patología nueva para el médico y de baja incidencia y que determinó además grandes dificultades diagnósticas con el planteo de varios diagnósticos diferenciales. El grupo considerado mostró dos perfiles; una forma de presentación típica donde se destacó el compromiso pulmonar severo y de gran riesgo vital y una forma de menor severidad donde el compromiso pulmonar fue más leve y donde predominaron las manifestaciones extrapulmonares. De todas formas todos los casos presentaron afectación multiorgánica, con edema pulmonar, plaquetometría, compromiso hepatocítico y renal pero sin compromiso de su función. Dos pacientes ingresaron a la Unidad de Cuidados Intensivos y todos evolucionaron en forma favorable