Mario Smith

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

BackgroundRecovery 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.MethodsThis 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.ResultsThe 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.ConclusionThe 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.

A systematic review of the relationship between family structure and health risk behaviours amongst young people: An African perspective

Objective: The aim of this study was to review the published literature on the relationship between family structure and engagement in health risk behaviour amongst youth in African countries. Methods: A systematic review was conducted between 2000 and 2014. Suitable titles were identified from database searches. Thereafter, abstracts were evaluated along specific inclusion criteria. Eleven full text articles were evaluated for methodological quality using a modified critical appraisal tool and six studies were included in the final review that satisfied the threshold criterion of 70%. A narrative synthesis was completed for all included records to provide a textual answer to the research question. Results: Findings indicated that there was a relationship between family structure and engagement in health risk behaviour, specifically risky sexual behaviour. The importance of family structure was evident, and the active involvement of parents in the activities of youth is cardinal. The review further underscores that there is lack of methodologically rigorous research that can provide empirical support for and insight into the relationship between family structure and engagement in health risk behaviour. Discussion: Risky sexual behaviour was the most prevalent outcome assessed across studies. Family structure impacted positively on delaying or reducing engagement in risky sexual behaviour. Diverse family structures were identified and orphans living with caregivers were identified as a particular structure that might be more prevalent in the African context. Parental involvement and investment in adolescent activities were more strongly identified as an important factor. There is a lack of and need for more methodologically rigorous research to gain empirical support for and insight into the relationship between family structure and health risk behaviours.

A six week contextualised physical activity intervention for women living with HIV and AIDS of low socioeconomic status: a pilot study

ABSTRACT Research has consistently shown the benefits of regular physical activity (PA) for women living with HIV and AIDS (WLWHA). This study is a pilot, randomised controlled crossover trial, reporting the effects of a contextualised PA intervention amongst a sample of 21 HIV positive Xhosa-speaking women of low socioeconomic status (SES). The study determined total moderate-to-vigorous PA (TMVPA) as measured subjectively by the Global Physical Activity Questionnaire (GPAQ), total weekly steps (TWS) as measured by a pedometer, and self-efficacy for PA as measured by the Physical Exercise Self-efficacy scale (PESES). Multivariate analysis of covariance (MANCOVA) was used to compute the impact of the intervention on TMVPA, TWS, and self-efficacy for PA from baseline to six weeks, and baseline to 12 weeks post-intervention controlling for pre-test differences in TMVPA. Results showed that participants exposed to the intervention had significant increases in PA as measured by TMVPA (p = .027), TWS (p = .032), as well as exercise self-efficacy (p = .000) from pre-test to 6 weeks. Insignificant findings were reported for all three variables when measured from baseline to 12 weeks. In conclusion, the findings of the pilot study suggest that the intervention was effective in producing significant increases in PA in a sample of PLWHA of low SES over six weeks. Careful consideration of behavioural constructs, such as self-efficacy, can help WLWHA of low SES to adopt regular PA as a complementary therapy for managing their health.

Research capacity development in a South African higher education institution through a north-south collaboration

One of the constraints that prevent institutions in developing countries from engaging in effective and essential research is a lack of research capacity. This study reports on a north-south collaboration between a group of Flemish universities and a higher education institution in South Africa with the specific goal of improving productivity, quality and capacity amongst researchers. A collaborative project with multiple sub-projects was established in 2003, and extended over two consecutive five-year phases. Document analysis was conducted of annual reports, monitoring and evaluation reports, curriculum vitae of participating members, and progress reports of students and supervisors during this time. The findings of this study illustrate the extent to which research capacity objectives can be achieved through a north-south partnership. Members of the collaboration were able to develop intra- and inter-disciplinary partnerships that resulted in maximising the capacity- building efforts, enhancing both individual and institutional research capacity. Keywords: International partnerships; professional development; student development; staff development.

Physical activity behaviours of persons living with HIV of low socioeconomic status: domain, intensity and sociodemographic correlates

ABSTRACT Physical activity (PA) is healthy for People Living with HIV and AIDS (PLWHA). This study examined the PA profile of 978 PLWHA based on PA domains and PA intensity. The study also sought to determine whether employment status and level of education can predict PA among PLWHA of low SES. PA and sociodemographic data of 978 PLWHA of mean age 35 (8.77) years were collected using the global physical activity questionnaire and a sociodemographic questionnaire. Results showed that, participants engaged more in work-related PA [160.11 (346.95) min/wk], followed by transport related PA [115.21(SD = 142.04) min/wk], and lastly in leisure related PA [40.84 (SD = 110.37) min/wk]. Participants also engaged more in moderate PA [265.86 (SD = 335.45) min/wk], than in vigorous PA [50.29 (SD = 205.30) min/wk]. Employment was a significant predictor of overall PA controlling for age, CD4 count and education level. The model explained 2.5% of the variance (R2 = 0.025) on overall PA and tested significant at a 0.01 alpha level (p < 0.01). PA interventions for this population should be domain- and intensity-specific. Researchers promoting healthy lifestyle behaviour change can benefit from determining the factors that facilitate domain-specific PA.

Exploring the subjective experiences of allied health professionals in their transition from clinical educators to academia: Barriers and facilitators to successful transition

Background. Currently, clinicians who move into academia may not have the necessary skills for this transition. Given that most health professionals are socialised into their professional roles as clinicians, the shift to academia requires a second socialisation into the academic role. There is a body of existing research that suggests that the transition for clinicians as they become lecturers in higher education is challenging. Aim. This study aimed to determine the subjective experiences of young academics in their transition from clinicians to clinical educators/academics. In particular, participants were asked to identify the factors that acted as facilitators or barriers to their transition from clinician to academic. Methods. The study employed a phenomenological framework. Participants (N=7) were a group of clinical educators/lecturers involved with undergraduate students at an identified institution. Unstructured interviews were conducted. Following each interview, audio-recordings were transcribed verbatim and all data were anonymised. Data were analysed manually by each author and consensus was reached on the identified themes. Results. The mean age of participants was 31 years, with an average of 8.4 years of clinical experience and 3.4 years of academic/clinical education experience. The transition experience from clinician to academic is discussed according to two themes, i.e. intrinsic factors (confidence, competence, personality, and ability to draw on personal experience) and extrinsic factors (supportive environment, peer relationships, mentoring, understanding institutional rules and regulations). Conclusion. The findings identified both intrinsic and extrinsic factors that may facilitate or hinder the transition process. Intrinsic factors such as uncertainty and personality influences or extrinsic factors such as supportive environments can interact to thwart the adjustment or transition of new staff. Despite individual differences, there is an essence to the experience of the adjustment to academic, as evidenced by the reaching of saturation in a relatively small sample. Based on the results, it is evident that there is a clear need for staff development initiatives related to internal motivation of the individual and supportive extrinsic factors to successfully make the transition to clinical education.