The interrelationship between pain, life satisfaction and mental health in adults with traumatic spinal cord injury, in the context of a developing country.

STUDY DESIGN: Cross-sectional, analytical study design using a conveneient sampling strategy. OBJECTIVES: To examine the interrelationship between pain, life satisfaction and indices of negative mental well-being amongst the traumatic spinal cord injury (TSCI) population. SETTING: Western Cape Rehabilitation Center in Cape Town, South Africa. METHODS: Participants (n = 70) were adults (mean age of 36.3, SD = 9.2) with TSCI. Participants completed the following instruments: 10 satisfaction items from the World Health Organization Quality of Life Brief Version, short forms of the Center for Epidemiological Studies Depression Scale and the trait scale of the State-Trait Anxiety Inventory, a one-item measure of pain intensity taken from the International Spinal Cord Injury Pain Basic Data Set and the interference scale of the Brief Pain Inventory. RESULTS: Correlational analysis (Pearson r) demonstrated that all the indices of mental well-being as well as the two indices of pain was significantly negatively related to life satisfaction. In addition, life satisfaction mediated the relationship between pain intensity and depression as well as anxiety. Life satisfaction only mediated the relationship between pain interference and depression but not anxiety. CONCLUSIONS: An improvement in life satisfaction may lead to improvements in pain interference, pain intensity as well as psychological distress, amongst persons suffering from TSCI Future research should focus on assessing measures/treatment which may improve life satisfaction in the TSCI population.

Cardiac surgery in East Africa: a profile of cases and referral to physiotherapy.

Background: A significant increase in cardiac surgery has been observed globally, with prolonged length of stay (LOS) still prevalent due to post-operative complications. Physiotherapy pre and post cardiac surgery is known to reduce these complications and LOS, however cases referred for physiotherapy is unknown. Objective: The study aimed to describe the profile and pre- and post-operative referrals to physiotherapy of patients admitted to the cardiothoracic unit at a selected hospital in Tanzania over a four-year period. Method: Descriptive, retrospective design. A data extraction sheet was used to capture demographic, cardiac disease, ICU and hospital LOS, post-operative complications and physiotherapy referral data of all patients ≥18 years of age. Results: 105 cardiac surgeries were performed. Patients' mean age was 30.6 years (SD=10.48) and 54.3% (n=57/105) were female. Cardiac surgeries performed declined from 48.6% (n=51/105) in 2010 to 10.5% (n=11/105) in 2013. Cardiac arrest (33%, n=7/21), pneumonia (19%, n=4/21) and lung collapse (4.8%, n=1/21) were the notable documented post-operative complications. ICU mortality was highest (72,7%, n=8/11). Only 1% (n=1/105) of cases were referred pre-operatively versus 77.7% (n=80/103) post-operatively for physiotherapy. Conclusion: Cardiac surgeries were reduced annually but the post-operative complications need to be reduced. Pre-operative physiotherapy referral may reduce pneumonia and lung collapse following cardiac surgery.

Knowledge of non-communicable diseases among adolescents in Uasin Gishu County, Kenya.

Introduction: Exposure to risk factors of non-communicable diseases (NCDs) begins early especially during adolescence while morbidity and mortality occurs mainly in adulthood. Objective: To assess the level of knowledge of major NCDs (cardiovascular disease, cancer, and diabetes) and risk factors among adolescents in a semi-urban setting. Methods: A descriptive cross-sectional survey was used to collect data. The study targeted students attending mixed secondary schools in Uasin Gishu County in Kenya. An adapted knowledge assessment questionnaire relating to chronic diseases of lifestyle was used for data collection. Data was analysed using SPSS version 25. Results: A total of 1,281 students participated in the study. The results revealed that most of the participants (62.1%) had low levels of knowledge about NCD risk factors. Very few students in the present study recognized the role of family history and genetic predisposition as potential risk factors of hypertension (18%) and diabetes (24.7%) as well as the normal blood pressure (35.9%) and blood glucose levels (20.5%). Although most of the students identified alcohol and smoking as risk factors for cancer, half (51.6%) of them did not have the knowledge that regular physical activity reduces the risk of getting cancer. Conclusion: Many of the adolescents in Uasin Gishu County, Kenya had low level of knowledge regarding NCDs and their risk factors. The findings of this study highlight the need for a school-based intervention programme to raise awareness of non-communicable disease risk factors among adolescents.

Prevalence of risk factors of non-communicable diseases among adolescents in Uasin Gishu County, Kenya

Objective: This study aimed to establish the prevalence of risk factors (tobacco use, alcohol abuse, physical inactivity and unhealthy diet) of non-communicable diseases (NCDs) among secondary school students in a developing country. Design: A descriptive cross-sectional study using the self-administered WHO STEP-wise questionnaire for chronic disease risk factor surveillance on adolescents attending secondary schools in Kenya. The study was carried out in the period between May and July 2018. Setting: Ten secondary schools were randomly selected in Uasin Gishu County, using stratified proportional sampling. Subjects: A total of 1,281 students assented to participate in the study. The mean age of the participants was 16.6 (SD±1.509) with the majority being female (55%, n=704) Results: The prevalence of alcohol abuse was 30.8%(n=394) with males having statistically significant higher rates than females (p < 0.05) and 6.8% of the participants were smokers. Of those that reported smoking, 60.9% were between 15-17 years of age. Adequate intake of three (3) servings of vegetables per day was seen in 13.5% of the respondents and 54.4% (n=697) of the total sample were found to be physically inactive. Conclusion: The prevalence of NCD risk factors among secondary school students in Uasin Gishu County is significant. As a result, health education and targeted interventions should be implemented in order to promote a healthy lifestyle which is important in preventing NCDs in future.

Psychosocial reintegration following traumatic spinal cord injury in South Africa: The influence of employment, injury characteristics and living situation.

OBJECTIVES: To determine the influence of employment, injury characteristics and living situation on psychosocial reintegration in individuals who sustained a traumatic spinal cord injury (TSCI) in South Africa. DESIGN: A cross-sectional exploratory survey. SETTINGS: Communities of the Cape Metropolitan Area, South Africa. PARTICIPANTS: A total of 108 community- dwelling adults, between ages of 19 and 71 years, who have sustained a TSCI more than 1- year ago. OUTCOME MEASURES: : The Sydney psychosocial reintegration scale (SPRS-2). RESULTS: The SPRS-2 and domains mean (SD) scores were: (1) Overall SPRS-2 of 27.87(13.4); (2) Occupational activity of 8.62 (4.8); (3) Interpersonal relationships of 9.80 (5.1); and (4) Living skills of 9.45 (4.9). Multivariate regression analysis resulted in two significant independent variables, namely employment and living situation. Employment alone explained 24.3% of the variance in the overall psychosocial model, 25.6% in the occupational activity model, while employment together with living situation explained 24.2% of the variance in the living skills model, with those employed reporting better psychosocial reintegration and those living in informal dwellings reporting poorer psychosocial reintegration. CONCLUSION: Employment and living situation strongly influenced psychosocial reintegration following a TSCI, indicating the important role of socio-economic status for psychosocial adaptation after injury. As employment plays a significant mediating role, and living in informal dwellings negatively affect psychosocial reintegration following a TSCI, rehabilitation stakeholders and policy makers need to continue lobbying for social and political change that support employment opportunities and provide accessible housing for persons with TSCI.

Quality of life after traumatic spinal cord injury in a developing context: the influence of contextual factors and injury characteristics.

PURPOSE: To identify contextual factors and injury characteristics influencing the quality of life (QoL) among individuals who sustained a traumatic spinal cord injury (TSCI) in South Africa. MATERIALS AND METHODS: We carried out a cross-sectional survey to examined the influence of contextual factors and injury characteristics on quality of life among 108 conveniently selected community-dwelling adults between the ages of 19 and 71 years old, who sustained a TSCI more than 1 year post-injury. RESULTS: Multivariate regression analysis resulted in three significant independent variables (gender, employment, and time living with the injury) that explained 38.1% of the variance in the model, of which being employed and living with a TSCI between 11 and 15 years were the strongest factors influencing the overall and each domain of quality of life. CONCLUSION: Our results highlight that employment plays an important role in QoL for individuals who sustained a TSCI. They also suggest that increased time since the injury is most likely to provide individuals an opportunity to develop efficient coping strategies, allowing for greater overall adjustment and life satisfaction, leading to a better quality of life.IMPLICATIONS FOR REHABILITATIONSince the time of the injury was found to be improved QoL, there is a need to improve the health care system of Individuals with SCI.As the employment is a significant factor positively influencing QoL, vocational rehabilitation programs should be included during the rehabilitation processes.Rehabilitation stakeholders need to continue lobbying for social and political changes that support expanded employment options for individuals who sustained a TSCI in order to improve their quality of life.

Exploration of the Experiences of Persons in the Traumatic Spinal Cord Injury Population in Relation to Chronic Pain Management.

Chronic pain amongst individuals with traumatic and nontraumatic spinal cord injury (SCI) has high prevalence rates, with severe impact on the activities of daily living, mood, sleep and quality of life. This study aimed to explore the experiences and challenges of chronic pain management amongst the traumatic spinal cord injury (TSCI) population in the Western Cape region of South Africa. A qualitative descriptive approach was chosen for the study, in which 13 individuals living with TSCI were purposively recruited and interviewed telephonically. An inductive thematic analytic approach was used. The results indicate ineffectiveness of standard pain management, with a lack of education regarding pain physiology and pain management strategies as well as unbalanced decision-making between clinician and patient. Thus, patients develop coping strategies to survive with pain. Current pain regimes are suboptimal at best, underpinned by the lack of clarity or a mutually agreed plan to mitigate and eradicate pain. There is a need for chronic pain management beyond pharmacological prescription. Future practices should focus on adopting a holistic, biopsychosocial approach, which includes alternative pain therapy management. In addition, advances in pain management cannot be achieved without adopting a therapeutic alliance between the clinician and patient.

Supporting a student with visual impairment in the intensive care unit.

BACKGROUND: The Department of Physiotherapy at the University of the Western Cape began accepting students with visual impairments (VIs) into the undergraduate physiotherapy programme in 1996. However, until recently, none had received a clinical rotation in any high care setting. OBJECTIVES: The aim of this study was to explore the experiences of all stakeholders involved in the process of placing a student with VI into the intensive care unit (ICU). METHOD: This case study used interviews with relevant stakeholders to explore their experiences of integrating the ICU placement into the student's clinical programme. Interviews were recorded and transcribed, and then analysed thematically. RESULTS: There was a certain amount of anxiety present, especially among clinical staff, before the placement began. Discussions among stakeholders at each stage of the process served to identify potential problems before they arose, and allowed staff to plan solutions in advance. Challenges were found in both the attitudes of staff, and in the clinical environment, some of which were relatively easy to address, while others will require significant investments of resources to resolve. CONCLUSION: Our findings suggest that it may be possible to successfully place students with VI into intensive care settings, and they can enjoy positive learning experiences, given an appropriate context and adequate support. However, care needs to be taken at every stage of the process to ensure that supporting structures are in place prior to, and during, the placement. CLINICAL IMPLICATIONS: All stakeholders, including the students and the relevant clinical and academic staff, need to be actively involved in the process of planning for the clinical placement.

Body Weight Misperception and Dissatisfaction Among Overweight and Obese Adult Nigerians.

BACKGROUND: The increase in the prevalence of overweight and obesity in low- and medium-income countries has a negative impact on overall health. Correct perception of one's body weight is a step in seeking healthy help toward weight reduction in overweight and obese individuals. OBJECTIVE: This study was carried out to assess the body weight misperception and dissatisfaction among overweight and obese adults in an urban African setting. METHODS: This study was part of a larger cross-sectional study that was designed to plan an intervention for overweight and obese adults in an urban African setting. For this study, we randomly selected only overweight and obese adults (≥18 years old) who consented to participate in the study from 15 enumeration areas in Alimosho Local Government Area of Lagos State, Nigeria. We followed the World Health Organization guidelines for conducting community surveys in recruiting overweight and obese participants. We assessed body weight perception and dissatisfaction through their responses to the following: "How do you describe your weight?" and "I feel bad about myself because of my weight." Data for this study were collected between November 2012 and March 2013. RESULTS: We recruited 567 participants, of whom more than half (n=304, 53.6%) misperceived their weight as either underweight or normal weight, and 61.2% (n=186) of whom were women. The strength of agreement between the actual body mass index and weight perception was very poor (κ=.032, SE .015, P=.04). The strongest predictor of weight perception was sex (female) with an odds ratio of 1.63 (95% CI 1.13-2.35). About 41.1% (n=233) of the participants were dissatisfied with their weight, of whom 30.0% (n=70) were men. Age (young adult) was a predictor of weight dissatisfaction with an odds ratio of 2.37 (95% CI 1.62-3.46). CONCLUSIONS: More than half of the participants misperceived their body weight as either underweight or normal weight, and the majority of them were women. More men were not happy with their body weight, and participants in the young adult age group were more dissatisfied with their body weight.