Concussion in sports: postconcussive activity levels, symptoms, and neurocognitive performance

Context:

Evidence suggests that athletes engaging in high-intensity activities after concussion have more difficulties with cognitive recovery.

Objective:

To examine the role postinjury activity level plays in postconcussive symptoms and performance on neurocognitive tests in a population of student-athletes.

Design:

Retrospective cohort study with repeated measures of neurocognitive performance and symptom reporting.

Setting:

University-based sports concussion clinic.

Patients or Other Participants:

Ninety-five student-athletes (80 males, 15 females: age  =  15.88 ± 1.35 years) were retrospectively assigned to 1 of 5 groups based on a postinjury activity intensity scale.

Main Outcome Measure(s):

We employed a regression analysis for repeated measures to evaluate the relationship of activity intensity to symptoms and neurocognitive outcome up to 33 days after concussion. Postconcussion symptom scores and neurocognitive (verbal memory, visual memory, visual motor speed, and reaction time) scores served as the primary outcome measures.

Results:

Level of exertion was significantly related to all outcome variables (P < .02 for all comparisons). With multivariate analysis, activity intensity remained significant with respect to visual memory (P  =  .003) and reaction time (P < .001).

Conclusions:

Activity level after concussion affected symptoms and neurocognitive recovery. Athletes engaging in high levels of activity after concussion demonstrated worse neurocognitive performance. For these tasks, those engaging in moderate levels of activity demonstrated the best performance.     

Experiences in conducting multiple community-based HIV prevention trials among women in KwaZulu-Natal, South Africa

Background

South Africa, with its scientific capacity, good infrastructure and high HIV incidence rates, is ideally positioned to conduct large-scale HIV prevention trials. The HIV Prevention Research Unit of the South African Medical Research Council conducted four phase III and one phase IIb trials of women-initiated HIV prevention options in KwaZulu-Natal between 2003 and 2009. A total of 7046 women participated, with HIV prevalence between 25% and 45% and HIV incidence ranging from 4.5-9.1% per year. Unfortunately none of the interventions tested had any impact on reducing the risk of HIV acquisition; however, extremely valuable experience was gained, lessons learned and capacity built, while the communities gained associated benefits.

Experience

Our experience in conducting these trials ranged from setting up community partnerships to developing clinical research sites and dissemination of trial results. Community engagement included setting up community-based research sites with approval from both political and traditional leaders, and developing community advisory groups to assist with the research process. Community-wide education on HIV/sexually transmitted infection prevention, treatment and care was provided to over 90 000 individuals. Myths and misconceptions were addressed through methods such as anonymous suggestion boxes in clinic waiting areas and intensive education and counselling. Attempts were made to involve male partners to foster support and facilitate recruitment of women. Peer educator programmes were initiated to provide ongoing education and also to facilitate recruitment of women to the trials. Recruitment strategies such as door-to-door recruitment and community group meetings were initiated. Over 90% of women enrolled were retained. Community benefits from the trial included education on HIV prevention, treatment and care and provision of ancillary care (such as Pap smears, reproductive health care and referral for chronic illnesses). Social benefits included training of home-based caregivers and sustainable ongoing HIV prevention education through peer educator programmes.

Challenges

Several challenges were encountered, including manipulation by participants of their eligibility criteria in order to enroll in the trial. Women attempted to co-enroll in multiple trials to benefit from financial reimbursements and individualised care. The trials became ethically challenging when participants refused to take up referrals for care due to stigma, denial of their HIV status and inadequate health infrastructure. Lack of disclosure of HIV status to partners and family members was particularly challenging. Some of the ethical dilemmas put to the test our responsibility as researchers and our obligation to provide health care to research participants.

Conclusion

Conducting these five trials in a period of six years provided us with invaluable insights into trial implementation, community participation, recruitment and retention, provision of care and dissemination of trial results. The critical mass of scientists trained as clinical trialists will continue to address the relentless HIV epidemic in our setting and ensure our commitment to finding a biomedical HIV prevention option for women in the future.     

Mixed-strain Mycobacterium tuberculosis infections among patients dying in a hospital in KwaZulu-Natal, South Africa

We performed spoligotyping and 24-locus mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) typing on M. tuberculosis culture-positive biopsy specimens collected from adults dying in a hospital in KwaZulu-Natal. Of 56 culture-positive samples genotyped, we detected mixed strains in five (9%) and clonal heterogeneity in an additional four (7%).     

Socio-economic status as predictors of malaria transmission in KwaZulu-Natal,South Africa. A retrospective study

BackgroundUnderstanding the socioeconomic status that influences malaria transmission in KwaZulu-Natal, South Africa is vital in creating policies and strategies to combat malaria transmission, improve socioeconomic conditions and strengthen the malaria elimination campaign.ObjectivesTo determine the relationship between socioeconomic status and malaria incidence in KwaZulu-Natal, South Africa.MethodsSocioeconomic information (gender, age, no formal education, no electricity, no toilet facilities, unemployment) and malaria data for 2011 were obtained from Statistics South Africa and the malaria control program of KwaZulu-Natal, South Africa respectively. The analysis was conducted employing the Bayesian multiple regression model.ResultsThe obtained posterior samples show that all the variables employed in this study were significant and positive predictors of malaria disease at 95% credible interval. The low socioeconomic status that exhibited the strongest association with malaria risk was lack of toilet facilities (odd ratio =12.39; 95% credible interval = 0.61, 24.36). This was followed by no formal education (odd ratio =11.11; 95% credible interval = 0.51, 24.10) and lack of electricity supply (odd ratio =8.94; 95% credible interval = 0.31, 23.21) respectively.ConclusionsLow socioeconomic status potentially sustains malaria transmission and burden. As an implication, poverty alleviation and malaria intervention resources should be incorporated side by side into the socioeconomic framework to attain zero malaria transmission.     

Clinical educator's experiences of the decentralised training platform for Occupational Therapy students in KwaZulu-Natal,South Africa

BackgroundIn piloting a shift from traditional practice-based placements to decentralised clinical training (DCT), there was a need to explore the factors that influenced the placement as part of monitoring and evaluation. DCT involves placement to clinical sites away from the higher education institution necessitating changes to supervision strategies utilised.ObjectiveThis study explored the experiences of clinical educators supervising occupational therapy students within this new model during a pilot phase of the DCT programme at one institution in South Africa.MethodThe study was located in KwaZulu-Natal province and followed an explorative qualitative design with semi-structured interviews and focus groups with purposively sampled clinical educators (n=11). Data were audio-recorded and d thematically analysed.FindingsTwo central themes emerged and included the clinical educators'' expectations (organisation factors, role and scope of partners in decentralised training and communication) and experiences (perspectives and value of decentralised training).ConclusionDecentralised training has considerable potential to contribute to authentic student learning. Improved communication between all stakeholders would assist in enhancing the quality of the learning experiences on such platforms. Students need to be more prepared prior to commencing DCT, and there is a need for more rural placements with a primary health care focus.     

Perceptions of vaginal microbicides as an HIV prevention method among health care providers in KwaZulu-Natal, South Africa

Background  

The promise of microbicides as an HIV prevention method will not be realized if not supported by health care providers. They are the primary source of sexual health information for potential users, in both the public and private health sectors. Therefore, the aim of this study was to determine perceptions of vaginal microbicides as a potential HIV prevention method among health care providers in Durban and Hlabisa, South Africa, using a combination of quantitative and qualitative methods.     

Satisfaction and adherence of patients with amputations to physiotherapy service at public hospitals in KwaZulu-Natal,South Africa

Background

Individuals who have undergone a lower limb amputation require comprehensive rehabilitation from the multidisciplinary team to ensure optimal treatment outcomes and social integration. Physiotherapists play a pivotal role within the multidisciplinary team and offer patients physical and psychosocial rehabilitative care. Determining patients'' satisfaction levels and exploring factors affecting adherence to physiotherapy interventions can inform practice and improve service delivery of rehabilitation within resource poor settings such as South Africa.

Objectives

To determine the level of satisfaction with physiotherapy services rendered to acute and sub-acute in-patients with lower limb amputations and to explore factors affecting adherence to physiotherapy intervention.

Methods

A prospective survey of 35 patients with lower limb amputations from four public hospitals in South Africa was undertaken. A modified version of the Hampstead rehabilitation centre patient satisfaction questionnaire was utilised.

Results

Majority of participants were satisfied with the physiotherapy services whilst a few reported dissatisfaction. Three themes emerged whilst exploring the patients'' experience relating to adherence to physiotherapy programmes. Themes included service delivery, patient-therapist interaction and participation barriers and facilitators.

Conclusion

Recommendations aimed to improve quality of care and healthcare outcomes thereby enhancing the participants'' adherence to the physiotherapy programme.     

Knowledge,attitudes, and practices towards drug-food interactions among patients at public hospitals in eThekwini,KwaZulu-Natal,South Africa

BackgroundDrug-food interactions can lead to adverse drug reactions and therapy failure which can potentially impact patient safety and therapy outcome.ObjectivesThis study assessed patients'' knowledge, attitudes and practices regarding drug-food interactions.MethodsA cross-sectional study was conducted among patients at three public hospitals in eThekwini, KwaZulu-Natal. Statistical analysis was performed using SPSS® version 25. The association between demographic variables and patients'' knowledge, attitudes and practices were assessed.ResultsOf the 342 patients, 70.5% were female, and the mean age was 42.87±0.89 years. Almost 50% of patients had secondary level education, and 64% were unemployed. About 52% of patients had high knowledge of drug-food interactions; however, only 30–50% of the patients could identify potential drug-food interactions of their drugs. More than half of the patients (51.5%) answered that they took multivitamin pills with medications and 61.7% responded they consulted healthcare professionals for drug-food interactions'' information before taking new medications. Few patients (15.2%) had experienced drug-food interactions.ConclusionsOverall, patients had gaps in their knowledge and practices, and positive attitudes towards drug-food interactions. Many patients could not identify food items that can potentially interact with their drugs. It is important that education and medication counselling are provided to patients to prevent drug-food interactions, ensure optimal drug therapy and patient safety.     

Patients Consulting Traditional Health Practioners in the Context of HIV/AIDS in Urban Areas in KwaZulu-Natal, South Africa

The purpose of this study is to assess patients consulting full-time traditional health practitioners (THPs) and the practice of THPs after they had been trained on Human Immunodeficiency Virus (HIV)/ Sexually Transmitted Infections (STI) prevention and care. The sample included 222 patients interviewed when exiting a THP''s practice (n=17) in purposefully chosen two urban sites in KwaZulu-Natal. Results indicate that at post training evaluation the majority of the THPs were involved in HIV/STI management and most had low levels of HIV risk practices at the workplace. Major self-reported reasons for consulting the THP included a complex of supernatural or psychosocial problems, chronic conditions, acute conditions, generalized pain, HIV and other STIs. Overall, patients including HIV positive (n=18) patients had moderate knowledge of Antiretroviral Therapy (ART). A number of HIV positive patients were using traditional medicine and ART concurrently, dropped out of ART because of side effects and were using traditional medicine for HIV.     

Modelling CD4 counts before and after HAART for HIV infected patients in KwaZulu-Natal South Africa

BackgroundThis study aims to make use of a longitudinal data modelling approach to analyze data on the number of CD4+cell counts measured repeatedly in HIV-1 Subtype C infected women enrolled in the Acute Infection Study of the Centre for the AIDS Programme of Research in South Africa.MethodologyThis study uses data from the CAPRISA 002 Acute Infection Study, which was conducted in South Africa. This cohort study observed N=235 incident HIV-1 positive women whose disease biomarkers were measured repeatedly at least four times on each participant.ResultsFrom the findings of this study, post-HAART initiation, baseline viral load, and the prevalence of obese nutrition status were found to be major significant factors on the prognosis CD4+ count of HIV-infected patients.ConclusionEffective HAART initiation immediately after HIV exposure is necessary to suppress the increase of viral loads to induce potential ART benefits that accrue over time. The data showed evidence of strong individual-specific effects on the evolution of CD4+ counts. Effective monitoring and modelling of disease biomarkers are essential to help inform methods that can be put in place to suppress viral loads for maximum ART benefits that can be accrued over time at an individual level.     

Clinic-based intervention reduces unprotected sexual behavior among HIV-infected patients in KwaZulu-Natal, South Africa: results of a pilot study

OBJECTIVE: To evaluate the feasibility, fidelity, and effectiveness of a human immunodeficiency virus (HIV) prevention intervention delivered to HIV-infected patients by counselors during routine clinical care in KwaZulu-Natal, South Africa. METHODS: A total of 152 HIV-infected patients, aged 18 years and older, receiving clinical care at an urban hospital in South Africa, were randomly assigned to intervention or standard-of-care control counselors. Intervention counselors implemented a brief risk reduction intervention at each clinical encounter to help patients reduce their unprotected sexual behavior. Self-report questionnaires were administered at baseline and 6 months to assess number of unprotected sex events in previous 3 months. RESULTS: Intervention was delivered in 99% of routine patient visits and included a modal 8 of 8 intervention steps. Although HIV-infected patients in both conditions reported more vaginal and anal sex events at 6-month follow-up than at baseline, patients who received the counselor-delivered intervention reported a significant decrease over time in number of unprotected sexual events. There was a marginally significant increase in these events among patients in the standard-of-care control condition. CONCLUSIONS: A counselor-delivered HIV prevention intervention targeting HIV-infected patients seems to be feasible to implement with fidelity in the South African clinical care setting and effective at reducing unprotected sexual behavior.     

Clinical Evaluation of the OneStep Gonorrhea RapiCard InstaTest for Detection of Neisseria gonorrhoeae in Symptomatic Patients from KwaZulu-Natal,South Africa

We evaluated a point-of-care test for the detection of Neisseria gonorrhoeae in patients attending a public health clinic in KwaZulu-Natal, South Africa. The test showed a low sensitivity against PCR and culture (<40%); however, a higher specificity was observed (>95%). This test is unsuitable as a screening tool for gonorrhea.     

Knowledge of multidrug-resistant tuberculosis amongst Durban University of Technology students in KwaZulu-Natal,South Africa: the need for integrating public health education

BackgroundKwazulu-Natal is the epicenter of South Africa''s Multidrug-resistant Tuberculosis (MDR-TB) burden which represents a growing threat to public health. Knowledge and awareness of MDR-TB are crucial for effective management and University students are an important vehicle for knowledge transfer of public health education.ObjectiveThis study aimed to evaluate the knowledge of MDR TB and risk factors for transmission, prevention, treatment and control of MDR-TB among Durban University of Technology (DUT) students.MethodsThis quantitative cross-sectional study was conducted among 150 randomly sampled undergraduate students from 3 faculties and data was collected using a validated questionnaire.ResultsWhile a majority of participants (70.67%) had previous knowledge on TB, only 30.67% knew of MDR-TB. Only 23.49% of students reported knowledge of preventative measures associated with MDR TB. Women had a lower probability of having knowledge of MDR-TB compared to men (OR=0.45; CI:0.22,0.95; p<0.05) and students from the Accounting and Informatics faculty were less likely to believe that MDR-TB was a life-threatening illness (OR=0.24; CI:0.05,1.44; p<0.05) and showed limited knowledge of MDR-TB transmission.ConclusionThis study showed that students lacked knowledge of MDR-TB with respect to risk factors, treatment and prevention, which necessitates intervention strategies at a tertiary level to educate and inform students about MDR-TB.     

2010年广东省云浮市手足口病流行病学分析

目的了解云浮市2010年手足口病流行病学特征。方法对国家疾病监测信息管理系统监测的2010年云浮市手足口病发病情况进行描述性流行病学分析。结果云浮市2010年累计报告手足口病病例为7262例,发病率为299.33/10万。其中城镇发病2938例,发病率为401.58/10万,农村发病4324例,发病率为254.45/10万,城镇发病率高于农村（P〈0.01）;男性发病率为381.39/10万,女性发病率为208.86/10万,男女发病率差异有统计学意义（P〈0.01）;发病以低年龄组为主,5岁以下年龄组发病6047例,占83.27%,各年龄段发病率差异有统计学意义;职业分布以散居儿童为主,共报告散居儿童6050例,占83.31%;3-7月份为发病高峰,共报告3699例,占病例总数的50.94%,10月份有一个次高峰,报告病例数664例,占病例总数的9.14%。结论云浮市手足口病发病率较高,存在明显的季节、地区、性别、年龄差异,防控重点是5岁以内的散居儿童;开展手足口病的流行病学和病原学研究,将有助于制定更好的预防和控制措施。     

Traditional Healers and Nurses: A Qualitative Study on Their Role on Sexually Transmitted Infections Including HIV and AIDS in KwaZulu-Natal, South Africa

The aim of this study was to investigate the role of traditional healers in sexually transmitted infections including HIV/AIDS and collaboration between the traditional and biomedical health care systems as seen by nurses and traditional healers. A convenient sample of 15 professional nurses and 15 traditional healers were interviewed using a semi-structured questionnaire. Qualitative analyses identified the following themes: (1) attitude and respect, (2) collaboration between traditional healers and nurses, (3) control/regulation of (traditional) health practices, (4) training needs of healers and nurses. The main results indicated that the professional nurses had mixed attitudes towards traditional healers, mostly negative (e.g. lacked training, used expired medicines, gave improper dosages, and kept poor or no records), but, also positive, such as contributing to the management of opportunistic infections (STIs). The traditional healers also had mixed attitudes towards nurses. The traditional healers believed that nurses undermined their work (did not accept their efficacy in treatment and consequently did not refer patients). Notably, most of the traditional healers were willing to learn and refer patients to clinics and hospitals, while this was not true for the nurses.