Examining the organizational factors that affect health workers' attendance: Findings from southwestern Uganda

Sub‐Saharan Africa experiences human resources crisis in the health sector. Specifically, Uganda faces significant shortages in health care workforce at all levels. However, there is limited literature on factors contributing to health care workforce absenteeism. This study aims to explore reasons for absenteeism among health workers in rural Uganda. Data were collected using a demographic questionnaire and focus groups. Eight focus groups were conducted with participants (n = 27) selected from 39 selected health centers. Four main themes emerged as the reasons for absenteeism among health workers. These included personal/family related challenges, distance or transportation issues, income specifically additional sources of income, and poor support/supervision. Barriers to active engagement at work were also identified, including loss of motivation, concerns at home, patient level issues, and lack of equipment. Recommendations were also elicited from the participants. These findings are critical in formulating and developing interventions to address absenteeism and low performance among health workers.     

The relationship between diabetic retinopathy and psychosocial functioning: a systematic review

Quality of Life Research - Previous work has reported a link between diabetic retinopathy/diabetic macular edema (DR/DME) and psychosocial functioning, although the extent and direction of the...     

Soleus H-reflex excitability during pedaling post-stroke

A major contributor to impaired locomotion post-stroke is abnormal phasing of paretic muscle activity, but the mechanisms remain unclear. Previous studies have shown that, in the paretic limb of people post-stroke, Group Ia reflexes are abnormally elevated and fail to decrease in amplitude during locomotion. Hence, we hypothesized that inappropriate muscle phasing may be associated with enhanced transmission in the monosynaptic Group Ia afferent pathway. Soleus (SO) H-reflexes were used to examine transmission in the Group Ia afferent pathway to SO motor neurons during pedaling, a locomotor task in which abnormal muscle phasing is evident. Our hypothesis predicted that H-reflexes would be elevated during the flexion phase of pedaling where inappropriate SO activity occurs. H-reflexes were elicited in paretic (n = 13) and neurologically intact (NI, n = 26) individuals at 11 different positions in the pedaling cycle and during tonic plantar flexion at comparable limb positions and levels of SO EMG. In both groups, SO H-reflexes were smaller during pedaling as compared to matched tonic plantar flexion. In the NI group, but not the paretic group, SO H-reflex amplitude was significantly modulated across the pedaling cycle. H-reflexes were large during extension and small during flexion. Reduced H-reflex modulation post-stroke was associated with the level of neuromuscular impairment as indicated by Fugl-Meyer score. However, regardless of impairment level, stroke subjects displayed H-reflex suppression during the flexion phase of pedaling. After correcting for the level of background muscle activity, H-reflexes were found to be larger in paretic as compared to NI individuals, regardless of the phase of the pedaling cycle. We conclude that Group Ia afferent transmission is enhanced in the paretic SO of people post-stroke as compared to NI individuals. However, contrary to our hypothesis, enhanced transmission in the Group Ia monosynaptic spinal pathway is not specifically associated with extraneous extensor muscle activity during the flexion phase of pedaling and is unlikely to account for abnormal locomotor muscle phasing post-stroke. This result is important because it suggests that, despite the presence of hyperactive monosynaptic reflexes post-stroke, this impairment may not make an important contribution to abnormal locomotor muscle activity.     

Assessing patient acceptance of virtual clinics for diabetic retinopathy: a large scale postal survey

Objective

To explore the views of patients with diabetic retinopathy and maculopathy on their acceptance of virtual clinic review in place of face-to-face clinic appointments.

Chinese and Indian interpretations of pain: A qualitative evidence synthesis to facilitate chronic pain management

Objective

People from minority ethnicities often have a greater impact of chronic pain, are underrepresented at pain services, and may not benefit from treatment to the same extent as dominant cultures. The aim of this study was to review Indian and Chinese cultural views of pain and pain management, as a basis for improving management of chronic pain in migrant populations from these ethnicities.

Methods

A systematic review of qualitative studies addressing pain beliefs and experiences involving Indian and Chinese participants was conducted. Thematic synthesis was used to identify themes across the studies, and the quality of the articles was appraised.

Results

Twenty-six articles were included, most of which were appraised as high quality. Five themes were identified: Making meaning of pain described the holistic interpretation of the meaning of pain; Pain is disabling and distressing described the marked physical, psychological, and spiritual impact of pain; Pain should be endured described the cultural expectation to suppress responses to pain and not be a burden; Pain brings strength and spiritual growth described the enrichment and empowerment some people experienced through living with pain, and Management of pain goes beyond a traditional or Western approach described the factors that guided people in their use of healthcare.

Discussion

The review identified a holistic interpretation and impact of pain in Indian and Chinese populations, with pain management guided by multiple factors that transcended a single cultural framework. Several strength-based management strategies are recommended based on preferences for traditional treatments and respect for Western healthcare.