Promotion, prevention and protection: interventions at the population- and community-levels for mental, neurological and substance use disorders in low- and middle-income countries

Background In addition to services within the health system, interventions at the population and community levels are also important for the promotion of mental health, primary prevention of mental, neurological and substance use (MNS) disorders, identification and case detection of MNS disorders; and to a lesser degree treatment, care and rehabilitation. This study aims to identify “best practice” and “good practice” interventions that can feasibly be delivered at these population- and community-levels in low- and middle-income countries (LMICs), to aid the identification of resource efficiencies and allocation in LMICs. Methods A narrative review was conducted given the wide range of relevant interventions. Expert consensus was used to identify “best practice” at the population-level on the basis of existing quasi-experimental natural experiments and cost effectiveness, with small scale emerging and promising evidence comprising “good practice”. At the community-level, using expert consensus, the ACE (Assessing Cost-Effectiveness in Prevention Project) grading system was used to differentiate “best practice” interventions with sufficient evidence from “good practice” interventions with limited but promising evidence. ResultsAt the population-level, laws and regulations to control alcohol demand and restrict access to lethal means of suicide were considered “best practice”. Child protection laws, improved control of neurocysticercosis and mass awareness campaigns were identified as “good practice”. At the community level, socio-emotional learning programmes in schools and parenting programmes during infancy were identified as “best practice”. The following were all identified as “good practice”: Integrating mental health promotion strategies into workplace occupational health and safety policies; mental health information and awareness programmes as well as detection of MNS disorders in schools; early child enrichment/preschool educational programs and parenting programs for children aged 2–14 years; gender equity and/or economic empowerment programs for vulnerable groups; training of gatekeepers to identify people with MNS disorders in the community; and training non-specialist community members at a neighbourhood level to assist with community-based support and rehabilitation of people with mental disorders. Conclusion Interventions provided at the population- and community-levels have an important role to play in promoting mental health, preventing the onset, and protecting those with MNS disorders. The importance of inter-sectoral enga

Factors which are predictive of return work after stroke

Stroke impacts on a survivor’s ability to participate in community activities such as return to work (RTW) and affects people who are within the working age. There is a dearth of literature on RTW after stroke in developing countries. This study aimed to bridge this gap in South Africa, and was conducted within the Gauteng province as it comprises the largest share of the South African population. Seventy-two stroke survivors participated in this cross-sectional study. A demographic questionnaire; Barthel index; Modified Rivermead mobility index and Montreal cognitive assessment were used to determine the characteristics of study participants. The mean (standard deviation) scores for the Barthel Index (BI), Modified Rivermead mobility index (MRMI) and Montreal cognitive assessment (MoCA) were 19.6 (±0.2), 39.5 (±0.9) and 25.1 (±4.8) respectively. Thirty-one (43%) of the stroke survivors returned to work at six months after stroke. Stroke survivors with left hemiplegia had a greater chance of RTW than those with right hemiplegia (odds ratio 7.7). For every unit increase in the BI and MoCA score, the likelihood of RTW increased by 1.6 and 1.3 respectively. Conclusion: Side of hemiplegia, independence in activities of daily living and cognitive ability were found to be predictors of RTW at six months after stroke. It is important to identify people with cognitive impairments after stroke so that efforts can be made to increase awareness of the potential role that cognitive impairments may play in RTW

The implementation of the Objective Structured Practical Examination (OSPE) method: Students’ and examiners’ experiences

Background. Traditionally, physiotherapy practical skills have been assessed by a method that relies on the subjective interpretation of competency by the examiner and lacks the formative benefits of  assessment.Objective. To describe and compare student performance and satisfaction and examiner satisfaction  with regard to the Objective Structured Practical Examination (OSPE) and traditional mark sheets during the practical skills assessment.Method. Students and examiners taking part in the second-year physiotherapy practical skills test were invited to participate by completing a series of questionnaires. Performance of techniques was marked using both the OSPE and traditional mark sheets.Results. Sixty-seven students and nine examiners participated in the study. Students scored an average of 4.6% (SD ±16.4) better when using the traditional mark sheet. Nonetheless, students and examiners expressed a preference for the OSPE mark sheet.Conclusion. The OSPE mark sheet allows for increased objectivity, as the specific micro-skills are clearly  listed and appropriately weighted. This resulted in increased satisfaction, but a decrease in marks obtained. By assessing the effect of implementation of the OSPE method on performance and satisfaction, change in the current situation can be monitored

Inter-examiner reliability when using the Objective Structured Practical Examination (OSPE) mark sheet for physiotherapy practical

The Objective Structured Practical Examination (OSPE) format is used during practical examinations as part of the physiotherapy undergraduate curriculum at the University of the Witwatersrand. Various factors influence inter-examiner reliability and investigating the inter-examiner reliability when using the OSPE can lead to improvement of the examination process. The aim of this study was to establish inter-examiner reliability when using the OSPE mark sheet. Methods: Twelve examiners participated in this study. Thirty-three second year PT students were examined at six stations and by two examiners at each station. The Spearman’s correlation test was used to establish inter-examiner reliability. Results: The general inter-examiner reliability of the OSPE mark sheet was high. There was a high correlation between examiners who had the same level of experience (r=0.79 to r=0.93; p<0.001). The background knowledge section of the OSPE mark sheet showed the greatest inter-examiner reliability (r=0.75 to r=0.91; p<0.001). Discussion: In general, a high inter-examiner reliability was found. Examiners with the same level of experience seemed to generally have better inter-examiner reliability when using the OSPE mark sheet. Furthermore, a well-described, operationalised list of micro-skills also improved inter-examiner reliability. Conclusion: The OSPE mark sheet aids inter-examiner reliability. The use of this method of examination should be encouraged