Mental health of healthcare workers during the COVID-19 outbreak: A rapid scoping review to inform provincial guidelines in South Africa

COVID-19 is prevalent in sub-Saharan Africa. The healthcare response to the pandemic depends upon a mentally and physically healthy workforce. Infectious disease outbreaks cause high psychosocial stress among healthcare workers, which may impact negatively on workplace functioning. To understand which mental health conditions may occur and which interventions could be considered, we conducted a rapid scoping review. Using a 2018 systematic review as the starting point, PubMed, Cochrane, Web of Science and MEDLINE databases were searched for any type of evidence published in English between 2014 and 2020 on mental health of healthcare workers exposed to infectious disease outbreaks; 19 primary studies and 13 opinion pieces were included. Depression, anxiety, post-traumatic stress, and other mental health conditions were noted among healthcare workers exposed to COVID-19 and other outbreaks. Although no effectiveness studies were identified, certain proposed interventions may be implemented by healthcare leaders. Further research is recommended

Sentinel seroprevalence of SARS-CoV-2 in Gauteng Province, South Africa, August - October 2020

Background. Estimates of prevalence of anti-SARS-CoV-2 antibody positivity (seroprevalence) for tracking the COVID-19 epidemic are lacking for most African countries.Objectives. To determine the prevalence of antibodies against SARS-CoV-2 in a sentinel cohort of patient samples received for routine testing at tertiary laboratories in Johannesburg, South Africa.Methods. This sentinel study was conducted using remnant serum samples received at three National Health Laboratory Service laboratories in the City of Johannesburg (CoJ) district. Collection was from 1 August to 31 October 2020. We extracted accompanying laboratory results for glycated haemoglobin (HbA1c), creatinine, HIV, viral load and CD4 T-cell count. An anti-SARS-CoV-2 targeting the nucleocapsid (N) protein of the coronavirus with higher affinity for IgM and IgG antibodies was used. We reported crude as well as population-weighted and test-adjusted seroprevalence. Multivariate logistic regression analysis was used to determine whether age, sex, HIV and diabetic status were associated with increased risk for seropositivity.Results. A total of 6 477 samples were analysed, the majority (n=5 290) from the CoJ region. After excluding samples with no age or sex stated, the model population-weighted and test-adjusted seroprevalence for the CoJ (n=4 393) was 27.0% (95% confidence interval (CI) 25.4 - 28.6). Seroprevalence was highest in those aged 45 - 49 years (29.8%; 95% CI 25.5 - 35.0) and in those from the most densely populated areas of the CoJ. Risk for seropositivity was highest in those aged 18 - 49 years (adjusted odds ratio (aOR) 1.52; 95% CI 1.13 - 2.13; p=0.0005) and in samples from diabetics (aOR 1.36; 95% CI 1.13 - 1.63; p=0.001).Conclusions. Our study conducted between the first and second waves of the pandemic shows high levels of current infection among patients attending public health facilities in Gauteng Province

Comparison of cardiovascular health profiles across population surveys from five high- to low-income countries

Aims With the greatest burden of cardiovascular disease morbidity and mortality increasingly observed in lower-income countries least prepared for this epidemic, focus is widening from risk factor management alone to primordial prevention to maintain high levels of cardiovascular health (CVH) across the life course. To facilitate this, the American Heart Association (AHA) developed CVH scoring guidelines to evaluate and track CVH. We aimed to compare the prevalence and trajectories of high CVH across the life course using nationally representative adult CVH data from five diverse high- to low-income countries. Methods Surveys with CVH variables (physical activity, cigarette smoking, body mass, blood pressure, blood glucose, and total cholesterol levels) were identified in Ethiopia, Bangladesh, Brazil, England, and the United States (US). Participants were included if they were 18-69y, not pregnant, and had data for these CVH metrics. Comparable data were harmonized and each of the CVH metrics was scored using AHA guidelines as high (2), moderate (1), or low (0) to create total CVH scores with higher scores representing better CVH. High CVH prevalence by age was compared creating country CVH trajectories. Results The analysis included 28,092 adults (Ethiopia n=7686, 55.2% male; Bangladesh n=6731, 48.4% male; Brazil n=7241, 47.9 % male; England n=2691, 49.5% male, and the US n=3743, 50.3% male). As country income level increased, prevalence of high CVH decreased (>90% in Ethiopia, >68% in Bangladesh and under 65% in the remaining countries). This pattern remained using either five or all six CVH metrics and following exclusion of underweight participants. While a decline in CVH with age was observed for all countries, higher income countries showed lower prevalence of high CVH already by age 18y. Excess body weight appeared the main driver of poor CVH in higher income countries, while current smoking was highest in Bangladesh. Conclusion Harmonization of nationally representative survey data on CVH trajectories with age in 5 highly diverse countries supports our hypothesis that CVH decline with age may be universal. Interventions to promote and preserve high CVH throughout the life course are needed in all populations, tailored to country-specific time courses of the decline. In countries where CVH remains relatively high, protection of whole societies from risk factor epidemics may still be feasible.This study was funded with support from the Institute for Global Health, Northwestern University [Catalyzer Award No. 1005]; from the DSI-NRF Centre of Excellence in Human Development hosted at the University of the Witwatersrand in South Africa, and the support of the University of the Witwatersrand research office

The Knee Osteoarthritis Grading System for Arthroplasty

Background: The aim of this study is to validate the Knee Osteoarthritis Grading System (KOGS) of progressive osteoarthritic degeneration for the tri-compartmental knee. This system defines the site and severity of osteoarthritis to determine a specific knee arthroplasty. Methods: The radiographic sequence for KOGS includes standing coronal (anteroposterior), lateral, 30° skyline patella, 15° and 45° Rosenberg and stress views in 20° of flexion. Cohen's kappa and related agreement statistical methods were used to assess the level of concordance of the 7 evaluators between A and B cohorts for each evaluator and also against the actual arthroplasty used. Sensitivity and specificity was also assessed for the KOGS in identifying true partial knee arthroplasties (PKAs) and total knee arthroplasties (TKAs) as decided from the cohort A evaluations. Results: From a cohort of 330 patients who were included in the study, 71 (22.5%) underwent a TKA procedure, 258 (78.2%) a PKA, and 1 (0.3%) was neither a TKA nor PKA. KOGS was able to identify true PKAs (sensitivity) in the range of 92.2%-98.5% across all the different evaluators. The KOGS method was able to identify a PKA or a TKA with an accuracy ranging from 92% to 98.8% across all different evaluators. The surgical results after 20 months are at least comparable with the expected average in the academic literature. Conclusion: The KOGS classification provides a reliable and accurate tool to assess suitability of an individual patient for undergoing PKA or TKA

Envisaging the alternatives : From knowledge of the powerful to powerful knowledge in history classrooms

In this case study, we explore pedagogical practices that could promote powerful knowledge in school history. We analyse teaching sessions conducted by two teachers. The cases were selected from an observation study that focused on historical literacy in Finnish schools. While Michael Young's ideas of powerful knowledge have gained considerable attention in recent years, the pedagogical aspects of powerful knowledge have been less explored than its knowledge theorization. Our results indicate that promoting powerful knowledge is possible in school history. We suggest that powerful knowledge could be supported by teacher-led pedagogy that involves the systematic use of historical texts, and that uses disciplinary concepts to re-conceptualize everyday knowledge. Hence, teaching strives to unpack the (political) use of historical knowledge and narratives that represent the knowledge of the powerful.Peer reviewe

A study Comparing TextBased WhatsApp and Face-to-Face Interviews to Understand Early School Dropout

The majority of adolescents communicate via text-based messaging, particularly through WhatsApp, a widely used free communication application. Written content on WhatsApp has the methodological potential to provide rich qualitative interview data. This study compares data collected using text-based WhatsApp versus face-to-face interview techniques. Semistructured interviews were conducted with a sample of early school leavers in South Africa, using WhatsApp (n = 9) and face-to-face (n = 27) followed by a focus group discussion with interviewers. Mann-Whitney U and chisquared were used to assess associations. WhatsApp text-based interviews took significantly longer to complete but were comparable to face-to-face on the number of themes generated. Rapport, measured as the number of statements from the interviewer aimed at creating a sense of affinity, comfort, and distress reduction, differed between interview conditions. It may be methodologically appropriate for researchers to offer participants a choice of a preferred method of interviewing or consider pragmatic blended approaches of face-to-face and WhatsApp

A study Comparing TextBased WhatsApp and Face-to-Face Interviews to Understand Early School Dropout

The majority of adolescents communicate via text-based messaging, particularly through WhatsApp, a widely used free communication application. Written content on WhatsApp has the methodological potential to provide rich qualitative interview data. This study compares data collected using text-based WhatsApp versus face-to-face interview techniques. Semistructured interviews were conducted with a sample of early school leavers in South Africa, using WhatsApp (n = 9) and face-to-face (n = 27) followed by a focus group discussion with interviewers. Mann-Whitney U and chisquared were used to assess associations. WhatsApp text-based interviews took significantly longer to complete but were comparable to face-to-face on the number of themes generated. Rapport, measured as the number of statements from the interviewer aimed at creating a sense of affinity, comfort, and distress reduction, differed between interview conditions. It may be methodologically appropriate for researchers to offer participants a choice of a preferred method of interviewing or consider pragmatic blended approaches of face-to-face and WhatsApp

The Knee Osteoarthritis Grading System (KOGS) for arthroplasty

Background The aim of this study is to validate the Knee Osteoarthritis Grading system (KOGS) of progressive osteoarthritic (OA) degeneration for the Tri-compartmental knee. This system defines the site and severity of OA to determine a specific knee replacement. Methods The radiographic sequence for KOGS includes standing coronal (antero-posterior), lateral, 30° skyline patella, 15° and 45° Rosenberg and stress views in 20° of flexion. Cohen’s Kappa and related agreement statistical methods were used to assess the level of concordance of the seven evaluators between A and B cohorts for each evaluator and also against the actual arthroplasty used. Sensitivity and specificity was also assessed for the KOGS in identifying true partial knee replacements (PKR) and total knee replacements (TKR) as decided from the cohort A evaluations. Results From a cohort of 330 patients who were included in the study, 71 (22.5%) underwent a TKR procedure, 258 (78.2%) a PKR and 1 (0.3%) was neither a TKR nor PKR. KOGS was able to identify true PKRs (sensitivity) in the range of 92.2% to 98.5% across all the different evaluators. The KOGS method was able to identify a PKR or a TKR with an accuracy ranging from 92% to 98.8% across all different evaluators. The surgical results after 20 months are at least comparable with the expected average in the academic literature. Conclusion The KOGS classification provides a reliable and accurate tool to assess suitability of an individual patient for undergoing partial or total knee replacement