TOURIST GUIDES, COVID 19 AND SURVIVAL MECHANISMS IN SOUTH AFRICA

The main aim of this research was to investigate the survival mechanisms employed by tourist guides in the context of the Covid 19 Pandemic. A mixed method research design was adopted, using in-depth interviews with key tourism informants and surveys administered to tourist guides in Gauteng. A total of five key informant interviews and two hundred surveys were collected at the end of the data collection period. Key findings indicate that many tourist guides were unable to access the aforementioned fund and had to implement their own short and long-term survival mechanisms. In many cases, various cost cutting measures were implemented and the utilization of personal savings and loans. Other guides temporarily engaged in different employment to secure an income. This study presents policy and systemic recommendations, which, if accepted and implemented, could assist the reignition of the tourist guide profession post-pandemic and ensure they form part of the tourism sector recovery trajectory. Additionally, further research on tourist guides in South Africa needs to be conducted, to fully understand the various aspects of this profession in the country.

Detecting Usability and User Experience Issues in Stroke Caregiving Apps: An Analysis of User Reviews (Preprint)

BACKGROUND Stroke caregivers often experience negative impacts when caring for a person living with a stroke. Technologically based interventions such as mHealth apps have demonstrated potential in supporting the caregivers during the recovery trajectory. Hence, there is an increase in apps in popular app stores, with a few apps addressing the healthcare needs of stroke caregivers. Since most of these apps were published without explanation of their design and evaluation processes, it is necessary to identify the usability and user experience issues to help app developers and researchers to understand the factors that affect long-term adherence and usage in stroke caregiving technology. OBJECTIVE The purpose of this study was to determine the usability and user experience issues in commercially available mHealth apps from the user reviews published within the app store to help researchers and developers understand the factors that may affect long-term adherence and usage. METHODS User reviews were extracted from the previously identified 47 apps that support stroke caregiving needs using a python-scraper for both app stores (i.e. Google Play Store and Apple App Store). The reviews were pre-processed to (i) clean the dataset and ensure unicode normalization, (ii) remove stop words and (iii) group words together with similar meanings. The pre-processed reviews were filtered using sentiment analysis to exclude positive and non-English reviews. The final corpus was classified based on usability and user experience dimensions to highlight issues within the app. RESULTS Of 1,385,337 user reviews, only 162,095 were extracted due to the limitations in the app store. After filtration based on the sentiment analysis, 15,818 reviews were included in the study and were filtered based on the usability and user experience dimensions. Findings from the usability and user experience dimensions highlight critical errors/effectiveness, efficiency and support that contribute to decreased satisfaction, affect and emotion and frustration in using the app. CONCLUSIONS Commercially available mHealth apps consist of several usability and user experience issues due to their inability to understand the methods to address the healthcare needs of the caregivers. App developers need to consider participatory design approaches to promote user participation in design. This might ensure better understanding of the user needs and methods to support these needs; therefore, limiting any issues and ensuring continued use.

Preliminary Evidence for the Clinical Utility of Tactile Somatosensory Assessments of Sport-Related mTBI

Objectives To evaluate the clinical utility of tactile somatosensory assessments to assist clinicians in diagnosing sport-related mild traumatic brain injury (SR-mTBI), classifying recovery trajectory based on performance at initial clinical assessment, and determining if neurophysiological recovery coincided with clinical recovery. Research Design Prospective cohort study with normative controls. Methods At admission (n = 79) and discharge (n = 45/79), SR-mTBI patients completed the SCAT-5 symptom scale, along with the following three components from the Cortical Metrics Brain Gauge somatosensory assessment (BG-SA): temporal order judgement (TOJ), TOJ with confounding condition (TOJc), and duration discrimination (DUR). To assist SR-mTBI diagnosis on admission, BG-SA performance was used in logistic regression to discriminate cases belonging to the SR-mTBI sample or a healthy reference sample (pooled BG-SA data for healthy participants in previous studies). Decision trees evaluated how accurately BG-SA performance classified SR-mTBI recovery trajectories. Results BG-SA TOJ, TOJc, and DUR poorly discriminated between cases belonging to the SR-mTBI sample or a healthy reference sample (0.54–0.70 AUC, 47.46–64.71 PPV, 48.48–61.11 NPV). The BG-SA evaluated did not accurately classify SR-mTBI recovery trajectories (> 14-day resolution 48%, ≤14–day resolution 54%, lost to referral/follow-up 45%). Mann-Whitney U tests revealed differences in BG-SA TOJc performance between SR-mTBI participants and the healthy reference sample at initial clinical assessment and at clinical recovery (p < 0.05). Conclusions BG-SA TOJ, TOJc, and DUR appear to have limited clinical utility to assist clinicians with diagnosing SR-mTBI or predicting recovery trajectories under ecologically valid conditions. Neurophysiological abnormalities persisted beyond clinical recovery given abnormal BG-SA TOJc performance observed when SR-mTBI patients achieved clinical recovery.

A Qualitative Investigation of the Psychological Experiences of COVID-19 Patients Receiving Inpatient Care in Isolation

Coronavirus disease 2019 (COVID-19) has spread rapidly throughout the world. Still, little is known about the psychological experiences of patients who received inpatient isolation treatment in order to improve the well-being of these patients. We randomly recruited 10 COVID-19 patients who received inpatient isolation treatment at a designated hospital in Wuhan from February to March 2020 and were discharged after recovery. The data were collected via a semi-structured interview over WeChat video and analyzed them using Calaizzi’s descriptive phenomenological method. COVID-19 patients experienced significant psychological stress during hospitalization that continued after recovery and discharge. This can be categorized into three themes: (1) negative emotions experienced; (2) uncertainty of treatment provided; and (3) worries about readjusting to daily life. The insight into a patient’s psychological experiences can support the timely implementation of personalized nursing interventions within hospitals and the community to improve the patient’s mental well-being and recovery trajectory.

Predictors of trajectories of obsessive-compulsive symptoms during the COVID-19 pandemic in the general population in Germany

The COVID-19 pandemic has been associated with an increase in obsessive-compulsive disorder/symptoms (OCD/OCS). However, knowledge is limited regarding the trajectories of OCS during the pandemic, as well as their predictors and mechanisms (e.g., experiential avoidance, EA). The aim of this study was to describe the trajectories of OCS and the identification of associated factors. We assessed 1207 participants of the general population in March 2020 (t1) and June 2020 (t2). Pre-pandemic data was available from March 2014 for a subsample (n = 519). To define trajectories, we determined OCS status (OCS+/−). We performed a hierarchical multinomial logistic regression to investigate predictors of trajectories. Between t1 and t2, 66% of participants had an asymptomatic trajectory (OCS−/OCS−); 18% had a continuously symptomatic trajectory (OCS+/OCS+). Ten percent had a delayed-onset trajectory (OCS−/OCS+), and the recovery trajectory group (OCS+/OCS−) was the smallest group (6%). Higher education reduced the odds of an OCS+/OCS− trajectory. OCS in 2014 was associated with increased odds of showing an OCS+/OCS+ or OCS−/OCS+ trajectory. When EA at t1 and change in EA from t1 to t2 were added to the model, higher EA at t1 was associated with increased odds of scoring above the cut score on one or more of the assessments. A higher decrease in EA from t1 to t2 reduced the probability of showing an OCS+/OCS+ and an OCS−/OCS+ trajectory. While the current data supports a slight increase in OCS during the pandemic, trajectories differed, and EA seems to represent an important predictor for an unfavorable development.

Postdischarge Recovery after Acute Pediatric Lung Disease Can Be Quantified with Digital Biomarkers

<b><i>Background:</i></b> Pediatric patients admitted for acute lung disease are treated and monitored in the hospital, after which full recovery is achieved at home. Many studies report in-hospital recovery, but little is known regarding the time to full recovery after hospital discharge. Technological innovations have led to increased interest in home-monitoring and digital biomarkers. The aim of this study was to describe at-home recovery of 3 common pediatric respiratory diseases using a questionnaire and wearable device. <b><i>Methods:</i></b> In this study, patients admitted due to pneumonia (<i>n</i> = 30), preschool wheezing (<i>n</i> = 30), and asthma exacerbation (AE; <i>n</i> = 11) were included. Patients were monitored with a smartwatch and a questionnaire during admission, with a 14-day recovery period and a 10-day “healthy” period. Median compliance was calculated, and a mixed-effects model was fitted for physical activity and heart rate (HR) to describe the recovery period, and the physical activity recovery trajectory was correlated to respiratory symptom scores. <b><i>Results:</i></b> Median compliance was 47% (interquartile range [IQR] 33–81%) during the entire study period, 68% (IQR 54–91%) during the recovery period, and 28% (IQR 0–74%) during the healthy period. Patients with pneumonia reached normal physical activity 12 days postdischarge, while subjects with wheezing and AE reached this level after 5 and 6 days, respectively. Estimated mean physical activity was closely correlated with the estimated mean symptom score. HR measured by the smartwatch showed a similar recovery trajectory for subjects with wheezing and asthma, but not for subjects with pneumonia. <b><i>Conclusions:</i></b> The digital biomarkers, physical activity, and HR obtained via smartwatch show promise for quantifying postdischarge recovery in a noninvasive manner, which can be useful in pediatric clinical trials and clinical care.

The physical and mental impact of surviving sepsis – a qualitative study of experiences and perceptions among a Swedish sample

Background Sepsis is a critical illness with high morbidity and mortality rates. Each year, sepsis affects about 48.9 million people all over the world. This study aims to illuminate how sepsis survivors experience sepsis and the impact of sepsis, as well as the health-related quality of life thereafter. Methods An interview study with eight sepsis survivors was carried out in Sweden with an inductive qualitative method. The data were analyzed with content analysis. Results Four themes were identified during the analysis; The experience of health care and being a sepsis patient, New circumstances´ impact on life, Family and social interactions, and The psychological impact on life. The lack of information about how sepsis can impact the survivors’ lives and what to expect can lead to prolonged agony. The long recovery time comes as an unexpected and unpleasant surprise to those affected. Initially, the sepsis survivors are almost euphoric that they have survived, which can later lead to chock and trauma when they realize that they could have died. This insight needs to be processed in order to reach reconciliation with life after sepsis. Conclusion Sepsis has a huge impact on both physical and mental aspects of life. Many survivors suffer from persistent residual symptoms of varying degrees, to which they have to adapt. The sepsis survivors need individually adjusted information about the sepsis recovery trajectory, and what to expect during and after the hospital stay.

Trajectories of Recovery after Atrial Fibrillation Ablation

Ablation procedures are common for patients with atrial fibrillation (AF), yet evidence is limited about patient perceptions of their recovery following ablation. We sought to expand understanding of this recovery process. Twenty participants undergoing their first AF ablation completed semi-structured interviews prior to ablation (baseline) and at one, three, and six months post AF ablation. Pre-procedure education is modeled after education used for other ablation procedures, preparing patients to expect a single recovery trajectory. We identified two recovery trajectories that varied in speed of symptom resolution: sustained improvement and pseudo improvement. Recovery was slower than expected in both trajectories. Moreover, returning to desired activity levels consistently lagged behind other symptom resolution by approximately two months. A more accurate understanding of what patients experience post-ablation, as illustrated in these findings, serves as a beginning step to alter patient education prior to AF ablation to better prepare individuals for the recovery process.

Endocrine Responses to Sport-Related Brain Injury in Female Athletes: A Narrative Review and a Call for Action

Sport-related brain injury (SRBI) occurs when a blow to the head causes the brain to move back and forth in the skull, and can lead to neuroendocrine dysfunction. Research has shown that males and females experience and recover from SRBI differently, yet most of what is known regarding diagnosis, treatment, and recovery of SRBI is based on male normative data even though females meet or exceed incidence numbers of SRBIs compared to those of males. Females also have been known to have worse outcomes and a greater number of symptoms following SRBI than males. Research is limited as to why females have worse outcomes, but sex hormones have been suggested as a potential reason. SRBI may cause a dysregulation of the hypothalamic–pituitary–gonadal (HPG) axis, which is responsible for regulating the sex hormones estrogen and progesterone. Initial research has shown that SRBI may suppress estrogen and progesterone, and the concentration of these sex hormones could be indicative of injury severity and recovery trajectory. This review discusses the sex-specific differences in SRBI and also the future direction of research that is needed in order to identify the repercussions of SRBIs for female athletes, which will eventually lead to better clinical treatment, sideline care, and recovery profiles.