Barriers to applying for medical rehabilitation: a time-to-event analysis of employees with severe back pain in Germany

Objective: Longitudinal studies on barriers to applying for rehabilitation in Germany are lacking in light of the suspected underutilization of rehabilitation services. The aim of this study was to examine application behaviour in persons with disabling back pain and to identify relevant predictors for making an application. Design: A prospective cohort study with randomized sampling of insurants in the German Pension Insurance, using a questionnaire at baseline and follow-up with linked administrative data for 1.5 years. Subjects/patients: Employed persons (age range 45–59 years) with a high degree of limitations due to back pain and a self-reported risk of permanent work disability (not applied for disability pension, no medical rehabilitation within the last 4 years). Methods: Multivariable Cox regression was used to examine the influence of pre-selected variables on making an application in the follow-up period. Results: Of 690 persons, only 12% applied for rehabilitation. Predictors for making an application were: support from physicians (hazard ratio (HR)=2.24; 95% confidence interval (95% CI) 1.32–3.80), family, and friends (HR=1.67; 95% CI 1.02–2.73), more pain-related disability days (HR=1.02; 95% CI 1.01–1.03), and worse work ability (HR=0.86; 95% CI 0.75–0.97). An intention to apply at baseline mediated the effect of family and physician support on the application. Conclusion: The low number of applications for rehabilitation despite disabling back pain indicates access barriers to, and underuse of, medical rehabilitation.

Healthcare practitioners experiences in delivering sexual and reproductive health services to unmarried adolescent clients in Jordan: results from a cross-sectional survey

Background The need for youth-friendly sexual and reproductive health (SRH) services has been identified as a national policy priority in Jordan, but there remains limited data on service utilization among adolescents, especially those who are unmarried, and there is limited training for healthcare practitioners (HCPs) in providing SRH services to youth. The objectives of this study are to 1) describe the most common reasons for encounters that HCPs have with unmarried youth clients about SRH topics and 2) explore differences in SRH services provided to unmarried youth by provider in Jordan. Methods This cross-sectional study used a two-stage cluster-randomized sampling scheme to sample HCPs (doctors, nurses, and midwives) from health facilities in four governorates in Jordan. Data were collected on practitioner demographics, facility characteristics, and self-reports of having provided services related to nine common SRH concerns to unmarried girls or boys between the ages of 15–19 years. Chi-square tests were conducted to analyze the associations between provider and facility characteristics, client sex, and types of services rendered. Results In total, 578 providers participated in the study (110 male and 468 female). Practitioners most commonly reported seeing unmarried female youth for concerns related to puberty (38.5%) and family planning (18.51%) and unmarried male youth for concerns of puberty (22.49%) or condoms (11.59%). In total, 64.45, 64.61 and 71.19% of midwives, nurses, and doctors reported having provided any SRH service to an unmarried adolescent. While practitioners most often reported seeing clients of the same sex, male practitioners were more likely to report having seen a female client for STIs (9.09% vs. 4.27% p = 0.040), and providing general information about sexual activity (12.73% vs. 5.77% p = 0.011) than female providers. Conclusions Our results suggest that a substantial proportion of HCPs have provided SRH services to unmarried youth – challenging existing perceptions of the SRH care-seeking practices of unmarried youth in this conservative context.

Relation Between Personality Traits and Academic Performance Among University Students of RAKMHSU, UAE-Using a Big Five Model

Introduction Students from diverse health care professions, their personality traits have a positive influence on their academic performance. This is viewed as an indicator of collaborative education and practice for efficient patient care. The health-care professional sciences graduates who join health sciences program should be highly motivated and determined to perform academically well to accomplish their goals. The personality trait assessment gives a holistic approach to know how efficiently students use their cognitive, psychomotor and affective domains for learning which improves patient-doctor relations and ultimately results in patient satisfaction. The objective of the study was to assess the preferred personality trait and to know its relation to their academic performance. Materials and methods The study design adopted was a prospective, cross sectional using a stratified randomized sampling. First year students enrolled for medical, dental, nursing and pharmacy programs at RAKMHSU were included in the study. The Big five model questionnaire was administered to study participants during their self-study hours and data collected were analyzed in SPSS version 18. Results The most common personality trait was openness 43% followed by agreeable 21%. The analysis of their GPA (Grade point average) found that agreeableness had high GPA and Neuroticism had the lowest GPA among all traits. The study also found that high unsuccessful students were seen with Neuroticism (31.5%), Extraversion (26.3%) followed by other traits. Conscientiousness also had positive and significant correlation with AP (p<0.001) along with agreeableness. In conclusion, each student is unique, and their personality trait can be used as an aptitude test tool during their admission process for health care professions related courses.

1277. Colonization Rates for Antimicrobial-resistant Bacteria in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study

Background Characterization of antimicrobial-resistant organism (ARO) colonization is critical to understand transmission dynamics and infection risk, however data in resource-limited settings are scare. We estimated the prevalence of Enterobacterales colonization with extended-spectrum cephalosporin-resistance (ESCrE), carbapenem-resistance (CRE) and methicillin-resistant Staphylococcus aureus (MRSA) among community residents and hospitalized patients in rural (Siaya County) and urban (Kibera) Kenya. Methods Community-dwelling adults and children were enrolled via cluster randomized sampling. Inpatients of all ages were enrolled by simple random sampling. Stool/rectal and nasal swabs were collected and screened for ESCrE, CRE and MRSA, respectively, using HardyChrom™ media. Vitek2® was used for isolate confirmation and antibiotic susceptibility testing. Fisher’s exact tests were used to compare prevalence of AROs. Results The prevalence of ESCrE was higher for the urban hospital (69.8%, 263/377) compared to rural hospitals (62.7%, 298/475, P=0.04); a similar pattern was evident for CRE (16.7%, 63/377 and 6.5%, 31/475, respectively, P&lt; 0.01). The prevalence of MRSA was 3.2% for both urban and rural hospitals (P=0.99). For adults, the prevalence of ESCrE was higher in Kibera households (51.4%, 346/673) compared to Siaya (44.6%, 283/634, P=0.02) while the prevalence of both CRE and MRSA was &lt; 3% for both areas and did not differ significantly (CRE, P=0.13, MRSA, P=0.14). There was no significant difference between urban and rural children for ESCrE (47.7%, 74/155 and 53.4%, 135/253, P=0.31); both CRE and MRSA were rarely detected (&lt; 2%) with no difference across settings (CRE, P=1.0, MRSA, P=0.42). Among Enterobacteriaceae recovered, Escherichia coli and Klebsiella spp. predominated. Conclusion Colonization with AROs were widespread in households and hospitals in urban and rural areas. Hospitals with elevated prevalence of highly transmissible AROs should consider whether implementation of colonization screening can be incorporated as part of their infection prevention and control programs. Risk factors for ARO colonization should be elucidated to identify novel prevention strategies. Disclosures All Authors: No reported disclosures

Factors affecting health services strategic purchasing for breast cancer patients: a mixed study in Iran

Background Inappropriate ways of health services purchasing for cancer patients can be challengeable and costly and seriously affect the access to health services and outcomes. This study aimed at Factors affecting health services strategic purchasing for breast cancer patients. Methods As a mixed study, this research was conducted in Iran in 2020. In the qualitative phase, 21 specialists and professionals in the field of health services purchasing were purposefully selected and interviewed. After data saturation, interviews were analyzed with the framework analysis and a structured questionnaire was made based on these analyses. 400 breast cancer patients were selected by randomized sampling and completed the questionnaire. Data were analyzed with SPSS23 in p < .05. Results The highest mean rate of the three main categories belonged to “insurance trusteeship” (4.71 ± .35), followed by “supply management” (4.48 ± .27) and “financial performance” (4.48 ± .37). There were significantly differences between the mean rates of the main categories and the cut-off point (p < .001). In addition, “insurance trusteeship” ranked first (2.58), followed by financial performance (1.77) and supply management (1.65). Conclusion Of main components in health services strategic purchasing for breast cancer patients, insurance trusteeship, supply management, and financial performance ranked first to third, respectively. Therefore, healthcare policy-makers should consider the placement of insurance trusteeship and coordinate between purchasers and providers for making reform in the health system.

COMPARATIVE STUDY OF EFFICACY OF CRYOTHERAPY AND MYOFASCIAL RELEASE TECHNIQUE IN CALF MUSCLE SPASTICITY IN SPASTIC DIPLEGIC CEREBRAL PALSY CHILDREN

The greatest substantial consequence of juvenile impairment is cerebral palsy (CP). Spasticity of numerous muscle groupings is common after Central Nervous System damage. Spasticity causes functioning issues. For individuals suffering from CP ankle anomalies seem strongly tied to workable limits. Spastic CP is highest frequent type of CP, which limits child's responsive status and prohibits them from participating in communal activities. Soft tissue mobilisation procedures would be used in variety ways. Cryotherapy is interventional method for stiffness in neurological patients that has narrow advantage. MFR can potentially utilised against spasticity. The focus of this investigation is to evaluate Cryotherapy and MFR influence over calf muscle stiffness in participants who have Spastic Diplegic CP. The survey's goal is to determine efficacy of Cryotherapy and MFR in calf muscle spasticity in Spastic diplegic CP subjects. Thirty individuals suffering spastic diplegic CP were chosen using randomized sampling procedure. The subjects was categorised onto 3 subgroups, each of ten individuals. Cryotherapy was applied to Group A, MFR was applied to B and C Group was applied with combination of cryotherapy and MFR. Both before and after therapy, MAS and goniometry are used to assess calf muscle spasticity and ankle PROM. Overall validity of MAS and PROM comparing before and after in subgroup was determined using Tukey Test. Spasticity was reduced and range of motion was improved (p<0.05) in intra group comparison. Cumulative influence of cryotherapy and MFR is beneficial in reducing calf muscle stiffness in spastic diplegic CP children, as per this investigation.

Self-reported Motorcycle Riding Behavior in Southeast of Iran

Background: Motorcyclists are among the greatest vulnerable individuals of road accident victims. Their behavior has a significant correlation with increased injury and mortality rate. Determining the risky and unsafe behaviors of motorcycle drivers is necessary for preventing riders and other citizen from potential accident risks. Objectives: The aim of this study was to determine the risky driving behaviors of motorcyclists in Iran. Methods: A cross-sectional study was done in 2019 in Sistan and Baluchestan Province as the second widest province of Iran. Using randomized sampling method, we included 613 motorcyclists from the province. To collect data, the Persian version of Motorcycle Riding Behavior Questionnaire (MRBQ), as a standard questionnaire, was used. For data analysis, descriptive and analytical statistics such as one-way analysis of variance (ANOVA), t-test, and linear regression were used by SPSS software version 21. Results: The age range of 57% of the motor riders was 15 - 30 years, and 50% of them did not use any safety equipment. About 58% of the subjects had started motorcycle riding under 18 years old, and 73% of them did not have a motorcycle riding license. Moreover, more than 50% of motorcyclists used mobile phones while driving. The mean score of driving behavior (106 ± 22) was desirable. Based on multivariate analysis, job, average amount of riding, lacking a riding license, type of motor, alert from police, non-fasting helmet band, exceeding speed limits, fatigue, and hand-free riding were the main predictors of risky riding score (P < 0.05). Conclusions: According to our results, the riding behavior of motorcyclists was desirable; however, many people used motorcycles without a license and safety equipment, which increases high-risk behaviors. Considering the potential dangers of motor riders, it seems necessary to hold training courses to obtain motorcycle certification and how to use safety equipment.

Asociación entre actividad física y salud mental positiva en estudiantes de medicina en México: un estudio transversal

Esta investigación tuvo como objetivo identificar la relación entre la práctica de actividad física y aspectos positivos de la salud mental de alumnos de medicina en México. Se trata de un estudio transversal realizado con una muestra aleatoria de 190 estudiantes, con edad media de 19.0 ±1.4 años, del primero y segundo grado de una escuela de medicina en la Ciudad de México. Se aplicó una batería de test de salud mental positiva que comprendía escalas para evaluar la satisfacción de los jóvenes con la vida, su resiliencia, autoconcepto y compromiso, así como el IPAQ que evalúa su práctica de actividad física. Se llevaron a cabo análisis descriptivos, comparativos y de regresión lineal múltiple. Se encontró una asociación significativa del nivel de actividad física practicada por los alumnos con su satisfacción con la vida (B = –1.64, IC95% = –2.90, –0.38, p = .011) y su capacidad de resiliencia (B = –2.41, IC95% = –3.87, –0.95, p = .001), controlando por factores sociodemográficos. La actividad física tuvo una asociación significativa con aspectos positivos de la salud mental de estudiantes de medicina en México; por ello, intervenciones orientadas a favorecer la práctica de actividad física pueden diseñarse y utilizarse no sólo en el tratamiento y prevención de trastornos mentales, sino también para promover la salud mental entre esta población. This study aimed to identify the relationship between the practice of physical activity and positive aspects of medical students’ mental health in Mexico. This was a cross-sectional study that applied randomized sampling, and data from 190 students, with a mean age of 19.0 ±1.4 years, from the first and second grades of a medical school in Mexico City were analyzed. The questionnaire comprised scales to assess students’ satisfaction with life, resilience, self-concept, and engagement, as well as the IPAQ that evaluates their practice of physical activity. Descriptive, comparative and multiple linear regression analyses were carried out. A significant association was found between students’ levels of physical activity, their satisfaction with life (B = –1.64, IC95% = –2.90, –0.38, p = .011) and their resilience skills (B = –2.41, IC95% = –3.87, –0.95, p = .001), controlling for sociodemographic factors. Physical activity had a significant association with positive aspects of Mexican medical students’ mental health; thus, interventions aimed at improving physical activity practice can be designed and utilized not only in the treatment and prevention of mental disorders but also to promote mental health among this population. Este estudo teve como objetivo identificar a relação entre a prática de atividade física e aspectos positivos da saúde mental de estudantes de medicina do México. Este é um estudo transversal realizado com uma amostra aleatória de 190 alunos, com idade média de 19.0 ±1.4 anos, do primeiro e segundo ano de uma escola de medicina na Cidade do México. Foi aplicado um questionário que incluía escalas para avaliar a satisfação dos alunos com a vida, sua resiliência, autoconceito e comprometimento, além do IPAQ que avalia sua prática de atividade física. Foram realizadas análises descritivas, comparativas e de regressão linear múltipla. Foi encontrada associação significativa entre os níveis de atividade física praticados pelos alunos, a satisfação com a vida (B = –1.64, IC95% = –2.90, –0.38, p = .011) e a resiliência (B = –2.41, IC95% = –3.87, –0.95, p = .001), controlando para fatores sociodemográficos. A atividade física teve associação significativa com aspectos positivos da saúde mental de estudantes de medicina mexicanos; portanto, intervenções destinadas a promover a prática de atividade física podem ser planejadas e utilizadas não apenas no tratamento e prevenção de transtornos mentais, mas também para promover a saúde mental dessa população.

EFFECT SIZE–DRIVEN SAMPLE-SIZE PLANNING, RANDOMIZATION, AND MULTISITE USE IN L2

In this focused methodological synthesis, the sample construction procedures of 110 second language (L2) instructed vocabulary interventions were assessed in relation to effect size–driven sample-size planning, randomization, and multisite usage. These three areas were investigated because inferential testing makes better generalizations when researchers consider them during the sample construction process. Only nine reports used effect sizes to plan or justify sample sizes in any fashion, with only one engaging in an a priori power procedure referencing vocabulary-centric effect sizes from previous research. Randomized assignment was observed in 56% of the reports while no report involved randomized sampling. Approximately 15% of the samples observed were constructed from multiple sites and none of these empirically investigated the effect of site clustering. Leveraging the synthesized findings, we conclude by offering suggestions for future L2 instructed vocabulary researchers to consider a priori effect size–driven sample planning processes, randomization, and multisite usage when constructing samples.

Regeneration of black ash (Fraxinus nigra Marsh.) in hardwood swamps of the Great Lakes – St. Lawrence Forest Region

An inductive, ordination-based approach was used to explore patterns in the microenvironment and natural regeneration of black ash across a range of representative stands in the central Ontario portion of the Great Lakes -St. Lawrence Forest Region (GLSL) near Lake Nipissing, Ontario, Canada. The objective of this study was to describe patterns of regeneration of black ash and determine the associations between multiple indicators of black ash regeneration success and biotic and abiotic factors. Using a randomized sampling design with specific selection criteria, 12 black ash stands were sampled, each with three 400 m2 circular sample plots that contained three 4 m2 sub-plots. A suite of environmental variables such as elevation, topographic wetness index, slope, and soil characteristics (percent moisture, pH, total nitrogen, exchangeable phosphorus, potassium, magnesium) were determined for each stand. Variables capturing regeneration potential, including density, diameter, and height of all germinants, seedlings, saplings and sprouts were also collected. A sample of 15 dominant or co-dominant trees in each stand, as well as numerous black ash seedlings, saplings and sprouts were examined using dendrochronological methods to estimate ages. Principal component analysis ordinations were performed exploring the variation in environment and black ash regeneration variables among the stands. High soil moisture and the presence of canopy gaps, (as indicated by high standard deviation of canopy closure), were key variables associated with greater abundance of regeneration. Black ash was the dominant species in all stands, which were also generally characterized by a common reverse-J diameter distribution. It was observed that black ash in the sapling layer reached substantial ages (up to 60 years), indicating they are capable of withstanding long periods of suppression below the canopy. Collectively, these findings suggest that black ash-dominated stands in the study area are regenerating in multiple cohorts. Based on these patterns, it appears that regeneration in these stands is occurring through gap-phase mechanisms, suggesting single tree selection as the best management option for black ash in the GLSL.