Standards of care and determinants of women's satisfaction with delivery services in Nepal: a multi-perspective analysis using data from a health facility-based survey.

BACKGROUND: Compliance with standards of care is required for sustained improvement in the quality of delivery services. It thus represents a key challenge to improving maternal survival and meeting the Sustainable Development Goal (SDG) target of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. This study examines the extent to which normal low-risk health facility deliveries in Nepal meet the standards of quality of care and assesses the effect of the standards of quality of care and various contextual factors on women's satisfaction with the services they receive. METHODS: Drawing on the 2021 Nepal Health Facility Survey, the sample comprised 320 women who used health facilities for normal, low-risk delivery services. A weighted one-sample t-test was applied to examine the proportion of deliveries meeting the eight standards of care. Women's overall satisfaction level was computed from seven satisfaction variables measured on a Likert scale, using principal component analysis. The composite measure was then dichotomized. Binary logistic regression was used to analyze the determinants of women's satisfaction with delivery care services. RESULTS: Deliveries complying with the eight standards of care and its 53 indicators varied widely; output indicators were more frequently met than input indicators. Of the eight standards of care, the "functional referral system" performed highest (92.0%), while "competent, motivated human resources" performed the least (52.4%). Women who were attended by a provider when they called for support (AOR: 5.29; CI: 1.18, 23.64), who delivered in health facilities that displayed health statistics (AOR 3.16; CI: 1.87, 5.33), who experienced caring behaviors from providers (AOR: 2.59; CI: 1.06, 6.30) and who enjoyed audio-visual privacy (AOR 2.13; CI: 1.04, 4.38) had higher satisfaction levels compared to their counterparts. The implementation of the Maternity Incentive Scheme and presence of a maternal waiting room in health facilities, however, were associated with lower satisfaction levels. CONCLUSIONS: Nepal performed moderately well in meeting the standards of care for normal, low-risk deliveries. To meet the SDG target Nepal must accelerate progress. It needs to focus on people-centered quality improvement to routinely assess the standards of care, mobilize available resources, improve coordination among the three tiers of government, and implement high-impact programs.

Changes in health facility readiness for obstetric and neonatal care services in Nepal: an analysis of cross-sectional health facility survey data in 2015 and 2021.

BACKGROUND: Nepal is committed to achieving the Sustainable Development Goal (SDG) 2030 target 3.1 of reducing the maternal mortality ratio to 70 deaths per 100,000 live births. Along with increasing access to health facility (HF)-based delivery services, improving HF readiness is critically important. The majority of births in Nepal are normal low-risk births and most of them take place in public HFs, as does the majority of maternal deaths. This study aims to assess changes in HF readiness in Nepal between 2015 and 2021, notably, if HF readiness for providing high-quality services for normal low-risk deliveries improved; if the functionality of basic emergency obstetric and neonatal care (BEmONC) services increased; and if infection prevention and control improved. METHODS: Cross-sectional data from two nationally representative HF-based surveys in 2015 and 2021 were analyzed. This included 457 HFs in 2015 and 804 HFs in 2021, providing normal low-risk delivery services. Indices for HF readiness for normal low-risk delivery services, BEmONC service functionality, and infection prevention and control were computed. Independent sample T-test was used to measure changes over time. The results were stratified by public versus private HFs. RESULTS: Despite a statistically significant increase in the overall HF readiness index for normal low-risk delivery services, from 37.9% in 2015 to 43.7%, in 2021, HF readiness in 2021 remained inadequate. The availability of trained providers, essential medicines for mothers, and basic equipment and supplies was high, while that of essential medicines for newborns was moderate; availability of delivery care guidelines was low. BEmONC service functionality did not improve and remained below five percent facility coverage at both time points. In private HFs, readiness for good quality obstetrical care was higher than in public HFs at both time points. The infection prevention and control index improved over time; however, facility coverage in 2021 remained below ten percent. CONCLUSIONS: The slow progress and sub-optimal readiness for normal, low-risk deliveries and infection prevention and control, along with declining and low BEmONC service functionality in 2021 is reflective of poor quality of care and provides some proximate explanation for the moderately high maternal mortality and the stagnation of neonatal mortality in Nepal. To reach the SDG 2030 target of reducing maternal deaths, Nepal must hasten its efforts to strengthen supply chain systems to enhance the availability and utilization of essential medicines, equipment, and supplies, along with guidelines, to bolster the human resource capacity, and to implement mechanisms to monitor quality of care. In general, the capacity of local governments to deliver basic healthcare services needs to be increased.

Stellate Ganglion Block and Intraarterial Spasmolysis in Patients with Cerebral Vasospasm: A Retrospective Cohort Study.

BACKGROUND: In patients with symptomatic cerebral vasospasm (CV) following aneurysmal subarachnoid hemorrhage who do not respond to medical therapy, urgent treatment escalation has been suggested to be beneficial for brain tissue at risk. In our routine clinical care setting, we implemented stellate ganglion block (SGB) as a rescue therapy with subsequent escalation to intraarterial spasmolysis (IAS) with milrinone for refractory CV. METHODS: In this retrospective analysis from 2012 to 2021, patients with CV following aneurysmal subarachnoid hemorrhage who received an SGB or IAS were identified. Patients were assessed through neurological examination and transcranial Doppler. Rescue therapy was performed in patients with mean cerebral blood flow velocity (CBFV) ≥ 120 cm/s and persistent neurological deterioration/intubation under induced hypertension. Patients were reassessed after therapy and the following day. The Glasgow Outcome Scale was assessed at discharge and 6-month follow-up. RESULTS: A total of 82 patients (mean age 50.16 years) with 184 areas treated with SGB and/or IAS met the inclusion criteria; 109 nonaffected areas were extracted as controls. The mean CBFV decrease in the middle cerebral artery on the following day was - 30.1 (± 45.2) cm/s with SGB and - 31.5 (± 45.2) cm/s with IAS. Mixed linear regression proved the significance of the treatment categories; other fixed effects (sex, age, aneurysm treatment modality [clipping or coiling], World Federation of Neurological Surgeons score, and Fisher score) were insignificant. In logistic regression, the presence of cerebral infarction on imaging before discharge from the intensive care unit (34/82) was significantly associated with unfavorable outcomes (Glasgow Outcome Scale ≤ 3) at follow-up. CONCLUSIONS: Stellate ganglion block and IAS decreased CBFV the following 24 h in patients with CV. We suggest SGB alone for patients with mild symptomatic CV (CBFV < 180 cm/s), while subsequent escalation to IAS proved to be beneficial in patients with refractory CV and severe CBFV elevation (CBFV ≥ 180 cm/s).

Emergency obstetric and newborn care signal functions: The situation in health facilities in Nepal between 2015 and 2021.

Expanding access to facility-based delivery services and improving the functionality of emergency obstetric and neonatal care (EmONC) are important strategies toward achieving a maternal mortality ratio of 70 deaths per 100,000 live births by 2030. In this study the researchers assess signal functions at designated facilities in Nepal, using Nepal Health Facility Survey data for 2015 and 2021. The functionality of basic and comprehensive EmONC sites was low, declining over the six-year period. Lack of progress may partly be attributed to the COVID-19 pandemic. Nepal needs to expand EmONC sites strategically, strengthen referral systems, improve service readiness, and periodically assess service quality.

[Quality of Life and Return to Work Following Rehabilitation - Results of the icfPROreha Study]. / Lebensqualität und Arbeitsfähigkeit nach unfallchirurgischer Rehabilitation ­ Ergebnisse der icfPROreha-Studie.

BACKGROUND: Not only the severity of an injury, but also bio-psycho-social factors affect health-related quality of life and participation in social life after severe musculoskeletal injuries. METHODS: Multicentre prospective longitudinal study with follow-up up to 78 weeks after discharge from inpatient trauma rehabilitation. Data were collected using a comprehensive assessment tool. Quality of life was assessed using the EQ-5D-5L, return to work by patients' self-reports and routine data of health insurances. Analyses of the association between quality of life and return to work, change over time in quality of life compared to the general German population and multivariate analyses to predict quality of life were conducted. RESULT: Of 612 study participants (444 men (72.5%); M=48.5 years; SD 12.0), 502 (82.0%) returned to work 78 weeks after discharge from inpatient rehabilitation. Quality of life improved during rehabilitation treatment from 50.18 to 64.50 (mean of visual analogue scale of EQ-5D-5L) and slightly to 69.38 78 weeks after discharge from inpatient trauma rehabilitation. EQ-5D index was below the values of the general population. In total, 18 factors were selected to predict quality of life 78 weeks after discharge from inpatient trauma rehabilitation. Among others, pain at rest and suspected anxiety disorder at admission had a very strong effect on quality of life. Contextual factors such as therapies after acute care and self-efficacy also had an effect on quality of life 78 weeks after discharge from inpatient rehabilitation. CONCLUSION: Bio-psycho-social factors affect long-term quality of life of patients with musculoskeletal injuries. Already at the time of discharge from acute treatment and even more at the beginning of inpatient rehabilitation, decisions can be made in order to achieve the best possible quality of life for those affected.

Factors Predicting Response to the Recovery-Oriented Cognitive Behavioural Workshop for Persons Diagnosed with Schizophrenia.

A recovery-oriented, cognitive behavioural workshop for service users diagnosed with schizophrenia was developed, implemented and evaluated in a pilot study. Further analysis is required regarding factors which contribute to better treatment response, as this will provide useful information for workshop adaptation. Secondary multilevel model analyses were performed to determine whether workshop and booster session attendance, as well as sociodemographic variables such as gender, age, education, and duration of illness, predicted workshop responsiveness. Results showed that completers had lower responsiveness to the workshop in terms of confidence and hope, whereas those who attended an online booster session demonstrated better responsiveness as to psychosocial functioning. Longer duration of illness and older age generally predicted lower intervention responsiveness. In conclusion, adaptations utilising more booster sessions and accommodating older participants with longer duration of illness are required, as is further workshop evaluation in a randomised controlled study.

Reliability, usability and applicability of the ICD-11 beta draft focusing on hand injuries and diseases: results from German field testing.

OBJECTIVE: To test the interrater reliability when using the codes of the 11th revision of the International Classification of Diseases (ICD)-11 beta draft as well as ICD-10 and to explore the usability of the ICD-11 beta draft and the applicability of ICD-11's Supplementary section for functioning assessment in hand injuries and diseases. DESIGN: We conducted a validation study of the ICD-11 beta draft complemented by a single-centre study to collect clinical routine data on functioning. SETTING: German hand surgery clinics. PARTICIPANTS: Twenty-three physicians coded real-life cases containing diagnostic information on hand injuries and diseases. Additionally, clinical information of 100 patients was coded by 6 physicians and a nurse using ICD-11's Supplementary section for functioning assessment. MAIN OUTCOME MEASURES: Physicians coded 210 cases using the ICD-11 beta draft and ICD-10. Krippendorff's alpha was calculated. Clinical routine data was coded using 38 functioning categories. RESULTS: Interrater reliability (Krippendorff's alpha) of 0.67 for ICD-11 coding and 0.71 for ICD-10 coding was obtained, indicating substantial agreement. However, physicians reported a high proportion of problems with ICD-11 coding and slightly fewer problems with ICD-10 coding. The collected data on functioning could be mapped to ICD-11's Supplementary section for functioning assessment. For some data, however, only unspecific codes were available. CONCLUSIONS: Interrater reliability of ICD-10 and ICD-11 was satisfactory. Training material for ICD-11 is needed to further improve reliability and usability. Future users of ICD-11 should be encouraged to use the Supplementary section for functioning assessment to shed light on the problems patients experience in everyday life.

Development and Evaluation of a Recovery-Oriented Cognitive Behavioural Workshop for People Diagnosed with Schizophrenia.

BACKGROUND: There is a need to develop culturally adapted interventions that support the personal recovery and real-world functioning of people diagnosed with schizophrenia. AIMS: This study reports on the development and evaluation of a culturally adapted, recovery-oriented, cognitive behavioural workshop for service users with schizophrenia. METHOD: The feasibility and acceptability were assessed, as were changes over time in personal recovery and psychosocial functioning (primary outcomes) along with psychopathology and health-related behaviours (secondary outcomes), using multi-level modelling. It was also assessed whether personal recovery predicts psychosocial functioning. RESULTS: The workshop was feasible and was received favourably. Participants improved over time regarding confidence and hope, feeling less dominated by symptoms, psychosocial functioning, and psychopathology. Personal recovery predicted decreased psychosocial difficulties. CONCLUSIONS: The workshop is a promising intervention. It shows potential in terms of both improving personal recovery as well as real-life functioning of people diagnosed with schizophrenia. Further workshop evaluation in a randomized controlled study is required.

De novo donor-specific anti-HLA antibodies after kidney transplantation are associated with impaired graft outcome independently of their C1q-binding ability.

Many aspects of post-transplant monitoring of donor-specific (DSA) and non-donor-specific (nDSA) anti-HLA antibodies on renal allograft survival are still unclear. Differentiating them by their ability to bind C1q may offer a better risk assessment. We retrospectively investigated the clinical relevance of de novo C1q-binding anti-HLA antibodies on graft outcome in 611 renal transplant recipients. Acute rejection (AR), renal function, and graft survival were assessed within a mean follow-up of 6.66 years. Post-transplant 6.5% patients developed de novo DSA and 11.5% de novo nDSA. DSA (60.0%; P < 0.0001) but not nDSA (34.1%, P = 0.4788) increased rate of AR as compared with controls (27.4%). C1q-binding anti-HLA antibodies did not alter rate of AR in both groups. Renal function was only significantly diminished in patients with DSAC1q+ . However, DSA significantly impaired 5-year graft survival (65.2%; P < 0.0001) in comparison with nDSA (86.7%; P = 0.0054) and controls (90.7%). While graft survival did not differ between DSAC1q- and DSAC1q+ recipients, 5-year allograft survival was reduced in nDSAC1q+ (80.9%) versus nDSAC1q- (90.7%, P = 0.0251). De novo DSA independently of their ability to bind C1q are associated with diminished graft survival.

Development of a metric for tracking and comparing population health based on the minimal generic set of domains of functioning and health.

BACKGROUND: The following minimal set of valid health domains for tracking the health of both clinical and general populations has recently been proposed: 1) energy and drive functions, 2) emotional functions, 3) sensation of pain, 4) carrying out daily routine, 5) walking and moving around, and 6) remunerative employment. This study investigates whether these domains can be integrated into a sound psychometric measure to adequately assess, compare, and monitor the health of populations. METHODS: Data from waves 3 and 4 of the English Longitudinal Study of Ageing (ELSA) were analysed (N = 9779 and 11,050). From ELSA, 12 items operationalizing the six domains of the minimal generic set were identified. The Partial Credit Model (PCM) was applied to create a health metric based on these items. The Item Response Theory (IRT) model assumptions of unidimensionality, local independence, and monotonicity were evaluated, and Differential Item Functioning (DIF) was examined for sex and age groups. The psychometric properties of: 1) internal consistency reliability, 2) construct validity, and 3) sensitivity to change were evaluated to establish the final health metric. RESULTS: IRT model assumptions were found to be fulfilled. None of the items showed DIF by sex or age group. The final health metric demonstrated sound psychometric properties. CONCLUSIONS: The health metric developed in this study - based on the domains of the minimal generic set - proved useful for a wide range of health comparisons, especially for different groups of persons, and both cross-sectionally and over time. Monitoring health over time provides especially useful information for health care providers and health policymakers and both in clinical settings and the general population. The developed health metric offers a wide range of applications, including comparisons of levels of health among different groups in the general population, clinical populations, and even populations within and across different countries.

Toward the International Classification of Functioning, Disability and Health (ICF) Rehabilitation Set: A Minimal Generic Set of Domains for Rehabilitation as a Health Strategy.

OBJECTIVE: To develop a comprehensive set of the International Classification of Functioning, Disability and Health (ICF) categories as a minimal standard for reporting and assessing functioning and disability in clinical populations along the continuum of care. The specific aims were to specify the domains of functioning recommended for an ICF Rehabilitation Set and to identify a minimal set of environmental factors (EFs) to be used alongside the ICF Rehabilitation Set when describing disability across individuals and populations with various health conditions. DESIGN: Secondary analysis of existing data sets using regression methods (Random Forests and Group Lasso regression) and expert consultations. SETTING: Along the continuum of care, including acute, early postacute, and long-term and community rehabilitation settings. PARTICIPANTS: Persons (N=9863) with various health conditions participated in primary studies. The number of respondents for whom the dependent variable data were available and used in this analysis was 9264. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: For regression analyses, self-reported general health was used as a dependent variable. The ICF categories from the functioning component and the EF component were used as independent variables for the development of the ICF Rehabilitation Set and the minimal set of EFs, respectively. RESULTS: Thirty ICF categories to be complemented with 12 EFs were identified as relevant to the identified ICF sets. The ICF Rehabilitation Set constitutes of 9 ICF categories from the component body functions and 21 from the component activities and participation. The minimal set of EFs contains 12 categories spanning all chapters of the EF component of the ICF. CONCLUSIONS: The identified sets proposed serve as minimal generic sets of aspects of functioning in clinical populations for reporting data within and across heath conditions, time, clinical settings including rehabilitation, and countries. These sets present a reference framework for harmonizing existing information on disability across general and clinical populations.

Which environmental factors are associated with lived health when controlling for biological health? - a multilevel analysis.

BACKGROUND: Lived health and biological health are two different perspectives of health introduced by the International Classification of Functioning, Disability and Health (ICF). Since in the concept of lived health the impact of the environment on biological health is inherently included, it seems intuitive that when identifying the environmental determinants of health, lived health is the appropriate outcome. The Multilevel Item Response Theory (MLIRT) model has proven to be a successful method when dealing with the relation between a latent variable and observed variables. The objective of this study was to identify environmental factors associated with lived health when controlling for biological health by using the MLIRT framework. METHODS: We performed a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data were collected from 17,303 adults living in 15,263 dwellings. The MLIRT model was used for each of the two steps of the analysis to: (1) calculate people's biological health abilities and (2) estimate the association between lived health and environmental factors when controlling for biological health. The hierarchical structure of individuals in dwellings was considered in both models. RESULTS: Social support, being able to maintain one's job, the extent to which one's health needs are addressed and being discriminated against due to one's health problems were the environmental factors identified as associated with lived health. Biological health also had a strong positive association with lived health. CONCLUSIONS: This study identified environmental factors associated with people's lived health differences within and between dwellings according to the MLIRT-model approach. This study paves the way for the future implementation of the MLIRT model when analysing ICF-based data.

Biological health or lived health: which predicts self-reported general health better?

BACKGROUND: Lived health is a person's level of functioning in his or her current environment and depends both on the person's environment and biological health. Our study addresses the question whether biological health or lived health is more predictive of self-reported general health (SRGH). METHODS: This is a psychometric study using cross-sectional data from the Spanish Survey on Disability, Independence and Dependency Situation. Data was collected from 17,739 people in the community and 9,707 from an institutionalized population. The following analysis steps were performed: (1) a biological health and a lived health score were calculated for each person by constructing a biological health scale and a lived health scale using Samejima's Graded Response Model; and (2) variable importance measures were calculated for each study population using Random Forest, with SRGH as the dependent variable and the biological health and the lived health scores as independent variables. RESULTS: The levels of biological health were higher for the community-dwelling population than for the institutionalized population. When technical assistance, personal assistance or both were received, the difference in lived health between the community-dwelling population and institutionalized population was smaller. According to Random Forest's variable importance measures, for both study populations, lived health is a more important predictor of SRGH than biological health. CONCLUSIONS: In general, people base their evaluation of their own health on their lived health experience rather than their experience of biological health. This study also sheds light on the challenges of assessing biological health and lived health at the general population level.

Towards a minimal generic set of domains of functioning and health.

BACKGROUND: The World Health Organization (WHO) has argued that functioning, and, more concretely, functioning domains constitute the operationalization that best captures our intuitive notion of health. Functioning is, therefore, a major public-health goal. A great deal of data about functioning is already available. Nonetheless, it is not possible to compare and optimally utilize this information. One potential approach to address this challenge is to propose a generic and minimal set of functioning domains that captures the experience of individuals and populations with respect to functioning and health. The objective of this investigation was to identify a minimal generic set of ICF domains suitable for describing functioning in adults at both the individual and population levels. METHODS: We performed a psychometric study using data from: 1) the German National Health Interview and Examination Survey 1998, 2) the United States National Health and Nutrition Examination Survey 2007/2008, and 3) the ICF Core Set studies. Random Forests and Group Lasso regression were applied using one self-reported general-health question as a dependent variable. The domains selected were compared to those of the World Health Survey (WHS) developed by the WHO. RESULTS: Seven domains of the International Classification of Functioning, Disability and Health (ICF) are proposed as a minimal generic set of functioning and health: energy and drive functions, emotional functions, sensation of pain, carrying out daily routine, walking, moving around, and remunerative employment. The WHS domains of self-care, cognition, interpersonal activities, and vision were not included in our selection. CONCLUSIONS: The minimal generic set proposed in this study is the starting point to address one of the most important challenges in health measurement--the comparability of data across studies and countries. It also represents the first step in developing a common metric of health to link information from the general population to information about sub-populations, such as clinical and institutionalized populations.

The psychosocial difficulties in brain disorders that explain short term changes in health outcomes.

BACKGROUND: This study identifies a set of psychosocial difficulties that are associated with short term changes in health outcomes across a heterogeneous set of brain disorders, neurological and psychiatric. METHODS: Longitudinal observational study over approximately 12 weeks with three time points of assessment and 741 patients with bipolar disorders, depression, migraine, multiple sclerosis, parkinson's disease, stroke and traumatic brain injury. The data on disability was collected with the checklist of the International Classification of Functioning, Disability and Health. The selected health outcomes were the Short Form 36 and the World Health Organization Disability Assessment Schedule. Multilevel models for change were applied controlling for age, gender and disease severity. RESULTS: The psychosocial difficulties that explain the variability and change over time of the selected health outcomes were energy and drive, sleep, and emotional functions, and a broad range of activities and participation domains, such as solving problems, conversation, areas of mobility and self-care, relationships, community life and recreation and leisure. CONCLUSIONS: Our findings are of interest to researchers and clinicians for interventions and health systems planning as they show that in addition to difficulties that are diagnostic criteria of these disorders, there are other difficulties that explain small changes in health outcomes over short periods of time.

Validation of the brief International Classification of Functioning, Disability, and Health (ICF) core set for hand conditions.

STUDY DESIGN: Cross-sectional multi-centre study. INTRODUCTION: The ICF Core Sets for Hand Conditions (HC) have been developed to describe functioning of patients with HC. PURPOSE OF THE STUDY: To study the content validity of the Brief ICF Core Set for HC. METHODS: Patients with HC were interviewed using the Comprehensive ICF Core Set for HC. ICF categories that best explained variation in patients' general health were identified using multiple regression methods. RESULTS: Overall, 12 of the 23 ICF categories of the Brief ICF Core Set could be validated. Our analyzes further revealed that the categories "b134 Sleep functions", "s830 Structure of nails", "e225 Climate" as well as categories referring to "e4 Attitudes" also deserve consideration when assessing functioning in patients with HC. CONCLUSIONS: Clinicians are encouraged to complement the Brief ICF Core Set for HC by adding sleep functions, structure of nails, climate and attitudes, especially when following patients over time. LEVEL OF EVIDENCE: Level 3.

ICF-based prediction of return to work after trauma rehabilitation: Results of the icfPROreha study in patients with severe musculoskeletal injuries.

Background: Physical aspects such as the type and severity of an injury are not the only factors contributing to whether or not a person can return to work (RTW) after a serious injury. A more comprehensive, biopsychosocial approach is needed to understand the complexity of RTW fully. The study aims to identify predictors of RTW 78 weeks after discharge from initial inpatient trauma rehabilitation in patients with severe musculoskeletal injuries using a biopsychosocial perspective. Methods: This is a prospective multicenter longitudinal study with a follow-up of up to 78 weeks after discharge from trauma rehabilitation. Data on potential predictors were collected at admission to rehabilitation using a comprehensive assessment tool. The status of RTW (yes vs. no) was assessed 78 weeks after discharge from rehabilitation. The data were randomly divided into a training and a validation data set in a ratio of 9:1. On the training data, we performed bivariate and multiple logistic regression analyses on the association of RTW and potential predictors. The final logit model was selected via stepwise variable selection based on the Akaike information criterion. The final model was validated for the training and the validation data. Results: Data from 761 patients (n = 561 male, 73.7%; mean age: 47.5 years, SD 12.3), primarily suffering from severe injuries to large joints and complex fractures of the large tubular bones, could be considered for analyses. At 78 weeks after discharge, 618 patients (81.2%) had returned to work. Eleven predictors remained in the final logit model: general health, current state of health, sensation of pain, limitations and restrictions in activities and participation (disability), professional sector, ongoing legal disputes, financial concerns (assets), personality traits, life satisfaction preaccident, attitude to life, and demand for pension claim. A predicted probability for RTW based on the multiple logistic regression model of 76.3% was revealed as the optimal cut-off score based on the ROC curve. Conclusion: A holistic biopsychosocial approach is needed to address RTW and strengthen person-centered treatment and rehabilitation. Patients at risk for no RTW in the long term can already be identified at the onset of rehabilitation.

Evaluating the Effectiveness of a One-Week Multimodal Prevention Program for Slowing down and Stress Reduction Performed in a German Health Resort: Results of a Randomized Controlled Trial.

BACKGROUND: Effective concepts are required to overcome the negative impact of daily stressful overwhelming. We investigated the effectiveness of a 1-week multimodal program for stress reduction. METHODS: We performed a randomized controlled trial including adults with above-average stress level. The intervention consisted of health coaching, relaxation, physical activity, and balneotherapeutic elements. Individuals were randomized either to the intervention group (IG) or to one of the two control groups B and C. The main outcome was change in stress (Perceived Stress Questionnaire [PSQ], Screening Scale of Chronic Stress of the Trier Inventory for Chronic Stress [TICS-SSCS]) at 6 months post intervention; further outcomes were well-being (World Health Organization 5-Item Well-Being Index [WHO-5]) and health status (EuroQol visual analog scale [EQ-5D VAS]). Data were collected pre/post intervention as well as after 1, 3, and 6 months. RESULTS: Data of 96 individuals (mean age 48.0 years, 74% female) were available for analyses. The IG improved overtime with -13.45 points for the PSQ and -6.44 points for the TICS-SSCS after 6 months. At 6-month follow-up the IG did not significantly differ from group B (PSQ: p = 0.2332; TICS-SSCS: p = 0.0805) or group C (PSQ: p = 0.0950; TICS-SSCS: p = 0.0607) when controlling for baseline (ANCOVA). Compared to group C, ANCOVA revealed significant differences in WHO-5 (p = 0.0292) and EQ-5D VAS (p = 0.0177) post intervention. At the 3- and 6-month follow-up and compared to group B, no substantial differences could be found for WHO-5 and EQ-5D VAS. CONCLUSION: The results indicate that even a short-term multimodal program for stress reduction appears to set a positive trend towards less perceived and chronic stress.

Physical Activity during COVID-19 in German Adults: Analyses in the COVID-19 Snapshot Monitoring Study (COSMO).

The novel coronavirus (COVID-19) and the resulting outbreak response measures in Germany and worldwide led to severe limitations in everyday life. This affected all sorts of daily activities and the possibility for physical activity (PA), which represents a major coping strategy against stress. The objective of this study was to analyse PA in German adults during a total lockdown phase including school closures in April 2020 in certain subgroups and in relation to other coping strategies. Data from the COVID-19 Snapshot Monitoring (COSMO) survey, an online cross-sectional study with 1034 participants between 18 and 74 years, were utilised (14/15 April 2020). In addition to descriptive analyses, the odds of performing PA according to the World Health Organization (WHO) recommendations for adults (at least 2.5 h/week of at least moderate intensity) were analysed by univariate and multivariate logistic regression analyses. In total, 440 (42.6%) participants fulfilled this criterion. Participants with children <6 years were less likely to meet the WHO recommendation (OR = 0.51; 95% CI: 0.33-0.78), while those with a higher level of education, good coping behaviour, regular alcohol consumption, and being satisfied with life were more likely to meet the WHO recommendation. In conclusion, PA intervention strategies tailored to specific vulnerable subgroups such as individuals with low educational background and parents with young children are needed in future pandemic response.

A Multimodal Stress-Prevention Program Supplemented by Telephone-Coaching Sessions to Reduce Perceived Stress among German Farmers: Results from a Randomized Controlled Trial.

This study compared the effectiveness of a 12-day stress-prevention program (SGS) supplemented by individualized, structured, four-session telephone-coaching to that of an SGS without telephone-coaching in entrepreneurs from the green professions presenting with increased stress levels. All participants went through the SGS before being randomized either to the telephone-coaching group (TC) or to the control group without telephone-coaching (noTC). SGS included four key therapeutic elements: stress-management intervention, relaxation, physical exercise, and balneotherapy. The primary outcome was the current degree of subjectively experienced stress assessed with the Perceived Stress Questionnaire (PSQ) at a 9-month follow-up. Secondary outcomes included burnout symptoms, well-being, health status, sleep disorders, expectation of self-efficacy, depression, anxiety, ability to work, pain, and days of sick leave. Assessments were conducted at baseline, 12 days (end of program), and 1 (start telephone-coaching), 3, 6 (end of telephone-coaching), and 9 months. Data from 103 adults (TC = 51; noTC = 52), mostly fulltime farmers, were available for analysis (mean age: 55.3; 49.1% female). Participants experienced significant immediate improvement in all outcome measurements, which declined somewhat during the first three months after the end of SGS and then remained stable for at least another six months. While within-group changes from baseline to 9 months showed significant improvements at medium to large effect sizes for all target variables (PSQ-total, TC: -13.38 (±14.98); 95%-CI: (-17.68; -9.07); noTC: -11.09 (±14.15); 95%-CI: (-15.11; -7.07)), no statistically significant differences were found between the groups at any time and for any target variable (between-group ANCOVA for PSQ-total at 9 months, parameter estimator for the group: -1.58; 95%-CI: (-7.29; 4.13)). The stress-prevention program SGS is a feasible, effective, and practical way to reduce perceived stress and improve participants' resources. Four subsequent telephone-coaching sessions do not seem to contribute to a further improvement in the results.