Evaluating the Impact of the COVID-19 Pandemic on Acute Ischemic Stroke Outcomes in the Stroke Belt

Objectives: The COVID-19 pandemic disrupted many facets of healthcare including patients delaying medical care for potentially life-threatening conditions. This study sought to compare specific key outcomes related to ischemic stroke that occurred before and during the COVID-19 pandemic. We assessed mortality rates, morbidity rates, and the administration of thrombolytics in patients with ischemic stroke admitted to emergency departments (ED) in the Stroke Belt, a region of the United States with historically worse stroke outcomes. Method(s): Cerner Real-World Data was used to identify patients residing in the Stroke Belt (Southeastern United States) who were admitted to the ED with ICD-10 codes indicating acute ischemic stroke. We determined in-hospital and 30-day mortality rates, morbidity rates (physical disability tracked 1-year post-ischemic stroke), and administration of thrombolytics for acute ischemic stroke patients before the COVID-19 pandemic (March 2019-February 2020) and during the pandemic (March 2020-February 2021). Result(s): In the defined period prior to COVID-19, 2,338 patients presented to the ED with ischemic strokes (49.5% male;mean age 64.8, SD:15.23;69.6% white). During COVID-19, 2,052 ischemic stroke patients presented to the ED (50.9% male;mean age 65.8, SD:15.04;71.5% white). Our analyses show a significant decrease in thrombolytic administration during the pandemic compared to before the pandemic (12.2% and 14.5%, respectively;p<0.05). There was no significant difference in rates of in-hospital mortality, 30-day mortality, or morbidity following ischemic strokes. Conclusion(s): The findings of our study suggest a reduction in ischemic stroke related ED encounters during the COVID-19 period, but no differences were observed in mortality and morbidity rates in ischemic stroke compared to before the pandemic. Future studies are required to determine if these trends were true in other regions of the United States, as well as to investigate other potential covariates linked to outcomes before and during the COVID-19 pandemic.Copyright © 2023

Economic Inequality during Covid-19 as a Pathway to Food Insecurity for People who are Disabled and Racialized as Non-White

Covid-19 heightened economic inequality across the U.S., especially for people who are disabled and non-white. These intersecting economic vulnerabilities open pathways to hunger. Using a survey from July 2020 (n = 2,043) in the Intermountain West, we find that economic inequality explained a substantial portion of food insecurity for people with disabilities. Racially stratified models show that people who were also non-white were more likely to be food insecure and receive differential protection from economic resources. Stronger social support will help mitigate food insecurity, yet such programs must grapple with the ways that ableism and racism intersect, especially during economic shock.Copyright © 2022 Taylor & Francis Group, LLC.

How Did Governments Address the Needs of People With Disabilities During the COVID-19 Pandemic? An Analysis of 14 Countries' Policies Based on the UN Convention on the Rights of Persons With Disabilities

Background: People with disabilities have experienced heightened social risks in the context of the pandemic, resulting in higher rates of infection and mortality. They have also borne elevated burdens associated with public health measures. The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) obliges its 184 state parties to eliminate discrimination and ensure equality and inclusion for persons with disabilities, including protection and safety in situations of emergency. It remains unclear to what extent national COVID-19 policies have aligned with these commitments under the UNCRPD. Our objective in this exploratory study was to assess alignment between the UNCRPD indicators and COVID-19 policies from 14 countries with the goal of informing policy development that is inclusive of persons with disabilities and responsive to rights under the UNCRPD. Methods: We identified COVID-19 policy documents from 14 purposively selected countries. Country selection considered diversity based on geographic regions and national income levels, with restriction to those countries that had ratified the UNCRPD and had English or French as an official language. We used a computational text mining approach and developed a complex multilevel dictionary or categorization model based on the UNCRPD Bridging the Gap indicators proposed by the Office of the High Commissioner on Human Rights (OHCHR). This dictionary was used to assess the extent to which indicators across the entirety of the UNCRPD were represented in the selected policies. We analyzed frequency of associations with UNCRPD, as well as conducting ‘key word in context' analyses to identify themes. Results: We identified 764 COVID-19 national policy documents from the period of January 2020 to June 2021. When analyzed in relation to the Articles of the UNCRPD, the most frequently identified were Articles 11 (risk and humanitarian emergencies), 23 (home and family), 24 (education), and 19 (community living). Six countries produced 27 policies that were specifically focused on disability. Common themes within these documents included continuation of services, intersectionality and equity, and disability considerations in regulations and public health measures. Conclusion: Analyzing country policies in light of the UNCRPD offers important insights about how these policies do and do not align with states' commitments. As new policies are developed and existing ones revised, more comprehensive approaches to addressing the rights of persons with disabilities are urgently needed. © 2023 The Author(s);Published by Kerman University of Medical Sciences.

THE RELATIONSHIP BETWEEN THE FUNCTIONALITY OF CHILDREN WITH DISABILITIES AND ITS EFFECTS ON PARENTS DURING THE COVID-19 PANDEMIC PROCESS.

Purpose: The aim of this study was to investigate the relationship between the functionality of disabled children and its effects on parents during the Covid-19 pandemic. Method(s): A total of 168 people, including 84 disabled children and 84 mothers, were included in the study. The Pediatric Disability Assessment Inventory (PEDI) and Gross Motor Function Classification System (GMFCS) were used for children with disabilities. The Zarit Burden Scale (ZBS), Fatigue Severity Scale (FSS) and The Nordic Musculoskeletal Questionnaire (NMQ) were applied to the mothers to question musculoskeletal disorders. Result(s): There was no correlation between care burden score and PEDI, total score, self-care and mobility scores (p>0.05). A moderately negative (r=-0.306;p<0.01) significant linear relationship was found between care burden score and social function score. There was no significant linear relationship between the fatigue severity score and PEDI total score, self-care, mobility and social function scores (p>0.05). No correlation was found between care burden score and fatigue severity score (p>0.05). For the last 12 months, only the pain in the lumbar region of the parents prevented them from doing their usual work. It was determined that the most aching body parts of the parents who complained of musculoskeletal pain during the last 12 months were in the waist, neck, shoulder, back, and knee regions. Conclusion(s): As a result, no relationship was found between the functionality of disabled children and their parents' influences during the Covid-19 pandemic.Copyright © 2022 Turkish Physiotherapy Association. All rights reserved.

Adult learners with learning disabilities' motivation to succeed in higher education online learning during Covid-19

Many students had to transition to online learning due to the COVID-19 pandemic while other students were already enrolled in online education. Online study may hold additional struggles for students with learning disabilities. The problem addressed in this qualitative, phenomenological study was the motivating factors of online higher education students who have a learning disability during the COVID-19 pandemic. The theoretical foundation was Maslow's hierarchy of needs. Data were gathered through 10 semistructured interviews and then analyzed through the thematic analysis yielding five themes: (a) lack of professional support, (b) resources, (c) support system, (d) consistent motivation, and (e) low motivation. These findings showed that students needed support within families and educational institutions to continue to be successful in their schooling and motivated. Additionally, it showed that students needed resources to better help them succeed in their assignments. Implications for positive social change include better understanding of how students are motivated when doing online school despite the different challenges they may be experiencing. Additionally, this study may also contribute to social change by informing other students that they are not alone during the process of their education and that there are ways to continue to be motivated. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Assessment Processes of Dependency Situations in Spain: The Role of Social Work

The paper analyses the processes of assessment of situations of dependency in Spain and the role of Social Work in them. The study provides new information, trying to detect possible influences of Covid-19 on these processes and analysing existing territorial disparities. From an intentional documentary search, information was subsequently collected from the General Directorates or Sub -directorates, or the autonomous Institutes of social services through an ad hoc questionnaire, obtaining responses from the universe of analysis units (17 autonomous communities). Said information was organized into three categories of analysis: mandatory nature of the social report in the assessment of situations of dependency;place of application of the DAS and the SRS;and professional profiles of the teams for assessing dependency situations. The results show, among other results, the existence of very different interprofessional teams, the application of the scale in divergent contexts, and the different relevance of the social report in the processes. In conclusion, the need to deepen the inclusion of the social report and the professional figure of Social Work in the assessment processes is evident by contributing to the improvement of the coordination of objectives, processes, and resources.

Bridging the gap: the challenge of mitigating health inequalities in lung cancer

Background: The COVID-19 pandemic, together with the cost-of- living crisis, have shone a light on health inequalities running through our society - not least in UK lung cancer. Lung cancer has the widest deprivation gap of all cancers. Despite published data about socio-economic factors, the amount of evidence available about other health inequalities is poor. Method(s): The Bridging the Gap report is the output from a Health Inequalities focus-group meeting of the UKLCC's Clinical Advisory Group in June 2022. These opinions were supplemented by views and information gathered from 15 interviews with leading lung cancer and health inequalities experts, from across the four UK nations in August/September 2022. Further desk research and literature reviews were carried out over the same period. Result(s): The report calls for a 'comprehensive' approach to data collection on health inequalities - to bridge gaps in current knowledge, improve outcomes and ensure people with lung cancer have equitable access to diagnosis, treatment, and care - wherever they live and from whatever background. Key recommendations include: * Extending the remit of the National Lung Cancer Audit (NLCA) to collect more data on ethnicity, LGBTQ+ and other health inequality factors - such as gender, religion and disability. * Establishing a single, coordinated data strategy, compiling evidence on health inequalities at local, regional and national levels. * Introducing a Personal Care and Access Card scheme, carried by the patient, combining their Holistic Needs Assessment information with their personal treatment and care plan to facilitate transfer of information between hospitals and specialists. * Disease awareness campaigns targeted to address local needs and communities. Conclusion(s): The UKLCC believes that - with the implementation of these recommendations and support from policy makers, commissioners and clinicians - we can successfully mitigate health inequalities in lung cancer and have further impact on lung cancer outcomes. Report accessible here: www.uklcc.org.uk/our-reports Disclosure: No significant relationships.Copyright © 2023 Elsevier B.V.

Levels and Trends of Maternal Mortality and Morbidity by Cause in North Africa and Middle East, 1990 to 2019: An Analysis for the Global Burden of Disease Study 2019

Background: Since 1990, the maternal mortality significantly decreased at global scale as well as the North Africa and Middle East. However, estimates for mortality and morbidity by cause and age at national scale in this region are not available. Method(s): This study is part of the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. Here we report maternal mortality and morbidity by age and cause across 21 countries in the region from 1990 to 2019. Result(s): Between 1990 and 2019, maternal mortality ratio (MMR) dropped from 148.8 (129.6-171.2) to 94.3 (73.4-121.1) per 100 000 live births in North Africa and Middle East. In 1990, MMR ranged from 6.0 (5.3-6.8) in Kuwait to 502.9 (375.2-655.3) per 100 000 live births in Afghanistan. Respective figures for 2019 were 5.1 (4.0-6.4) in Kuwait to 269.9 (195.8-368.6) in Afghanistan. Percentages of deaths under 25 years was 26.0% in 1990 and 23.8% in 2019. Maternal hemorrhage, indirect maternal deaths, and other maternal disorders rank 1st to 3rd in the entire region. Ultimately, there was an evident decrease in MMR along with increase in socio-demographic index from 1990 to 2019 in all countries in the region and an evident convergence across nations. Conclusion(s): MMR has significantly declined in the region since 1990 and only five countries (Afghanistan, Sudan, Yemen, Morocco, and Algeria) out of 21 nations didn't achieve the Sustainable Development Goal (SDG) target of 70 deaths per 100 000 live births in 2019. Despite the convergence in trends, there are still disparities across countries.Copyright © 2022 Academy of Medical Sciences of I.R. Iran. All rights reserved.

Teaching menopause to health care professionals

The menopause is a stage in the life cycle that affects all women. Managing perimenopausal and postmenopausal health is therefore a key issue for all healthcare professionals, not just gynecologists. The curriculum should include terminology and definitions, assessment, diagnosis and evidence-based management strategies. Healthcare professionals should be aware that women have different perceptions and experiences of the menopause which may be determined by: age and type of menopause, pre-existing health conditions, disability, employment and adverse childhood events. Specialist services may be required for some. These include women with chronic disease, premature ovarian insufficiency or early menopause or pre-existing health conditions and disability, as well as transgender and gender-nonconforming people. The COVID-19 pandemic has changed the mode of delivering healthcare from face-to-face only to include virtual consultations. Teaching now needs to include both types of consultations. A holistic approach is required and teaching should be provided by an accredited expert. Rees M, Abernethy K, Bachmann G, et al. The essential menopause curriculum for healthcare professionals: A European Menopause and Andropause Society (EMAS) position statement. Maturitas. 2022;158:70-77. doi: https://doi.org/10.1016/j.maturitas.2021.12.001Copyright © 2023

Creating Co-Curricular Activist Writing Projects for Students in Writing Programs: The Case of the Neurodiversity Celebration Collaborative (NCC)

Context The NCC originally came into being through calls from various corners for more attention to the unmet mental health needs of college students and students with autism (Beiter et al.;Bruffaerts et al.;Lipson et al.;PinderAmake;Storrie et al.) as well as calls from disability activists for more space to support, highlight, and celebrate disabled and neurodiverse persons and the rich diversity they bring to our campuses (Dwyer et al.;Clouder et al.;Sachs;Yergeau). Through strategic research and advocacy, we will evaluate current mental health resources on and off campus, create appreciation versus sympathy for cognitive differences, bring to light inconsistencies and inaccuracies in the literature, establish appropriate forums of disclosure for students, and ultimately help constitute a more connected and understanding campus climate that celebrates neurodiversity as an integral part of any functioning university and its surrounding community. [...]most recently during the 2021-2022 academic year, the group held an event in which they discussed the concept of neurodiversity itself with a wider audience. Establishing student leaders is a crucial step in moving the faculty member out of the leadership role and making it clear to students that they have agency and the final say in how things will go.

Persistent Work Limitations in Long COVID: A Cross-Sectional Analysis of Employed US Respondents to the 2022 National Health and Wellness Survey

Objectives: Many Americans experience continued symptoms after SARS-CoV-2 infection. In addition to people who leave the workforce after experiencing COVID, those who remain employed may experience loss of productivity from short-term absences (absenteeism) and reduced productivity while working (presenteeism). We examined reported losses of work productivity among adults who reported physician-identified Long COVID. Method(s): We conducted a retrospective, cross-sectional analysis of data from National Health and Wellness Survey (May-Aug 2022) respondents. We included employed adults who reported having experienced COVID in the past (no date specified), said their physician identified them as having Long COVID or COVID syndrome, and reported symptoms at the time of survey. Respondents were stratified by their magnitude of activity limitations reported on the Work Productivity and Activity Impairment questionnaire;we describe responses for the lowest (LT) and highest tertiles (HT). Work productivity (absenteeism, presenteeism, overall work limitations from either absenteeism or presenteeism), and mental health (anxiety via General Anxiety Disorder-7 questionnaire, depression via Patient Health Questionnaire-9), were compared across tertiles. Result(s): Among 1036 Long COVID respondents meeting inclusion criteria, presenteeism ranged from 24.2% of LT respondents (n=291) to 92.8% of HT respondents (n=304), and absenteeism ranged from 12.7% (LT respondents) to 47.3% (HT respondents). Almost all (99.7%) HT respondents reported their overall work productivity was reduced by 50% or more while 26.7% of LT respondents reported the same. The prevalence of moderate-to-severe depression (92.4% vs. 37.8%) and moderate-to-severe anxiety (84.2% vs. 26.1%) was higher among HT relative to LT (all p<.001). Conclusion(s): Adults with Long COVID exhibit substantial heterogeneity in activity limitations;however, work limitations were substantial in all groups. Our results suggest significant economic impacts of Long COVID through lower productivity among those who remain employed. Further work with a comparison group is important to understand Long COVID-related work impairments, limitations, and disability.Copyright © 2023

Guest editorial: Special issue introduction repurposing and repositioning events: real, responsible and revolutionary futures

Findings revealed that hygiene is not perceived as an integral part of event safety, but rather as a disconnected pillar beside traditional event safety measures and that event and health safety measures strongly influence each other, both positively, but often also negatively as event organisers are often concerned with how to get their events successfully through the approval process rather than focussing on the safety aspects. Acknowledging the prevalence of disability in its various forms in society and highlighting the fact that existing research exploring inclusive events and disabled people as event participants focuses mostly on the challenges faced by attendees, the author offers a refreshing perspective by exploring the potential that these events have and the opportunities they bring to people with disabilities and the wider community. [...]the author embraces the argument suggested in the call for papers of this special issue that events provide opportunities to determine new paths, make the future less fearsome, allow more positive outcomes and uses this description to define what they propose to be "revolutionary futures”. In an exploratory case study inspired by a hermeneutics approach and combining different methods of data collection, the author explores the perspectives of attendees, volunteers, event staff and organisers to investigate if the event can indeed create revolutionary futures.

Right to nomination in Colombia, legal representatives, and termination of power in the general procedural code

This article covers the theoretical concept of the right to nomination in Colombia detailing its many exceptions where direct intervention is authorized both legally and constitutionally. After having explained the legal actions, various hypothesis, and controversies that, in turn, constitute exceptions, the General Code of Procedure's framework and the many vicissitudes of the physical appearance, along with proposals in such regard, are shown without forgetting, on the other hand, the statutes by which powers of attorney are to be produced during the current time (COVID-19). In this sense, after an adequate analysis, the theoretical reach, as well as the mechanism of action of the revocation of the power of attorney and its renunciation (causes for termination) are laid out. Among the latter, the death of the lawyer representing his or her client and two kinds of legal incompetence known as: «sudden incompetence» (fortuitous) and «original incompetence» (by nature), which do not constitute cause for procedural nullity. The methodology by which this article was written had the very intention of analyzing the statutes set forth before and after the 1991 Constitution, and before and after the doctrine (jurists) and case law;statutes in which comments, critics, and propositions are observed due to the existing "symbiosis” between Procedural Law and Positive Law. © 2022, Universidad Pontificia Bolivariana. All rights reserved.

The 'Life after ICU' mobile application- a process in creating an accessible patient-centred platform for Intensive Care rehabilitation resources

Introduction: InS:PIRE (Intensive Care Syndrome: Promoting Independence and REcovery) is a multidisciplinary programme whose role is to assist patients in the identification of, and subsequent rehabilitation from the sequelae of an admission to the Intensive Care Unit (ICU). In NHS Aryshire and Arran (NHSAA) InS:PIRE has traditionally consisted of in-person rehabilitation and support meetings to help manage common post-ICU issues. COVID-19 forced all InS:PIRE activities online, and has required services to redesign their delivery of supporting resources to be readily accessible remotely. Thus, the 'Life after ICU' app was created. Objective(s): The role of this application was to help better-provide accessible information to former ICU patients and their relatives, as well as, improve connectivity between medical professionals and patients. Method(s): The app platform was developed by Piota. Resources were chosen for inclusion through surveying InS:PIRE attendees, who identified their main areas of concern. These areas included: physical problems, emotional issues, social issues, family support, COVID specific support, and physiotherapy. The multidisciplinary InS:PIRE team co-ordinated the identification and collation of the appropriate resources. Additionally, the app serves as a platform for InS:PIRE to disseminate information about the on-going programmes as well as allowing attendees to contact the InS:PIRE team. Result(s): A trial version of the 'Life After ICU' app has now been launched. This app will allow patients and their families to readily access the resources they require. Following a trial period, feedback from app users will be collected and further adaptations made. Conclusion(s): Launching the app recognises the wider view of the importance of eHealth, and its role in modernising service-delivery. Indeed, the Scottish National Clinical Strategy recognises this as an area for future development. The efficacy of eHealth interventions for rehabilitation have been acknowledged,1-2 and thus translating them to the ICU context can be considered as a means of improving the holistic rehabilitation of this complex patient group. Furthermore, through providing services easily accessible by patients, this app allows InS:PIRE to realise NHSAA's 'Caring for Ayshire' strategy, whose aim is to provide care closer to home.

The effect of COVID-19 pandemic on depression and suicidal ideation in Korean community dwelling elderly

Aims: The impacts of the coronavirus disease of 2019 (COVID-19) pandemic on mental health have been relatively severe. This study examined the influence of the COVID-19 especially on depression and suicidal ideation in community-dwelling elderly in Korea. Method(s): Data were employed from a survey on elderly mental health in Jeollanam-do (southwest province in Korea). A total of 2423 elderlies were recruited from 22 counties in Jeollanam-do between April and October 2021. We used self-reported questionnaires, including sociodemographic factors, COVID-19 related stress, suicidal ideation, Geriatric Depression Scale-Short Form Korean Version (GDS-SF). Logistic regression was performed to examine the factors on depression and suicidal ideation. Result(s): Of the 2423 subjects, 622 (25.7%) reported depressive symptoms and 518 (21.4%) reported suicidal ideation. The multivariate logistic regression analysis revealed that living alone, poor perceived health status, the worry of COVID-19 infection and restriction of daily activity due to COVID-19 pandemic were significantly associated with depression. Male sex, poor perceived health status, disability in house chores and depressive symptom are risk factors for suicidal ideation. Conclusion(s): These findings showed that increased risk factor for depression and suicidal ideation in community dwelling elderly during COVID-19 pandemic. We confirmed that feelings of isolation and negative perception of health were risk factors on depression in community dwelling elderly in the context of the COVID -19 pandemic. Also male, poor self-perceived health status, difficulty of independent living and worry and depression are increased the risk of suicidal ideation among the elderly.

Social disability and impairment in childhood anxiety

This chapter discusses social disability and impairment in childhood anxiety. The chapter starts with a discussion of clinical characteristics of the condition. Approaches to evidence-based assessment and cognitive-behavioral treatment are discussed. Future directions are highlighted. © Springer Nature Switzerland AG 2011, 2023. All rights reserved.

Rehabilitation needs after critical illness: Referral outcomes from a ICU follow up clinic in Northern Ireland

Introduction: In 2019/20 a total of 171,900 people were admitted to adult general intensive care units (ICU) across England, Wales and Northern Ireland, with a survival rate of 79.6% at hospital discharge.1 Patients who survive critical illness and admission to ICU often experience ICU-related long-term physical and non-physical impairments and disability following hospital discharge.2 National guidance advocates multidisciplinary team (MDT) follow up to identify and manage the unmet health needs of this patient population.3-4 The UK has seen an increase in the number of follow up services available in the last 7 years.2 The Covid-19 pandemic further highlighted the need to provide this service, locally resulting in the establishment of the Belfast Health and Social Care Trust (BHSCT) ICU follow up clinic in July 2020. The follow up clinic is offered to patients aged = 18 years, an ICU length of stay of = 4 days, who have been discharged from an inpatient setting within the last 12 weeks and do not receive follow up from any other established care pathway. The clinic consists of an ICU Nurse, Doctor, Clinical Psychologist and Physiotherapist. Patients are offered either a virtual, face-to-face or telephone appointment. Objective(s): To identify unmet rehabilitation needs and onward referral requirements of patients presenting at an ICU follow-up clinic in Northern Ireland. Method(s): Data was gathered retrospectively using an excel database detailing patient demographics, appointment details and onward referrals generated from the clinic. Data was analysed for a set time period between the 01/12/2021 - 09/02/2022. The type of referral and the profession responsible were captured. Result(s): During the time period eight post ICU follow up clinics were completed. A total of 36 patient's attended (14 male and 22 female). Six appointments were attended virtually via MS Teams, 12 via telephone and 18 face-to-face. Twenty-three (64%) of the patients required at least one onward health referral. A total of 61 onward health referrals were generated from this population. Table 1 details the number of onwards referrals by speciality. Conclusion(s): Approximately 64% of patients who attended the post ICU follow up clinic, during a 10 week period, demonstrated unmet rehabilitation needs resulting in onward health referrals. This data supports the need for a post ICU follow up clinic at BHSCT to identify ongoing need, ensure transition of care to relevant services and optimise patient's physical and psychological outcomes. One limitation of this study is that not all recommended allied health professionals are commissioned for the clinic which may impact on the health needs identified. Future work should consider the impact of this and discussions regarding the need for a commissioned post ICU follow up clinic which is truly MDT for this patient population should be considered.

Disability, workplace inclusion and organizational citizenship behavior: an exploratory study of the legal profession

PurposeMany workers with disabilities face cultures of exclusion in the workplace, which can affect their participation in decisions, workplace engagement, job attitudes and performance. The authors explore a key indicator of engagement—perceptions of organizational citizenship behavior (OCB)—as it relates to disability and other marginalized identities in the workplace.Design/methodology/approachUsing an online survey, legal professionals answered questions about their workplace experiences. Ordinary least squares (OLS) multivariate regression analysis with progressive adjustment was used to investigate the effect of demographic and organizational factors on perceptions of OCB.FindingsThe authors find that employees with disabilities have lower perceptions of OCB, both before and after controlling for other personal and job variables. The disability gap is cut nearly in half, however, when controlling for workplace culture measures of co-worker support and the presence of an effective diversity, equity and inclusion (DEI) policy. Disability does not appear to interact with gender, race/ethnicity and LGBTQ + status in affecting perceptions of OCB.Originality/valueThe results point to the workplace barriers faced by people with disabilities that affect their perceptions of engagement, and the potential for supportive cultures to change these perceptions.

Navigating visibility and risk: disabled young women's self-presentation practices on social media

Visibility is a requirement of neoliberal postfeminist girlhood and social media is often attributed with the capacity to provide disabled young women with visibility that they lack elsewhere. While some attention has been paid to the intersections of gender and disability through the self-presentations of disabled young women who are known as disabled content creators, such as bloggers and YouTubers, this article goes beyond this to examine how disabled young women represent themselves on social media as part of their everyday practices. Using a combination of discursive textual analysis of Twitter and Instagram accounts and semi-structured interviews with five disabled young women, I explore how affordances such as Twitter retweets play a key role in how disabled young women navigate their visibility online as part of their self-presentation practices. I argue that visibility is potentially risky and disabled young women's social media use is shaped by concerns about harassment and questions about the 'legitimacy' of their disabled identities that operate at the intersections of gender, disability and race, stemming from their experiences of 'systemic disbelief'. Finally, I situate these self-representation practices within the context of the COVID-19 pandemic.

New Zealanders with low back pain seeking health care: a retrospective descriptive analysis of Accident Compensation Corporation-funded low back pain healthcare service usage

Introduction. Most New Zealanders experience low back pain (LBP) at least once throughout their lifetime and many seek help from the large range of health providers in primary care. Accident Compensation Corporation (ACC) funds a significant proportion of those claims, but which services are they funding and what are the costs? Method. This was a retrospective audit and descriptive analysis of ACC-funded, non-public hospital healthcare service use by people with LBP in New Zealand (NZ). Outcome measures were the healthcare services accessed by people with ACC-funded LBP,the claims (all occurrences for a service that has generated a payment/ year), single contact (with a service), and costs (NZ$) for services between 2009 and 2020. Results. The number of claims for services were 129 000 for physiotherapy, 105 000 for general practitioner and 59 000 for radiology services. Per single contact, elective surgery and radiology services were the most expensive. During 2009-2020, there were 3.3 million ACC claims for LBP with a total cost of NZ$4 billion. Over this time, there was an increase in claims, costs and single contacts. Costs decreased slightly during 2010 due to changes in healthcare funding and in 2020 due to the COVID-19 pandemic. Discussion. Consumers have considerable choice in where they access health care for ACC-funded LBP services. This study shows the services they use most frequently and the cost to NZ for those services. These data can inform service planning for ACC-funded LBP health care in NZ.