Medical students' contribution to research; the scientific output of medical theses held in Moroccan medical schools during the last decade (2011-2021).

BACKGROUND: In order to obtain their medical degree, medical students in Morocco are required to carry out a research project and provide a thesis outlining its methodology and findings. However, little is known about the scientific output of these theses. The aim of the present study was to explore and evaluate the characteristics and publication patterns in scientific-indexed journals of medical theses written by medical students in Morocco. METHODS: Data was extracted from registered theses between 2011 and 2021 in four medical schools that have an open-source documents archiving platform. Publication of these theses was assessed in 2022 using a search strategy in three indexed databases; Pubmed, Scopus and Web of science. RESULTS: 9807 theses were registered between 2011 and 2021, 41% of them in the faculty of medicine of Rabat. 99.1% of these theses were written in French, 61.7% were reporting a retrospective case series, and 38.9% of them covered surgical disciplines. 83 (0.8%) of the registered theses were published in a scientific-indexed journal, and half of the papers (49.4%) was written in French. The graduate student was the paper's lead author in 54.2% of the papers. The articles driven from the theses were published after a mean delay of 1.49 ± 1.34 years and the targeted journals had a mean SJR score of 0.69 ± 1.21. The total number of detected citations of the 83 published papers was 216. CONCLUSION: The publication rate of Moroccan medical theses is very low when compared to other countries, which leads to question the real benefit of this time and resources consuming educational activity.

Changes to physical activity behavior during the COVID-19 pandemic and their associated factors: a cross sectional survey of Mexican women.

BACKGROUND: On March 24, 2020, the Mexican Government established social distancing measures to address the outbreak of the COVID-19 pandemic. The resulting home confinement affected daily lifestyle habits such as eating, sleeping, and physical activity (PA). The objectives of this study were to determine changes in PA behaviors among Mexican women due to the COVID-19 pandemic and to assess potential factors associated with these changes. METHODS: This was a cross-sectional study based on an anonymous online questionnaire developed by the Task Force on Physical Activity for Persons with Disabilities (PAPD) within the International Society of Physical and Rehabilitation Medicine (ISPRM). Descriptive, quantitative statistics were used for data analysis. A Chi-squared (χ²) test was used to explore associations between dependent and independent variables. RESULTS: A total of 1882 surveys were completed. Among the respondents, 53.3% declared that their PA was reduced during the pandemic, 26.6% reported similar PA behavior, and 20.1% declared that their PA had increased during the pandemic. Lower PA behavior during the pandemic was associated with lower education levels, stricter pandemic constraints, obesity, and lower self-perceived functioning levels. A statistically significant association between poorer self-perceived mental health and decreased PA behaviors was also found. Respondents who were younger, self-perceived as unimpaired, not overweight, and whose income was not impacted by COVID-19 were associated with higher levels of reported physical and mental health. CONCLUSIONS: The study results identify disparities experienced in PA behavior during the COVID-19 pandemic among Mexican women and highlights the need for social support for PA participation.

Does gender moderate the association between socioeconomic status and health? Results from an observational study in persons with spinal cord injury living in Morocco.

Background: Socioeconomic status (SES) and gender are well-known social determinants of health. However, their impact on health in populations with physical disabilities in low-resource countries is still lacking. Therefore, the objective of this study was to investigate associations of individual SES with health and the moderating effect of gender on this association in a Moroccan population with a physical disability, namely spinal cord injury. Methods: Cross-sectional survey data from 385 participants with spinal cord injury living in Morocco were analyzed. SES was operationalized by education level, household income, financial hardship, and subjective social status. Health indicators included secondary conditions, pain, vitality, quality of life, and general health. Associations between SES and health indicators were investigated using linear and logistic regressions. To test the potential moderation of gender, interaction terms between SES and gender were introduced in regression models. Results: Financial hardship and lower subjective social status were associated with poorer health outcomes in four out of five indicators in the total sample. In contrast, education and income were inconsistently associated with health. Overall, gender did not moderate the association between SES and health, except that educational inequalities in general health were more pronounced in women, and the observation of a trend for a stronger negative effect of subjective social status on men's than woman's health (p > 0.05). Conclusion: This study revealed that subjective indicators of SES negatively impact on health, whereas evidence for the moderating role of gender in this association was weak. These findings underline the importance to reduce social marginalization and poverty in populations with disabilities in low-resource countries to reduce their double burden of living with a disability and encountering social disadvantages through low SES.

Knowledge, attitudes, and practice of leadership skills among undergraduate medical students.

BACKGROUND AND AIM: Medical knowledge alone is insufficient to provide excellent medical care. Modern healthcare challenges require that all physicians have leadership skills in order to better cooperate and collaborate with other healthcare professionals and effectively lead their teams to provide the best possible care to their patients. The objective of this study was to describe medical students' prior knowledge of leadership concepts, to assess their common practice of its main skills and to explore their general perception of its application by their seniors. METHODS: Non-graduated medical students enrolled in the 5th year of medicine or above were invited to fill-in an anonymous online questionnaire. 267 students (66% women) from different medical faculties took part in the study. RESULTS: 44% of the participants had a vague idea about leadership and 29% were completely ignorant of the concept. 52% of them thought that leadership was not to be expected from medical students, and 65% did not know that leadership in healthcare would benefit the patient. In their responses to simulated situations, the participants presented optimal attitudes embracing leadership attributes regarding self-awareness, receiving feedback, teamwork, stress and conflict management, however they present more contrasting attitudes when it came to time management and questioning oneself. Seniors with good leadership skills were perceived as few by half the participants. CONCLUSIONS: This survey highlighted the need of introducing specific leadership training programs within the curriculum of medical studies in Morocco.

Impact of the COVID-19 Pandemic on the Perceived Physical and Mental Health and Healthy Lifestyle Behaviors of People With Disabilities: A Quantitative Analysis of the International Community Survey.

OBJECTIVE: This study aims to determine the perceived impact of the coronavirus pandemic on physical and mental health and healthy lifestyle behaviors in community-dwelling persons with disabilities, as compared with those without disabilities. DESIGN: A prospective cross-sectional study was conducted with a web-based global survey. RESULTS: Over 3 mos, 3550 responses were collected from 65 countries. The study included 2689 responses without skipped questions as full data for analysis. Most respondents were women (82.82%), and approximately half (52.81%) were between the ages of 25 and 39 yrs, followed by those between the ages of 40 and 60 yrs (38.6%). Among the participants, 52% indicated physical activity levels decreased and 20% reported eating less fruit and vegetables than before. Furthermore, 45% noted that they slept less than before. Perceived physical and mental health and changes to eating habits during the pandemic showed a significant difference in people with and without disabilities. Furthermore, perceived effects on physical health had a significant effect on the reported degree of disability. CONCLUSIONS: This study indicates that the pandemic had a larger impact on perceived physical and mental health and changes in eating habits and tobacco use among people with disabilities than people without disabilities.

The Impact of the COVID-19 Pandemic on Healthy Lifestyle Behaviors and Perceived Mental and Physical Health of People Living with Non-Communicable Diseases: An International Cross-Sectional Survey.

The huge burden and vulnerability imposed by non-communicable diseases (NCDs) during the COVID-19 pandemic highlighted how healthy lifestyle behaviors and the well-being of people living with NCDs need to be prioritized. The aim of our study is to better understand the impact of the COVID-19 pandemic on healthy lifestyle behaviors and perceived mental and physical health among adults living with NCDs, as compared to people without NCDs. We conducted a cross-sectional study using a global online survey through Qualtrics. Over four months, 3550 participants from 65 countries worldwide responded to the survey. The study included 3079 surveys with no missing data (complete survey responses) that were used for analysis. People with NCDs were more likely to report statistically significant worsening physical health (p = 0.001) and statistically insignificant worsening mental health (p = 0.354) when compared to pre-pandemic levels. They reported lower rates of smoking during the pandemic than those without NCDs, and a statistically significant (p < 0.001) relationship was found between weight gain and NCDs. Therefore, the perceived physical and mental health, including changes in body weight and tobacco consumption, of people with NCDs were significantly impacted during the pandemic. In conclusion, this study indicates that the pandemic had a significant impact on perceived physical and mental health, changes in body weight, and tobacco consumption among people with NCDs.

Healthcare service utilization patterns and patient experience in persons with spinal cord injury: a comparison across 22 countries.

BACKGROUND: Persons with spinal cord injury frequently visit numerous clinical settings. Such all-around experience of the system may serve as a comprehensive experience indicator. This study compared the patient experience of persons with chronic SCI in relation to healthcare service utilization patterns in 22 countries, hypothesizing that primary-care oriented patterns would offer a better experience. METHODS: This study was based on International Spinal Cord Injury Survey with 12,588 participants across 22 countries worldwide. Utilization patterns/clusters were identified by cluster analysis and experience score - by the partial credit model. The association between healthcare utilization and experience at the provider and cluster level was explored by regression analysis. RESULTS: The highest share of visits was to primary care physicians (18%) and rehabilitation physicians (16%). Utilization patterns had diverse orientations: from primary care to specialized and from inpatient to outpatient. The experience was reported as very good and good across different dimensions: 84% reported respectful treatment; 81% - clear explanations; 77% - involvement in decision making; 65% - satisfaction with care. The average experience score (0-100) was 64, highest - 74 (Brazil) and the lowest - 52 (Japan, South Korea). Service utilization at provider and at cluster levels were associated with patient experience, but no utilization pattern resulted in uniformly better patient experience. CONCLUSION: While there are distinct patterns between countries on how persons with chronic SCI navigate the healthcare system, we found that different utilization patterns led to similar patient experience. The observed difference in patient experience is likely determined by other contextual factors than service utilization.

Perceived Physical and Mental Health and Healthy Eating Habits During the COVID-19 Pandemic in Korea.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has disrupted the lives of people around the world since 2020. This study aims to reveal perceived impact of the coronavirus pandemic on physical and mental health and eating behaviors among people with disabilities and without disabilities in South Korea, as compared to other countries. METHODS: A secondary analysis of a prospective cross-sectional study which was conducted with a web-based global survey. RESULTS: Among the 3,550 responses from 65 countries, 2,621 responses with nation information were set as full data, 189 for South Korea and 2,432 for other countries. In Korea, there was no significant difference in healthy lifestyle behaviors between people with and without disabilities before the COVID-19 pandemic. Perceived physical and mental health and changes in eating habits during the COVID-19 pandemic showed no significant difference between people with and without disabilities in Korea. There were significant differences in physical health and dietary habits, but no differences in its effect on mental health between people living in Korea and other countries in both people with and without disabilities groups. In other words, more than 60% of people in all groups (disability vs. non-disability, Korea vs. non-Korea) reported worse mental health than before the COVID-19 pandemic. CONCLUSION: In Korea and other countries, mental health showed a tendency to deteriorate regardless of the presence or absence of disability during the COVID-19 pandemic. In terms of healthy eating habits, Koreans were relatively less affected than people from other countries.

Distant education in Moroccan medical schools following COVID-19 outbreak at the early phase of lockdown: Were the students really engaged?

The Coronavirus pandemic outbreak has induced many urgent adaptation measures in Morocco including medical education that had to abruptly adopt an exclusive distant education approach, without former sufficient preparation. The present study aimed to assess medical students' engagement in their acutely implemented distant learning and to identify factors that could be associated to the students' studying engagement levels. Medical students from 1st to 5th years of medical studies, enrolled in all Moroccan public medical faculties were invited to fill-in an anonymous online questionnaire. 3174 medical students took part in the study, with a mean age of 20.4 +/- 1.8 years old, and 65.4% of them were women. 90% of the participants reported moderate to drastic change of their sleeping habits and 65% suffered depression symptoms. 20.7% of students didn't engage at all in their learning, 26% studied for less than one hour daily, and only 53.3% studied for one hour or more daily. Only 46.4% of the participants had access to multimedia studying resources and only 20.9% were offered online interactive sessions with their teachers. 41.8% of the participants were unsatisfied from their distant learning experience. Lower studying engagement rates were significantly associated with older age, male gender, change of sleeping patterns, depression symptoms, and also with lack of access to multimedia studying resources and poor general satisfaction from the distant learning experience. Distant Education needs to include more interactive activities and more multimedia studying resources to engage students more efficiently in their self-regulated learning.

Does developing multiple-choice Questions Improve Medical Students' Learning? A Systematic Review.

Practicing Multiple-choice questions is a popular learning method among medical students. While MCQs are commonly used in exams, creating them might provide another opportunity for students to boost their learning. Yet, the effectiveness of student-generated multiple-choice questions in medical education has been questioned. This study aims to verify the effects of student-generated MCQs on medical learning either in terms of students' perceptions or their performance and behavior, as well as define the circumstances that would make this activity more useful to the students. Articles were identified by searching four databases MEDLINE, SCOPUS, Web of Science, and ERIC, as well as scanning references. The titles and abstracts were selected based on a pre-established eligibility criterion, and the methodological quality of articles included was assessed using the MERSQI scoring system. Eight hundred and eighty-four papers were identified. Eleven papers were retained after abstract and title screening, and 6 articles were recovered from cross-referencing, making it 17 articles in the end. The mean MERSQI score was 10.42. Most studies showed a positive impact of developing MCQs on medical students' learning in terms of both perception and performance. Few articles in the literature examined the influence of student-generated MCQs on medical students learning. Amid some concerns about time and needed effort, writing multiple-choice questions as a learning method appears to be a useful process for improving medical students' learning.

Access denied: the shortage of digitized fitness resources for people with disabilities.

PURPOSE: The COVID-19 pandemic has drastically impacted every aspect of life, including how people exercise and access fitness resources. Prior to COVID-19, the global burden of disease attributable to sedentary behavior disproportionately affected the health of people with disabilities (PWD). This pre-existing gap has only widened during COVID-19 due to limited disability-friendly digital exercise resources. The purpose of this work is to examine this gap in accessibility to digital fitness resources, and re-frame the notion of accessibility to suit the contemporary context. MATERIALS AND METHODS: Using machine learning, video titles/descriptions about home exercise ordered by relevance populated on YouTube between 1 January 2020 and 30 June 2020 were examined. RESULTS: Using the search terms, "home exercise," "home-based exercise," "exercise no equipment," "workout no equipment," "exercise at home," or "at-home exercise," 700 videos ordered by relevance included 28 (4%) that were inclusive of participants with disabilities. Unfortunately, most digital fitness resources are therefore inaccessible to PWD. The global pause the pandemic has induced may be the right moment to construct a comprehensive, indexed digital library of home-based fitness video content for the disabled. There is a further need for more nuanced understandings of accessibility as technological advancements continue.Implications for RehabilitationPhysical activity is incredibly important to the quality of life and health of all people.Physical activity levels, however, remain lower among persons with disabilities.Access to disability-friendly resources remains a challenge and worsened by the circumstances of COVID-19 due to an apparent lack of digital fitness resources for persons with disabilities.A broader and comprehensive definition of accessibility must recognize digital advances and access to physical activity for persons with disabilities must feature digital resources.

People with spinal cord injury in Morocco: results from the very first systematic data collection.

PURPOSE: To report on the methodology, participant characteristics, and associations of four most frequent environmental barriers with health conditions, general health and quality of life (QoL) in the very first systematic data collection in people with spinal cord injury (SCI) in Morocco. MATERIALS AND METHODS: We obtained data from 385 participants of the cross-sectional Moroccan SCI community survey (MorSCI). We used descriptive statistics to describe participant characteristics and regression models to investigate associations of the five most frequently reported environmental barriers with health conditions (secondary conditions, pain intensity, mental health), general health and QoL. RESULTS: The most frequently reported environmental barriers were "lack of public services" (92.5%), "financial strain" (93.0%), restricted access to "public transportation" (85.5%), "public places" (83.9%) and "private places" (84.7%). People who perceived those factors as barriers also reported more secondary conditions, higher pain intensity, lower mental health, lower general health, and lower QoL. CONCLUSIONS: This study on Moroccans with SCI found that environmental barriers detract from health and QoL. Given that environmental barriers are potentially modifiable, policy interventions present powerful tools to reduce barriers and potentially increase health and QoL in this vulnerable population.IMPLICATIONS FOR REHABILITATIONPublic policy on the construction of transportation and public places is important to make the physical environment accessible for wheelchair users to support their participation in society.The provision of adequate rehabilitation services and specialized post-acute rehabilitation units for people with SCI in Morocco is urgently needed, not only to contribute to health and QoL but also to contribute to their abilities to overcome environmental barriers.Adequate state services including universal health coverage and access to rehabilitation services and assistive devices or adapted tools must be a priority on the policy level to facilitate activities of daily living and reduce barriers.Improving the skills and knowledge of health professionals in SCI rehabilitation and guide policy makers to promote patient education and self-advocacy in the meantime, may help reduce the gap between needs of people with SCI and available support.

Spinal cord injury in the Moroccan healthcare system: A country case study.

In this article, the authors report an overview of the healthcare management of People with Spinal Cord Injury living in Morocco. The authors' experience in monitoring neurologic recovery and rehabilitation expectations and outcomes are also presented. In addition to the epidemiological data, the patient journey through the chain of care, living with Spinal Cord Injury, the health and rehabilitation system are discussed. This paper illustrates well the suffering of people with Spinal Cord Injury specifically and of disabled persons in general living in low and middle-income countries, especially with the lack of access to specialized and quality rehabilitation facilities and shortage of healthcare workers specialized in rehabilitation.

Medical education in Morocco: Current situation and future challenges.

Morocco is a North African lower middle income country; home to the oldest University in the world, where the first identifiable medical degree was issued. Medical Education in Morocco is provided through 10 Medical Schools offering each year around 3200 new places in the first year of medical studies. It is facing many challenges in both its undergraduate and postgraduate programs that need to be addressed urgently through the currently debated national reform of medical studies.

Environmental Barriers Experienced by People With Spinal Cord Injury Across 22 Countries: Results From a Cross-Sectional Survey.

OBJECTIVES: To investigate the experience of environmental barriers by people with spinal cord injury (SCI) across 22 countries. Specific aims were to describe and compare the prevalence of environmental barriers experienced across countries, and to analyze determinants of environmental barriers at individual and country level. DESIGN: Cross-sectional community survey. PARTICIPANTS: Individuals (N=12,591) living with SCI in the community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Nottwil Environmental Factors Inventory-Short Form. RESULTS: Most barriers were experienced in relation to accessibility, climate, transportation, finances, and state services. More severe barriers were experienced in settings with lower gross domestic product (GDP), which especially refers to medical supplies (gamma=-0.38; P<.001) and finances (gamma=-0.37; P<.001) in this study. However, in a multivariable negative binomial regression using within-between estimation of the number of barriers experienced on the selected predictors, the effect of GDP was reversed when it was adjusted for covariates. On the individual level, the number of experienced barriers decreased with better mental health and greater self-care ability. People with low income, with paraplegia, complete lesions, and more health problems reported more barriers. On the country level, fewer barriers were reported in countries with higher average age, better mental health, and greater self-care ability, as well as in those with a higher percentage of traumatic SCI, paraplegia, and complete lesions. More barriers were reported in countries with a higher percentage of married individuals, lower average household income, higher average time since injury, higher mean vitality scores, and greater income inequality. CONCLUSIONS: Study participants reported a significant number of environmental barriers, many of which are modifiable. Complementary interventions are recommended. Within and between country effects of covariates sometimes pointed in different directions, suggesting that countries with a different composition of SCI population also differed in environmental contexts.

Prevalence of disability in Morocco: Results from a large-scale national survey.

OBJECTIVE: Disability is considered a global health problem, with an increasing number of persons with disabilities. Up-to-date and good-quality data on disability are essential to policymakers in order to establish tailored programmes for persons with disabilities based on the specific needs of each category. The aims of this study were to determine the prevalence of disability in the adult Moroccan population, and its distribution according to socio-demographic characteristics and geographical regions. METHODS: A national survey was conducted in 2014, including a sample of 47,275 adult participants drawn from 16,044 households from urban and rural areas proportioned to population size. The sample's socio-demographic characteristics were collected in face-to-face interviews. The data were then screened for disability using the Washington Group Short Set of Questions on Disability. RESULTS: Overall prevalence of disability among the Moroccan adult population was 9.5%, with important geographical disparities. Older age, lower education rates, unemployment, being single, and living in rural areas, were associated with higher prevalence rates of disability. Visual and motor deficiencies were the most common disability modalities, and the prevalence of moderate-to-extreme disability, which is associated with more significant limitations in functioning, was 2.6%. DISCUSSION/CONCLUSION: Results from this national Survey are critical and would guide national disability policies and programmes, in order to reduce disabling barriers and improve persons with disabilities access to healthcare and participation.

Prevalence of disability and rehabilitation needs amongst adult hospitalized patients in a Moroccan university hospital.

OBJECTIVES: To investigate the prevalence of disabilities amongst adult hospitalized patients and to estimate their specific needs for rehabilitation support. METHODS: A cross-sectional study was conducted in a Moroccan university hospital. A total of 411 patients were included, and assessed for impairments, activity limitations and participation restrictions through medical examination and structured questionnaires. Patients' clinical and assessment data were used to estimate the specific needs for rehabilitation professionals' intervention, and the optimal mode of rehabilitation support. RESULTS: Patients' mean age was 47.75 years (standard deviation 17.34). Prevalences of types of impairments were led by pain (41.6%), followed by sensory-motor deficits (21.9%) and limitations in joint range of motion (21.4%). Activity limitations were dominated by gait and balance disorders (25.3%). Participation restrictions in social and family life were reported by 118 patients; and in professional life by 44 patients. The most needed rehabilitation interventions were: physiotherapy (36.2%), occupational therapy (20.4%), and prosthetics (15.8%), and 24.5% patients were eligible for inpatient rehabilitation support. CONCLUSION: Disability is very common among hospitalized Moroccan patients, and there is a great need for inpatient rehabilitation support in Moroccan hospitals.

Iterative fragmentation of cognitive maps in a visual imagery task.

It remains unclear whether spontaneous eye movements during visual imagery reflect the mental generation of a visual image (i.e. the arrangement of the component parts of a mental representation). To address this specificity, we recorded eye movements in an imagery task and in a phonological fluency (non-imagery) task, both consisting in naming French towns from long-term memory. Only in the condition of visual imagery the spontaneous eye positions reflected the geographic position of the towns evoked by the subjects. This demonstrates that eye positions closely reflect the mapping of mental images. Advanced analysis of gaze positions using the bi-dimensional regression model confirmed the spatial correlation of gaze and towns' locations in every single individual in the visual imagery task and in none of the individuals when no imagery accompanied memory retrieval. In addition, the evolution of the bi-dimensional regression's coefficient of determination revealed, in each individual, a process of generating several iterative series of a limited number of towns mapped with the same spatial distortion, despite different individual order of towns' evocation and different individual mappings. Such consistency across subjects revealed by gaze (the mind's eye) gives empirical support to theories postulating that visual imagery, like visual sampling, is an iterative fragmented processing.

Long term outcome following mild traumatic brain injury in Moroccan patients.

PRIMARY OBJECTIVES: To describe the symptoms of chronic post-concussion syndrome (PCS) and to investigate the relationship between the persistence of these symptoms and different aspects of social life (return to work, quality of life, sport and leisure activities and family relationships) in Moroccan patients with mild traumatic brain injury (MTBI), one year after the trauma. METHODS: Forty-two adult patients who sustained MTBI were reviewed one year after trauma. We investigated the persistence of PCS by using the "Problem Checklist" questionnaire. We also assessed their quality of life using a visual analogue scale, and noted the changes in employment status, social activities and family relationships. Then, we examined whether there were significant relationships between these different data. RESULTS: More than half of the patients (n=23, 54.8%) were found with persistent post-concussion symptoms at one year post-injury. Chronic PCS was significantly more common in married persons (p=0.008) and significantly related to both non return to work (p≤0.01), and QoL deterioration (p≤0.001). CONCLUSION: In this study, a large proportion of persons who sustained a MTBI experienced persistent symptoms up to one year after trauma. MTBI might have significant and lasting impact on the quality of life, which is to be verified by further studies.