Evaluation of physiotherapy and speech therapy treatment in patients with apraxia: a systematic review and meta-analysis.

Apraxia affects 20% of the right brain-damaged patients and 50% of the left brain-damaged patients. This disorder of motor programming reduces patients' independence and there are few guidelines on the rehabilitative treatment in the physiotherapy and speech therapy field.The aim of this study was to assess which therapeutic interventions are the most effective in stroke patients with apraxia in considering the mentioned purviews. Four databases were systematically searched in order to detect all available studies investigating the physical and speech rehabilitation of patients. The literature research produced five studies including 168 patients for the physiotherapy and 50 for speech therapy fields; two were eligible for meta-analysis. Quality was rated with Jadad, PEDro scale and Cochrane Risk Of Bias Tool. Both for physiotherapy and speech therapy fields, the RCTs interventions obtained statistically significant results for outcomes of interest. Despite this, it is still not possible to determine the best approach due to the low number of patients involved, the lack of maintenance of the results at follow up and the timing of the revaluation period being very short to confirm the efficacy of treatments.

Evaluation of the psychometric properties of the Barthel Index in an Italian ischemic stroke population in the acute phase: a cross-sectional study.

The objective of this study was to assess and validate the psychometric properties of the Italian culturally adapted Barthel Index (IcaBI) in a cohort of people with ischemic stroke. The validation process was conducted in an Italian cohort of 99 stroke inpatients to whom the IcaBI was administered in order to test its structural validity, and inter-and intrarater reliability. The internal consistency (Cronbach's alpha) was 0.901. Factor analysis revealed a two-factor structure. The interclass correlation coefficient 3,1 (ICC) for intra-rater reliability was estimated at 0.987 (95% CI: 0.975-0.993), while the ICC for inter-rater reliability was 0.909 (95% CI: 0.852-0.948). This study demonstrates the psychometric properties of the IcaBI in an Italian stroke population, and therefore shows that the scale can be considered a valid and reliable assessment tool for measuring functional disability in Italian acute ischemic stroke survivors.

The effect of physiotherapy on fatigue and physical functioning in chronic fatigue syndrome patients: A systematic review.

OBJECTIVE: The objectives of this work were to fill the gap in the scientific literature and to evaluate the results of physical therapy treatments in individuals affected by chronic fatigue syndrome, considering only studies that employed a randomized controlled trial. METHODS: A systematic review was carried out according to PRISMA guidelines. Three bibliographic databases were searched: MEDLINE, Cochrane Library, and PEDro. The minimum prerequisites for papers to be included in the systematic review were that they had to (a) employ a randomized controlled trial; (b) be published in English; and (c) be published during the last ten years (2007-2017). The studies were evaluated according to Jadad score. RESULTS: Four studies were included. This systematic review suggests that a treatment that is more effective than all the others cannot be defined. This conclusion is related to the low number of investigated studies; therefore, the collected results cannot be generalized. CONCLUSION: Chronic fatigue syndrome is not yet a well-understood pathology, and the physical mechanisms that influence the outcomes still need more study. Rehabilitation programs that promote physiotherapy techniques such as exercise, mobilization, and body awareness (e.g., MRT and GET) are the most effective in reducing medium and long-term fatigue severity in CFS patients.

[Construction and validation of a tool for the evaluation of environmental risks and limitations to the manual handling of loads: cross-sectional study].

INTRODUCTION: The manual handling of loads has a strong impact on many types of work. All health professionals, due to their job, are subjected to a high risk of disease from the manual handling of loads. TARGET: The purpose of our work has been therefore the construction and the validation of a specific tool for the evaluation of both environmental risks and individual limitations of the manual handling of loads / patients. MATERIALS AND METHODS: The questionnaire we created is composed of two main sections: the first section includes the registry card of the operator personal data while the second section, consisting of eleven items it is further organized into two sections/parts. The first part consists of four items about environmental risk factors, while the second part consists of seven items about generic limitations and the assessment of pain from manual handling of loads. RESULTS: The operators'health nurses, including those ones with a coordination responsibility, that are available in the structure are 704 while the response rate to the questionnaire was of 93.18%. The test-retest showed optimal values of the intra-class correlation coefficient (0.843) so demonstrating the absence of measurement errors in the two administrations. The values related to the internal consistency of the two sections of the questionnaire were greater than 0.80that also demonstrated the internal stability of the questionnaire. CONCLUSIONS: The tool we described therefore is to be intended as a means of assessment for environmental risks, restrictions on movement of loads and pain associated with the task.

Mental health in complex emergencies.

Mental health is becoming a central issue for public health complex emergencies. In this review we present a culturally valid mental health action plan based on scientific evidence that is capable of addressing the mental health effects of complex emergencies. A mental health system of primary care providers, traditional healers, and relief workers, if properly trained and supported, can provide cost-effective, good mental health care. This plan emphasises the need for standardised approaches to the assessment, monitoring, and outcome of all related activities. Crucial to the improvement of outcomes during crises and the availability to future emergencies of lessons learned from earlier crises is the regular dissemination of the results achieved with the action plan. A research agenda is included that should, in time, fill knowledge gaps and reduce the negative mental health effects of complex emergencies.

Equity and changing patient characteristics--1950 to 1975.

The treatment patterns for psychiatric patients in a northeastern industrial community in 1975 are compared with treatment patterns in 1950. This survey is a follow-up of Hollingshead and Redlich's Social Class and Mental Illness. Special emphasis is placed on current treatment settings for the patient groups that in 1950 were either totally excluded from psychiatric care or using the state hospital exclusively. In spite of an enormous proliferation in the range and number of psychiatric services available to inpatients in the community in 1975, these patients were still receiving much of their inpatient care at the state hospital. In addition, they were found in public inpatient and outpatient units characterized by low-intervention treatment and staffed by semiprofessional and nonprofessional clinicians. These survey findings raise equity issues for such "low-status" patients. The concept of equity is applied to the survey results to generate relevant social policy questions.

Making strides towards better mental health care in Peru: Results from a primary care mental health training.

Our program attempted to improve attitudes and confidence of Peruvian primary care physicians (PCPs) providing mental health care. The training program underwent an evaluation to determine impact of sustained confidence in performing medical and psychiatric procedures, and application of learned skills. Fifty-two Peruvian primary care practitioners were trained at the Harvard Program in Refugee Trauma (HPRT) over a two-week period. There was significant improvement in PCPs' confidence levels of performing psychiatric procedures (counseling, prescribing medications, psychiatric diagnosis, assessing the risk for violence, and treating trauma victims) when comparing baseline and post-two-week to one year follow-up. When comparing post-two-week and one-year follow-up quantitative measures, confidences levels went slightly down. This may be an implication that the frequency of trainings and supervisions are needed more frequently. In contrast, qualitative responses from the one-year follow-up revealed increase in victims of violence clinical care, advocacy, awareness, education, training, policy changes, accessibility of care, and sustainment of diagnostic tools. This study supports the feasibility of training PCP's in a culturally effective manner with sustainability over time.

Social class and psychiatric practice: a revision of the Hollingshead and Redlich model.

In 1958, Hollingshead and Redlich demonstrated that there were major differences in mental health care for lower-class patients: they primarily received low-intervention treatments from nonprofessional staff. The authors report a follow-up study initiated by F.C. Redlich that reveals new trends at the community mental health center (CMHC) serving the region studied by Hollingshead and Redlich. More than half of the lower-class patients who sought evaluation at this CMHC were discharged without a treatment assignment. Many lower-class patients, however, gained access to the CMHC's psychotherapy unit. Most of these patients were women, employed, and diagnosed as psychoneurotic. The authors conclude that the effect of social class on psychiatric care is less complete than Hollingshead and Redlich originally demonstrated.

Overview: Ethical issues in contemporary psychiatry.

The authors survey the ethical problems confronting psychiatry today. They state that with rare exceptions psychiatric intervention can be morally justified only with the potential patient's informed consent. Within this framework, they discuss the fact that today nonpsychiatrists, particularly ethicists, lawyers, legislators, and social scientists, as well as psychiatrists are concerned about medical ethics, specifically regarding the right to be treated, the right not to be treated, the civil rights of psychiatric patients, the ethics of behavior control, the problem of conflicts of interest in therapeutic goals, privacy and confidentiality, the ethics of human experimentation, policy decisions, and psychiatry's relationship to the changing moral value structure of U.S. society.

The psychosocial impact of war trauma and torture on Southeast Asian refugees.

More than 700,000 refugees from Southeast Asia have settled in the United States since 1975. Although many have suffered serious trauma, including torture, few clinical reports have described their trauma-related symptoms and psychosocial problems. The authors conducted a treatment study of 52 patients in a clinic for Indochinese. They found that these patients were a highly traumatized group; each had experienced a mean of 10 traumatic events and two torture experiences. Many of the patients had concurrent diagnoses of major affective disorder and posttraumatic stress disorder as well as medical and social disabilities associated with their history of trauma. The authors also found that Cambodian women without spouses demonstrated more serious psychiatric and social impairments than all other Indochinese patient groups.

A community study of formal pastoral counseling activities of the clergy.

Although the clergy have been identified as a major community mental health resource, few epidemiologic studies of clergy practices have been conducted. The authors report a comprehensive survey of the counseling activities of clergy groups serving south-central Connecticut. They found that the clergy were a heterogeneous counseling group and that the counseling activities of many were extremely limited, although all were experienced with "troubled individuals". In recent years pastoral counselors have separated from their parishes and emerged as a psychotherapy profession. In contrast, certain parish-based clergy, especially the black clergy, have functioned as a major mental health resource to communities with limited access to professional mental health care.

Indochinese versions of the Hopkins Symptom Checklist-25: a screening instrument for the psychiatric care of refugees.

The United States is accepting the largest number of displaced persons since World War II. Over 70% are Southeast Asians; many have suffered serious war trauma and torture. Cultural differences in health-seeking behavior and lack of specialized mental health services make the recognition of psychiatric distress in Southeast Asia refugees difficult for American health care providers. The authors describe the development and validation of Cambodian, Laotian, and Vietnamese versions of the Hopkins Symptom Checklist-25. This brief, simple, and reliable instrument is well received by refugee patients, offers an effective screening method for the psychiatric symptoms of anxiety and depression, and is especially helpful for evaluating trauma victims.

Assessing symptom change in Southeast Asian refugee survivors of mass violence and torture.

The authors evaluated changes in symptoms and levels of perceived distress of 21 Cambodian, 13 Hmong/Laotian, and 18 Vietnamese patients before and after a 6-month treatment period. Most of the patients improved significantly. Cambodians had the greatest and Hmong/Laotians had the least reductions in depressive symptoms. Although psychological symptoms improved, many somatic symptoms worsened. The authors conclude that refugee survivors of multiple traumata and torture can be aided by psychiatric care. They recommend investigations with larger samples and suitable control groups to further clarify the relative contributions of trauma, diagnosis, and acculturation stress to treatment outcome.

Effects of war trauma on Cambodian refugee adolescents' functional health and mental health status.

OBJECTIVE: To measure the effect of war trauma on the functional health and mental health status of Cambodian adolescents living in a refugee camp on the Thai-Cambodian border. METHOD: A multistage probability sample identified 1,000 households in the camp known as Site Two. Interviews were conducted in each household with randomly selected adults 18 years of age and older. All adolescents aged 12 and 13 years old, along with one parent were interviewed. One hundred eighty-two adolescents (94 girls, 88 boys) and their parents participated. Culturally sensitive instruments were used including Cambodian versions of the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). RESULTS: Parents and adolescents reported the latter having experienced high levels of cumulative trauma, especially lack of food, water, and shelter. Mean Total Problem scores were in ranges similar to those of adolescents receiving clinical care in the United States, Netherlands, and Israel. Nearly 54% (53.8%) had Total Problem scores in the clinical range by parent report on the CBCL and 26.4% by adolescent report on the YSR. The most commonly reported symptoms were somatic complaints social withdrawal attention problems, anxiety, and depression. The dose-effect relationship between cumulative trauma and symptoms was strong for parent reporting on the CBCL; the subscales on both the YSR and CBCL for Anxious/Depressed and Attention Problems revealed dose-effect associations. Dose-effect relationships between cumulative trauma and social functioning or health status were lacking. CONCLUSION: The high levels of emotional distress in this population of Cambodian adolescents and corresponding dose-effect relationships reveal the important negative psychosocial impact of violence on Cambodian adolescents. Lack of findings related to physical health status and the presence of positive social functioning of many youths should not deter health care providers and public health officials from diagnosing and treating underlying high levels of psychological distress.

Cultural dimensions in the evaluation and treatment of sexual trauma. An overview.

Although many women worldwide experience sexual trauma, they constitute a neglected patient population. Refugee women, in particular, reveal a high prevalence of sexual trauma. Despite the recognition that sexual trauma afflicts the lives of many, little is known about the impact on health of sexual trauma and its evaluation and treatment. Few empirical studies exist. This article focuses on describing the cultural issues relevant to treating patients who have been sexually traumatized. Clinical descriptions and patient testimonies are used to provide a clinical guide for evaluation and treatment, as well as for outlining directions for future research.

Managed care and assisted living: trends and future prospects.

With its emergence as a new, residential long-term care option, more than half of the states have established policy on assisted living. In 1996, over 30 states had created a state licensure category or passed legislation authorizing development of regulations. Known primarily as a resource for wealthy elders needing assistance with activities of daily living and health care needs, assisted living is increasingly being covered as a service under state Medicaid programs. Assisted living is widely seen as a resource for managed care organizations enrolling Medicare beneficiaries. Flexible capitation payments and incentives to substitute services create opportunities for assisted living facilities and HMOs to form partnerships. Enrollment of beneficiaries in Medicare HMOs has reached 4.5 million and is growing over 30% a year. In addition, state Medicaid agencies are developing programs to enroll elders, most of whom are also Medicare beneficiaries, in managed care programs that include long-term care. The move toward managed care and the increasing interest in integrating acute and long-term care for dual eligibles signals a growing role for assisted living facilities as a major resource for elders who need a supportive and service-rich residential living environment.

The evolution of assisted living. A view from the states.

Use of nursing homes has declined significantly with the expansion of home care services and the explosion of assisted living facilities. To give consumers more choices, many states allow assisted living facilities to provide higher levels of service that enable residents to continue to live as independently as possible as their needs change.