[Medical rehabilitation in dermatology : Goals, program content, and application process]. / Medizinische Rehabilitation in der Dermatologie : Ziele, Inhalte und Antragstellung.

BACKGROUND: Medical rehabilitation plays an important role in the management of patients with chronic dermatoses and dermato-oncological diseases. OBJECTIVES: Which dermatological indications qualify for a medical rehabilitation? What forms need to be completed for a successful application? Which treatments are provided and what are goals to be accomplished during dermatological rehabilitation? MATERIALS AND METHODS: Evaluation of current guidelines, directives, and recommendations as well as exemplary reviews. RESULTS: Dermato-oncological diseases and every chronic dermatological disease that is associated with a limitation of body functions and structures, activity and participation is eligible for medical rehabilitation. They include need, ability to absolve a rehabilitation, and a favorable prognosis. Treatments range from therapy of the underlying dermatological condition to interdisciplinary treatment of comorbidities with the aim of restoring functional health. CONCLUSIONS: Medical rehabilitation follows a holistic approach and represents a significant addition to outpatient and acute inpatient care, often leading to a long-term improvement in clinical outcome, participation, and activity.

Association Between Children With Life-Threatening Conditions and Their Parents' and Siblings' Mental and Physical Health.

Importance: Despite concerns regarding the potential deleterious physical and mental health outcomes among family members of a child with a life-threatening condition (LTC), few studies have examined empirical measures of health outcomes among these family members. Objectives: To examine whether mothers, fathers, sisters, and brothers of children with 1 of 4 types of pediatric LTCs have higher rates of health care encounters, diagnoses, and prescriptions compared with families of children without these conditions. Design, Setting, and Participants: This retrospective cohort study included US families with commercial insurance coverage from a single carrier. Children who had 1 of 4 LTCs (substantial prematurity, critical congenital heart disease, cancer, or a condition resulting in severe neurologic impairment) were identified by a diagnosis in their insurance claim data between July 1, 2015, and June 30, 2016. Each case child and their family was matched with up to 4 control children and their families based on the age of the case and control children. Data were analyzed between August 2020 and March 2021. Exposures: Having a child or sibling with substantial prematurity, critical congenital heart disease, cancer, or a condition resulting in severe and progressive neurologic impairment. Main Outcomes: Rates of occurrence of health care encounters, physical and mental health diagnoses, and physical and mental health medication prescriptions, identified from insurance claims data, were compared between case and control families using a multivariable negative binomial regression model. The statistical analysis adjusted for observed differences between case and control families and accounted for clustering at the family level. Results: The study included 25 528 children (6909 case children [27.1%] and 18 619 control children [72.9%]; median age, 6.0 years [IQR, 1-13 years]; 13 294 [52.1%] male), 43 357 parents (11 586 case parents [26.7%] and 31 771 control parents [73.3%]; mean [SD] age, 40.4 [8.1] years; 22 318 [51.5%] female), and 25 706 siblings (7664 case siblings [29.8%] and 18 042 control siblings [70.2%]; mean [SD] age, 12.1 [6.5] years; 13 114 [51.0%] male). Overall, case mothers had higher rates of the composite outcome of health care encounters, diagnoses, and prescriptions compared with control mothers (incident rate ratio [IRR], 1.61; 95% CI, 1.54-1.68), as did case fathers compared with control fathers (IRR, 1.55; 95% CI, 1.46-1.64). Sisters of children with LTCs had higher rates of the composite outcome compared with sisters of children without LTCs (IRR, 1.68; 95% CI, 1.55-1.82), as did brothers of children with LTCs compared with brothers of children without LTCs (IRR, 1.70; 95% CI, 1.56-1.85). Conclusions and Relevance: In this cohort study, mothers, fathers, sisters, and brothers who had a child or sibling with 1 of 4 types of LTCs had higher rates of health care encounters, diagnoses, and medication prescriptions compared with families who did not have a child with that condition. The findings suggest that family members of children with LTCs may experience poorer mental and physical health outcomes. Interventions for parents and siblings of children with LTCs that aim to safeguard their mental and physical well-being appear to be warranted.

La telerehabilitación durante la pandemia COVID-19: experiencia de las familias de niños con condiciones crónicas complejas / Telerehabilitation during the COVID-19 pandemic: experience of families of children with complex chronic conditions

La telerehabilitación ha sido una solución rápida y efectiva para la atención de pacientes durante la pandemia COVID-19. Nuestro objetivo ha sido describir la experiencia de las familias de niños con condiciones crónicas complejas (CCC) asistidos con la modalidad de telerehabilitación durante la pandemia. Materiales y métodos: Se ha realizado un estudio observacional, descriptivo y transversal de tipo encuesta online. Se encuestaron familias de niños (1 mes a 5 años de edad) con al menos una CCC que recibieron seguimiento interdisciplinario a distancia durante la pandemia de 2 o más áreas de rehabilitación (kinesiología, fonoaudiología y terapia ocupacional) pertenecientes al Servicio de Kinesiología del Hospital de Pediatría Juan P Garrahan, durante marzo a octubre de 2020. Resultados: El 88,3% de los participantes (n=43) se expresó satisfecho con la modalidad de telerehabilitación. Entre los facilitadores seleccionados por los participantes se mencionan la reducción de tiempos, mayor frecuencia de consultas, disminución de gastos por traslados y mayor comodidad, mientras que entre las barreras se destacaron: el no vínculo con profesionales, alargue en tiempos de tratamiento, problemas de conectividad. El análisis estadístico no indicó diferencias significativas entre quienes se reportaron como más satisfechos según su estrato social (alto o bajo), la disponibilidad de wifi propio, o respecto a la edad del niño. Se reportaron diferencias significativas en cuanto a la distancia al hospital (p=0.034). Conclusión: Esta forma de intervención ofreció nuevas posibilidades de atención que podrían considerarse a futuro en el seguimiento de nuestros pacientes. (AU)

Telerehabilitation has been a fast and effective solution in patient care during the COVID-19 pandemic. Our aim was to describe the experience of families of children with complex chronic conditions (CCC) treated through telerehabilitation during the pandemic. Materials and methods: An observational, descriptive, cross-sectional, online survey study was conducted. Families of children (1 month to 5 years of age) with at least one CCC who received interdisciplinary remote follow-up during the pandemic from two or more rehabilitation areas (physical therapy, speech therapy, and occupational therapy) belonging to the Department of Physical Therapy of Hospital de Pediatría Juan P Garrahan, from March to October 2020, were surveyed. Results: 88.3% of the participants (n=43) expressed satisfaction with the telerehabilitation modality. Among the facilitators selected by the participants, the following were mentioned: time saving, greater frequency of consultations, reduction of travel expenses and greater comfort, while among the barriers, the following stood out: no connection with the professionals, longer treatment times, connectivity problems. Statistical analysis did not show significant differences between those who reported being more satisfied according to socioeconomic level (high or low), availability of their own wifi connection, or age of the child. A significant difference was found for distance to the hospital (p=0.034). Conclusion: This type of intervention provided new possibilities of care that could be considered in the future follow-up of our patients (AU)

Postoperative Rehabilitation of Chronic Lateral Ankle Instability: A Systematic Review.

Chronic lateral ankle instability often causes adults to require a surgical intervention with subsequent physical therapy to assist with returning to their prior level of function. This systematic review is hoping to provide an up to date understanding of surgical procedures performed to correct chronic lateral ankle instability and establish a protocol for others to follow when treating adults who are status-post chronic lateral ankle instability surgery. This review looked at level I to III research studies that included surgical interventions to correct chronic lateral ankle instability as well as a rehabilitation protocol. This study found implementation of a rehabilitation protocol after surgical intervention could improve balance and subjective functional outcomes. It also determined that early weight-bearing may allow for early strengthening as range of motion returns faster. Further research is required utilizing larger randomized studies to better evaluate the outcomes of specific rehabilitation protocols in this patient population.

Efficacy of a Brief, Peer-Delivered Self-management Intervention for Patients With Rare Chronic Diseases: A Randomized Clinical Trial.

Importance: Patients coping with rare diseases need psychosocial support. Objective: To evaluate the efficacy of a brief, transdiagnostic, peer-delivered intervention for patients with rare diseases in addition to care as usual (CAU) compared with CAU only. Design, Setting, and Participants: In this 2-group randomized clinical trial conducted from October 5, 2017, to July 12, 2019, patients were recruited via specialized clinics and patient organizations across Germany and participated from home. The study included consecutive adult patients with neurofibromatosis type 1, Marfan syndrome, primary sclerosing cholangitis, and pulmonary arterial hypertension who have limited functionality because of the disease. Exclusion criteria were a life-threatening health status and ongoing psychotherapeutic treatment. Of 143 patients screened for eligibility with a semistructured telephone interview, 54 were excluded, and 89 were randomized: 45 patients were randomly allocated to the peer-delivered intervention group, and 44 to the control group; 87 patients (98%) completed the 6-month follow-up assessment. The analysis was performed using an intention-to-treat principle. Data cleansing and analysis were conducted between April 25, 2019, and February 13, 2020. Interventions: The 6-week intervention consisted of a self-help book and telephone-based peer counseling in addition to CAU. The control group received CAU alone. Peer counselors received training, structured consultation guidelines, and supervision. Main Outcomes and Measures: The primary outcome was acceptance of the disease as assessed using the Illness Cognition Questionnaire (ICQ; mean sum scores range from 0 to 18, with higher values representing more acceptance) 6 months after the intervention. Secondary outcomes included self-reported coping strategies (Health Education Impact Questionnaire), illness cognition (ICQ and Illness Perception Questionnaire), depression severity (Patient Health Questionnaire 9-item depression scale), anxiety severity (Generalized Anxiety Disorder Scale), quality of life (12-Item Short-Form Health Survey), and social support (Social Support Questionnaire). Outcomes were assessed before the intervention, after the intervention, and at a 6-month follow-up. Results: The mean (SD) age of the 89 participating patients was 46.3 (14.9) years; 59 (66%) were women. There were no group differences regarding baseline variables. All patients allocated to the intervention group completed the intervention. Six months after the intervention, but not directly after completing the program, the intervention group had significantly higher rates of acceptance (ICQ) of the disease (primary outcome) compared with the CAU group. Mean (SD) baseline ICQ scores were 9.61 (3.79) in the control group and 9.86 (3.40) in the intervention group. Mean (SE) ICQ scores at 6 months were 10.32 (0.42) for the control group and 11.79 (0.42) for the intervention group, with a significant mean difference of -1.47 (95% CI, -2.63 to -0.31; P = .01). Several secondary outcomes, including different coping strategies, social support, and mental quality of life, were significantly higher after the intervention compared with the control group. Conclusions and Relevance: In this randomized clinical trial, a self-help and peer counseling intervention improved patients' acceptance of their rare chronic diseases. Self-management and peer support can efficiently address the unique care needs of patients with rare diseases. Trial Registration: isrctn.org Identifier: ISRCTN13738704.

Creatine in Health and Disease.

Although creatine has been mostly studied as an ergogenic aid for exercise, training, and sport, several health and potential therapeutic benefits have been reported. This is because creatine plays a critical role in cellular metabolism, particularly during metabolically stressed states, and limitations in the ability to transport and/or store creatine can impair metabolism. Moreover, increasing availability of creatine in tissue may enhance cellular metabolism and thereby lessen the severity of injury and/or disease conditions, particularly when oxygen availability is compromised. This systematic review assesses the peer-reviewed scientific and medical evidence related to creatine's role in promoting general health as we age and how creatine supplementation has been used as a nutritional strategy to help individuals recover from injury and/or manage chronic disease. Additionally, it provides reasonable conclusions about the role of creatine on health and disease based on current scientific evidence. Based on this analysis, it can be concluded that creatine supplementation has several health and therapeutic benefits throughout the lifespan.

Nested graft for chronic ulcer in scar tissue after heroin extravasation in a drug addict.

INTRODUCTION: Nested graft is a surgical technique that allows to manage difficult-to-treat medical conditions such as chronic cutaneous ulcers, thanks to the high efficacy it has in reverting the fibroblasts senescence. Because of its peculiar regenerative property, nested graft is a surgical technique suitable also for the treatment of cutaneous ulcers developing on fibrotic scar tissue. CASE REPORT: We reported the case of a 45-year-old man, drug-addict, with a large ulcer on the back of the right forearm in the context of scar fibrotic tissue. This lesion resulted from a previous heroin extravasation treated with a dermo-epidermal skin graft, that was accidentally scratched away by mechanical trauma. After several therapeutic failures with topical medications, we decided to treat the ulcer performing a skin graft using the nested graft technique. No adverse events were reported by the patient during or after the surgery. At the clinical evaluation performed three years later the wound was completely healed. CONCLUSIONS: Nested graft represents a safe and easy-to-use technique that can be successfully used to treat ulcers on scar tissue, ensuring the achievement and the long-term maintenance of optimal resistance and aesthetic results.

Transição do cuidado de usuários com doenças crônicas do serviço de emergência para a casa: continuidade do cuidado na rede de atenção à saúde / Care transitions of users with chronic diseases from emergency department to home: the continuity of care in healthcare network

Introdução: A transição do cuidado visa assegurar a coordenação e a continuidade dos cuidados de saúde na transferência de pacientes entre os diferentes serviços que contemplam a Rede de Atenção à Saúde, prevenindo readmissões hospitalares não planejadas e reduzindo custos. As ações desenvolvidas durante a transição do cuidado promovem suporte para os pacientes quando estes necessitam de atendimento em serviços de emergência. Objetivo: Analisar a transição do cuidado, na perspectiva de usuários com Doenças Crônicas Não-Transmissíveis que receberam alta de um serviço de emergência para a Rede de Atenção à Saúde. Métodos: Estudo descritivo e transversal, com abordagem de métodos mistos incorporados, desenvolvido em três etapas, com 364 pacientes com Doenças Crônicas Não-Transmissíveis que agudizaram suas condições e passaram por atendimento em um serviço de emergência de um hospital de nível quaternário do estado de São Paulo/Brasil, com coleta de dados realizada no período de dezembro de 2018 a junho de 2019. Na primeira etapa, foram caracterizados os participantes considerando variáveis sociodemográficas e clínicas, através do Prontuário Eletrônico do Paciente e, posteriormente, complementados durante o contato telefônico na segunda e terceira etapas, caso houvesse necessidade; para a análise de dados desta etapa foi aplicada análise descritiva das variáveis categóricas e cálculo de medidas de posição e dispersão para as variáveis contínuas. A segunda e terceira etapas foram realizadas de forma concomitantemente, por meio de contato telefônico utilizando a versão adaptada do instrumento Care Transitions Measure (CTM-Brasil); durante a aplicação, os participantes possuíam liberdade para falar sobre situações vividas que consideravam pertinentes e, após o término da aplicação do CTM-Brasil, foi feita uma pergunta disparadora estimulando-os a complementarem suas entrevistas; a análise de dados da segunda etapa foi feita respeitando as propriedades psicométricas do instrumento, obtendo-se uma média simples de resposta de cada item, bem como a média da escala total e por fator; as características sociodemográficas e clínicas dos participantes foram associadas e correlacionadas à qualidade da transição do cuidado, com nível de significância estatística de 5%. Para análise da terceira etapa, optou-se pela análise de conteúdo, modalidade temática, onde as categorias encontradas foram: TEMA 1 - Etapas do processo de alta hospitalar (Subtema I Preparação para o autogerenciamento; Subtema II Entendimento sobre medicações; Subtema III Preferências asseguradas; Subtema IV Plano de cuidado); TEMA 2 - Influência do ambiente hospitalar no cuidado prestado ao usuário; TEMA 3 - Avaliação do serviço e da assistência prestada pelo serviço de emergência ao usuário e TEMA 4 - Continuidade do cuidado aos usuários na Rede de Atenção à Saúde municipal. Após o término da análise dos resultados da segunda e terceira etapas, foi realizada a integração do resultado qualitativo ao quantitativo. Resultados: A maioria dos participantes era do sexo masculino, idosos, casados, de baixa escolaridade, moradores da zona norte, apresentavam mais de uma morbidade, sendo que 80,4% possuíam complicações relacionadas às patologias; o diagnóstico mais prevalente foi o de doenças cardiovasculares; 92,5% faziam uso de medicamentos para tratamento, 83,5% frequentavam a UBS e todos os participantes tiveram pelo menos um atendimento prévio no serviço de emergência no último ano; 27,7% reinternou pelo menos uma vez em um período de até 60 dias pós-alta do serviço de emergência; a média de escore do CTM-Brasil foi de 79,92 indicando nível elevado de qualidade na transição do cuidado, sendo que o fator que obteve os melhores escores foi o de preparação para autogerenciamento de saúde no domicílio e o fator com menor escore foi o de garantia das preferências do paciente. Foram identificadas apenas associações entre os escores do CTM-Brasil com as características sociodemográficas e clínicas dos participantes, não havendo significância estatística com readmissões no serviço de emergência em 60 dias pós-alta, bem como na frequência de readmissões não planejadas. Todavia, ao integrar os métodos mistos, demonstra-se que, mesmo que a média do escore do CTM-Brasil tenha sido alta, os participantes, em suas falas, fizeram importantes críticas relacionadas ao processo de transição do cuidado realizado no serviço de emergência para a rede, bem como do atendimento recebido e as condições às quais eles foram expostos durante internação, o que reforça a necessidade do uso do CTM-Brasil ser associado a outros indicadores de qualidade da assistência recebida nos serviços de saúde. Conclusão: Aponta-se para a necessidade de abordar adequadamente as questões de humanização do cuidado, planejamento de alta, educação em saúde, comunicação eficaz, de forma a desenvolver melhores estratégias para suprir as fragilidades da transição do cuidado, qualificando-a para prover o autogerenciamento em saúde, fornecimento de informações quanto ao uso adequado de medicamentos, incorporação das metas e expectativas dos pacientes e cuidadores na tomada de decisão e encaminhamento ágil e eficaz para continuidade do cuidado na Rede de Atenção à Saúde.

Introduction: Care transitions aims to ensure coordination and continuity of care in the patients' transfer between the different services of Healthcare Network, preventing unplanned hospital readmissions and reducing costs. The actions developed during the care transition promote support for patients when they need assistance in emergency departments. Objective: To analyze the care transitions, from the perspective of users with chronic non-communicable diseases who were discharged from an emergency department to the Healthcare Network. Methods: A descriptive and cross-sectional study, with a mixed method approach, developed in three stages, with 364 patients with chronic non-communicable diseases who had received hospital discharged from an emergency department of a quaternary-level hospital in the state of São Paulo, Brazil, from December 2018 to June 2019. In the first stage, participants were characterized considering sociodemographic and clinical variables, through the medical records systems and, after, complemented during telephone contact in the second and third stages; for the data analysis of this stage, a descriptive analysis of categorical variables was applied and calculation of position and dispersion measures for continuous variables. The second and third stages were carried out concurrently, through telephone contact using the adapted version of the Care Transitions Measure (CTM-Brazil) instrument; during the application, the participants were free to talk about lived situations that they considered pertinent and, after the end of the application of CTM-Brazil, a triggering question was asked encouraging them to complement their interviews; the data analysis of the second stage was carried out respecting the psychometric properties of the instrument, obtaining a simple average response for each item, as well as the average of the total scale and by factor; the participants' sociodemographic and clinical characteristics were associated and correlated with the quality of the care transition, with a level of statistical significance of 5%. For analysis of third stage, the content analysis was chosen, thematic modality, where the categories found were: THEME 1 - Stages of hospital discharge process (Subtheme I - Preparation for self-management; Subtheme II - Understanding about medications; Subtheme III - Preferences assured; Subtheme IV - Care plan); THEME 2 - Influence of the hospital environment on care provided to user; THEME 3 - Evaluation of the service and assistance provided by the emergency department to the user and THEME 4 - Continuity of care in the municipal Healthcare Network. After the analysis of the results of the second and third stages was completed, the qualitative and quantitative results were integrated. Results: Most of the participants were male, elderly, married, with low education, living in the northern area, more than one morbidity; 80.4% having complications to pathologies; the most prevalent diagnosis was cardiovascular disease; 92.5% used medication for treatment, 83.5% attended in basic health units and all participants had at least one previous medical treatment in the emergency department in the last year; 27.7% of patients readmitted at least once in a period of up to 60 days after discharge from the emergency department. The average score of the CTM-Brazil was 79.92, indicating a high level of quality in care transition; the factor that obtained highest's scores being the preparation for self-management of health at home and the factor with the worst score was the guaranteeing patient preferences. Only associations were identified between the scores of CTM-Brazil with the sociodemographic and clinical characteristics of the participants, but, with no statistical significance with readmissions to the emergency department at 60 days post-discharge, as well as the frequency of unplanned readmissions. Conclusion: It points to the need to adequately address the issues of humanization of care, discharge planning, health education, effective communication, in order to develop better strategies to address the weaknesses of the care transition, qualifying it to provide self-management in health, providing information on the proper use of medicines, incorporating the goals and expectations of patients and caregivers in decision-making and agile and effective referral for continuity of care in the Healthcare Network

Risk Factors for Relapse of Childhood B Cell Acute Lymphoblastic Leukemia.

BACKGROUND B cell acute lymphoblastic leukemia (B-ALL) is the most common type of ALL. This study aimed to explore risk factors for relapse of childhood B-ALL. MATERIAL AND METHODS Total of 102 pediatric B-ALL patients were included in this study. B-ALL patients were divided into a relapse group and a non-relapse group. Chemotherapy-induced agranulocytosis time, fusion gene, and minimal residual disease (MRD) were assessed. White blood cell (WBC) count in peripheral blood and risk stratification were evaluated in newly-diagnosed patients. Kaplan-Meier plots were used to evaluate the correlation between risk factors and relapse rates. Multivariate analysis was performed with Cox proportional hazard model to estimate relative risk (RR), 95% confidence interval (95% CI), and hazard ratio (HR). Finally, 99 cases of B-ALL were included in this study. RESULTS There were significant differences between the relapse group and the non-relapse group in age (p=0.004), chemotherapy-induced agranulocytopenia (p=0.001), WBC count in peripheral blood of newly diagnosed patients (p=0.016), risk stratification (p=0.000), and MRD at 12th week (p=0.007). Age over 10 years, high-risk stratification, long period of agranulocytopenia, higher WBC counts, and MRD more than 10⁻4 were correlated with higher B-ALL relapse rate (p<0.05). Multivariate analysis showed significantly higher relapse rates for age ≥10 years, high-risk stratification, and MRD at 12th week >10⁻4, with RR (95% CI) of 4.001 (1.005-15.930), 4.964 (1.050-23.456), and 4.646 (1.383-15.614), respectively. CONCLUSIONS Agranulocytopenia ≤7 days, peripheral blood WBC >100×109/L, and MRD at 33rd day >10⁻4 were associated with B-ALL relapse. Age ≥10 years, high-risk stratification, and MRD at 12th week >10⁻4 were independent risk factors for relapse.

The Wildman Programme. A Nature-Based Rehabilitation Programme Enhancing Quality of Life for Men on Long-Term Sick Leave: Study Protocol for a Matched Controlled Study In Denmark.

Many men have poor mental health and need help to recover. However, designing a rehabilitation intervention that appeals to men is challenging. This study protocol aims to describe the 'Wildman Programme', which will be a nature-based rehabilitation programme for men on long-term sick leave due to health problems such as stress, anxiety, depression, post-cancer and chronic cancer, chronic obstructive pulmonary disease (COPD), cardiovascular disease, or diabetes type II. The programme will be a nature-based rehabilitation initiative combining nature experiences, attention training, body awareness training, and supporting community spirit. The aim of the study will be to examine whether the 'Wildman Programme' can help to increase quality of life and reduce stress among men with health problems compared to treatment as usual. The study will be a matched control study where an intervention group (number of respondents, N = 52) participating in a 12-week nature-based intervention will be compared to a control group (N = 52) receiving treatment as usual. Outcomes are measured at baseline (T1), post-treatment (T2), and at follow up 6 months post-intervention (T3). The results of this study will be important to state whether the method in the 'Wildman Programme' can be implemented as a rehabilitation offer in the Danish Healthcare System to help men with different health problems.

Clinicians and patients perspectives on follow-up care and eHealth support after allogeneic hematopoietic stem cell transplantation: A mixed-methods contextual analysis as part of the SMILe study.

PURPOSE: We report on our contextual analysis's methodology, as a first step of an implementation science project aiming to develop, implement, and test the effectiveness of an integrated model of care in SteM-cell transplantatIon faciLitated by eHealth (SMILe). METHODS: We applied an explanatory sequential mixed-methods design including clinicians and patients of the University Hospital Freiburg, Germany. Data were collected from 3/2017 to 1/2018 via surveys in 5 clinicians and 60 adult allogeneic stem-cell transplantation patients. Subsequently, we conducted 3 clinician focus groups and 10 patient interviews. Data analysis followed a 3-step process: (1) creating narrative descriptions, tables, and maps; (2) mapping key observational findings per dimension of the eHealth-enhanced Chronic-Care Model; (3) reflecting on how findings affect our choice of implementation strategies. RESULTS: Current clinical practice is mostly acute care driven, with no interdisciplinarity and weak chronic illness management. Gaps were apparent in the dimensions of self-management support and delivery-system design. Health behaviors that would profit from support include medication adherence, physical activity and infection prevention. The theme "being alone and becoming an expert" underpinned patients need to increase support in hospital-to-home transitions. Patients reported insecurity about recognizing, judging and acting upon symptoms. The theme "eHealth as connection not replacement" underscores the importance of eHealth augmenting, not supplanting human contact. Synthesis of our key observational findings informed eight implementation strategies. CONCLUSION: Stakeholders are willing towards a chronic care-focused approach and open for eHealth support. The contextual information provides a basis for the SMILe model's development and implementation.

Effects of group kinesiotherapy on primary and secondary symptoms of osteoarthrosis

The aim of this study was to investigate the influence of a specific, kinesiotherapy-based rehabilitation program on the various symptoms of osteoarthrosis (OA), following group treatment. Thirty-one individuals, of both sexes, aged over 50 years and with medical diagnosis of OA, underwent 16 sessions, twice a week, totaling eight weeks, of a specific rehabilitation protocol based on group kinesiotherapy. Primary OA symptoms were assessed (directly related to the disease: OA symptoms, trunk flexibility, balance and pain), and so were secondary ones (indirectly related to the disease: signs of depression and anxiety, and quality of life). Data were tested through Student's t test or Wilcoxon's test, and contingencies of categorical data were analyzed using McNemar's test. There was an improvement in all primary symptoms of OA after the kinesiotherapy protocol was applied. Signs of anxiety and depression improved only in contingency, when risk stratification was taken into account. In addition, physical components of quality of life also showed improvement, which did not occur with mental components though. Therefore, the kinesiotherapy-based rehabilitation program was capable of positively influencing all primary symptoms, and only some aspects of secondary OA symptoms.

Rehabilitation approaches for children living with HIV in sub-Saharan Africa: a protocol for scoping review.

BACKGROUND: A large number of children living with chronic conditions such as HIV experience impairments and disabilities. Current sub-Saharan African healthcare systems are challenged with paediatric care that does not integrate rehabilitation into management of chronic diseases such as HIV. Furthermore, little attention is paid to societal inclusion, community engagement and educational needs of these children. Integration of paediatric care and rehabilitation in a holistic approach can help to overcome the challenges associated with living disabilities. This scoping review proposes a synthesis of existing evidence on rehabilitation intervention strategies to increase functioning and to address disability-related barriers in children living with HIV and disability in sub-Saharan Africa. METHODS: A scoping review will be conducted to systematically map evidence on rehabilitation intervention for children living with HIV in sub-Saharan Africa. Studies in sub-Saharan Africa from December 2012 to 2019 on rehabilitation interventions for children aged 5 to 10 years living with HIV will be included in the review. Peer-reviewed primary studies, as well as grey literature, will be identified from electronic databases including Google Scholar; PubMed; Medline; CINAHL and Cochrane. The search strings using keywords such as "HIV", "impairment", "disability", "neurocognitive impairment", "behavioural", "rehabilitation" and "intervention" will be conducted using Boolean logic. Two groups of independent reviewers will conduct all title, abstract and full article screening. The study selection process will be mapped using Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A predesigned data-charting table will supplement the extraction of data. NVIVO software will aide in the thematic analysis of the data. DISCUSSION: The information from studies will be discussed in relation to the research questions using a critical narrative to explore the emergent themes. The quality of studies will be appraised using the mixed method appraisal tool. The scoping review will provide a baseline of evidence on rehabilitation interventions for children living with HIV in sub-Saharan Africa. The scoping review will inform healthcare providers, scholars and policy developers about the current use of rehabilitation interventions and what gaps need to be addressed with further research and intervention development. SYSTEMATIC REVIEW REGISTRATION: OSF Center for Open Science: https://osf.io/ed7zb/.

E-cigarettes and Smoking Cessation in Smokers With Chronic Conditions.

INTRODUCTION: Many smokers with chronic medical conditions use e-cigarettes. This study assessed the association between e-cigarette use and subsequent smoking-cessation efforts in adult smokers with and without chronic medical conditions. METHODS: This was a longitudinal cohort study of adult cigarette smokers using Waves 1 and 2 of the Population Assessment of Tobacco and Health Study (2013-2015), analyzed in 2018‒2019. The exposure was the initiation of e-cigarette use by Wave 2. The outcomes at Wave 2 were: (1) past 12-month attempts to quit, (2) cigarette abstinence, (3) ≥50% reduction in cigarette use, and (4) past 12-month use of evidence-based smoking-cessation treatment. RESULTS: E-cigarette use initiation was associated with increased odds of attempting to quit smoking at Wave 2 among smokers with any chronic medical condition (AOR=1.92, 95% CI=1.42, 2.59) and without chronic medical conditions (AOR=1.81, 95% CI=1.50, 2.18). E-cigarette use initiation was also significantly associated with Wave 2 smoking abstinence in smokers with (AOR=1.95, 95% CI=1.11, 3.43) and without chronic medical conditions (AOR=1.63, 95% CI=1.17, 2.28). CONCLUSIONS: At a population level, e-cigarette use by smokers with chronic medical conditions is associated with more quitting activity and smoking abstinence. Future studies are needed to assess e-cigarette safety and efficacy to determine whether they may provide an alternative smoking-cessation or harm-reduction strategy for adults with smoking-sensitive disease who cannot achieve these goals with other methods.

The experiences of young people with chronic illness in New Zealand: A qualitative study.

BACKGROUND: Around 10% of young people suffer from chronic health conditions, and their health care needs are different from those of children or adults. Most research about young people's chronic illness focuses on specific conditions, on younger children's experience, and on the perspectives of parents. This study explored the experiences of young people with two very different chronic conditions (asthma and cancer) and their perception of the New Zealand health system's response to their needs. METHODS: This was a collaborative research process where eight young co-researchers who had asthma or cancer were employed to work alongside the research team to develop protocols, interview peers, and assist with analysis. The challenges of this process are described in the article. Twenty-one young people between ages 15 and 27 from two urban areas of New Zealand participated in semistructured open-ended interviews about their health care experiences. Sixteen participants were female, and five male. Eleven of the participants had finished cancer treatment (with an average of 3.6 years since diagnosis), and 10 had asthma. Purposeful sampling meant that 80% of the participants with asthma were identified as Maori and the other participants identified with a range of other ethnic groups. Data were thematically coded, and coresearchers were consulted to derive the ultimate findings. RESULTS: Chronic illness disrupted the trajectory of young people's lives and had significant effects on their relationships. The New Zealand health system generally did not respond well to the needs of these young people, but many encountered extraordinary individuals who supported them effectively. The experiences of some indigenous participants indicate that health professionals require effective cultural competence training. CONCLUSIONS: This study provides insights into how young people with very different conditions experience the health system. Young people should be consulted and actively included in decision making about making health systems responsive to their diverse needs.

The social network of adolescents who need special health care / La red social de los adolescentes que necesitan una atención especial a la salud / Rede social de adolescentes que necessitam de atenção especial à saúde

ABSTRACT Objective: To describe the social network of adolescents who need special health care. Method: A qualitative, descriptive and exploratory study conducted between 2016 and 2017 in the pediatric outpatient clinic of a teaching hospital in southern Brazil. Thirty-five semi-structured interviews were conducted with adolescents between 12 and 18 years of age, followed by the construction of genograms and ecomaps. After transcription, the enunciations were subjected to Pêcheux's method of discourse analysis. Results: The institutional network consists of health services, schools and religious entities, as well as adolescents' families and friends. In the family network, women family members—such as mothers, grandmothers and aunts—have a special role. Final Consideration: The adolescents' social network is composed of institutional and family circles. In the view of adolescents, the tertiary service is more capable of solving their problems, and for this reason used the most. In order to ensure these adolescents access to and continuity of care, the articulation between health policies and health services is suggested.

RESUMEN Objetivo: Describir la red social de los adolescentes que necesitan una atención especial a la salud. Método: Estudio cualitativo, descriptivo y exploratorio, realizado entre 2016 y 2017 en la clínica pediátrica de un hospital escuela en la región sur de Brasil. Se realizaron 35 entrevistas semiestructuradas con adolescentes de 12 a 18 años de edad, y después se elaboraron genogramas y ecomapas. Después de la doble transcripción, se sometieron los relatos a análisis de discurso pecheutiano. Resultados: En la red institucional constan de servicios de salud, escuelas y organismos religiosos, así como de familiares y amigos de los adolescentes. En la red de la familia, se elogian a las mujeres, representadas por las madres, las abuelas y las tías. Consideraciones Finales: La red social de los adolescentes se compone de círculos institucionales y familiares. En la perspectiva de los adolescentes, el servicio terciario es más resolutivo, por lo tanto, es lo más utilizado. Se recomienda articular las políticas con los servicios de salud para que se oferte a estos adolescentes el acceso a la salud y la continuidad del cuidado.

RESUMO Objetivo: Descrever a rede social de adolescentes que necessitam de atenção especial à saúde. Método: Estudo qualitativo, descritivo e exploratório realizado entre 2016 e 2017 no ambulatório pediátrico de um hospital de ensino no sul do Brasil. Foram realizadas 35 entrevistas semiestruturadas com adolescentes entre 12 a 18 anos de idade, seguidas pela construção de genogramas e ecomapas. Após a dupla transcrição, as enunciações foram submetidas à análise de discurso pechetiana. Resultados: A rede institucional é composta por serviços de saúde, escolas e entidades religiosas, além de familiares e amigos dos adolescentes. Na rede familiar, as mulheres são enaltecidas, representadas pelas mães, avós e tias. Considerações Finais: A rede social dos adolescentes é composta pelos círculos institucional e familiar. Na ótica dos adolescentes, o serviço terciário é mais resolutivo e por isso é o mais utilizado. Sugere-se articular as políticas e os serviços de saúde para o acesso e continuidade do cuidado desses adolescentes.

Núcleo de Apoio à Saúde da Família: promoção da saúde, atividade física e doenças crônicas no Brasil - inquérito nacional PMAQ 2013 / Núcleo de Apoyo a la Salud de la Familia: promoción de la salud, actividad física y enfermedades crónicas en Brasil - encuesta nacional PMAQ 2013 / Family Health Support Center: health promotion, physical activity, and chronic diseases in Brazil - national PMAQ survey 2013

Objetivo: descrever o relato de ações de promoção da saúde dirigidas a portadores de doenças crônicas não transmissíveis, o apoio do profissional de educação física (PEF) e a realização da ação de promoção de práticas corporais e atividade física (PCAF) pelas equipes do Núcleo de Apoio à Saúde da Família (NASF), segundo variáveis de contexto dos municípios do Brasil. Métodos: estudo transversal, integrante do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ) 2013/2014, mediante entrevistas a profissionais do NASF. Resultados: a ação mais relatada pelas equipes foi a avaliação e reabilitação de condições psicossociais (90,8%); a ação de promoção de PCAF foi a sexta mais realizada e teve maior prevalência no Sudeste brasileiro (89,6%), em municípios de médio porte (88,7%), com índice de desenvolvimento humano (IDH) médio (86,7%); o PEF apoiou 87% das equipes. Conclusão: revelou-se importante contribuição do NASF para as ações de PCAF.

Objetivo: describir el relato de acciones de promoción de la salud dirigidas a portadores de enfermedades crónicas no transmisibles (ECNT), el apoyo del profesional de educación física (PEF) y la realización de la acción de promoción de prácticas corporales y actividad física (PCAF) por los equipos del Núcleo de Apoyo a la Salud de la Familia (NASF), según variables de contexto de los municipios de Brasil. Métodos: estudio transversal, integrante del Programa Nacional de Mejoría del Acceso y de la Calidad de la Atención Básica (PMAQ) 2013/2014, con entrevistas a profesionales del NASF. Resultados: la acción más relatada por los equipos fue la evaluación y la rehabilitación de condiciones psicosociales (90,8%); la acción de promoción de PCAF fue la sexta más realizada, tuvo mayor prevalencia en el Sudeste brasileño (89,6%), en municipios de mediano porte (88,7%), con índice de desarrollo humano (IDH) medio (86,7%); el PEF apoyó 87% de los equipos. Conclusión: se reveló una importante contribución del NASF a acciones de PCAF.

Objective: to describe reported health promotion actions directed towards chronic non-communicable disease (CNCD) patients, the support of physical education professionals (PEP) and the implementation of actions to promote body practices and physical activity (BPPA) by the Family Health Support Center (FHSC) teams, according to Brazilian municipality context variables. Methods: this was a cross-sectional study, forming part of the 2013/2014 National Primary Health Care Access and Quality Improvement Program (PMAQ), by means of interviews with FHSC professionals. Results: the action most reported by the teams was evaluation and rehabilitation of psychosocial conditions (90.8%); promotion of BPPA was the sixth most performed action, and was more prevalent in the Brazilian Southeast region (89.6%), in medium-sized municipalities (88.7%), with medium human development index (HDI) (86.7%); PEP provided support to 87% of the teams. Conclusion: FHSC were found to make an important contribution to BPPA.

[Physical activity, tool for the prevention and management of chronic diseases]. / Attività fisica, strumento di prevenzione e gestione delle malattie croniche.

OBJECTIVES: Physical activity is a key element in the prevention, treatment and rehabilitation of many diseases. METHODS: In the context of an adequate lifestyle, its practice amplifies the health benefits and increases the fitness, and furthermore counteracts the development and progression of chronic non-communicable diseases, modulating many risk factors. Its function is important in all life cycles and helps to keep the functional capabilities and independence even with aging. RESULTS: While inadequate physical activity (due to a sedentary lifestyle) is currently the fourth leading cause of mortality in developed countries, being one of the main public health issues, strong scientific evidences show that a regular and sufficient dose of physical activity reduces by about 30% the risk of premature death, cardiovascular disease and stroke, type II diabetes, colon and breast cancer, depression. CONCLUSIONS: Several guidelines and recommendations define the type, intensity, frequency and duration of physical activity, and many lifestyle preventative interventions prove its effectiveness and sustainability. Although so far a minority of the population actually adheres to the recommendations, the epidemiological strenght of lifestyle-oriented programs is considerable: quitting sedentariness, even low doses of physical activity are protective for health and reduce by about 22 % the risk of premature death. Physical activity is also an important therapeutic tool for patients with cardiovascular diseases, hypertension, diabetes II, cancer, chronic obstructive pulmonary diseases; an appropriate dosage reduces the risk of recurrence and disease progression, improves the control of clinical parameters and increases the patient's quality of life.