Reclaiming public spaces: The case for the built environment as a restorative tool in neighborhoods with high levels of community violence.

Early-life exposure to neighborhood violence can negatively affect children's socioemotional development and long-term health outcomes. Community-level interventions that modify the built environment to facilitate social encounters can have a positive impact on health. An example of such interventions is the building of green spaces and playgrounds. This case study describes collaboration among residents, local organizations, and a university that aimed to increase the utilization of a vacant lot by converting it into a green space with a playground. Informal conversations at volunteer gatherings and neighborhood association meetings indicated a positive impact of this project in the community. We propose a model for future program implementation and research to improve health in disinvested and disordered communities. We conclude that more research is needed on community partnerships that modify the built environment to decrease community violence. Community-based participatory research may be successful in evaluating future projects with this goal.

Enhancing community-based rehabilitation for stroke survivors: creating a discharge link.

BACKGROUND AND OBJECTIVE: Intensive poststroke rehabilitation is critical to maximizing outcomes, improving inpatient flow, and decreasing long-term costs. This regional initiative investigated the impact of improving access to timely intensive home-based stroke rehabilitation follow-up care on hospital length of stay (LOS) and readmission rates. The enhanced service was made available across the region's rural geography to new stroke survivors transitioning home who were unable to access outpatient care. METHODS: All new stroke survivors with ongoing rehabilitation needs being discharged from the hospital and eligible for home care received timely enhanced intensity of home-based rehabilitation services from existing community rehabilitation providers for 2 months after discharge. Five hundred twenty-four stroke survivors received this service over a 3-year period. The service priority rating was increased to reduce wait times to less than 5 days. Collaborative planning across sectors occurred through discharge link meetings. Comparative analysis was used to investigate health system measures before and after service implementation. RESULTS: A 15.7-day decrease in hospital LOS and decreased hospital readmission rates were observed after enhanced service implementation. Functional Independence Measure (FIM) efficiency improved for those discharged from inpatient rehabilitation. Average wait time for community rehabilitation services decreased from 44 days to 4.4 days. The mean total number of community therapy visits more than doubled to an average of 12 per client. CONCLUSION: The provision of timely more intensive home-based rehabilitation services for new stroke survivors transitioning home and unable to access outpatient care was associated with decreased hospital LOS and decreased readmission rates.

Acute stress symptoms 1-2 weeks after stroke predict the subsequent development of post-traumatic stress symptoms: A prospective cohort study.

OBJECTIVE: To date no research has examined the potential influence of acute stress symptoms (ASD) on subsequent development of post-traumatic stress disorder (PTSD) symptoms in stroke survivors. Our objective was to examine whether acute stress symptoms measured 1-2 weeks post-stroke predicted the presence of post-traumatic stress symptoms measured 6-12 weeks later. DESIGN: Prospective within-groups study. METHODS: Fifty four participants who completed a measure of acute stress disorder at 1-2 weeks following stroke (time 1) and 31 of these participants completed a measure of posttraumatic stress disorder 6-12 weeks later (time 2). Participants also completed measures of stroke severity, functional impairment, cognitive impairment, depression, anxiety, pre-morbid intelligence and pain across both time points. RESULTS: Some 22% met the criteria for ASD at baseline and of those, 62.5% went on to meet the criteria for PTSD at follow-up. Meanwhile two of the seven participants (28.6%) who met the criteria for PTSD at Time 2, did not meet the ASD criteria at Time 1 (so that PTSD developed subsequently). A hierarchical multiple regression analysis indicated that the presence of acute stress symptoms at baseline was predictive of post-traumatic stress symptoms at follow-up (R2 = .26, p < .01). Less severe stroke was correlated with higher levels of post-traumatic stress symptoms at Time 2 (rho = .42, p < .01). CONCLUSIONS: The results highlight the importance of early assessment and identification of acute stress symptoms in stroke survivors as a risk factor for subsequent PTSD. Both ASD and PTSD were prevalent and the presence of both disorders should be assessed.

Oral manifestations of psoriasis. Clinical presentation and management.

Psoriasis is a chronic immune-mediated disease of unknown etiology that affects the skin and mucous membranes. According to the National Institutes of Health (NIH), approximately five million Americans, 3% of the population, have been diagnosed with psoriasis. Oral manifestations of psoriasis are less well recognized than skin lesions, and treatment for oral lesions is not standardized. This article will review the clinical presentation of skin and mucous membrane psoriasis, along with the therapeutic modalities available to oral health-care providers.

Diagnosis and treatment of salivary gland disorders.

The keystone of the architecture of the oral cavity is saliva; however, it is rarely acknowledged as a vital physiologic secretion. Saliva plays three major roles in oral and systemic health. It provides host protection, assists in the initiation of food and fluid intake, and enables communication through speech. Without adequate salivary output augmented by a rich assortment of salivary proteins and electrolytes, oral and pharyngeal health declines as well as a person's quality of life. This article will provide a brief summary of the function of saliva, oral and systemic etiologies of salivary dysfunction, and methods to treat and prevent salivary disorders. Oral health care professionals can play a vital role in identifying patients at risk for developing salivary dysfunction and should provide appropriate preventive and interventive techniques that will help preserve oral health and function.