Family Fellowship Society for Psychosocial Rehabilitation Services (1993-2019): A Self-help Movement.

Family Fellowship Society for Psychosocial Rehabilitation Services is an initiative of families of persons with mental illness and with psychiatric disabilities. It has been advocating self-help movement on the part of the families who have been on the lookout for alternative care services. This venture has been technically supported by the mental health professionals at National Institute of Mental Health and Neurosciences, Bangalore. It is a collaborative effort of families and professionals to address the needs that have been felt by the consumers and the professionals. It is the first of its kind in India. Over a period of 26 years, 150 + families have availed the alternative care for psychosocial rehabilitation services for their wards. In this context, an attempt was made to enlighten the psychosocial rehabilitation services at family fellowship society.

Risks for re-hospitalization of persons with severe mental illness living in rehabilitation care settings.

BACKGROUND: The high rates of psychiatric re-hospitalizations (also termed "revolving door") presents a "wicked problem" which requires a systematic and holistic approach to its resolution. Israel's mental-health rehabilitation law provides a comprehensive set of services intended to support the ability of persons with severe mental illness to rely on community rather than in-patient facilities for their ongoing care needs. Guided by the Health Behavior Model, we examined the relationship between psychiatric re-hospitalizations and the three Health Behavior Model factors (predisposing factor: socio-demographic characteristics and health beliefs; enabling factor: personal and social/vocational relationships facilitated by rehabilitation interventions and services; and need factor: outcomes including symptoms, and mental health and functional status) among persons with severe mental illness receiving rehabilitation services. METHODS: Logistic regression models were used to measure the association between re-hospitalization within a year and variables comprising the three Health Behavior Model factors on the sample of consumers utilizing psychiatric services (n = 7,165). The area under the curve for the model was calculated for each factor separately and for all three factors combined. RESULTS: A total of 846 (11.8%) consumers were hospitalized within a year after the study began. Although multivariable analyses showed significant associations between re-hospitalization and all three Health Behavior Model factors, the magnitude of the model's area under the curve differed: 0.61 (CI = 0.59-0.64), 0.56 (CI = 0.54-0.58), 0.78 (CI = 0.77-0.80) and 0.78 (CI = 0.76-0.80) for predisposing, enabling, need and the full three-factor Health Behavior Model, respectively. CONCLUSION: Findings revealed that among the three Health Behavior Model factors, the need factor best predicted re-hospitalization. The enabling factor, comprised of personal relationships and social/vocational activities facilitated by interventions and services representing many of psychiatric rehabilitation's key goals, had the weakest association with reduced rates of re-hospitalization. Possible explanations may be inaccurate assessments of consumers' personal relationships and social/vocational activities by the mental healthcare professionals, problematic provider-consumer communication on the consumers' involvement in social/vocational activities, or ineffective methods of facilitating consumer participation in these activities. Clearly to reduce the wicked "revolving-door" phenomenon, there is a need for targeted interventions and a review of current psychiatric rehabilitation policies to promote the comprehensive integration of community rehabilitation services by decreasing the fragmentation of care, facilitating continuity of care with other healthcare services, and utilizing effective personal reported outcomes and experiences of consumers with severe mental illness.

Barriers and facilitators to access post-stroke rehabilitation services in the first six months of recovery in Brazil.

PURPOSE: To identify barriers and facilitators to accessing post-stroke rehabilitation services six months after discharge from the stroke unit of a Brazilian public hospital. MATERIALS AND METHODS: This cross-sectional and descriptive study collected sociodemographic and clinical-functional data during hospitalization. Then, barriers and facilitators for accessing the post-stroke rehabilitation services were collected six months after discharge. We considered economic conditions and displacement, the quality and organization of post-stroke rehabilitation services, and personal conditions. RESULTS: A total of 174 patients were included. Among the 20 aspects analyzed, 17 (85.0%) were reported as facilitators, while three (15.0%) were as barriers. The identified barriers included financial income available for healthcare (49.4%), waiting time to schedule or to be seen (47.0%), and process to scheduling (45.4%). The main facilitators (> 79.0%) were the expectation of the patient with the treatment and assistance from family and friends. Moreover, most patients indicated as facilitators all aspects related to the quality of post-stroke rehabilitation services. CONCLUSION: Access to post-stroke rehabilitation services presented more facilitators than barriers. Public policies to subsidize health costs, optimize waiting time, and process for scheduling post-stroke rehabilitation services should be considered to reduce barriers. Likewise, human and financial resources must promote the facilitators.

Public policies to subsidize health costs, optimize waiting times and scheduling in post-stroke rehabilitation services should be considered to facilitate access to rehabilitation services for post-stroke patients.The involvement of family and friends in the treatment of post-stroke patients should be encouraged.Patients' motivation and positive expectations can facilitate access to post-stroke rehabilitation services.

Demographic covariates and vocational rehabilitation services as predictors of employment outcomes of people with physical disabilities: a hierarchical logistic regression analysis.

PURPOSE: Stable employment is essential for the health, psychosocial, and financial well-being of people with physical disabilities (PwPD). Unfortunately, the low employment rate for PwPD in the U.S. exposes them to adverse effects of unemployment, including depression, anxiety, low self-esteem, and physical pain. Helping PwPD find gainful employment will improve their general health and well-being. However, few empirical studies examine factors affecting the employment outcomes of PwPD. This study aims to examine the relationship between demographic covariates, vocational rehabilitation (VR) services, and employment outcomes of PwPD. MATERIALS AND METHODS: This secondary data analysis study includes 17,598 PwPD from the U.S. Department of Education's Rehabilitation Services Administration's Case Service Report (RSA-911) dataset. Our analysical approach was hierarchical logistic regression analysis. RESULTS: For VR services, workplace support, technology support, job placement assistance, and VR counseling significantly contribute to predicting employment outcomes for PwPD. Even after entering VR services, the demographic variables (age, race, education, referral sources, low-income, long-term unemployment, and disability significancy) were still significant predictors of employment. CONCLUSIONS: Findings from this study can be used by state VR counselors and other disability service providers to plan and select effective employment-related interventions to improve the employment outcomes of PwPD.

The alarmingly low employment rate among PwPD significantly impacts their psychological, financial, social, and overall health well-being in the U.S.Vocational rehabilitation services, including workplace support, technology assistance, VR counseling, and job placement support, are pivotal in facilitating employment for PwPD.PwPD who received workplace support exhibited nearly six times higher odds of attaining employment compared to those without such assistance.PwPD who received technology support experienced four times higher odds of achieving employment in contrast to those without technology assistance.

Criterios de referencia y barreras para la atención de personas con baja visión en Santander

Objetivo: Identificar criterios de derivación y barreras percibidas por los optómetras para la rehabilitación de personas con baja visión en Santander. Métodos: Estudio de corte transversal que incluyó 82 optómetras de municipios de Santander, seleccionados mediante muestreo intencionado. Se diseñó un cuestionario con 36 preguntas para recolectar los datos que son reportados empleando estadística descriptiva. Resultados: El 47,5 % de los profesionales tiene claro el nivel de agudeza visual para clasificar a una persona con baja visión. Las principales barreras identificadas para el acceso a servicios de baja visión fueron: el proceso de derivación dentro del sistema de salud es engorroso (74,39 %), falta de servicios cerca (57,31 %) y considerar que los pacientes no pueden pagar las ayudas (48,78 %). Discusión: Es necesario fortalecer la formación de los optómetras para mejorar los procesos de identificación, atención y rehabilitación. Conclusiones: Es importante ubicar como prioritaria la discapacidad visual en Santander, para así robustecer la red de atención en salud.

Objective: To identify referral criteria and barriers perceived by optometrists for the rehabilitation of people with low vision in Santander. Methods: Cross-sectional study, which included 82 optometrists from municipalities of Santander, selected by purposive sampling. A questionnaire with 36 questions was designed to collect data that are reported using descriptive statistics. Results: A total of 47.5% of the professionals are clear about the level of visual acuity to classify a person with low vision. The main barriers identified for access to low vision services were: the referral process within the health system is cumbersome (74.39%), lack of services nearby (57.31%) and considering that patients cannot afford the aids (48.78%). Discussion: It is necessary to strengthen the training of optometrists to improve the processes of identification, care and rehabilitation. Conclusions: It is important to prioritize visual impairment in Santander in order to strengthen the health care network.

Quality of life of services users in psychotropic drug treatment and rehabilitation services: a qualitative study from service user and provider perspectives.

Quality of life (QoL) is a widely recognized and valuable social outcome measure in drug treatment and rehabilitation services, but the discrepancies in QoL perceptions between service users and providers remain under-explored. In this study, semi-structured interviews were conducted with service users (n = 22) and providers (n = 29) to capture their perceptions of QoL and explore the similarities and discrepancies between their views. A thematic analysis and contrast exploration revealed a shared understanding of QoL that extends beyond health to six dimensions and prioritizes empowerment and connection. However, divergent views emerged regarding the priorities of material conditions, emotional well-being, and physical health. Findings underscore the importance of using shared decision-making as a strategy to effectively address these discrepancies and promote a more patient-centered approach in treatment and rehabilitation services.

Public sector rehabilitation services for physical disabilities in tertiary care hospitals of Karachi, Pakistan: A qualitative study.

BACKGROUND: Around the globe there are 2.4 billion people in need of rehabilitation. Disability and rehabilitation have not gained much importance in the public health arena, possibly due to limited research and awareness regarding the significance of rehabilitation. This study aimed to provide an in-depth understanding of the barriers and facilitators to the provision and utilization of rehabilitation services in public sector tertiary care hospitals of Karachi, Pakistan. METHODOLOGY: This qualitative exploratory study was conducted from August to September 2015 in two tertiary care hospitals of Karachi. The criterion for hospital selection included the availability of functional rehabilitation services. Twenty-four key informant interviews were conducted with health professionals, including doctors, physiotherapists, occupational therapists, prosthetists, orthotists, as well as patients and caregivers. Qualitative content analysis was performed using a consensual qualitative research approach. Responses from key informant interviews were coded into free nodes and then categorized into themes. RESULTS: Two themes emerged from the data: constraints to the provision of rehabilitation services, and barriers to the utilization of rehabilitation services. Basic infrastructure was available at both study sites; however, a lack of structured guidelines for referring patients to these services, a lack of information-sharing and guidance to the patients, and a limited supply of equipment (treatment modalities) hampered the provision of services. The barriers to rehabilitation services included cost pertaining to transport, environmental barriers, lack of support from the employer, and strain on and lack of support from caregivers. CONCLUSION: Rehabilitation services require attention and investment in research and allocation of funds to strengthen the service delivery system. Hospitals, alongside the department of health, need to develop a strategic plan to set future directions and standards of available rehabilitation services.

Predictors of long-stay in a tertiary care psychiatry hospital in India.

BACKGROUND: Many psychiatric patients continue to stay for longer duration in psychiatric institutions. Community reintegration and rehabilitation of such patients needs to be explored to ensure appropriate bed occupancy rates and access to in-patient care for newer patients in need of the same. OBJECTIVES: The aim is to identify the risk and protective factors leading to long-term admission of mentally ill patients in tertiary care hospital. METHODOLOGY: A cross-sectional study was conducted with all patients in the long-stay ward between May 2018 and February 2023. A retrospective chart review followed by cross sectional assessment of risks and disability was carried out with all the patients living in a long-stay psychiatric ward (N = 101) at a tertiary hospital in Bangalore, India, between May 2018 and February 2023. RESULTS: The hospital's average length of stay (LOS) was 5.70 ± 8.30 years. The risk and protective factors for LOS in psychiatric hospitals were analyzed using the Poisson Regression model. The results revealed that the male gender, diagnosis of schizophrenia or psychosis, clinicians' knowledge of family information, good clinical improvement, and higher participation in ward activities are the protective factors for a shorter hospital stay. While higher age, family history of mental illness, being married and employed, absence of children, and/or having family members rarely visiting the patient at the hospital were some factors that increased the risk of LOS. CONCLUSION: This study highlighted the importance of possible LOS predictors in the tertiary care psychiatric hospital. The multi-disciplinary team may utilize risk and protective factors for delayed LOS to introduce comprehensive psychosocial interventions and policies that reduce the risk of delays or length of stay in mental health hospitals.

World Health Organization survey on the level of integration of traditional Chinese medicine in Chinese health system rehabilitation services.

Background: To meet the growing global demand for rehabilitation services, the World Health Organization (WHO) launched Rehabilitation 2030. This study was commissioned by the WHO to investigate the integration degree of traditional Chinese medicine (TCM) in Chinese health system rehabilitation services and the demand for TCM rehabilitation in China. Methods: Twenty TCM rehabilitation experts and relevant government administrators were invited to complete the questionnaire between September 2019 and January 2022. The development of traditional, complementary, and integrative medicine (TCI) rehabilitation in China was assessed primarily based on six different health system components. Results: 26 policies, regulations, and national strategic plans related to TCI rehabilitation were issued by relevant government departments since 2002; notably, 14 policies related to TCI rehabilitation development were intensively introduced from 2016 to 2021. These policies cover the three main areas of financing, infrastructure development, and service delivery. The National Administration of Traditional Chinese Medicine's investment in TCM clinical capacity infrastructure and scientific research in 2019-2021 increased by 66% compared to 2010-2012, and the average number of TCM hospitals with rehabilitation departments in 2020 increased by 6.5% compared to 2018. The proportion of community health service centers providing TCM services in primary medical and health institutions has increased by 30.8% over the past 10 years. Conclusion: Long-term continuous policies, substantial financial investment, and expansion of the scope of TCI rehabilitation services in primary care institutions have effectively contributed to the rapid development of TCI rehabilitation. However, human resources and financing mechanisms for TCI rehabilitation need further improvement.

The effect of a disability-targeted cash transfer program on universal health coverage and universal access to education: a nationwide cohort study of Chinese children and adolescents with disabilities.

Background: To achieve improved outcomes for children and adolescents with disabilities, it is central to have universal health coverage (UHC) and universal access to education. This study investigates whether a disability-targeted cash transfer (CT) program is associated with improved access to healthcare and education for children and adolescents with disabilities. Methods: We used nationwide survey data of two million children and adolescents living with disabilities, who aged 8-15 years when entering the cohort between January 1, 2015, and December 31, 2019. With a quasi-experimental study design, we compared the outcomes between CT beneficiaries who newly received CT benefits during the study period and non-beneficiaries who were disabled but never received CT using logistic regressions after propensity score matching with a 1:1 ratio. Outcomes of interest were utilization of rehabilitation services in the past year, medical treatment if the individual had illness in the past two weeks, school attendance if not in school at the start of the study, and reported financial hardship to access these services. Findings: Of the total cohort, 368,595 children and adolescents fit the inclusion criteria, including 157,707 new CT beneficiaries and 210,888 non-beneficiaries. After matching, CT beneficiaries showed 2.27 (95% confidence interval [CI]: 2.23, 2.31) higher odds of utilizing rehabilitation services and 1.34 (95% CI: 1.23, 1.46) higher odds of getting medical treatment compared to non-beneficiaries. CT benefits were also significantly associated with less report of financial barrier to access rehabilitation services (odds ratio [OR]: 0.63, 95% CI: 0.60, 0.66) and medical treatment (OR: 0.66, 95% CI: 0.57, 0.78). Moreover, CT program was associated with higher odds of school attendance (OR: 1.99, 95% CI: 1.85, 2.15) and lower odds of reporting financial difficult to access education (OR: 0.41, 95% CI: 0.36, 0.47). Interpretation: Our results suggest that the receipt of CT was associated with improved access to health and educational resources. This finding provides supporting evidence for the identification of efficient and feasible interventions to move toward UHC and universal education under the Sustainable Development Goals. Funding: This research was supported by Sanming Project of Medicine in Shenzhen (NO.SZSM202111001), China National Natural Science Foundation (Grant/Award Number: 72274104, 71904099) and Tsinghua University Spring Breeze Fund (20213080028).

Diagnóstico situacional de un grupo de Unidades Productoras de Servicios de Medicina de Rehabilitación (UPS-MR) del Perú: estudio preliminar / Situational diagnostic of a group of units producing medical rehabilitation services (UPMRS) in Peru: a preliminary study

Objetivo : Describir el diagnóstico situacional de un grupo de Unidades Productoras de Servicios de Medicina de Rehabilitación (UPS-MR) del Perú evaluadas en el 2019 y 2020. Material y métodos : Estudio observacional, transversal y descriptivo del análisis secundario de datos de la evaluación que realizó la Dirección Ejecutiva de Investigación y Docencia en Prevención de Riesgos y Promoción de la Salud del Instituto Nacional de Rehabilitación "Dra. Adriana Rebaza Flores" AMISTAD PERÚ - JAPÓN a UPS-MR durante los años 2019 y 2020. Las variables fueron: logro en el equipamiento, infraestructura, documentos/herramientas de gestión y manuales y guías de práctica clínica, funciones, recursos humanos, procedimientos y logro total. Cada logro tenía como puntaje mínimo 0% y como puntaje máximo 100%. Además, se realizó un análisis secundario para comparar el logro de las UPS-MR según nivel de categorización y región. Resultados: Catorce UPS-MR fueron incluidas en la investigación. Seis (42,9%) fueron de categoría III-1 y 6 (42,9%) eran de la región Lima. El mayor logro fue en las funciones (74,1%) y el menor logro en los recursos humanos y procedimientos (41,9% y 40,8%). Finalmente, el logro total tuvo una media de 58,3%±14,6%. Conclusiones : Las UPS-MR tienen el mayor logro en las funciones y los menores logros en recursos humanos y procedimientos. El logro total fue alrededor del 50%.

SUMMARY Objective : To describe the situational diagnostic of a group of units producing medical rehabilitation services (UPMRS) in Peru from 2019 to 2020. Methods: This a cross-sectional study that included a secondary analysis of an evaluation performed by the Dirección Ejecutiva de Investigación y Docencia en Prevención de Riesgos y Promoción de la Salud of the Instituto Nacional de Rehabilitación "Dra. Adriana Rebaza Flores" AMISTAD PERÚ - JAPÓN a UPMRS from 2019 to 2020. Variables included in the analyses were achievement of infrastructure, equipment, documents of administration, guidelines of clinical practice, human resources and total achievement. The minimal score per achievement was 0% and the maximum was 100%. Achievements stratified by region and categorization were made. Results: Fourteen PMRS were included; six (42.9%) were category III-1 and six (42.9%) were from Lima Region. Best achievement was in functions (74.1%) and worst was in human resources and procedures (41.9% and 40.8%, respectively). Finally, total achievement had a mean score of 58.3%±14.6%. Conclusions: UPMRS had better achievements in functions and worse in human resources and procedures, total achievement was 50%.

Impact of the COVID-19 Pandemic and Governmental Policies on Rehabilitation Services and Physical Medicine in Jordan: A Retrospective Study.

Background: Although the COVID-19 pandemic led to a series of governmental policies and regulations around the world, the effect of these policies on access to and provision of rehabilitation services has not been examined, especially in low and middle- income countries. Aims: The aim of this study was to investigate the impact of governmental policies and procedures on the number of patients who accessed rehabilitation services in the public sector in Jordan during the pandemic and to examine the combined effect of sociodemographic factors (age and gender) and the governmental procedures on this number of patients. Methods: A retrospective cohort study was conducted based on records of 32,503 patients who visited the rehabilitation center between January 2020 and February 2021. Interrupted time-series analysis was conducted with three periods and by age and gender. Results: The number of patients who visited the rehabilitation clinics decreased significantly between January 2020 and May 2020 due to government-imposed policies, then increased significantly until peaking in September 2020 (p = 0.0002). Thereafter, the number of patients decreased between October 2020 and February 2021 as a result of the second wave of the COVID-19 pandemic (p = 0.02). The numbers of male and female patients did not differ (p > 0.05). There were more patients aged 20 years and older attending rehabilitation clinics than younger patients during the first strict lock down and the following reduction of restriction procedures periods (p < 0.05). Conclusions: The COVID-19 public measures in Jordan reduced access to rehabilitation services. New approaches to building resilience and access to rehabilitation during public health emergencies are needed. A further examination of strategies and new approaches to building resilience and increasing access to rehabilitation during public health emergencies is warranted.

Percepção de pais e cuidadores de crianças com deficiência sobre os serviços de reabilitação durante a pandemia da COVID-19 no Brasil / Perception of parents and caregivers of children with disabilities about rehabilitation services during the COVID-19 pandemic in Brazil

INTRODUÇÃO: Observou-se durante a pandemia do coronavírus no Brasil a suspensão das sessões de reabilitação de crianças com deficiência. OBJETIVO: Analisar o andamento das sessões de reabilitação durante a pandemia, bem como a forma de suporte que os pais/cuidadores receberam neste período. MATERIAIS E MÉTODOS: Estudo qualitativo, com delineamento transversal, conduzido on-line pela plataforma Survey Monkey. Participaram pais e cuidadores de crianças com deficiência motora de zero a quatro anos de idade, que foram recrutados através das mídias sociais. A coleta de dados ocorreu por um questionário com 17 perguntas abertas e fechadas, acessível por um período de três meses durante o período de novembro de 2020 a janeiro de 2021. RESULTADOS: Todos os questionários foram lidos na íntegra e após observada saturação das respostas, 37 foram elegíveis. A suspensão das sessões nos serviços de reabilitação variou de 2 a 9 meses. Durante este período, vinte e seis famílias receberam orientações do profissional ou da instituição para estimular a criança em casa; para os demais, que não receberam orientações, a justificativa fornecida era que deviam aguardar a retomada dos atendimentos. Dezesseis famílias tiveram dificuldades para realizar as atividades/exercícios propostos pelos profissionais de saúde em ambiente domiciliar. CONCLUSÃO: Foram identificados, através das respostas dos pais, sentimentos de preocupação e ansiedade com a suspensão dos serviços de reabilitação durante a pandemia e medo com os possíveis prejuízos no desenvolvimento neuropsicomotor das crianças. Além disso, os pais se sentiram desamparados pelos serviços de saúde e profissionais.

INTRODUCTION: During the coronavirus pandemic in Brazil, the suspension of rehabilitation sessions for children with disabilities was observed. OBJECTIVE: To analyze the progress of rehabilitation sessions during the pandemic, as well as the form of support that parents/caregivers received during this period. MATERIALS AND METHODS: Qualitative study, with a cross-sectional design, conducted online through the Survey Monkey platform. Parents and caregivers of children with motor disabilities aged zero to four years old participated, and were recruited through social media. Data collection took place by a questionnaire with 17 open and closed questions, accessible for a period of three months during the period November 2020 to January 2021. RESULTS: All questionnaires were read in full and after observing saturation of responses, 37 were eligible. The suspension of sessions in rehabilitation services ranged from 2 to 9 months. During this period, twenty-six families received guidance from the professional or the institution to stimulate the child at home, for the others who did not receive guidance, the justification provided was to wait for the resumption of care. Sixteen families had difficulties performing the activities/exercises proposed by health professionals in the home environment. CONCLUSION: Parents' responses identified feelings of concern and anxiety about the suspension of rehabilitation services during the pandemic and fear of possible damage to children's neuropsychomotor development. In addition, parents felt helpless by health services and professionals.

[Errata] Percepção de pais e cuidadores de crianças com deficiência sobre os serviços de reabilitação durante a pandemia da COVID-19 no Brasil / [Erratum] Perception of parents and caregivers of children with disabilities about rehabilitation services during the COVID-19 pandemic in Brazil

INTRODUÇÃO: Observou-se durante a pandemia do coronavírus no Brasil a suspensão das sessões de reabilitação de crianças com deficiência. OBJETIVO: Analisar o andamento das sessões de reabilitação durante a pandemia, bem como a forma de suporte que os pais/cuidadores receberam neste período. MATERIAIS E MÉTODOS: Estudo qualitativo, com delineamento transversal, conduzido on-line pela plataforma Survey Monkey. Participaram pais e cuidadores de crianças com deficiência motora de zero a quatro anos de idade, que foram recrutados através das mídias sociais. A coleta de dados ocorreu por um questionário com 17 perguntas abertas e fechadas, acessível por um período de três meses durante o período de novembro de 2020 a janeiro de 2021. RESULTADOS: Todos os questionários foram lidos na íntegra e após observada saturação das respostas, 37 foram elegíveis. A suspensão das sessões nos serviços de reabilitação variou de 2 a 9 meses. Durante este período, vinte e seis famílias receberam orientações do profissional ou da instituição para estimular a criança em casa; para os demais, que não receberam orientações, a justificativa fornecida era que deviam aguardar a retomada dos atendimentos. Dezesseis famílias tiveram dificuldades para realizar as atividades/exercícios propostos pelos profissionais de saúde em ambiente domiciliar. CONCLUSÃO: Foram identificados, através das respostas dos pais, sentimentos de preocupação e ansiedade com a suspensão dos serviços de reabilitação durante a pandemia e medo com os possíveis prejuízos no desenvolvimento neuropsicomotor das crianças. Além disso, os pais se sentiram desamparados pelos serviços de saúde e profissionais.

INTRODUCTION: During the coronavirus pandemic in Brazil, the suspension of rehabilitation sessions for children with disabilities was observed. OBJECTIVE: To analyze the progress of rehabilitation sessions during the pandemic, as well as the form of support that parents/caregivers received during this period. MATERIALS AND METHODS: Qualitative study, with a cross-sectional design, conducted online through the Survey Monkey platform. Parents and caregivers of children with motor disabilities aged zero to four years old participated, and were recruited through social media. Data collection took place by a questionnaire with 17 open and closed questions, accessible for a period of three months during the period November 2020 to January 2021. RESULTS: All questionnaires were read in full and after observing saturation of responses, 37 were eligible. The suspension of sessions in rehabilitation services ranged from 2 to 9 months. During this period, twenty-six families received guidance from the professional or the institution to stimulate the child at home, for the others who did not receive guidance, the justification provided was to wait for the resumption of care. Sixteen families had difficulties performing the activities/exercises proposed by health professionals in the home environment. CONCLUSION: Parents' responses identified feelings of concern and anxiety about the suspension of rehabilitation services during the pandemic and fear of possible damage to children's neuropsychomotor development. In addition, parents felt helpless by health services and professionals.

Expectations of caregivers of persons with severe mental illness from mental health rehabilitation services: A qualitative study.

BACKGROUND: Mental health rehabilitation services (MHRS) play an essential role in addressing the diverse and often complex needs of persons with severe mental illness (SMI). The rehabilitation services are of utmost importance in training these patients to lead an independent and meaningful life. In India, caregivers of persons with SMI play a significant role in the decision-making process concerning treatment and rehabilitation. AIM: The main objective of the present study was to understand and analyze the expectations of caregivers of persons with severe mental illness from mental health rehabilitation services in the Indian context. METHOD: The present study is qualitative in nature. A semi-structured interview schedule was used to capture the caregivers' expectations. Fifteen caregivers who met inclusion and exclusion criteria were interviewed for the study. The data obtained was analyzed using Braun and Clarke's six-phase data analysis framework. RESULTS: Thematic analysis of the data emerged into five themes, namely (1) 'proximity', (2) 'professionalism of staff', (3) 'treatment related expectations', (4) 'welfare benefits', and (5) 'infrastructure'. These themes and their sub-themes were subsequently discussed in the light of existing literature. CONCLUSION: Caregivers of persons with SMI identified the most relevant as well as generic expectations from MHRS. Understanding these expectations can help improvise the existing services delivery system and help institutes, non-government organizations (NGOs) and other concerned entities working in mental health rehabilitation to develop service user friendly rehabilitation models.

Effects of an electronic health record-based mobility assessment and automated referral for inpatient physical therapy on patient outcomes: A quasi-experimental study.

OBJECTIVE: To assess the effectiveness of a hospital physical therapy (PT) referral triggered by scores on a mobility assessment embedded in the electronic health record (EHR) and completed by nursing staff on hospital admission. DATA SOURCES: EHR and billing data from 12 acute care hospitals in a western Pennsylvania health system (January 2017-February 2018) and 11 acute care hospitals in a northeastern Ohio health system (August 2019-July 2021). STUDY DESIGN: We utilized a regression discontinuity design to compare patients admitted to PA hospitals with stroke who reached the mobility score threshold for an EHR-PT referral (treatment) to those who did not (control). Outcomes were hospital length of stay (LOS) and 30-day readmission or mortality. Control variables included demographics, insurance, income, and comorbidities. Hospital systems with EHR-PT referrals were also compared to those without (OH hospitals as alternative control). Subgroup analyses based on age were also conducted. DATA EXTRACTION: We identified adult patients with a primary or secondary diagnosis of stroke and mobility assessments completed by nursing (n = 4859 in PA hospitals, n = 1749 in OH hospitals) who completed their inpatient stay. PRINCIPAL FINDINGS: In the PA hospitals, patients with EHR-PT referrals had an 11.4 percentage-point decrease in their 30-day readmission or mortality rates (95% CI -0.57, -0.01) relative to the control. This effect was not observed in the OH hospitals for 30-day readmission (ß = 0.01; 95% CI -0.25, 0.26). Adults over 60 years old with EHR-PT referrals in PA had a 26.2 percentage-point (95% CI -0.88, -0.19) decreased risk of readmission or mortality compared to those without. Unclear relationships exist between EHR-PT referrals and hospital LOS in PA. CONCLUSIONS: Health systems should consider methodologies to facilitate early acute care hospital PT referrals informed by mobility assessments.

Terapia de rehabilitación olfatoria en pacientes con síndrome pos-COVID-19 / Olfactory rehabilitation therapy in patients with post-COVID-19 syndrome

El olfato desempeña una función importante en el desarrollo diario de la vida de las personas. Sus alteraciones pueden ser cualitativas (disosmias, parosmias o fantosmias) y cuantitativas (hiposmia o anosmia). Estas alteraciones pueden deberse por enfermedades rinosinusales, neurodegenerativas o infecciones respiratorias como el resfriado común, la gripe y también el SARS-CoV-2, el agente causal del COVID-19. En relación a esta etiología, su fisiopatología no es del todo clara y la anosmia es poco distinguible clínicamente del resto de las infecciones virales, con una duración variable desde ocho días hasta más de cuatro semanas, en cuyo caso se denomina síndrome pos-COVID-19 o COVID prolongado. Este cuadro se caracteriza por la presencia de síntomas que se desarrollan durante la enfermedad aguda por COVID-19,y que persisten durante más de cuatro semanas, sin explicación por un diagnóstico alternativo. El autor de este artículo realiza una revisión de la literatura médica a partir de un caso clínico con el fin de identificar y resumir la evidencia disponible sobre la terapia de rehabilitación olfatoria. (AU)

Sense of smell plays an important role in the daily development of people's lives. Its alterations can be both qualitative (dysosmias, parosmias, or phantosmias) and quantitative (hyposmia or anosmia). These alterations may be due to rhinosi-nusal diseases, neurodegenerative diseases, and respiratory infections such as common cold, influenza, and SARS-CoV-2,causative agent of COVID-19. In relation to this etiology, its pathophysiology is not entirely clear, and anosmia is clinically indistinguishable from the rest of the viral infections, with a variable duration ranging from eight days to more than four weeks, in which case it would be called post COVID- 19 syndrome or prolonged COVID. This condition is characterized by the presence of symptoms that develop during acute COVID-19 illness and persist for more than four weeks without an explanation by an alternative diagnosis.The author of this article carries out a review of the medical literature based on a clinical case in order to identify and summarize the available evidence on olfactory rehabilitation therapy. (AU)

Continuidade do cuidado aos egressos hospitalares da COVID-19: novos e antigos desafios para o enfrentamento da pandemia no Brasil / Continuity of care for outpatients of COVID-19: new and old challenges to face the pandemic in Brazil

Resumo Trata-se de um debate acerca dos desafios da continuidade do cuidado relativo às ações de reabilitação aos egressos hospitalares da COVID-19. O elevado número de internações hospitalares e as limitações funcionais decorrentes dessa doença geram necessidades de cuidado em serviços de reabilitação no nível secundário e na Atenção Básica. No Sistema Único de Saúde (SUS), essa modalidade de cuidado historicamente foi vinculada à política da pessoa com deficiência, e apesar de haverem alguns avanços para a construção da Rede de Cuidados, ainda existem barreiras de acesso aos serviços. Isso, somado aos retrocessos que o SUS vem sofrendo, à ausência de planejamento adequado, e às dificuldades para a utilização das Tecnologias da Informação e Comunicação são os principais desafios para a continuidade do cuidado aos egressos da COVID-19. Neste cenário, é fundamental a indução de políticas públicas e programas de saúde a fim de aprimorar as ações em reabilitação, qualificar as práticas de cuidado e estabelecer uma rede de cuidados articulada que consiga dar conta das novas demandas. Para tanto, o fortalecimento do SUS e da Atenção Básica devem ser a aposta principal para a mitigação da pandemia e seus impactos sociais.

Abstract This is a debate about the challenges of continuity of care regarding rehabilitation for outpatients of COVID-19. The high number of hospital admissions and the functional limitations resulting from this disease generate needs for care in rehabilitation services at the secondary level and in Primary Health Care (PHC). In the Brazilian Unified Health System (Sistema Único de Saúde — SUS), this type of care has historically been linked to the policy of people with disabilities, and although there have been some advances in the construction of the Care Network, barriers to access to services still exist. This, in addition to the setbacks that SUS has been suffering, the lack of adequate planning, and the difficulties in the use of Information and Communication Technologies are the main challenges for the continuity of care for outpatients of COVID-19. In this scenario, it is essential to induce public policies and health programs in order to improve the actions in rehabilitation, qualify care practices, and establish an articulated care network that can cope with the new demands. Therefore, the strengthening of SUS and PHC must be the main bet for the mitigation of the pandemic and its social impacts.

Job satisfaction and work context among rehabilitation care professionals in Alagoas, Brazil: an observational study / Satisfação no trabalho e contexto de trabalho entre profissionais de reabilitação em Alagoas, Brasil: um estudo observacional

ABSTRACT Job satisfaction is multifactorial and is directly related to the quality of health services. The main objective of this study was to characterize the level of job satisfaction and the work context of the multidisciplinary teams in specialized rehabilitation services in the state of Alagoas, Brazil. We evaluated the professional profile of participants and sociodemographic information. The Work Context Assessment Scale (WCAS) which is divided into three dimensions and questions adapted from the satisfaction and remuneration dimensions of the Great Place to Work methodology for the Organizational Climate Survey, was used. We included 190 professionals, the mean age was 35.47±9.25 and 86.3% were women. Most participants worked in the capital (60%) and 84.7% had a monthly wage ranging from R$1,000 to R$3,000. The dimension of "work organization" was crucial. The items "pace of work," "strong demand," "performance monitoring," and "repetitive tasks" presented the worst results, but 92.7% are satisfied with their professional activities. The logistic regression analysis showed that more years since graduation and lower scores of Work conditions and Socio-professional relationships were associated with higher job satisfaction. Job satisfaction was found to be high, the dimension of work organization was crucial, and almost half of the participants have already thought about leaving their careers.

RESUMEN La satisfacción laboral es multifactorial y está directamente relacionada con la calidad de los servicios de salud. El objetivo principal de este estudio fue identificar el nivel de satisfacción y el contexto de trabajo de equipos multidisciplinarios en servicios especializados de rehabilitación en el estado de Alagoas, Brasil. Se evaluó el perfil profesional y el perfil sociodemográfico, y se aplicaron la Escala de Evaluación del Contexto de Trabajo (EACT), dividida en tres dimensiones, y preguntas adaptadas de las dimensiones de satisfacción y remuneración de la metodología de encuesta de clima organizacional, Great Place to Work. Se incluyeron a 190 profesionales, de los cuales el 86,3% eran mujeres, y la edad media fue de 35,47±9,25 años. La mayoría trabajaba en la capital (60%) y el 84,7% ganaba entre R$1.000 y R$3.000. La dimensión "organización del trabajo" fue crítica. Los ítems "ritmo de trabajo", "exigencia de resultados", "control del rendimiento" y "tareas repetitivas" obtuvieron los peores resultados, pero el 92,7% de los participantes estaban satisfechos con su actividad profesional. La regresión logística mostró que a más años de formación y puntuaciones más bajas en las dimensiones "condiciones de trabajo" y "relación socioprofesional" se asociaban a una mayor satisfacción laboral. La satisfacción laboral fue alta, la dimensión "organización del trabajo" crítica, y casi la mitad de los participantes había pensado en dejar su carrera.

RESUMO A satisfação no trabalho é multifatorial e está diretamente relacionada com a qualidade dos serviços de saúde. O objetivo principal deste estudo foi caracterizar o nível de satisfação e o contexto de trabalho de equipes multidisciplinares de serviços especializados em reabilitação no estado de Alagoas, Brasil. Foi avaliado o perfil profissional e sociodemográfico e foram aplicadas a escala de avaliação do contexto de trabalho (EACT), que é dividida em três dimensões, e questões adaptadas das dimensões de satisfação e remuneração da metodologia Great Place to Work da pesquisa de clima organizacional. Incluímos 190 profissionais, sendo 86,3% do sexo feminino, e a idade média foi de 35,47±9,25 anos. A maioria trabalhava na capital (60%) e 84,7% recebiam mensalmente de R$ 1.000,00 a R$ 3.000,00. A dimensão organização do trabalho foi considerada crítica. Os itens ritmo de trabalho, cobrança por resultados, fiscalização do desempenho e tarefas repetitivas tiveram os piores resultados, mas 92,7% dos participantes estavam satisfeitos com suas atividades profissionais. A regressão logística mostrou que mais anos de formado e menores pontuações nas dimensões condições de trabalho e relações socioprofissionais estão associados com maior satisfação no trabalho. A satisfação no trabalho foi alta, a dimensão organização do trabalho crítica, e quase metade dos participantes já pensaram em deixar sua carreira.