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1.
BMC Infect Dis ; 21(1): 1100, 2021 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-34702208

RESUMO

BACKGROUND: Tuberculosis (TB) is an airborne chronic infectious disease mainly caused by Mycobacterium tuberculosis complex bacteria. Currently, about 1.7 billion (26%) of the world's population are considered to be infected with M. tuberculosis. The risk of acquiring tuberculosis is higher on some segments of societies including people with severe mental illness. As a result, World health organization (WHO) strongly recommends screening for tuberculosis in such risk groups and setting. METHODS: A cross-sectional study was conducted to assess the prevalence of active tuberculosis and associated factors among patients with chronic psychotic disorders admitted at St. Amanuel Mental Specialized Hospital and Gergesenon Mental rehabilitation center from February to June, 2020. All admitted patients were screened for any sign of TB as recommended by WHO. Presumptive TB cases were identified. Sputum samples were collected and tested by Xpert MTB/RIF assay. Data analysis was performed using SPSS version 25.0 statistical software and Chi square analysis was used to test the statistical association. RESULTS: From a total 3600 pschotic patients screened for TB, 250 (6.94%) presumptive tuberculosis cases were detected. From these, 27 (10.8%) were positive by Xpert MTB/RIF assay. Most of the patients were males (68.4%). The mean ± SD age of the participant was 36.5 ± 9.7 years. The overall prevalence of tuberculosis was found to be 750 per 100,000 population. The number of patients per room (p = 0.039) was associated with Xpert MTB/RIF positive active tuberculosis. CONCLUSION: The prevalence of active tuberculosis among chronic psychotic patients was high. Number of admitted patients per room was identified as risk factors for Xpert MTB/RIF positive active tuberculosis. Therefore, to control TB transmission in chronic mental health treatment facilities, efforts should be directed to periodic screening for early case detection and improving the number of patients per room.


Assuntos
Transtornos Mentais , Mycobacterium tuberculosis , Transtornos Psicóticos , Tuberculose Pulmonar , Tuberculose , Adulto , Estudos Transversais , Etiópia/epidemiologia , Hospitais Especializados , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Transtornos Psicóticos/epidemiologia , Centros de Reabilitação , Sensibilidade e Especificidade , Escarro , Tuberculose/epidemiologia , Tuberculose Pulmonar/epidemiologia
2.
Acta Myol ; 40(3): 132-134, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34632295

RESUMO

The outbreak of COVID-19 has forced the health care system to undergo profound rearrangements in services and facilities, especially during the periods of lockdown. In this context, inpatient and outpatient services had to rethink and reorganize their activities to meet the needs of severely disabled patients, as those affected by Muscular Dystrophies (MDs). We present the preliminary results of a survey aiming to explore the staff views on the changes in the care provided by the Gaetano Torre Rehabilitation Centre, and, the impact of these changes on professionals, patients and their families. The survey was carried out using an open-ended questionnaire including six-items, on the practical and psychological aspects emerged during the pandemic in relation to the healthcare services provided by the Centre and to the patients/caregivers conditions. The participants, most of them physiotherapists, highlighted 169 aspects emerging in the pandemic, 48.5% referring to the resources used to cope with critical issues and 51.5% concerning the difficulties encountered. Emotional aspects prevailed on practical aspects both in resources (52.4 vs 47.6%) and in difficulties (57.5 vs 42.5%) categories. In particular, with regard to patients' resources, psychological benefits, despite the burden, were greater than practical ones (87 vs 13%), in the form of improved intra-family relationships, feeling more cared for, and satisfaction for the received care. As for the patients' relatives, the staff indicated more resources than difficulties (72.8 vs 17.2%). Among the former, 75% concerned the emotional sphere, such as the perception of having a point of reference even in such a difficult time.


Assuntos
Atitude do Pessoal de Saúde , COVID-19/epidemiologia , Doenças Musculares/reabilitação , Centros de Reabilitação/organização & administração , Feminino , Acesso aos Serviços de Saúde , Humanos , Controle de Infecções , Itália , Masculino , Pandemias , SARS-CoV-2 , Inquéritos e Questionários
3.
Rev Saude Publica ; 55: 54, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34614117

RESUMO

OBJECTIVE: To build and validate a logical model for health care in Specialized Rehabilitation Centers (CER) by analyzing the work process and organizational issues of centers in Rio Grande do Norte. METHODS: This is a methodological study developed in three stages: 1) documentary research of legislation and ordinances concerning the healthcare service and the Disability Care Network (RCPD); 2) focus groups with a Census study of the CER in Rio Grande do Norte to understand and assess the daily activities of the service; and 3) systematization of the information collected and, finally, proposition and validation of the evaluative logical model. RESULTS: The model encompassed five central categories of the work and organizational process: "demands", "resources" (inputs, financial and workforce), "processes", "products and results" and "mission, values and external factors". CONCLUSION: The logical model built was suitable for graphical representation of the work process and organizational issues of the SRC. The study showed that the functioning of the services is in line with the regulations. However, there are still organizational gaps that need to be addressed to improve the resolution capacity of the service and the articulation with other points of the network.


Assuntos
Censos , Centros de Reabilitação , Brasil
4.
Emerg Infect Dis ; 27(11): 2856-2863, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34670647

RESUMO

We report a disease and mortality event involving swans, seals, and a fox at a wildlife rehabilitation center in the United Kingdom during late 2020. Five swans had onset of highly pathogenic avian influenza virus infection while in captivity. Subsequently, 5 seals and a fox died (or were euthanized) after onset of clinical disease. Avian-origin influenza A virus subtype H5N8 was retrospectively determined as the cause of disease. Infection in the seals manifested as seizures, and immunohistochemical and molecular testing on postmortem samples detected a neurologic distribution of viral products. The fox died overnight after sudden onset of inappetence, and postmortem tissues revealed neurologic and respiratory distribution of viral products. Live virus was isolated from the swans, seals, and the fox, and a single genetic change was detected as a potential adaptive mutation in the mammalian-derived viral sequences. No human influenza-like illness was reported in the weeks after the event.


Assuntos
Encefalite , Vírus da Influenza A Subtipo H5N8 , Influenza Aviária , Focas Verdadeiras , Animais , Centros de Reabilitação , Estudos Retrospectivos
5.
Spinal Cord Ser Cases ; 7(1): 93, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620844

RESUMO

STUDY DESIGN: Descriptive study. OBJECTIVES: To describe functional outcomes using Spinal Cord Independence Measure III (SCIM III) following inpatient rehabilitation among individuals with complete spinal cord injury (SCI) in the low-income setting of Nepal; to evaluate functional changes from rehabilitation admission to discharge and to compare functional outcomes between neurological levels of injury (NLI) at discharge. SETTING: Spinal Injury Rehabilitation Centre (SIRC), Kavrepalanchowk, Nepal. METHODS: We present data of all individuals with complete SCI who completed rehabilitation at SIRC in 2017. Data collected included: demographics, aetiology, neurological assessment, admission/discharge SCIM III scores, and length of stay. Data were analyzed using descriptive statistics. Pre/post-SCIM III scores were analyzed using Related-Samples Wilcoxon signed-rank test. Comparative analysis between NLIs was done using the Kruskal Wallis ANOVA test followed by pairwise Mann-Whitney U tests. RESULTS: Ninety-six individuals were included. Mean (SD) age was 33.5 (14.2) years, with a male/female ratio of 3.4:1. Median admission and discharge total SCIM III scores for cervical, thoracic and lumbosacral levels were 10 and 21, 16 and 61, and 41 and 79.5, respectively. Median total SCIM III score change between admission and discharge were 11 (p = 0.003), 43 (p < 0.001) and 40 (p = 0.068) for cervical, thoracic and lumbar groups, respectively. CONCLUSIONS: This study is the first of its kind to describe functional outcomes among individuals with complete SCI in the low-income setting of Nepal. All SCI groups showed a positive trend in SCIM III from admission to discharge, with improvements reaching statistical significance among groups with cervical and thoracic NLIs.


Assuntos
Pacientes Internados , Traumatismos da Medula Espinal , Atividades Cotidianas , Adulto , Feminino , Humanos , Masculino , Nepal/epidemiologia , Centros de Reabilitação , Traumatismos da Medula Espinal/epidemiologia
6.
Am J Phys Med Rehabil ; 100(11): 1031-1032, 2021 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-34483264

RESUMO

ABSTRACT: This brief report summarizes the comparative experience of an inpatient rehabilitation facility dealing with two episodes of COVID-19 infection, one before and one after the availability of vaccination, which was deployed to staff. The experience exemplifies the high rate of infection and potential for asymptomatic presentation of COVID-19 as well as the protective advantage of the vaccine for healthcare workers in this report. With a significant reduction in the rate of infection, from nearly 30% before vaccination to only 2.5% after vaccination. The data presented should serve as an encouragement for vaccination across all populations.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/prevenção & controle , Pessoal de Saúde , Controle de Infecções/normas , Pneumonia Viral/prevenção & controle , Centros de Reabilitação , Adulto , COVID-19/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Fidelidade a Diretrizes , Humanos , Pacientes Internados , Masculino , Programas de Rastreamento , Pennsylvania/epidemiologia , Pneumonia Viral/virologia , SARS-CoV-2
7.
BMC Cancer ; 21(1): 1019, 2021 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-34521359

RESUMO

BACKGROUND: Patients who have breast cancer surgery are at risk of axillary web syndrome (AWS), an under-recognized postsurgical complication which can result in shoulder morbidity and functional impairment. Emerging studies have indicated that AWS may persist beyond the first few months after surgery, although few studies have assessed the prevalence and association of AWS beyond a year after diagnosis. Therefore, the aim of this study was to investigate the prevalence and associations for AWS in post-operative breast cancer patients up to 3 years after surgery. METHODS: This cross sectional observational study was conducted at a community-based cancer rehabilitation center. Patients were evaluated for the presence of AWS via physical examination. Disease-related data was obtained from clinical review and medical records. Descriptive statistics were utilized to illustrate patient demographics and clinical characteristics. Logistic regression analyses were used to determine associations of AWS. RESULTS: There were 111 Asian women who were recruited, who had undergone breast surgery and were referred to a national outpatient rehabilitation center. The prevalence of AWS in this population was 28.9%. In the multivariate regression model, significant factors were age < 50 years (OR = 3.51; 95% CI = 1.12-11.0; p = 0.031) and ALND (OR = 6.54; 95% CI = 1.36-31.3; p = 0.019). There was reduced shoulder flexion ROM (p < 0.001) in patients with AWS compared to patients without AWS. CONCLUSIONS: A high prevalence of AWS was reported in breast cancer survivors even at 3 years after breast surgery. Our findings highlight the need to identify breast cancer survivors with AWS even in the survivorship phase, and develop strategies to raise awareness and minimize functional impairment in these patients.


Assuntos
Grupo com Ancestrais do Continente Asiático , Neoplasias da Mama/cirurgia , Complicações Pós-Operatórias/epidemiologia , Adulto , Fatores Etários , Axila , Neoplasias da Mama/etnologia , Neoplasias da Mama/reabilitação , Métodos Epidemiológicos , Feminino , Humanos , Linfedema/diagnóstico , Pessoa de Meia-Idade , Exame Físico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etnologia , Amplitude de Movimento Articular , Centros de Reabilitação , Articulação do Ombro , Dor de Ombro/epidemiologia , Dor de Ombro/etnologia , Síndrome , Fatores de Tempo
8.
Rheumatol Int ; 41(12): 2167-2175, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34580754

RESUMO

This study aimed to detect patients' characteristics who suffered severe and critical COVID-19 pneumonia admitted to the post-acute COVID-19 rehabilitation clinic in Ankara City Hospital, Physical Medicine and Rehabilitation Hospital and to share our experiences and outcomes of rehabilitation programmes applied. This study was designed as a single-centre, retrospective, observational study. Severe and critical COVID-19 patients, admitted to the post-acute COVID-19 rehabilitation clinic, were included in patient-based rehabilitation programmes, targeting neuromuscular and respiratory recovery. Functional status, oxygen (O2) requirement and daily living activities were assessed before and after rehabilitation. Eighty-five patients, of which 74% were male, were analysed, with the mean age of 58.27 ± 11.13 and mean body mass index of 25.29 ± 4.81 kg/m2. The most prevalent comorbidities were hypertension (49.4%) and diabetes mellitus (34.1%). Of the 85 patients, 84 received antiviral drugs, 81 low-molecular-weight heparin, 71 corticosteroids, 11 anakinra, 4 tocilizumab, 16 intravenous immunoglobulin and 6 plasmapheresis. 78.8% of the patients were admitted to the intensive care unit, with a mean length of stay of 19.41 ± 18.99 days, while those who needed O2 support with mechanic ventilation was 36.1%. Neurological complications, including Guillain-Barré syndrome, critical illness-related myopathy/neuropathy, cerebrovascular disease and steroid myopathy, were observed in 39 patients. On initial functional statuses, 55.3% were bedridden, 22.4% in wheelchair level and 20% mobilised with O2 support. After rehabilitation, these ratios were 2.4%, 4.7% and 8.2%, respectively. During admission, 71 (83.5%) patients required O2 support, but decreased to 7 (8.2%) post-rehabilitation. Barthel Index improved statistically from 44.82 ± 27.31 to 88.47 ± 17.56. Patient-based modulated rehabilitation programmes are highly effective in severe and critical COVID-19 complications, providing satisfactory well-being in daily living activities.


Assuntos
COVID-19/reabilitação , Terapia por Exercício/métodos , Centros de Reabilitação/organização & administração , Idoso , COVID-19/epidemiologia , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Centros de Reabilitação/estatística & dados numéricos , Estudos Retrospectivos , SARS-CoV-2 , Resultado do Tratamento , Turquia/epidemiologia
9.
Medicine (Baltimore) ; 100(31): e26861, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397862

RESUMO

ABSTRACT: Cardiac rehabilitation (CR) can improve clinical indicators in patients with cardiovascular diseases. The literature reports a 20% reduction in all-cause mortality and a 27% reduction in heart-disease mortality following CR. Although its clinical efficacy has been established, there is uncertainty whether center-based (CBCR) is more effective than home-based (HBCR) programs in acute and subacute phases. We aimed to verify significant differences in their effectiveness for the improvement of cardiopulmonary function by analyzing cardiopulmonary exercise (CPX) with laboratory tests following both CR programs.A single-center cohort study of 37 patients, recently diagnosed with underlying cardiovascular diseases, underwent CBCR(18) and HBCR(19). CBCR group performed a supervised exercise regimen at the CR center, for 1 hour, 2 to 3 days a week, for a total of 12 to18 weeks. HBCR group completed a self-monitored exercise program at home under the same guidelines as CBCR. Participants were evaluated by CPX with laboratory tests at 1- and 6-month, following the respective programs.There was no statistical significance in clinical characteristics and laboratory findings. Pre-post treatment comparison showed significant improvement in VO2/kg, minute ventilation/carbon dioxide production slope, breathing reserve, tidal volume (VT), heart rate recovery, oxygen consumption per heart rate, low-density lipoprotein (LDL), LDL/HDL ratio, total cholesterol, ejection fraction (EF) (P < .05). CBCR approach showed greater improvement with significance in VO2/kg, metabolic equivalents, and EF on between groups analysis (P < .05).The time effect of CPX test and laboratory data showed improvement in cardiopulmonary function and serum indicators for both groups. VO2/kg, metabolic equivalents, and EF were among the variables that showed significant differences between groups. In the acute and subacute phases of 1 to 6 months, the CBCR group showed a greater cardiac output improvement than the HBCR group.


Assuntos
Biomarcadores/sangue , Reabilitação Cardíaca , Doenças Cardiovasculares , Terapia por Exercício , Serviços de Assistência Domiciliar/estatística & dados numéricos , Centros de Reabilitação/estatística & dados numéricos , Reabilitação Cardíaca/métodos , Reabilitação Cardíaca/normas , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/fisiopatologia , Doenças Cardiovasculares/terapia , Pesquisa Comparativa da Efetividade , Teste de Esforço/métodos , Terapia por Exercício/métodos , Terapia por Exercício/organização & administração , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , República da Coreia/epidemiologia , Testes de Função Respiratória/métodos , Testes de Função Respiratória/estatística & dados numéricos , Resultado do Tratamento
10.
Medicine (Baltimore) ; 100(32): e26880, 2021 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-34397904

RESUMO

ABSTRACT: Poor oral hygiene can be potentially life-threatening in inpatients. However, no basic protocol on oral hygiene customized for inpatients exists, and lack of oral care related knowledge, attitude, and skills among caregivers could be detrimental to the general health of patients. This study sought to identify the oral care practices and oral health status of inpatients with varying physical activity limitations in a rehabilitation ward.Sixty-one inpatients in a rehabilitation ward were evaluated for their medical and physical conditions and oral health status. These were assessed using the bedside oral exam, decayed, missing, filled teeth index, plaque index, gingival index, and caries activity test.In total, 40 men and 21 women (mean age, 56.6 years) were included in this study. Among them, 50.8% of the patients could brush their teeth unassisted, whereas 49.2% required assistance from an assistant for oral care. The proportion of patients receiving nasogastric tube feeding was higher in the group that could not provide oral self-care; 36.7% and 33.3% of these patients showed moderate and severe dysfunction, respectively, based on bedside oral exam. Scores for the swallowing, tongue, and total domains of bedside oral exam were poorer for patients who could not provide oral self-care (P < .01). The caries activity test indicated a moderate risk for both groups.Our findings suggest that an oral care protocol that considers the physical activity limitations in inpatients in rehabilitation wards is necessary to minimize negative influences on the systemic health of these patients.


Assuntos
Atividades Cotidianas , Cárie Dentária , Saúde Bucal/normas , Higiene Bucal , Autocuidado , Cuidadores/educação , Cárie Dentária/diagnóstico , Cárie Dentária/prevenção & controle , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Higiene Bucal/educação , Higiene Bucal/métodos , Índice Periodontal , Desempenho Físico Funcional , Centros de Reabilitação/estatística & dados numéricos , República da Coreia/epidemiologia , Autocuidado/métodos , Autocuidado/estatística & dados numéricos
11.
Nutrients ; 13(7)2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34371802

RESUMO

The obesity pandemic has reached old age but the effect of obesity on functional recovery in geriatric rehabilitation patients has not been investigated to date. In this prospective cohort study, patients admitted into geriatric rehabilitation were consecutively included between September 2015 and September 2016, aged ≥70 years. Individual activities of daily living were documented by the Barthel index (BI, 0-100 points). Obesity was assessed by the measurement of body mass index (BMI, kg/m²), waist circumference (WC, cm) and percentage of body fat mass (%FM) based on triceps' skinfold thickness at admission (t1), discharge (t2) and six months after discharge (t3). A total of 122 patients were included in the analysis. Prevalence of obesity according to BMI, WC and %FM was 33.6%, 83.6% and 71.3% respectively. Patients with a high WC and patients with a high BMI had lower BI values at t1, t2, t3 and the improvement in BI (t1-t2, t2-t3) was lower than in those with low WC and low BMI, but without statistical significance. In multiple regression analysis, BMI, WC and %FM were not associated with BI at t3 and improvement of BI (t2-t3). Obesity was highly prevalent in geriatric rehabilitation patients, but it was not associated with BI during the 6-month follow-up.


Assuntos
Atividades Cotidianas , Pacientes Internados/estatística & dados numéricos , Obesidade/fisiopatologia , Recuperação de Função Fisiológica/fisiologia , Idoso , Índice de Massa Corporal , Fenômenos Fisiológicos da Nutrição do Idoso/fisiologia , Feminino , Avaliação Geriátrica , Humanos , Masculino , Obesidade/epidemiologia , Obesidade/reabilitação , Prevalência , Estudos Prospectivos , Análise de Regressão , Centros de Reabilitação , Pregas Cutâneas , Resultado do Tratamento , Circunferência da Cintura
12.
Toxins (Basel) ; 13(8)2021 08 22.
Artigo em Inglês | MEDLINE | ID: mdl-34437456

RESUMO

The COVID-19 pandemic severely impacted the function of medical facilities and rehabilitation services worldwide, including toxin services delivering Botulinum toxin treatments for neuromuscular conditions such as spasticity, dystonia, and sialorrhea. The aim of this paper is to understand how toxin services have dealt with the situation and what strategies have been adopted to continue services. The recommendations are based on a virtual round table held with toxin services experts from different European countries who shared their experiences and discussed the best practices. The challenges for toxin services were reviewed based on the experts' experiences and on relevant literature from 2020 and 2021. A set of recommendations and best practices were compiled, focusing firstly on guidance for clinical practice, including assessing patients' health and risk status and the urgency of their treatment. Secondly, it was discussed how patients on botulinum toxin therapy can be cared for and supported during the pandemic, and how modern technology and tele-medicine platforms can be generally used to optimize effectiveness and safety of toxin treatments. The technological advances prompted by the COVID-19 crisis can result in better and more modern patient care in the future.


Assuntos
Toxinas Botulínicas/uso terapêutico , COVID-19/epidemiologia , Doenças Neuromusculares/tratamento farmacológico , Centros de Reabilitação , SARS-CoV-2 , Toxinas Botulínicas/administração & dosagem , COVID-19/prevenção & controle , Europa (Continente) , Humanos , Telemedicina
13.
CMAJ Open ; 9(3): E818-E825, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34446461

RESUMO

BACKGROUND: One in 5 people in Canada have a disability affecting daily activities, and, for rural patients, accessing lifelong physiatry care to improve function and manage symptoms requires complex and expensive travel. We compared the costs of new outreach physiatry clinics with those of conventional urban clinics in Manitoba. METHODS: Six outreach clinics were held from January 2018 to September 2019 in the remote communities of St. Theresa Point and Churchill, Manitoba. A general physiatry population was seen in these clinics, including patients with musculoskeletal and neurologic conditions seen in consultation and follow-up. We performed a societal cost-minimization analysis comparing outreach clinic costs to estimated costs of standard care at conventional outpatient clinics in Winnipeg. Outcomes of interest included direct costs to government health services and patients, and indirect opportunity cost of travel time. We calculated total costs, average cost per clinic visit and incremental costs for outreach clinics compared to conventional urban clinics. Costs were inflated to 2020 Canadian dollars. RESULTS: Thirty-one patients (48 visits) were seen at the outreach clinics. The total cost of providing outreach clinics, $33 136, was 21% of the estimated cost of standard care, $158 344. When only direct costs were included, outreach clinics cost an estimated 24% of conventional care costs. The average unit cost per outreach visit was $690, compared to $3299 per conventional visit, for an incremental cost of -$2609 per outreach visit. INTERPRETATION: An outreach physiatry visit in Manitoba cost an estimated 21% of a conventional urban outpatient visit, or 24% when only direct costs were included, with costs savings largely related to travel. Outreach physiatry care in this model provides substantial cost savings for the public health care system as the primary payer, and can reduce the travel cost burden for patients who do not have public travel funding.


Assuntos
Instituições de Assistência Ambulatorial , Acesso aos Serviços de Saúde , Doenças Musculoesqueléticas , Doenças do Sistema Nervoso , Medicina Física e Reabilitação , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/organização & administração , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Estado Funcional , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Manitoba/epidemiologia , Doenças Musculoesqueléticas/epidemiologia , Doenças Musculoesqueléticas/reabilitação , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/reabilitação , Medicina Física e Reabilitação/economia , Medicina Física e Reabilitação/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Centros de Reabilitação/economia , Centros de Reabilitação/normas , Saúde da População Rural/economia , Saúde da População Rural/normas , Transporte de Pacientes/economia , Transporte de Pacientes/estatística & dados numéricos
14.
J Am Heart Assoc ; 10(16): e020528, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34387132

RESUMO

Background Evidence suggests intracerebral hemorrhage survivors have earlier recovery compared with ischemic stroke survivors. The Centers for Medicare and Medicaid Services prospective payment system instituted documentation rules for inpatient rehabilitation facilities (IRFs) in 2010, with the goal of optimizing patient selection. We investigated whether these requirements limited IRF and increased skilled nursing facility (SNF) use compared with home discharge. Methods and Results Intracerebral hemorrhage discharges to IRF, SNF, or home were estimated using GWTG (Get With The Guidelines) Stroke registry data between January 1, 2008, and December 31, 2015 (n=265 444). Binary hierarchical models determined associations between the 2010 Rule and discharge setting; subgroup analyses evaluated age, geographic region, and hospital type. From January 1, 2008, to December 31, 2009, 45.5% of patients with intracerebral hemorrhage had home discharge, 22.2% went to SNF, and 32.3% went to IRF. After January 1, 2010, there was a 1.06% absolute increase in home discharge, a 0.46% increase in SNF, and a 1.52% decline in IRF. The adjusted odds of IRF versus home discharge decreased 3% after 2010 (adjusted odds ratio [aOR], 0.97; 95% CI, 0.95-1.00). Lower odds of IRF versus home discharge were observed in people aged <65 years (aOR, 0.92; 95% CI, 0.89-0.96), Western states (aOR, 0.89; 95% CI, 0.84-0.95), and nonteaching hospitals (aOR, 0.90; 95% CI, 0.86-0.95). Adjusted odds of SNF versus home discharge increased 14% after 2010 (aOR, 1.14; 95% CI, 1.11-1.18); there were significant associations in all age groups, the Northeast, the South, the Midwest, and teaching hospitals. Conclusions The Centers for Medicare and Medicaid Services 2010 IRF prospective payment system Rule resulted in fewer discharges to IRF and more discharges to SNF in patients with intracerebral hemorrhage. Health policy changes potentially affect access to intensive postacute rehabilitation.


Assuntos
Hemorragia Cerebral/reabilitação , Reforma dos Serviços de Saúde , Medicare , Avaliação de Processos e Resultados em Cuidados de Saúde/tendências , Alta do Paciente/tendências , Sistema de Pagamento Prospectivo , Centros de Reabilitação/tendências , Instituições de Cuidados Especializados de Enfermagem/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Humanos , Pacientes Internados , Masculino , Medicare/economia , Medicare/legislação & jurisprudência , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde/economia , Avaliação de Processos e Resultados em Cuidados de Saúde/legislação & jurisprudência , Alta do Paciente/economia , Alta do Paciente/legislação & jurisprudência , Formulação de Políticas , Sistema de Pagamento Prospectivo/economia , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Sistema de Registros , Centros de Reabilitação/economia , Centros de Reabilitação/legislação & jurisprudência , Instituições de Cuidados Especializados de Enfermagem/economia , Instituições de Cuidados Especializados de Enfermagem/legislação & jurisprudência , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
15.
Arch Phys Med Rehabil ; 102(10): 1972-1981, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34242626

RESUMO

OBJECTIVE: To describe differences in home care use in the 30 days after discharge from inpatient rehabilitation after a hip fracture among older adults with dementia compared with those without dementia. DESIGN: Retrospective cohort study of individually linked health administrative data. SETTING: Community-dwelling older adults after discharge from inpatient rehabilitation facilities in Ontario, Canada. PARTICIPANTS: A total of 17,263 older adults (N=17,263), of whom 2489 had dementia (14.4%), who were treated for hip fracture in acute care and then admitted to inpatient rehabilitation facilities between January 1, 2011 and March 31, 2017. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The proportion receiving home care services and number of visits (physiotherapy, occupational therapy, nursing, personal/homemaking) in the 30 days after discharge were compared by dementia status with multivariate models, stratified by sex. RESULTS: Compared with those without dementia, adults with dementia were older, had lower functional scores, and were more likely to receive home care services in the 30 days after discharge from inpatient rehabilitation (87.0% vs 79.0%, P<.001), including personal/homemaking services (66.1% vs 46.4%, P<.001) and occupational therapy (45.3% vs 37.4, P<.001) but not physiotherapy (55.8% vs 56.2%, P=.677) or nursing (19.6% vs 18.7%, P=.268). After adjustment, older adults with dementia were more likely to receive home care in both men (odds ratio [OR] =2.01; 95% confidence interval [CI], 1.57-2.57) and women (OR=1.50; 95% CI, 1.30-1.74) as well as more services (rate ratio men=1.60; 95% CI, 1.44-1.79; rate ratio women=1.50; 95% CI, 1.41-1.60). CONCLUSIONS: Among older adults discharged from inpatient rehabilitation, older adults with dementia received home care services more often than older adults without dementia. However, irrespective of sex and dementia status, almost half of this population (44%) did not receive physiotherapy. We recommend that, resources permitting, all older adults receive physiotherapy to facilitate recovery.


Assuntos
Demência , Fraturas do Quadril/reabilitação , Fraturas do Quadril/cirurgia , Serviços de Assistência Domiciliar , Modalidades de Fisioterapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Ontário , Alta do Paciente , Centros de Reabilitação , Estudos Retrospectivos
16.
Spinal Cord Ser Cases ; 7(1): 54, 2021 06 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193818

RESUMO

STUDY DESIGN: Sub-study of a randomized controlled trial. OBJECTIVES: To examine if hybrid cycling (cycling with the legs via electrical stimulation combined with voluntary handcycling) compared to handcycling leads to different systemic vascular adaptations in individuals with a long-term spinal cord injury (SCI). SETTING: Two rehabilitation centers in the Netherlands. METHODS: Ten individuals with a SCI trained on a hybrid bicycle (N = 5) or a handcycle (N = 5) for 16 weeks twice a week. Prior to and following the training the intima media thickness (IMT) of the common coronary artery (CCA) and superficial femoral artery (SFA) were measured and the flow-mediated dilation (FMD) of the brachial artery (BA) was analyzed. RESULTS: Before training, there were no significant differences in any of the outcome measures between the groups. We found no change in CCA IMT (pre: 0.616 mm, post: 0.586 mm), or in SFA (pre: 0.512 mm, post: 0.520 mm) after hybrid cycling. We also found no change in FMD % of BA after hybrid cycling (pre: 9.040%, post: 9.220%). There were no changes in CCA IMT, SFA IMT, and FMD% after handcycling either. CONCLUSIONS: It appears that 16 weeks of twice-weekly training of up to 30 min on a hybrid bicycle or handcycle does not lead to systemic vascular adaptations. A larger sample size and training protocol with more frequent and higher intensity training (which might involve a home-based setting and an adapted period prior to the training) might show different results.


Assuntos
Espessura Intima-Media Carotídea , Traumatismos da Medula Espinal , Adaptação Fisiológica , Humanos , Projetos Piloto , Centros de Reabilitação
17.
Subst Abuse Treat Prev Policy ; 16(1): 55, 2021 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-34187512

RESUMO

BACKGROUND: Provision of culturally safe care has been proposed to address health inequity, including in the areas of mental health and addiction. The factors that influence the provision of culturally safe care remain understudied. This paper explores the factors influencing the efforts of a mainstream residential addiction rehabilitation centre to provide culturally appropriate and quality care for Inuit. METHODS: An instrumental case study was conducted, informed by ethnographic and creative research methods. Over 700 h of participant observation were carried out between March 2018 and January 2020, in addition to qualitative semi-structured interviews (34 participants) and/or member-checking activities (17 participants) conducted with a total of 42 individuals: 20 Inuit residents, 18 clinical/specialized staff, and 4 clinical/administrative managers. An interpretive thematic analysis was performed to examine the factors that may influence the provision of culturally safe care for Inuit residents. RESULTS: Ten categories of interrelated factors were identified and classified according to whether they relate to individual, programmatic, organizational, or systemic levels. These categories covered: (1) residents' and staff's life experiences; (2) personal and relational qualities and skills; (3) the model of care; (4) model flexibility; (5) ways in which relational aspects were considered; (6) sensitivity of the organization towards the population served; (7) human resources and professional development issues; (8) social climate; (9) political, relational, and funding climate; and (10) legislative, regulatory, and professional environment. While system-level factors generally had a negative effect on experiences of cultural safety, most factors at other levels had both favourable and unfavourable effects, depending on the context and dimensions examined. CONCLUSIONS: The results offer insight into the interplay between the challenges and barriers that mainstream organizations face when working with Inuit, and the opportunities and enablers that organizations can build on to improve their services. This paper contributes to a better understanding of the challenges and opportunities to providing culturally safe addiction programs to Inuit within a complex intervention setting. It concludes by highlighting some areas for improvement to advance cultural safety in this context.


Assuntos
Inuítes , Centros de Reabilitação , Canadá , Humanos
18.
Arch Phys Med Rehabil ; 102(11): 2074-2082, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34174225

RESUMO

OBJECTIVE: To investigate the feasibility of exoskeleton-assisted anthropomorphic movement training (EAMT) and its effects on upper extremity motor impairment, function, and kinematics after stroke. DESIGN: A single-blind pilot randomized controlled trial. SETTING: Stroke rehabilitation inpatient unit. PARTICIPANTS: Participants with a hemiplegia (N=20) due to a first-ever, unilateral, subacute stroke who had a score of 8-47 on the Fugl-Meyer Assessment for Upper Extremity (FMA-UE). INTERVENTIONS: The exoskeleton group received EAMT therapy that provided task-specific training under anthropomorphic trajectories and postures. The control group received conventional upper limb therapy. For both groups, therapy was delivered at the same intensity, frequency, and duration: 45 minutes daily, 5 days per week, for 4 weeks. MAIN OUTCOME MEASURES: Primary outcome: feasibility analysis. SECONDARY OUTCOMES: FMA-UE, Action Research Arm Test (ARAT), modified Barthel Index (MBI), and kinematic metrics during exoskeleton therapy. RESULTS: Twenty participants with subacute stroke were recruited and completed all therapy sessions. EAMT therapy was feasible and acceptable for the participants. The recruitment rate, retention rate, and number of therapists required for EAMT therapy were acceptable compared with other robotic trials. EAMT was determined to be safe, as no adverse event occurred except tolerable muscle fatigue in 2 participants. There were significant between-group differences in the change scores of FMA-UE (difference, 4.30 points; P=.04) and MBI (difference, 8.70 points; P=.03) in favor of EAMT therapy. No significant between-group difference was demonstrated for the change scores of ARAT (P=.18). Participants receiving EAMT showed significant improvements in kinematic metrics after treatment (P<.01). CONCLUSIONS: Our results indicate that EAMT is a feasible approach and may improve upper extremity motor impairment, activities of daily living, and kinematics after stroke. However, fully powered randomized controlled trials are warranted to confirm the results of this pilot study and explore the underlying mechanisms by which EAMT therapy might work.


Assuntos
Exoesqueleto Energizado , Hemiplegia/reabilitação , Reabilitação do Acidente Vascular Cerebral/instrumentação , Extremidade Superior/fisiopatologia , Atividades Cotidianas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Projetos Piloto , Postura , Recuperação de Função Fisiológica , Centros de Reabilitação , Método Simples-Cego
19.
Nutrients ; 13(6)2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34073813

RESUMO

A study of the literature shows the lack of data on a comprehensive analysis of eating disorders in children with neurodysfunction, which constitute a clinical subgroup with an increased risk of abnormalities in this area. Therefore, the aim of this study was to determine the relationship between the coexistence of nutritional disorders and diseases or syndromes associated with neurodysfunction based on data collected during hospitalization at a rehabilitation center for children and adolescents. A retrospective analysis was carried out in a group of 327 children and adolescents aged 4-18 years. The study group covered various types of diseases or syndromes involving damage to the central nervous system. A retrospective analysis of baseline data (age, sex, main and additional diagnosis and Body Mass Index-BMI) was performed. Two assessment criteria of nutritional status were taken into account (z-score BMI and other previously published normative values). In the study group, malnutrition was found more frequently (18.0% of the respondents) than obesity (11.3% of the subjects). Hypothyroidism coexisting with malnutrition was identified in the study group (N% = 43.8%, p = 0.011) and malnutrition with tetraplegia in the subgroup of spastic cerebral palsy (N% = 34.2 %, p = 0.029).


Assuntos
Doenças do Sistema Nervoso Central/epidemiologia , Transtornos Nutricionais/epidemiologia , Adolescente , Índice de Massa Corporal , Paralisia Cerebral/epidemiologia , Criança , Pré-Escolar , Disfunção Cognitiva/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Hipotireoidismo/epidemiologia , Masculino , Desnutrição/epidemiologia , Transtornos Motores/epidemiologia , Estado Nutricional , Obesidade/epidemiologia , Quadriplegia/epidemiologia , Centros de Reabilitação , Estudos Retrospectivos , Síndrome
20.
SMAD, Rev. eletrônica saúde mental alcool drog ; 17(2): 64-71, abr.-jun. 2021. ilus, tab
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1290026

RESUMO

OBJETIVO: verificar a prevalência do Transtorno Depressivo Maior em pessoas com dependência química. MÉTODO: estudo transversal com a aplicação da entrevista estruturada para os transtornos do DSM-V em 183 indivíduos internados em comunidades terapêuticas de acolhimento para dependentes químicos, localizadas no sul de Santa Catarina, durante o de ano de 2019. RESULTADOS: todos os participantes não realizaram consulta psiquiátrica ao ingressar na instituição e a maioria não realizou consulta psiquiátrica regular (94,5%). Constatou-se que 89 participantes (55,3%) possuíam critérios diagnósticos para o Transtorno Depressivo Maior e 59,1% destes possuíam adicção ao álcool (p<0,028). CONCLUSÃO: o diagnóstico do transtorno depressivo deve-se consolidar como uma variável importante para a eficácia do tratamento, visto que sua prevalência é elevada e possui repercussões sobre a qualidade do tratamento e tempo de institucionalização.


OBJECTIVE: to verify the prevalence of Major Depressive Disorder in people with chemical dependence. METHOD: cross-sectional study with the application of the structured interview for the DSM-V disorders in 183 individuals admitted to therapeutic communities for chemical dependents, located in the south of Santa Catarina, during the year 2019. RESULTS: All participants did not have a psychiatric consultation when entering the institution and the majority did not have a regular psychiatric consultation (94.5%). It was found that 89 participants (55.3%) had diagnostic criteria for Major Depressive Disorder and 59.1% of these had alcohol addiction (p<0.028). CONCLUSION: the diagnosis of depressive disorder should be consolidated as an important variable for the effectiveness of treatment, since its prevalence is high and has repercussions on the quality of treatment and time of institutionalization.


OBJECTIVO: verificar la prevalencia del transtorno depressivo major en personas con adicción. METODO: estudio transversal con aplicación de la entrevista estructurada para los transtornos del DSM-V en 183 personas internadas en comunides de tratamiento de adicción en el departamento de Santa Catarina durante el ano de 2019. RESULTADOS: la totalidad de los pacientes no realizaron cita con psiquiatra al ingressar en las instituiciones y la mayoria no realiza visitas regulares al psiquiatra (94,5%). Se observó que 89 participantes (55,3%) tenian critérios diagnósticos para depressión y 59,1% de ellos eram adictos al álcohol (p<0,028). CONCLUSIÓN: el diagnóstico del transtorno depressivo debe consolidarse como una variable importante para la eficácia del tratamiento, pues su prevalencia es elevada y pose repercursiones sobre la calidad del tratamiento y el tiempo de permanencia en las comunidades.


Assuntos
Humanos , Masculino , Feminino , Centros de Reabilitação , Inquéritos e Questionários , Inquéritos Epidemiológicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtorno Depressivo Maior
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