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Background: The burden of stroke is high in Romania and data regarding access to post – stroke rehabilitation are almost non–existent. We aimed to determine the percentage of patients who benefited from post–stroke rehabilitation and to describe the most common rehabilitation settings. Methods: A structured telephone-based questionnaire regarding access to post–stroke rehabilitation therapy and outcomes was administered to all patients with ischemic stroke who benefited from reperfusion therapy in a tertiary center in 2019. Results: 211 stroke patients received reperfusion therapy during the studied period. Out of these, 208 patients were included in the initial analysis and 109 patients were deemed eligible for post–stroke rehabilitation therapy. 57 patients (55.8%) performed post–stroke rehabilitation. In-hospital rehabilitation was reported by 35 patients (32.1%) with a median length of hospital stay of 14 days. 28 patients (25.6%) performed home based physical therapy with a median frequency of 3 sessions per week. 12 patients (11.1%) were admitted to nursing homes. Compared to stroke patients who did not perform in–hospital rehabilitation, those who did were younger (median age 65 years vs. 73 years, p=0.01) and more likely to have moderate–severe post–stroke disability (mRS score 3 – 5 at discharge 80% vs. 59.4%, p=0.03). mRS score at discharge ≤ 2 was a significant predictor for not pursuing post-stroke rehabilitation (p < 0.001). Conclusion: Approximately 50% of the stroke patients treated with reperfusion therapies were eligible for post–stroke rehabilitation and approximately 50% of them had access to rehabilitation therapy while only 30% had access to in-hospital rehabilitation. Keywords: Stroke rehabilitation; Eastern Europe; Romania; Rehabilitation Center; Physical Therapy

WOS:000569098300002 PubMed: 33089080 Objectives: The outbreak of novel coronavirus-2019 (COVID-19) has affected Turkey very seriously, as well as all around the world. Many urgent and radical measures were taken due to the high contagious risk and mortality rate of the outbreak. It is noteworthy that isolation recommendations and the provision of health services for pandemic have a negative impact on Physical Medicine and Rehabilitation (PMR) services. In this study, we aimed to evaluate the effects of COVID-19 on the PMR services and physiatrists immediately after the first month of pandemic in Turkey. Patients and methods: An online survey consisting of 45 items was sent to the members of the Turkish Society of Physical Medicine and Rehabilitation. The main goal of the survey was to evaluate the changes in the provided service of PMR and conditions of physiatrists one month after the first reported COVID-19 case in Turkey. Results: A total of 606 PMR specialists and residents responded to the survey. The mean number of the patients visited the outpatient clinics was 148.2 +/- 128.5 per week before the pandemic, it significantly decreased to 23.4 +/- 33.1 per week after the first month of the reported first COVID-19 case. Similarly, the mean number of the patients of inpatient service significantly decreased from 21.7 +/- 39.3 per week to 2.5 +/- 10.0 per week after the first month of the pandemic. Most of the residents (69%) reported that their training was seriously affected due to pandemic. From the economic aspect, 69.2% of the participants who were working at private hospitals reported a decrease in their monthly salary, and 21% of them were sent to an unpaid vacation. A total of 21.9% of private-practice institutions paused their services. During the first month, 46.9% of the participants were assigned to the different services such as COVID-19 inpatient service, emergency or COVID-19 outpatient clinics. According to the Republic of Turkey, Ministry of Health guideline and algorithm, 15.7% of the physicians were in the category of healthcare workers with suspected COVID-19. Conclusion: The COVID-19 pandemic affected seriously both the services and the PMR physicians as early as the first month. This effect is expected to become worse, when the duration of pandemic prolongs. Proper arrangements and measures should be planned to ameliorate the negative effects of the pandemic on the patients and PMR physicians.

Au Québec, environ 430 jeunes par année reçoivent une peine comportant une mise sous garde en centre de réadaptation sous la Loi sur le système de justice pénale pour les adolescents. Bien qu’elle soit une mesure visant la sécurité du jeune contrevenant et celle de la société, elle est décrite dans la littérature comme étant un facteur de risque du suicide. Malheureusement, les raisons qui font de la mise sous garde une expérience difficile pour les adolescents contrevenants restent inexplorées. La présente recherche est de nature qualitative et s’inscrit dans une approche phénoménologique. L’objectif est d’explorer les représentations personnelles des jeunes contrevenants, leurs expériences rapportées, perceptions et émotions concernant le temps passé en mise sous garde. La parole est donnée à dix jeunes contrevenants, à l’aide d’entretiens semi-structurés. Les résultats de l’analyse interprétative phénoménologique soulèvent que la majorité des participants vit une expérience négative en centre de réadaptation, rapportant avoir vécu des émotions difficiles. C’est surtout le fait de vivre avec des éducateurs, de vivre avec d’autres jeunes, de devoir se soumettre à des règles strictes et d’être coupé du monde qui crée de la détresse chez les jeunes. Les implications pour la recherche et l’intervention sont discutées., In the province of Quebec, about 430 young people a year are sentenced to custody in a rehabilitation center under the Youth Criminal Justice Act. Although it is a measure for young offender and societal safety, the custody is described as a risk factor for suicide. Unfortunately, the reasons that make custody a difficult experience for young offenders remain unexplored. This research uses a qualitative method and takes place in a phenomenological approach. The objective is to explore the personal representations of young offenders, their reported experiences, perceptions and emotions about time spent in rehabilitation centers. We give a voice to ten young offenders, using semi-structured interviews. The results of the interpretative phenomenological analysis suggest that majority of participants have a negative experience in rehabilitation center, reporting having experienced difficult emotions. It is mostly living with educators, living with other young people, having to abide by strict rules and being cut off from the world that creates distress among young people. The implications for research and intervention are discussed.

В статье рассматриваются проблемы формирования реабилитационного пространства для людей с ограниченными возможностями, которое будет работать в комплексе со всеми ключевыми видами медицинского и реабилитационного направления и способствовать восстановлению здоровья пациентов. На основании проведенных исследований и анализа примеров предложено решение: путем внедрения в среду медицинского реабилитационного центра природных элементов и разработка сенсорного сада с терапевтическими зонами для маломобильных групп., The article discusses the problems of forming a rehabilitation space for people with disabilities, which will work in conjunction with all key types of medical and rehabilitation areas and contribute to the restoration of patients' health. Based on the conducted research and analysis of examples, a solution is proposed: by introducing natural elements into the environment of the medical rehabilitation center and developing a sensory garden with therapeutic zones for groups with limited mobility.

El presente documento propone la construcción de un centro de rehabilitación para adolescentes adictos a sustancias psicoactivas en el municipio de Piedecuesta-Santander, Colombia, en respuesta a la necesidad detectada en el área estudiada. La inexistencia de un centro con atención integral y el aumento de la población drogodependiente, hizo posible el desarrollo de este proyecto para demostrar que la arquitectura puede funcionar en favor de la salud, brindando el espacio acondicionado para mejorar las salud de dichos pacientes y para que se realicen las actividades requeridas, además de para diseñar espacios que permitan tener sensaciones de tranquilidad y seguridad relacionados con la naturaleza que apoyen estos tratamientos desde un punto psicológico. Este sería el primer centro de rehabilitación especializado para personas que padecen de problemas de adicción ubicado en el municipio de Piedecuesta, el cual abastecería también a Bucaramanga y su área metropolitana. This document proposes the construction of a rehabilitation center for adolescents addicted to psychoactive substances in the municipality of Piedecuesta-Santander, Colombia, in response to the need detected in the area studied. The lack of a center with comprehensive care and the increase of the drug- dependent population made it possible to develop this project to demonstrate that architecture can work for health, providing spaces conditioned to improve the health of these patients and to perform the required activities, as well as designing spaces that allow feelings of tranquility and safety related to nature that support these treatments from a psychological point. This would be the first specialized rehabilitation center for people suffering from addiction problems located in the municipality of Piedecuesta, which would also supply Bucaramanga and its metropolitan area. Arquitecto http://www.ustabuca.edu.co/ustabmanga/presentacion Pregrado

Objective : To determine if the incidence of pressure injuries (PIs) upon admission to an inpatient rehabilitation hospital (IRH) system of care was increased during the early COVID-19 pandemic period. Design : Retrospective survey chart review of consecutive cohorts. Admissions to four acute IRHs within one system of care over the first consecutive 6-week period of admitting COVID-19 positive patients during the initial peak of the COVID-19 pandemic, April 1 to May 9, 2020. A comparison was made with the pre-COVID-19 period of 2020, January 1 to February 19, 2020. Setting : Four acute IRHs with admissions on a referral basis from acute care hospitals. Participants : A consecutive sample of pre-COVID-19 admissions (n = 768) and COVID-19 period admissions (n = 357); including persons who were COVID positive (n = 161) and COVID negative (n = 196). Main Outcome Measure(s) : Incidence of PIs on admission to IRH. Results : Prevalence of PIs on admission during the COVID-19 pandemic was increased when compared to the pre-COVID-19 period by 14.9% (p < 0.001). There was no difference in the prevalence of PIs in the COVID-19 period between patients who were COVID-19 positive and COVID-19 negative (35.4% to 35.7%). The severity of PIs, measured by the wound stage of the most severe PI the patient present with, worsened during the COVID-19 period in comparison to pre-COVID-19 (chi-squared 32.04%, p < 0.001). The length of stay in the acute care hospital prior to transfer to the IRH during COVID-19 was greater than in pre-COVID-19 by 10.9 % (p < 0.001). Conclusions : During the early part of the COVID-19 pandemic timeframe, there was an increase in the prevalence and severity of PIs noted on admission to our IRHs. This may represent the significant burden placed on the health care system by the pandemic, affecting all patients regardless of COVID-19 status. This information is important to help all facilities remain vigilant to prevent PIs as the pandemic continues, and potential future pandemics that place strain on medical resources.

Evaluation of long-term experience cardiac rehabilitation in a rehabilitation center "Chyornaya rechka" allowed to formulate general technology rehabilitation of cardiac patients in different categories. The key points of technology at the 2nd stage of rehabilitation are the risk stratification, evaluation classes severity of patients in a rehabilitation center, multidisciplinary rehabilitation. In practice cardiorehabilitation used notion of rehabilitation potential and prognosis of rehabilitation. Suggested modular design personalized rehabilitation programs. The modular structure allows individual programs to achieve optimum results of rehabilitation, facilitating current and final control effectiveness.

El Centro de rehabilitación integral para la discapacidad infantil está ubicado en el municipio de Pamplona en el departamento Norte de Santander, con el principal propósito de suplir el déficit de infraestructura a nivel local y mejorar la calidad de vida de la población infantil. El proyecto cuenta con instalaciones adecuadas y personal especializado para la rehabilitación de los niños con discapacidad, especialmente enfermedades congénitas. Según la problemática encontrada nos lleva al planteamiento de un nuevo diseño arquitectónico en salud terapéutica brindando tecnologías y diseños innovadores a favor del medio ambiente. The Center for Comprehensive Rehabilitation for Childhood Disability is located in the municipality of Pamplona in the North Department of Santander, with the main purpose of supplying the infrastructure deficit at the local level and improving the quality of life of the child population. The project has adequate facilities and specialized personnel for the rehabilitation of children with disabilities, especially congenital diseases. According to the problem found, it leads us to the proposal of a new architectural design in therapeutic health, offering innovative technologies and designs in favor of the environment. Pregrado

Background Literature shows that occurrence of comorbidities in people with severe acquired brain injury (sABI) is a common problem in rehabilitation stay. Consequently, patients could require an increase of interventions for diagnosis and treatment of clinical conditions, with a reduction of the rehabilitative take in charge for both clinical and organizational aspects. Aim The first aim was to evaluate the rate of clinical conditions of sABI patients at admission in rehabilitation and the types of rehabilitative interventions performed in the first week; second objective was to explore the impact of clinical conditions on real rehabilitative take in charge. Design Cross sectional study. Setting Inpatient rehabilitation centers. Population The study included data from 586 sABI patients. Methods Collected data regarded anamnestic information, functional status assessed by means of Glasgow Outcome Scale, Levels of cognitive functioning, Early Rehabilitation Barthel Index, comorbidities at admission and type of rehabilitative interventions carried out in first week of rehabilitation stay. Spearman correlation coefficients were applied to detect possible correlations between the number of treatments in first week and clinical variables; through a multiple regression analysis the effect of patient's characteristics on rehabilitative take in charge was explored. Results Data from the sABI patients: mean age 55.1±17.1 years; etiology of sABI was vascular in 315 patients (53.8%), anoxic in 83 (14.2%), neoplastic in 17 (2.9%), infectious in 15 (2.6%), traumatic in 150 (25.6%); 6 subjects (1%) presented a mixed etiology. Need of cardiorespiratory monitoring, pressure sores, infections or presence of multi drug resistant bacteria were the most frequent comorbidities. Passive mobilization, sitting positioning, arousal/awareness stimulation, evaluation and management of dysphagia were the interventions most frequently carried out in the first week. The regression analysis showed that severe neurological and clinical conditions, acute organ failure, cardio-respiratory instability and paroxysmal sympathetic hyperactivity significantly limit access to rehabilitative sessions. Conclusions In sABI patients clinical comorbidities requiring elevated care assistance are frequent at admission in rehabilitation from acute wards and may interfere with rehabilitative take in charge. Clinical rehabilitation impact The knowledge of clinical complexity of sABI patients may improve their care pathways, promoting early and appropriate transition from acute care to rehabilitation settings.

Background: In police officers, posttraumatic stress disorder (PTSD) is associated with alcohol use disorder (AUD), but we lack data on the association between PTSD and other substance-related and addictive disorders. Objectives: We assessed whether PTSD could be a risk factor for different substance-related and addictive disorders in police officers, including alcohol, tobacco, cannabis, and gambling. Method: This cross-sectional study included all police officers admitted consecutively for alcohol to an inpatient ward dedicated to police officers (Le Courbat rehabilitation center, France; n= 133). Each patient completed self-administered questionnaires that assessed lifetime exposure to potentially traumatic events (Life Event Checklist for DSM-5), PTSD severity and diagnosis (PTSD Checklist for DSM-5), AUD severity (Alcohol Use Disorder Identification Test [AUDIT]), tobacco dependence (Fagerström test for Nicotine Dependence), cannabis dependence (Cannabis Abuse Screening test), and gambling disorder (Canadian Problem Gambling Index). Results: Mean AUDIT score was 23.7 ± 8.0; 66.2% had an AUDIT score ≥20. Our sample comprised a high prevalence for PTSD (38.3%) and for substance-related and addictive disorders: tobacco dependence (68.4%), cannabis dependence (3.8%), and pathological gambling (3%). Patients with PTSD experienced higher lifetime exposure to traumatic experiences: physical assault, severe human suffering, sudden accidental death of another person, and other types of stressful events/experiences. In multiple linear regressions adjusted for age, sex, and marital status, PTSD was a significant predictor of the severity of AUD and tobacco use disorder, but not of the severity of cannabis use disorder nor gambling disorder. Conclusions: PTSD is common in police officers hospitalized for alcohol and associated with a higher severity of some addictive disorders (alcohol/tobacco). PTSD and its comorbid addictive disorders should be systematically screened and treated in this population.

Objective: To evaluate the efficacy of a rehabilitation programme including balance task-specific training in improving physical function, pain, activities of daily living (ADL), balance and quality of life in subjects after a hip fracture. Design: Randomized controlled trial. Subjects: A total of 52 older subjects selected for internal fixation due to extra-capsular hip fracture were randomized to be included in an experimental (n = 26) and control group (n = 26). Interventions: The experimental group underwent a rehabilitation programme based on balance task-specific training. The control group underwent general physiotherapy, including open kinetic chain exercises and walking training. Both groups individually followed programmes of 90-minute sessions five times/week for three weeks. Outcome measures: The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), a Pain Numerical Rating Scale, the Berg Balance Scale, the Functional Independence Measure and the 36-item Short-Form Health Survey. The participants were evaluated before and after training, and after 12 months. Results: Significant effects of time, group and time × group were found for all outcome measures in favour of the experimental group. A clinically important between-group difference of 25 points was achieved after training and at follow-up in terms of the primary outcome (WOMAC function before treatment, after treatment and at follow-up was 84.8 (3.7), 39.8 (4.9) and 35.7 (6.2) for the experimental group and 80.9 (5.7), 65.2 (7.1) and 61.0 (11.1) for the control group). Conclusion: An inpatient rehabilitation programme based on balance task-specific training is useful in improving physical function, pain, ADL and quality of life in older patients after hip fracture.

This thesis is a case study on counterterrorism methods. Specifically, it examines Saudi Arabia's multidimensional counterterrorism measures to combat the Islamic State's aggressions and threats. After deriving a theoretical framework based on counterterrorism measures developed from a review of scholarly literature, the thesis presents three questions. By comparing examples from the case study to the hypotheses, the thesis finds that Saudi Arabia effectively implements a multidimensional approach consisting of legal, financial, and informational methods to respond to the Islamic State's threats. In addition to enacting stricter criminal laws and enforcement of those laws to safeguard the homeland and its borders, Saudi Arabia has enacted laws that impose stiff penalties aimed at money laundering and other illicit activities that fund terrorist activity. Finally, the Kingdom has implemented stringent cybersecurity measures not only to prevent hacking of Saudi cyberspace by terrorists, but also to monitor the Islamic State's communications. Beyond these conventional and punitive measures, Saudi Arabia has implemented successful soft measures, including an innovative rehabilitation program. Based upon these findings, the study recommends Saudi Arabia expand its countermeasures by placing economic sanctions on the Islamic State and its supporters. Further recommendations direct policymakers to consider military intervention and regime change in Syria, and to destroy the Islamic State's infrastructure. http://archive.org/details/saudiarabiascoun1094555569 Major, Saudi Arabia National Guards Approved for public release; distribution is unlimited.

The article deals with the organization of cardiac rehabilitation in a rehabilitation center. Post stationary rehabilitation of various categories of cardiac patients should be performed on a single technology, but with taking into account the features of the rehabilitated contingents. Manufacturability of rehabilitation is ensured through risk stratification with the release of homogeneous groups of patients. Cardiorehabilitation success ensured its multidisciplinary character with the construction of personalized programs. A modular method for constructing individual rehabilitation programs is suggested.

HIV dan AIDS (Acquire Immune Deficiency Syndrome) merupakan masalah global. Kurangnya pengetahuan akan cara penularan virus HIV dan pengobatan terhadap ODHA di Indonesia, membuat semakin meningkatnya kasus HIV dan AIDS setiap tahunnya dan muncul berbagai stigma negatif dari masyarakat terhadap ODHA. Dengan adanya stigma negatif dari masyarakat lain terhadap penyakitnya membuat ODHA memiliki rasa takut, tidak percaya diri, marah, malu dan kecewa pada dirinya sendiri. Metode perancangan yang digunakan adalah metode pendekatan arsitektur perilaku. Beberapa data awal yang telah ditemukan pada survei awal, dikembangkan dalam survei lanjutan. Data-data tersebut kemudian diperdalam dan dikembangkan melalui serangkaian survei yang dilakukan berulang kali. Proses analisis merupakan bagian yang menyatu dengan proses observasi data. Dari proses ini kemudian dibangun konstruksi teori dari lapangan. Untuk memenuhi semua kebutuhan dalam proses rehabilitasi diperlukan penataan ruang yang baik agar hubungan antar ruang dapat mendukung semua kegiatan yang terjadi dalam proses tersebut. Selain itu juga, untuk menciptakan suasana rehabilitasi maka diperlukan lingkungan yang baik dalam perancangan panti rehabilitasi agar pasien dapat berinteraksi dengan sesama pasien dengan baik. Kesimpulan dari penelitian ini adalah, merancang sebuah bangunan panti rehabilitasi untuk orang dengan HIV/AIDS agar mampu mengembalikan fungsi sosial ODHA di dalam masyarakat dengan pendekatan arsitektur perilaku. Kata Kunci : Arsitektur Perilaku, HIV dan AIDS, Panti Rehabilitasi ABSTRACT HIV and AIDS (Acquired Immune Deficiency Syndrome) are global issues. A limited knowledge of HIV transmission and treatment for people with HIV/AIDS in Indonesia has increased the number of HIV/AIDS cases annually and made the society stigmatize people with HIV/AIDS. Such stigma has made people with HIV/AIDS feel frightened, unconfident, ashamed, and disappointed with themselves. The designing method used in this thesis was the behavioral architecture. Some preliminary data from an initial survey was developed in the follow-up survey. Such data was then further studied and developed through a series of repeated surveys. The analysis process became an integral part of the data observation process. Thereafter, a theory was constructed based on the field data processing. To fulfill all the needs of rehabilitation process, a well-designed spatial planning is required, so the relationship between spaces can support all the activities in the process. In addition, to support the atmosphere of rehabilitation, a good environment is required in designing a rehabilitation center to allow patients to interact well with each other. To conclude, a rehabilitation center for people with HIV/AIDS was designed to restore the social function of people with HIV/AIDS in society based on behavioral architecture. Keywords: Behavioral Architecture, HIV and AIDS, Rehabilitation Center

Objetivo: Conhecer as relações de socialização entre a comunidade do município de Caxias do Sul e os moradores do Serviço Residencial Terapêutico (SRT). Métodos: Trata-se de um recorte do Projeto de Pesquisa Redes que reabilitam – avaliando experiências inovadoras de composição de redes de atenção psicossocial (REDESUL), que utilizou os diários de campo de quatro pesquisadores os quais realizaram 700 horas de observação participante sobre o cotidiano dos moradores e sua rede social. Resultados: Os resultados foram agrupados em duas temáticas: Estratégias do SRT para reinserção dos moradores na comunidade; entendimento da comunidade vizinha ao SRT acerca da reabilitação psicossocial. Conclusão: O serviço demonstrou compromisso na reinserção dos sujeitos em sofrimento psíquico e constatou-se que a comunidade tem um bom relacionamento com os moradores, reconhecendo que a melhor maneira de cuidar é em liberdade.&nbsp

RésuméLe séjour en centre de rééducation, consécutif à l’arrivée d’une déficience motrice, est une période de changements importants pour l’individu et son intimité conjugale. Il doit à présent composer avec de nouveaux espaces, avec des autrui et conditions de vie imposés par le centre. Le présent article analyse le rôle de ces éléments sur la reconstruction d’une intimité conjugale, lors des visites du partenaire, tout en montrant que s’il existe des contraintes externes à l’individu, celui-ci n’est pas passif dans la reconstruction d’une telle intimité qui peut prendre plusieurs formes.AbstractThe stay in center of rehabilitation, following the arrival of a motor disability, is a period of important changes for the individual and his marital intimacy. He must now compose with new spaces, others and living conditions imposed by the center. This article analyzes the role of these elements on the reconstruction of a marital intimacy, at the time of the visits of the partner, while showing that if there are external constraints for the individual, this one is not passive in the reconstruction of such an intimacy, which can take several forms.

The most high-risk population for HCV transmission worldwide today are intravenous drug users. HCV genotypes in the general population in Cyprus demonstrate a polyphyletic infection and include subtypes associated with intravenous drug users. The prevalence of HCV, HBV, and HIV infection, HCV genotypes and risk factors among intravenous drug users in Cyprus were investigated here for the first time. Blood samples and interviews were obtained from 40 consenting users in treatment centers, and were tested for HCV, HBV, and HIV antibodies. On the HCV-positive samples, viral RNA extraction, RT-PCR and sequencing were performed. Phylogenetic analysis determined subtype and any relationships with database sequences and statistical analysis determined any correlation of risk factors with HCV infection. The prevalence of HCV infection was 50%, but no HBV or HIV infections were found. Of the PCR-positive samples, eight (57%) were genotype 3a, and six (43%) were 1b. No other subtypes, recombinant strains or mixed infections were observed. The phylogenetic analysis of the injecting drug users' strains against database sequences observed no clustering, which does not allow determination of transmission route, possibly due to a limitation of sequences in the database. However, three clusters were discovered among the drug users' sequences, revealing small groups who possibly share injecting equipment. Statistical analysis showed the risk factor associated with HCV infection is drug use duration. Overall, the polyphyletic nature of HCV infection in Cyprus is confirmed, but the transmission route remains unknown. These findings highlight the need for harm-reduction strategies to reduce HCV transmission. J. Med. Virol. 82:263-270, 2010. (C) 2009 Wiley-Liss, Inc.

Objectives: This study investigates the cognitive, functional, and clinical variables associated with the risk of institutionalization, rehospitalization, and death at 12 months among a population of elderly discharged from a Rehabilitation and Aged Care Unit (RACU) within a 1-year period (May 1, 2004 to April 30, 2005). The RACU is a relatively new setting of care providing intensive rehabilitation and clinical support to elderly with highly heterogeneous reasons for admission. Methods: There were 1303 patients (≥65 years old) contacted 12 months after discharge from the RACU. We obtained information about institutionalization, rehospitalization, and death. Predictors were all the demographic and clinical variables potentially related to these outcomes. The relationship among predictors and outcomes was tested with multiple stepwise logistic regression models. Results: Among the 1072 patients alive at the 12-month follow-up, 90 (8.4%) were institutionalized (3.4% early at discharge and 4.9% within the next period). The logistic regression analysis showed that 2 ranges of age (78 to 83 years and 84 years or more), living alone, occurrence of delirium, cognitive impairment (Mini Mental State Examination lower or equal to 20/30), and poor functional status at discharge (Barthel Index scores ranging from 69 to 85 and Barthel Index scores lower than 68/100) were independently and significantly associated with the risk of institutionalization during the 12 months following discharge from the RACU. Three hundred and twenty-three (30.1%) patients had been rehospitalized once and 86 (8.0%) patients twice at the 12-month follow-up. In the multivariate analysis, comorbidity (Charlson Index scores ranging from 2 to 3 and Charlson Index scores higher than 4) and delirium were significantly and independently associated with this outcome. One hundred and thirty-six (11.3%) patients had died by the 12-month follow-up. The stepwise logistic regression analysis showed that age greater than 83 years, poor functional status (Barthel Index lower than 60/100 at discharge), high comorbidity (Charlson Index scores ranging from 3 to 4 and Charlson Index scores higher than 4, respectively), and albumin serum levels ranging from 3.2 to 2.9 mg/dL and lower than 2.9 mg/dL independently and significantly predicted the 12-month risk of death. Absence of depressive symptoms (Geriatric Depression Scale

Aims In heart failure (HF), exercise training programmes (ETPs) are a well-recognized intervention to improve symptoms, but are still poorly implemented. The Heart Failure Association promoted a survey to investigate whether and how cardiac centres in Europe are using ETPs in their HF patients. Methods and results The co-ordinators of the HF working groups of the countries affiliated to the European Society of Cardiology (ESC) distributed and promoted the 12-item web-based questionnaire in the key cardiac centres of their countries. Forty-one country co-ordinators out of the 46 contacted replied to our questionnaire (89%). This accounted for 170 cardiac centres, responsible for 77 214 HF patients. The majority of the participating centres (82%) were general cardiology units and the rest were specialized rehabilitation units or local health centres. Sixty-seven (40%) centres [responsible for 36 385 (48%) patients] did not implement an ETP. This was mainly attributed to the lack of resources (25%), largely due to lack of staff or lack of financial provision. The lack of a national or local pathway for such a programme was the reason in 13% of the cases, and in 12% the perceived lack of evidence on safety or benefit was cited. When implemented, an ETP was proposed to all HF patients in only 55% of the centres, with restriction according to severity or aetiology. Conclusions With respect to previous surveys, there is evidence of increased availability of ETPs in HF in Europe, although too many patients are still denied a highly recommended therapy, mainly due to lack of resources or logistics.

Summary Objective. Urinary tract infections (UTIs) are amongst the most common infections and account for large proportion of antibacterial drug consumption. The aim of this study was to determine the rate and the etiologic agents of UTIs in inhabitants of rehabilitation centers of Mazandaran province in northern Iran and to evaluate the antimicrobial susceptibility patterns of the uropathogens isolated. Methods. Clean catch midstream urine sample was collected from each of 314 participants (163 males, 151 females) residing in 12 rehabilitation centers of Ramsar, Nowshahr, Chalous, Amol, Sari and Behshahr. Urine specimens were cultured and bacterial isolates were identified by conventional methods. All urines fulfilling the criteria for the presence of significant bacteriuria (≥104 cfu / ml urine) were defined as positive. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion method. Results. The rate of urinary tract infection was 30.9% with the highest rate in pediatrics (p < 0.0001).The prevalence of UTIs were shown to be higher in females than in males with the rate of 46.3% in young aged females (20-29 years), 60% in middle aged group (40-49 years) and 50% in elderly (> 50 years). Bacteria most frequently isolated from urine specimens was Escherichia coli (39.2%) with the highest rate of infection in females age group < 10 years (p < 0.001). Among the antibiotics tested against the isolated organisms for susceptibility test, ceftriaxone and gentamicin maintain good activity against the majority of gram negative bacteria that cause UTIs recovered from individuals with intellectual disability. Vancomycin was effective against Staphylococcus aureus. Conclusions. This survey shows that the prevalence of UTIs among inhabitants of institutions for mentally retarded persons in Mazandaran province of Iran is much higher than normal population.

Este proyecto desarrolla el planteamiento de un centro de rehabilitación física que contempla las distintas áreas a fin, situado en el área urbana de Bucaramanga, funcionando este como un centro de rehabilitación física no hospitalario, complementario al tratamiento medico dado en los centros hospitalarios y de salud dispuestos en la ciudad. Considerando al medio construido como facilitador o barrera para el mejoramiento de la calidad de vida de las personas y teniendo en cuenta contrariedades de exclusión en edificaciones construidas a hoy; se propone entonces el diseño de un centro de rehabilitación para personas en condición discapacidad fisica, de forma tal que se contemple en él, la planificación de espacios y áreas que permitan la rehabilitación física y la recuperación de la autonomía de las personas. La estructura del proyecto se forma a partir del estudio de los centros de rehabilitación dentro del contexto nacional, local y la evolución que han tenido en el desarrollo arquitectónico al paso del tiempo y como poder identificar los tipos de centros de rehabilitación según la escala y tratamientos prestados dentro de ellos. Dándole al planteamiento arquitectónico, condiciones de flexibilidad convertibilidad y posibilidad de expansión facilitando así la posibilidad de aumento o disminuir de acuerdo a la demanda del servicio. Inglés Este proyecto desarrolla el planteamiento de un centro de rehabilitación física que contempla las distintas áreas a fin, situado en el área urbana de Bucaramanga, funcionando este como un centro de rehabilitación física no hospitalario, complementario al tratamiento medico dado en los centros hospitalarios y de salud dispuestos en la ciudad. Considerando al medio construido como facilitador o barrera para el mejoramiento de la calidad de vida de las personas y teniendo en cuenta contrariedades de exclusión en edificaciones construidas a hoy; se propone entonces el diseño de un centro de rehabilitación para personas en condición discapacidad fisica, de forma tal que se contemple en él, la planificación de espacios y áreas que permitan la rehabilitación física y la recuperación de la autonomía de las personas. La estructura del proyecto se forma a partir del estudio de los centros de rehabilitación dentro del contexto nacional, local y la evolución que han tenido en el desarrollo arquitectónico al paso del tiempo y como poder identificar los tipos de centros de rehabilitación según la escala y tratamientos prestados dentro de ellos. Dándole al planteamiento arquitectónico, condiciones de flexibilidad convertibilidad y posibilidad de expansión facilitando así la posibilidad de aumento o disminuir de acuerdo a la demanda del servicio. This project develops the approach of a physical rehabilitation center that contemplates the different areas in order, located in the urban area of ​​Bucaramanga, functioning as a non-hospital physical rehabilitation center, complementary to the medical treatment given in the hospital and health centers willing in the city. Considering the environment built as a facilitator or barrier for the improvement of the quality of life of people and taking into account exclusion problems in buildings built today; The design of a rehabilitation center for people with physical disabilities is proposed, in such a way as to contemplate it, the planning of spaces and areas that allow physical rehabilitation and the recovery of people's autonomy. The structure of the project is formed from the study of the rehabilitation centers within the national, local context and the evolution they have had in the architectural development over time and how to identify the types of rehabilitation centers according to the scale and treatments rendered within them. Giving the architectural approach, conditions of flexibility convertibility and possibility of expansion thus facilitating the possibility of increase or decrease according to the demand of the service. Pregrado

"Der Beitrag präsentiert Zwischenergebnisse einer im Dezember 1995 angelaufenen Längsschnittstudie über die Wahmehmung und Verarbeitung von definierten chronischen Krankheiten (Herzinfarkt, Rückenschmerzen) bei 182 Patienten während ihres Aufenthaltes in einer Rehabilitationsklinik sowie im Anschluß an die stationäre Maßnahme. Die Auseinandersetzung mit einer chronischen Krankheit wird in diesem Beitrag als eine von den Individuen nichtintendierte Statuspassage im Lebenslauf angesehen, wobei nicht nur die psychophysische Integrität, sondern auch die soziale Verortung des Kranken in Frage gestellt wird. Das Ziel der Krankheitsverarbeitung besteht somit darin, über die Beschreibung der problematischen Aspekte hinaus, eine neue Sinnhaftigkeit herzustellen, d.h. ein Leben mit der Krankheit antizipierbar zu machen. Multidimensionale Konzepte von Gesundheit bzw. Lebensqualität als Handlungsergebnisse (Outcome) stellen Indikatoren dieser Verarbeitung dar. Als theoretischer Bezugsrahmen der Fragestellung wird die Ressourcentheorie Bourdieus nutzbar gemacht. In diesem Zusammenhang werden die drei Kapitalarten (sozial, ökonomisch, kulturell) als zur Verfügung stehende Handlungsressourcen erfaßt. Da Krankheitsverarbeitung nicht nur einen 'Vollzug sozial tradierter Wissensbestände' (Kohli) darstellt, sondern auch immer den 'Charakter des offenen Entwurfs' (Kohli) beinhaltet, gewinnt die zentrale Kategorie des Habitus als ein Produkt und Produzent von Praktiken zugleich seine Relevanz für diese Fragestellung. Der Habitus der Verarbeitung wird mit Hilfe des für Deutschland adaptierten 'Meaning-of-Illness'-Fragebogens erfaßt, welcher diesen inter-indiviuellen Konstruktionsunterschieden mit Hilfe von Appraisal-Prozessen Rechnung trägt. Die theoretische Herangehensweise erlaubt es, die Bedeutung von Handlungsressourcen und Wahrnehmungsunterschieden für die Verarbeitung des Lebensereignisses 'chronische Krankheit' anhand ausgewählter Parameter zu analysieren." (Autorenreferat)

Dissertação de Mestrado Integrado em Medicina Veterinária As aves de rapina são predadores de topo na cadeia alimentar podendo por isso, devido à sua dieta, ser expostas a vários parasitas, pois estão no final de muitos ciclos de vida indirectos. Durante o período compreendido entre Novembro de 2013 e Julho de 2014 foram realizados exames parasitológicos em várias espécies de aves de rapina que deram entrada no Centro de Recuperação de Animais Silvestres de Lisboa, Portugal (LxCRAS). Foram analisadas 137 amostras fecais com 51% (n=70) pertencentes à ordem Falconiformes (aves de rapina diurnas) e 49% (n=67) à ordem Strigiformes (aves de rapina nocturnas). Os métodos de flutuação de Willis e sedimentação natural foram os utilizados para realizar as análises coprológicas. A prevalência de parasitismo foi de 21,4%, com 13,9% (19/137) para protozoários, 8,7% (12/137) para nemátodes e 0,73% para céstodes (1/137). Em relação à ordem dos hospedeiros, verificou-se que a prevalência de infecção nos Falconiformes foi de 20% (14/70) e nos Strigiformes 23,9% (16/67). As formas parasitárias identificadas foram oocistos de coccídias, ovos de Capillaria spp., de Spiruridae e de Raillietina spp. Foram também realizadas 64 necrópsias, com 59,4% (n=38) das aves pertencentes aos Falconiformes e 40,6% (n=26) aos Strigiformes. A prevalência global encontrada foi de 34,4% de aves parasitadas, com 26,6% (17/64) para acantocéfalos, 18,7% (12/64) para nemátodes e 4,7% (3/64) para céstodes. Relativamente aos resultados de prevalência por ordem dos hospedeiros, os valores registados foram 47,4% (18/38) nos Falconiformes e 15,4% (4/26) nos Strigiformes. Os parasitas identificados foram Centrorhynchus sp., Synhimantus sp., Cyrnea sp. e Porrocaecum sp.. Estes resultados revelam um parasitismo gastrointestinal em termos qualitativos e quantitativos cujos resultados estão próximos dos obtidos em trabalhos previamente efectuados neste Centro de Recuperação, embora com números inferiores de prevalência. Desta forma, o conhecimento parasitológico obtido servirá para a decisão de futuras medidas terapêuticas e/ou sanitárias preventivas, para a melhoria da saúde e bem-estar dos animais em reabilitação e a sua rápida reintegração no ecossistema natural. ABSTRACT - Gastrointestinal parasitism in birds of prey in a Wildlife Rehabilitation Center - Birds of prey are top predators in the food chain and therefore, due their diet, may be exposed to several parasites, since they are at the end of many indirect life cycles. Between November 2013 and July 2014 parasitological examinations were conducted in several species of birds of prey received at the Wild Animal Rehabilitation Centre in Lisbon, Portugal (LxCRAS). 137 fecal samples were analyzed, with 51% (n = 70) belonging to Order Falconiformes (diurnal raptors) and 49% (n = 67) to Order Strigiformes (nocturnal raptors). Willis flotation and natural sedimentation were the coprological techniques performed. The prevalence of parasitism was 21.4%, with 13.9% (19/137) for protozoa, 8.7% (12/137) for nematodes and 0.73% (1/137) for cestodes. Regardind the host Order, it was found that prevalence of infection in Falconiformes was 20% (14/70) and in Strigifomes 23.9% (16/67). The parasitic forms identified were coccidia oocysts, Capillaria spp., Spiruridae and Raillietina spp. eggs. Necropsy procedures were also performed on 64 animals, with 59.4% (n = 38) of the birds belonging to the Falconiformes and 40.6% (n = 26) to Strigiformes. The prevalence found was 34.4% with 26.6% (17/64) for acanthocephalans, 18.7% (12/64) for nematodes and 4.7% (3/64) for cestodes. Regarding the results of prevalence by host Order, the recorded values were 47.4% (18/38) in Falconiformes and 15.4% (4/26) in Strigiformes. The identified parasites were Centrorhynchus sp., Synhimantus sp., Cyrnea sp. and Porrocaecum sp. These results show in qualitative and quantitative terms a gastrointestinal parasitism close to that obtained in studies previously carried out in this rehabilitation center, though with lower figures of prevalence. Thus, the obtained parasitological knowledge will provide a better decision in future therapeutic and/or preventive health measures, improving the health and welfare of animals in rehabilitation and their rapid reintegration into the natural ecosystem.

Background. Delirium superimposed on dementia (DSD) is highly prevalent and associated with high mortality among hospitalized elderly patients, yet little is known about the effect of DSD on midterm mortality. The purpose of this study was to assess 12-month survival in patients with DSD and matched groups with dementia alone, delirium alone, or neither delirium nor dementia. Methods. Among 1278 consecutively admitted elderly participants (aged >65 years) to our Rehabilitation Unit between January 2002 and May 2005, four matched samples of 47 participants each (DSD, dementia alone, delirium alone, or neither delirium nor dementia) were selected. Matching was based on age, gender, and reason for admission. Postdischarge 12-month survival was assessed in the four groups with Kaplan-Meyer analysis and compared with Cox proportional hazard regression models adjusted for confounders. Results. Survival was significantly lower for DSD patients than for the other three groups. After adjustment for comorbidity and Barthel Index score before admission, patients with DSD had significantly higher mortality (hazard ratio, 2.3; 95% confidence interval, 1.1-5.5; p = .04) than did patients with neither delirium nor dementia. Conclusions. Demented patients who experienced delirium during hospitalization had a more than twofold increased risk of mortality in the 12 months following discharge than did patients with dementia alone, with delirium alone, or with neither dementia nor delirium. Copyright 2007 by The Gerontological Society of America.

Background: Medical advances, improved health status, and increased longevity have led to increased elderly in the society; therefore, the role of rehabilitation centers in the service industry has grown considerably in the two past decades. Methods: The studies compared types of rehabilitation centers for the treatment of patients with motor or perception disability and other methods commonly used in rehabilitation, in terms of functional outcomes, Barthel index, and cost-effectiveness, were evaluated. The Cochrane, CRD (Centre for Reviews and Dissemination), Scopus, and Google scholar databases were searched until June 2012. Results were analyzed using qualitative method. Findings: According to 15 included articles, the Barthel index scores in patients with an inpatient rehabilitation (42 ± 29 points) were more than outpatient rehabilitation (26 ± 23 points) (P < 0.050). For inpatient centers, early rehabilitation led to the rapid acquisition of functional abilities than outpatient centers (1.55 vs. 0.50). Regarding to cost-effectiveness of heart diseases, the adjusted cost difference between outpatient and inpatient rehabilitation was about -2895 Euro (P = 0.102); adjusted effect difference was about 0.018 QALY (Quality-adjusted life year) in favor of outpatients rehabilitation, too. Conclusion: With regard to the potential of rehabilitation services and outpatient clinics in day clinics, the establishment of rehabilitation centers was not cost-effective. So, it is proposed to provide services to disabled patients in “rehabilitation units” established in specialized hospitals.