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The progressive aging of the population will notably increase the burden of those diseases which leads to a disabling situation, such as Alzheimer’s disease (AD) and ophthalmological diseases that cause a visual impairment (VI). Eye diseases that cause a VI raise neuroplastic processes in the parietal lobe. Meanwhile, the aforementioned lobe suffers a severe decline throughout AD. From this perspective, diving deeper into the particularities of the parietal lobe is of paramount importance. In this article, we discuss the functions of the parietal lobe, review the parietal anatomical and pathophysiological peculiarities in AD, and also describe some of the changes in the parietal region that occur after VI. Although the alterations in the hippocampus and the temporal lobe have been well documented in AD, the alterations of the parietal lobe have been less thoroughly explored. Recent neuroimaging studies have revealed that some metabolic and perfusion impairments along with a reduction of the white and grey matter could take place in the parietal lobe during AD. Conversely, it has been speculated that blinding ocular diseases induce a remodeling of the parietal region which is observable through the improvement of the integration of multimodal stimuli and in the increase of the volume of this cortical region. Based on current findings concerning the parietal lobe in both pathologies, we hypothesize that the increased activity of the parietal lobe in people with VI may diminish the neurodegeneration of this brain region in those who are visually impaired by oculardiseases.

Cerebral palsy (CP) is a group of the most common developmental disorders affecting movement and posture of the body, causing activity limitations and participation restrictions. The motor disorders of persons with CP are often accompanied by disturbances of sensation, cognition, communication and perception. The symptoms of CP are very diverse and persons with CP are usually presented with a mixed type of symptoms. The non-progressive disturbances can be attributed to disorders that were developed during pregnancy, birth and/or infant stage. The aim of this study was to improve physicians' professional practice of Physical and Rehabilitation Medicine for persons with cerebral palsy in order to improve their functionality, social and community integration, and to reduce activity limitations and/or participation restrictions. A systematic review of the literature including an 18-year period and consensus procedure by means of a Delphi process was performed and involved the delegates of all European countries represented in the Union of European Medical Specialists Physical and Rehabilitation Medicine (UEMS PRM) Section. As the result of a Consensus Delphi procedure, 74 recommendations are presented together with the systematic literature review. The PRM physician's role for persons with cerebral palsy is to lead and coordinate the multiprofessional team, working in an interdisciplinary way. They should propose and manage the complex but individual PRM program developed in conjunction with other health professionals, medical specialists and importantly in agreement with the patient, their family and care giver. This should be, according to the specific medical diagnosis to improve patients' health, functioning, social and education status, considering all impairments, comorbidities and complications, activity limitations and participation restrictions. This evidence-based position paper is representing the official position of The European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cerebral palsy.

This study examined differences in generalized and social anxiety symptoms across two age groups of children with autism spectrum disorder (ASD) while accounting for overall anxiety level, gender, and intellectual functioning. Older children (12-18 years) expressed more overall and social anxiety symptoms than younger children (6-11 years), and social anxiety symptoms were predominant in the older group. Younger children expressed more generalized anxiety symptoms than the older youth, and there was a trend for generalized anxiety symptoms to be more dominant in the younger group. Findings are consistent with theory of differential expression of specific anxiety symptoms across different ages seen with typically developing children, yet social evaluative concerns may be even stronger for adolescents with ASD.

Background Effectiveness in health services is achieved if desired clinical outcomes are reached. In rehabilitation the relevant clinical outcome is functioning, with the International Classification of Functioning, Disability and Health (ICF) as the reference system for the standardized reporting of functioning outcomes. To foster the implementation of the ICF in clinical quality management (CQM) across the rehabilitation services continuum, the UEMS-PRM Section and Board approved an ICF implementation action plan that includes the identification of types of currently provided rehabilitation services in Europe. The objective of this paper is to report on the development of a European framework of rehabilitation service types that can provide the foundation for the standardized reporting of functioning outcomes and CQM programs. Methods A multistage consensus process involving delegates (participants) from the UEMS-PRM Section and Board as well as external experts across European regions comprised the development of an initial framework by an editorial group, two feedback rounds via e-mail and a deliberation by the UEMS-PRM Section and Board in its September 2018 meeting in Stockholm (Sweden). In the first feedback round, participants were asked whether: 1) the initial framework of service types exists in their respective country: 2) the description represents the service type: and 3) an existing service type was missing. Based on the first-round results, the framework proposal was modified by the editorial group. In the second feedback round, participants were asked to confirm or comment on each of the service types in the revised framework. Based on the second-round results, the framework proposal was again modified and presented for discussion, revision and approval at the Stockholm meeting. Results In the first feedback round, eight rehabilitation services were added to the framework proposal and two service types that were deemed "missing" were not included. In the second round, all seven initially proposed and six of the added service types were reconfirmed, while two of the added service types were not supported. Based on deliberations at the Stockholm meeting, some modifications were made to the proposed framework, and the UEMS-PRM general assembly approved a European Framework of Rehabilitation Service Types that comprises of: Rehabilitation in acute care, General post-acute rehabilitation, Specialized post-acute rehabilitation, General outpatient rehabilitation, Specialized outpatient rehabilitation, General day rehabilitation, Specialized day rehabilitation, Vocational rehabilitation, Rehabilitation in the community, Rehabilitation services at home (incl. nursing home), Rehabilitation for specific groups of persons with disability, Rehabilitation in social assistance, Specialized lifelong follow-up rehabilitation, and Rehabilitation in medical health resorts. Conclusions The European Framework of Rehabilitation Services Types presented in this paper will be continuously updated according to new and emerging service types. Next steps of the UEMS-PRM effort to implement the ICF in rehabilitation include the specification of clinical assessment schedules for each service type and case studies illustrating service provision across the spectrum of rehabilitation service types. The European Framework will enable the accountable reporting of functioning outcomes at the national level and the continuous improvement of rehabilitation service provision in CQM.

This study systematically reviews the current state of aquatic treatment of neck pain and assesses the scientific evidence of its benefits. The databases PubMed, Scopus, Web of Science and PEDro were searched for relevant reports published from January 1, 2008, to November 7, 2017, using the keywords "neck pain" in addition to "balneotherapy", "spa treatment", "spa", "thalassotherapy", "hydrotherapy", "aquatic therapy" or "aquatic". Inclusion criteria were full-text articles published in journals included in Journal Citation Reports in English and Spanish describing human studies. Case studies, letters to the editor and meeting presentations or other contributions were excluded. Of 367 articles identified, only 13 fulfilled the inclusion criteria: 5 randomized trials, 1 single blind controlled study, 2 pilot studies, 2 observational retrospective studies, 1 prospective study, 1 clinical study and 1 not specified. Participants were 658 subjects with chronic neck pain. Main symptoms and signs treated were neck pain, disability, cervical disc herniation and compromised quality of life. Evidence that aquatic treatment improves quality of life in affected individuals was good in four studies, fair in eight and weak in one. Treatment of neck pain using different waters and techniques reduced pain and disability, and improved functional capacity, quality of life, joint mobility, balance, relaxation and mood.

Background Stroke is a major cause of disability worldwide, with an expected rise of global burden in the next twenty years throughout Europe. This EBPP represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with stroke. The aim of this study is to improve PRM physicians' professional practice for persons with stroke in order to promote their functioning and enhance quality of life. Methods A systematic review of the literature including a ten-year period and a consensus procedure by means of a Delphi process has been performed involving the delegates of all European countries represented in the UEMS PRM Section. Results The systematic literature review is reported together with 78 recommendations resulting from the Delphi procedure. Conclusions The professional role of PRM physicians for persons with stroke is to improve specialized rehabilitation services worldwide in different settings and to organize and manage the comprehensive rehabilitation programme for stroke survivors considering all impairments, comorbidities and complications, activity limitations and participation restrictions as well as personal and environmental factors.

Background Acquired brain injury (ABI) is damage to the brain that occurs after birth caused either by a traumatic or by a nontraumatic injury. The rehabilitation process following ABI should be performed by a multi-professional team, working in an interdisciplinary way, with the aim of organizing a comprehensive and holistic approach to persons with every severity of ABI. This Evidence Based Position Paper represents the official position of the European Union through the UEMS Physical and Rehabilitation Medicine (PRM) Section and designates the professional role of PRM physicians for people with ABI. The aim was to formulate recommendations on the PRM physician's professional practice for persons with ABI in order to promote their functioning and enhance quality of life. Methods This paper has been developed according to the methodology defined by the Professional Practice Committee of the UEMS-PRM Section: a systematic literature search has been performed in PubMed and Core Clinical Journals. On the basis of the selected papers, recommendations have been made as a result of five Delphi rounds. Results The literature review as well as thirty-one recommendations are presented. Conclusions The expert consensus is that structured, comprehensive and holistic rehabilitation program delivered by the multi-professional team, working in an interdisciplinary way, with the leadership and coordination of the PRM physician, is likely to be effective, especially for those with severe disability after brain injury.

Cardiovascular conditions are significant causes of mortality and morbidity leading to substantial disability. The aim of the paper is to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for people with cardiovascular conditions in order to promote their functioning and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with thirty recommendations resulting from the Delphi procedure. The professional role of PRM physicians having expertise in the rehabilitation of cardiovascular conditions is to lead cardiac rehabilitation programs in multiprofessional teams, working in collaboration with other disciplines in a variety of settings to improve functioning of people with cardiovascular conditions. This evidence-based position paper represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in persons with cardiovascular conditions.

Background Pain is a frequent complaint from patients undergoing rehabilitation. It can be a major problem and can lead to several activity limitations and participation restrictions. For this reason, when the Professional Practice Committee (PPC) of the Physical and Rehabilitation Medicine (PRM) Section of the European Union of Medical Specialists (UEMS) decided to prepare evidence-based practice position papers (EBPPs) on the most relevant fields of PRM, a paper on the role of the PRM specialist on pain conditions was also included. The goals of this paper are to provide recommendations on the PRM physician's role in pain management; how to address this major problem and what is the best evidence-based approach for the PRM physician in acute and chronic pain conditions. This paper follows the methodology defined by the Professional Practice Committee of the UEMS-PRM Section. Methods A systematic literature search in PubMed was carried out and the results obtained from filtered papers were subjected to four Delphi rounds. Results Fifteen recommendations were obtained from the Consensus Process and systematic review and were approved by all of the delegates of the UEMS-PRM Section. It is recommended that PRM physicians focus on pain as a primary aim of their interventions, in whatever field they are applying their competencies. It is also recommended that the approach to pain focuses either on reducing the symptoms and improving functioning/reducing disability or recurrences and improving the health condition in the long term avoiding chronicity. Conclusions Every PRM specialist encounters the problem of pain and some specialize in this field and their role is greater than that of the regular PRM doctor. Based on the evidence available, it is reasonable to determine the role of the physiatrist in managing pain.

Ageing people with disabilities (APwDs) are faced with challenges of ageing which is straightforwardly related to disability that adds to the burden related to their early-onset disability. The aim of the paper is to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for APwDs (as a distinct group from those who are disabled due to the ageing process) in order to promote their functioning properties and to reduce activity limitations and/or participation restrictions. A systematic review of the literature and a Consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. The systematic literature review is reported together with the 30 recommendations resulting from the Delphi procedure. The professional role of PRM physicians in relation to APwDs is extending, expanding and/or improving health-related rehabilitation services worldwide in various settings (getting beyond the rehabilitation facilities) emphasizing the concept of integrated care with collaboration across other sectors to meet the specific needs of APwDs. This evidence based position paper (EBPP) represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in APwDs.

Introduction The WHO world health statistics report in 2015 shows that in Europe the overall obesity rate among adults is 21.5% in males and 24.5% in females. Obesity has important consequences for morbidity, disability and quality of life. The aim of the paper was to improve physical and rehabilitation medicine physicians' professional practice for the rehabilitation of patients with obesity and related comorbidities. Evidence acquisition A systematic review of the literature and a Consensus procedure by means of a Delphi method process has been performed involving the delegates of all European countries represented in the UEMS PRM Section. Evidence synthesis The systematic literature review is reported together with the 13 recommendations from the Delphi procedure. Conclusions The professional role of PRM physicians in obesity is to propose a complete PRM treatment for the patients considering the comorbidities, impairments, activity limitations and participation restrictions, providing medical care and leadership to the multidisciplinary team, coordinating the individual PRM project developed in team in agreement with the patient and his family/care givers.

This study examined relations between anxiety, aggression, social understanding, IQ, and diagnosis in a sample of 231 children (ages 2-9) diagnosed with Autism Spectrum Disorders (ASDs; Autistic Disorder, Asperger's Disorder, Pervasive Developmental Disorder Not Otherwise Specified) in a hospital setting. Children were administered tests of IQ, and parents completed measures of remaining variables. ASD diagnosis was associated with level of anxiety, and level of IQ explained this relation. IQ was significantly and positively associated with anxiety. Tests of a developmental model to explain the relation between IQ and anxiety showed that social understanding and aggression mediated the relation for toddlers. For preschool- and early elementary school-aged children, respectively, three-way interactions between IQ, social understanding, and aggression predicted anxiety, and graphs of the interactions suggest that the association between IQ and anxiety is increasingly driven by either aggression or social understanding over the course of childhood.

Aims To prospectively examine the effects of fear of hypoglycemia (FH), adherence to blood glucose testing, and anxiety on metabolic control in youth with Type 1 diabetes. To examine the relationships among these variables in the context of a hurricane. Methods Participants included 158 children completing measures at two times, with 58 participants completing measures pre- and post-Hurricane Katrina. Hierarchical regressions were run predicting indices of metabolic control. Results HbA1c was a unique predictor of subsequent HbA1c although a significant interaction between children's FH and hurricane group was found for HbA1c. Percent of low blood glucose (BG) was the only unique predictor of subsequent low BG. Percent of high BG and demographic variables were predictors of subsequent high BG. There was also a significant interaction between children's FH and hurricane group for high BG. Conclusions Prior metabolic control is a strong predictor of subsequent metabolic control. Youth who exhibit FH are at risk for poor metabolic control, specifically demonstrating high BG levels and HbA1c if they have experienced a major stressor such as a natural disaster.

The present study examined the roles of loss and disruption, major life events, and social support in the relationship between exposure and PTSD symptoms in a group of children 33 months after Hurricane Katrina. One hundred fifty-six 4th, 5th, and 6th graders were surveyed in the New Orleans area. Results indicated that 46% of the children reported moderate to very severe levels of PTSD symptoms. Lower levels of classmate support and more negative life events after the hurricane were uniquely related to PTSD symptoms. Analyses did not reveal any moderating relationships among the variables. The results of this study have implications for the prevention and treatment of PTSD symptoms long after exposure to trauma.

This study examined the relationship between anxiety in Latin American children and Latino cultural schemas, parenting strategies, being an ethnic minority, and assimilation. Latin American (n=72; LA) and white European-American (n=46; EA) children living in the U.S., Mexican children living in Mexico (n=99; M), and at least one parent per family (n=283) were administered measures assessing anxiety, parenting strategies, collectivism, family cohesion, simpatia, parent-child communication, and assimilation. M and LA children expressed more anxiety symptoms than EA children. More mother control and less father acceptance were associated with childhood anxiety across all three groups. However, father control was associated with more anxiety for the EA group but not the MA group, and mother acceptance was associated with more anxiety for the EA and MA groups but with less anxiety for the M group. Family cohesion was negatively associated with children's anxiety independent of ethnic group. Finally, differing from parents in assimilation did not influence LA children's anxiety.

Adherence to antiepileptic drugs (AEDs) and use of complementary and alternative medicine (CAM) among Hondurans with epilepsy were evaluated. Our epilepsy cohort of 274 outpatients was surveyed to determine demographics, epilepsy treatment history, adherence, and use of CAM. Nonadherence to epilepsy therapy was reported by 121, with unavailability of AEDs (48%) the most common reason. CAM was reportedly used by 141, with prayer, herbs, and potions being common. Forty-nine rural Miskito Hondurans without epilepsy were also interviewed to gain an understanding of their beliefs and longstanding practices regarding epilepsy. Seventeen (34.7%) attributed epilepsy to the supernatural; only three knew of an AED. Widespread nonadherence to evidence-based epilepsy treatments in Honduras can be attributed to inadequate education, AED unavailability, insufficient resources, cultural beliefs, and wide use of CAM. A comprehensive epilepsy education program and improved access to evidence-based AEDs represent initial priorities to improve the Honduran epilepsy treatment gap.

Extracorporeal shockwave treatment (ESWT) and ultrasound-guided percutaneous lavage (UGPL) are two effective ways of treating rotator cuff calcific tendinopathy (RCCT).The aim of the present study was to compare the effectiveness of these techniques in the treatment of RCCT.Prospective, randomized, controlled trial.Patients treated in our sports medicine and rehabilitation center (Centro Médico Deyre, Madrid. Spain) between January 2007 and December 2013.This randomized study compares the results achieved with these techniques over one year following their use to treat the above condition. Eighty patients received ESWT and 121 received UGPL. A visual analogue scale was used to measure pain, and ultrasound to determine the extent of calcification, at 3, 6, and 12 months after treatment.Pain and the amount of calcification were significantly reduced by both techniques at 3, 6 and 12 months (P0.001 for each), but significantly more so by UGPL (P0.001).Both techniques are valid for the treatment of RCCT, although UGPL is associated with a greater reduction of calcification and greater reduction in pain.The results obtained applying UGPL, the low cost and the lack of complications should therefore make the treatment of choice in centers that are appropriately equipped and staffed.

Objective To provide preliminary psychometric data on the Children's Hypoglycemia Index (CHI), a new scale was designed to measure fear of hypoglycemia (FH) in children. Methods One hundred and nine children with type 1 diabetes attending a diabetes summer camp completed the CHI, and 57 of these children completed the CHI 2 weeks later. All participants also completed the Children's Hypoglycemia Fear Survey (CHFS), the Revised Children's Manifest Anxiety Scale (RCMAS), and a Hypoglycemia History Form. Parents of the children also completed a Hypoglycemia History Form. Results The CHI demonstrated good factor structure, internal consistency, test-retest reliability, and criterion-related validity with established measures. Frequency of severe hypoglycemic episodes since diabetes diagnosis also predicted scores on the Situation- and General-Fear subscales of the CHI. Conclusions The CHI demonstrated reliability and validity as a measurement of children's FH. The use of this measure offers important clinical and research implications.

To begin accounting for cultural and contextual factors related to child rearing in Mexican-descent (MD; Mexican American and Mexican immigrant) families in the United States, the current study examined parenting practices in 2-parent families of Mexican, MD, and Caucasian-non-Hispanic (CNH) parents. Parents in all groups reported using authoritative practices more often than authoritarian strategies. MD parents reported greater use of authoritarian practices than Mexican and CNH parents. Results suggest that previously found cultural variations in parenting between MD parents and CNH parents may be more related to the ecological context of MD families than to an affiliation with Mexican culture. Clinicians should explore the positive qualities of authoritative parenting in MD families along with the potential motivations for using authoritarian strategies.

To assess the impact of massage versus ear acupuncture on behavior and participation in occupational therapy of dementia patients.We performed a controlled, randomized longitudinal trial approved by the Bioethics Commission of the University of Extremadura. One hundred twenty elderly subjects with dementia institutionalized in residential homes in Extremadura (Spain) received treatment based on massage and ear acupuncture over three months. Behavior alterations, sleep disturbance, and participation in rehabilitation and eating were assessed every month during the three months of intervention, and at one and two months of follow-up after the end of treatment. The assessment was performed through a structured questionnaire with closed format questions done by an occupational therapist not involved in the study.There was a statistically significant positive effect of massage and ear acupuncture (P0.001) on measured variables in the third month of intervention, which were maintained at two months after completing the treatment (P0.021), when compared to the control group.Massage therapy and ear acupuncture can improve behavior and sleep disturbances, and increase the participation in eating and rehabilitation organized in residential homes, in dementia patients.

A number of factors are believed to confer risk for anxiety development in children; however, cultural variation of purported risk factors remains unclear. We examined relations between controlling and rejecting parenting styles, parental modeling of anxious behaviors, child interpretive biases, and child anxiety in a mixed clinically anxious (n = 27) and non-clinical (n = 20) sample of Latino children and at least one of their parents. Families completed discussion-based tasks and questionnaires in a lab setting. Results indicated that child anxiety was: linked with parental control and child interpretative biases; associated with parental modeling of anxious behaviors at a trend level; and not associated with low parental acceptance. Findings that controlling parenting and child interpretive biases were associated with anxiety extend current theories of anxiety development to the Latino population. We speculate that strong family ties may buffer Latino children from detrimental effects of perceived low parental acceptance.

Exercise therapy is an important part of symptomatic and supportive treatment in patients with multiple sclerosis (PwMS). According to the literature, equine-assisted therapies--such as therapeutic horseback riding (THR) and hippotherapy (HT)--are exercise therapies that can have positive physical effects on coordination, muscle tone, postural alignment, stiffness/flexibility, endurance and strength, correcting abnormal movement patterns and improving gait and balance. While HT is known to have a positive effect on balance in PwMS, data about THR are limited.The aim of the present work was to determine the effect of THR on the balance and gait of ambulatory PwMS.Twenty-seven PwMS were included in the study. Patients were divided into two groups: 12 underwent THR and 15 traditional physiotherapy (for both groups, two series of 10 weekly sessions were performed). Before and after the study period, the following outcome measures were applied: Extended Disability Status Scale (EDSS), Barthel Index, Tinetti Performance-Oriented Mobility Assessment (POMA). In addition, patients of the THR group underwent a gait analysis to assess spatiotemporal gait parameters and ground reaction forces.The THR group showed a significant improvement in POMA scores (p0.005) and two gait parameters: stride time (p0.04) and ground reaction forces (p0.01). No statistically significant change was found in the control group.The results of the study show that THR can improve balance and gait of ambulatory PwMS. Findings are preliminary, but promising and in line with the recent literature.

This study tested a theoretical model of the interrelations among controlling parenting, negative cognitive styles, children's anxiety, and race/ethnicity. The model suggests that, in general, cognitive style mediates the relation between maternal control and child anxiety but that the set of associations may differ as a function of ethnicity. African American (n = 235), Latin American (n = 56), and European American (n = 136) children completed measures of their anxiety, cognitive schemas reflecting impaired autonomy/performance and disconnection/rejection domains, and maternal control. Results indicated that a disconnection/rejection negative cognitive style mediated the effect of perceived maternal control on childhood anxiety only for the European American group. Maternal control was associated with the impaired autonomy/performance cognitive style for each of the three ethnic groups and with a disconnection/rejection cognitive style only for the European American and Latin American groups. Maternal control had an indirect effect on anxiety through the disconnection/rejection cognitive style for the Latin American group. The results are discussed in terms of how the model presented extends current theories of anxiety problems to African American and Latin American children by noting that significant cultural variations may exist in how parenting practices and cognitive styles relate to children's anxiety levels.

The present study examined effects of maternal anxiety, child age, and their interaction on mother-child anxiety reporting disagreement while taking into account the direction of each informant's report relative to the other. Participants were 41 dyads of mothers and clinically anxious children aged 7-13. A hierarchical regression revealed a significant interaction between maternal anxiety and child age (β = .30, p < .05). A graph of this interaction indicated that when maternal anxiety is high and the child is older, maternal report of anxiety is relatively higher, and when maternal anxiety is high and the child is younger, child report of anxiety is relatively higher. When maternal anxiety is low, the reporting discrepancy is relatively stable across age. Results may help explain previous mixed findings regarding effects of age and maternal anxiety on reporting discrepancies. Possible explanations for these results are discussed.

Effective team working plays a crucial role in Physical and Rehabilitation Medicine (PRM). As part of its role of optimizing and harmonizing clinical practice across Europe, the Professional Practice Committee of Union of European Medical Specialists (UEMS) Physical and Rehabilitation Medicine (PRM) Section reviewed patterns of team working and debated recommendations for good practice at a meeting of national UEMS delegates held in Riga, Latvia, in September 2008. This consensus statement is derived from that discussion and from a review of the literature concerning team working. Effective team working produces better patient outcomes (including better survival rates) in a range of disorders, notably following stroke. There is limited published evidence concerning what constitute the key components of successful teams in PRM programmes. However, the theoretical basis for good team working has been well-described in other settings and includes agreed aims, agreement and understanding on how best to achieve these, a multi-professional team with an appropriate range of knowledge and skills, mutual trust and respect, willingness to share knowledge and expertise and to speak openly. UEMS PRM Section strongly recommends this pattern of working. PRM specialists have an essential role to play in interdisciplinary teams; their training and specific expertise enable them to diagnose and assess severity of health problems, a prerequisite for safe intervention. Training spans 4-5 years in Europe, and includes knowledge and critical analysis of evidence-based rehabilitation strategies. PRM physicians are therefore well-placed to coordinate PRM programmes and to develop and evaluate new management strategies. Their broad training also means that they are able to take a holistic view of an individual patient's care.

Background: Leptospirosis is a zoonotic disease of major importance in the tropics where the incidence peaks in rainy seasons. Natural disasters represent a big challenge to Leptospirosis prevention strategies especially in endemic regions. Vaccination is an effective option but of reduced effectiveness in emergency situations. Homeoprophylactic interventions might help to control epidemics by using highly-diluted pathogens to induce protection in a short time scale. We report the results of a very large-scale homeoprophylaxis (HP) intervention against Leptospirosis in a dangerous epidemic situation in three provinces of Cuba in 2007. Methods: Forecast models were used to estimate possible trends of disease incidence. A homeoprophylactic formulation was prepared from dilutions of four circulating strains of Leptospirosis. This formulation was administered orally to 2.3 million persons at high risk in an epidemic in a region affected by natural disasters. The data from surveillance were usedto measure theimpact of theintervention by comparing withhistorical trends and non-intervention regions. Results: After the homeoprophylactic intervention a significant decrease of the disease incidence was observed in the intervention regions. No such modifications were observed in non-intervention regions. In the intervention region the incidence of Leptospirosis fell below the historic median. This observation was independent of rainfall. Conclusions: The homeoprophylactic approach was associated with a large reduction of disease incidence and control of the epidemic. The results suggest the use of HP as a feasible tool for epidemic control, further research is warranted. Homeopathy (2010) 99, 156e166.

This article reviews the literature on how culture influences anxiety in Latino youth. First, a review of cross-cultural variations in prevalence and measurement is presented. Then, the article focuses on how culture impacts the meaning and expression of anxiety. Specifically, we discuss the meaning and expression of anxiety, the impact of culture on anxiety at a societal level and through its effect on family and cognitive processes, and the influence of immigration and acculturation on anxiety. Finally, we propose recommendations on how to advance the literature in this area building on existing knowledge.

This study examined the relationships between trait anxiety and anxiety sensitivity and the outcome variables posttraumatic stress disorder (PTSD) symptoms and somatic complaints following a major hurricane. Sixth and seventh graders in the New Orleans area (N = 302) were surveyed 5 to 8 months following Hurricane Katrina. As expected, hurricane exposure was a significant predictor of PTSD symptoms and somatic symptoms. Also as hypothesized, certain factors of anxiety sensitivity interacted with trait anxiety to predict PTSD symptoms and somatic symptoms. Clinical implications of potential linkages among trait anxiety, dimensions of anxiety sensitivity and PTSD, and somatic symptoms are discussed.

To evaluate possible changes occurring in muscle fibers related to the training status of professional road cyclists.A comparative study was performed on two groups of male road cyclists: ten 21-yr-old cyclists with a history of 3 yr of sport competition (RC21) and ten 25-yr-old cyclists with a history of 7 yr of competition (RC25). The control group was formed by two subgroups of five nontrained, sedentary volunteers who were matched for age with the study subjects (NT21 and NT25). Biopsies of the vastus lateralis muscle were obtained to determine the fiber variables: percentage, cross-sectional area, mitochondrial volume, and capillary density.Control group variables were within the normal range. According to their training status, cyclists showed an increased percentage of type I and IIC fibers (RC25RC21NT) and decreased percentage of type IIA (RC25RC21NT) and IIB fibers (RC25 = RC21NT), an increased cross-sectional area of all fiber types after 3 yr of training (RC25 = RC21NT) except IIB fibers (RC25RC21), an increased mitochondrial volume in all fiber types (RC25RC21NT) except type IIA fibers (RC25RC21 = NT21), and an increased capillary density (RC25RC21NT).Findings indicate a progressive increase in the muscle fiber types that are mostly implicated in endurance sports, accompanied by phenotypic changes in the fiber population of lesser participation.