Non-therapeutic strategies to promote physical activity of stroke survivors in hospital settings: A systematic review

OBJECTIVE

To systematically summarize the evidence of strategies other than therapy to promote physical activity in hospital settings.

METHODS

Studies testing the various strategies to promote the physical activity of stroke survivors in different hospital settings, including stroke units, hospitals and rehabilitation centres were included. Two independent reviewers screened, extracted data, and assessed the study quality. Quality assessments were performed using standardized checklists. Data synthesis was done from the selected articles and results were reported.

RESULTS

Of the 3396 records retrieved from database searches, 12 studies (n = 529 participants) were included. All the studies were of moderate to good quality. The strategies were grouped into five categories: i) physical environment, ii) device-based feedback, iii) self-management approaches, iv) family presence, and v) education. Physical environmental and device-based feedback were the most common strategies to promote physical activity after a stroke in a hospital setting. Strategies such as family presence and education improved physical activity levels, whereas device-based feedback showed mixed results.

CONCLUSION

Despite the importance of physical activity in early stroke, there is limited literature present to enhance activity levels. Physical environment and device-based feedback were the two most common strategies used in acute stroke survivors. The impact of these strategies remain suboptimal to be considered as effective intervention methods to enhance physical activity.

Determinants and prevalence of relapse among patients with substance use disorders: case of Icyizere Psychotherapeutic Centre

BACKGROUND

Relapse to substance use after successful detoxication and rehabilitation is a public health concern worldwide. Forty to sixty percent of persons in general relapsed after completing detoxication and rehabilitation treatments. Although substance use remains a burden in Rwanda, very little is known about relapse among people with substance use disorder (SUD). Hence, this study aimed to examine prevalence and the factors associated with relapse to substance use at Icyizere Psychotherapeutic Centre (IPC), Rwanda.

METHODS

Retrospective, cross-sectional survey was conducted among 391 patients with SUD at IPC. Multiple logistic regression models using STATA version 13 were used to determine the factors associated with relapse among the patients with SUD.

RESULTS

Majority (84.1 %) of the participants were males. More than half (54.1 %) of them were aged between 18 and 30 years with the age average of 33 years (SD = 11.9 years). The results showed a higher prevalence of relapse among patients with SUD (59.9 %). The multivariate analyses indicated that people with SUD living only with their mothers had a greater risk of relapse compared to those with both biological parents [OR = 1.9, 95 % CI (1.02-3.6), p = 0.04]. Patients that were hospitalized between one to three months were more likely (11.2 times) to relapse after treatments compared to those who spent more than three months in hospitalization [OR = 9.2, 95 % CI (1.1-77.6), p = 0.02]. Furthermore, people that used more than two substances had 1.5 greater risk to relapse than those who consumed one substance. Participants were more likely to relapse if they lived with their peers [OR = 2.4, 95 % CI: (1.2-7.8), p = 0.01] or if they lived in a family with conflicts [OR = 2.1, 95 % CI (1.05-9.7), p = 0.02].

CONCLUSIONS

This study is conducted at one institution caring for patients with SUD. The prevalence was 59.9 %. Future studies are recommended to investigate the effectiveness of the existing relapse prevention programs in order to adjust prevention strategies.

An outbreak of Clostridioides difficile infections due to a 027-like PCR ribotype 181 in a rehabilitation centre: Epidemiological and microbiological characteristics

Clostridioides difficile is one of the most important healthcare-associated pathogens. Recently, several new 027-like types have been found that all belong to the multilocus sequence typing (MLST) Clade 2. We report a rapidly spreading outbreak of C. difficile infections (CDI) due to a newly identified PCR ribotype (RT) 181 in a Rehabilitation Centre (RC). Genomic analysis revealed the outbreak strain, not previously identified in Greece, belonged to clade 2, sequence type (ST) 1 and had a 18bp deletion in tcdC at position 311 together with a single nucleotide deletion at position 117, similarly to RT 027. The presence of a clonal outbreak was confirmed by whole genome sequencing, yet the source of this ribotype remained unclear. The emergence and rapid spread of new C. difficile ribotypes highlights the need for ongoing C. difficile surveillance and better understanding of overall Clade 2 phylogeny.

[Pulmonary rehabilitation in the in-hospital and outpatient phases]

Pulmonary rehabilitation programmes aim to improve aerobic capacity and enhance quality of life in patients with chronic pulmonary disease, facilitating their participation and integration in different areas and activities of daily living, through the prescription and performance of physical exercise, as well as education on risk factors and healthy living. In multidisciplinary processes, various health professionals work together to support patients through the rehabilitation process, guiding lifestyle changes to improve their level of physical activity, nutritional factors, smoking cessation, diabetes management, medication adherence and weight loss, based on theories of behavioural change. The main objective of pulmonary rehabilitation programmes is to empower users in self-care and facilitate long-term management of chronic lung disease.

Pododermatitis in raptors admitted in a wildlife rehabilitation centre in central spain

Pododermatitis is a chronic and progressive bacterial infectious disease of birds´ footpads, especially associated with captivity, which could represent an important problem in wildlife rehabilitation centres, delaying the release of the birds to the environment and harming their conservation. The objectives of the present study were i) to estimate the incidence rate of pododermatitis, ii) to analyse the influence of environmental, physiological, and pathological factors which may influence the onset of the infection in raptors after their admission to a rehabilitation centre, and iii) to follow up the evolution and macroscopic characteristics of the lesion. An observational retrospective study was carried out on clinical cases of raptors (n = 2004) admitted in a rehabilitation centre in central Spain from 2009 to 2015. The proportion of pododermatitis was 6.9%, with an incidence density of 6.8 cases/100 bird-years at risk. Our results showed that the disease was more likely to occur in birds staying longer (P < 0.001). According to Cox analysis, the variables 'raptor family' (P < 0.001) and 'age' (P = 0.002) may have significant effects on pododermatitis development. Raptors from the Falconidae and Strigidae families were less likely to develop pododermatitis than those from the Accipitridae family, with a hazard ratio (HR) of 0.31 and 0.13, respectively. Regarding age, fully feathered raptors had a three-fold higher risk of having pododermatitis than non-fully feathered birds. Survival analysis of time of pododermatitis development revealed significant differences associated with the variables 'raptor family' (P < 0.03); 'age' (P < 0.001) and 'cause of admission' (P = 0.001). Duration of the pathology (P < 0.05) and lesion location (P < 0.001) seemed to be phylogenetic dependent. Injuries were primarily located in the toes area or the whole footpad of birds belonging to the Accipitridae or Falconidae families, respectively (P = 0.003).

Quality of life in rehabilitation outpatients: normal values and a comparison with the general Dutch population and psychiatric patients

Purpose

To provide Dutch normal values for rehabilitation outpatients with chronic pain or musculoskeletal diseases utilizing the World Health Organization Quality of Life questionnaire abbreviated version (WHOQOL-BREF) and analyse influence of diagnosis and patient characteristics on normal values and increase understanding in those values.

Methods

Five hundred and forty-two outpatients were referred to a rehabilitation psychologist. Referral diagnoses were “musculoskeletal”, “chronic pain”, “neurological” and “miscellaneous”. Comparisons between groups were made for each of the four domains of the WHOQOL-BREF (scoring range 4–20).

Results

Domain scores of rehabilitation outpatients were physical domain 11.0 (±2.7), psychological domain 13.6 (±2.4), social domain 14.8 (±3.4) and environmental domain 14.2 (±2.2). Outpatients with chronic pain reported the lowest scores on the WHOQOL-BREF when compared to the “musculoskeletal”, “neurological” and “miscellaneous” groups. Increased age, lower education, living alone and unemployment had a negative impact on WHOQOL-BREF scores. Compared to the general Dutch population, rehabilitation outpatients scored, unadjusted for age, significantly lower difference for the physical domain 4.5 [95 % confidence interval (CI) 4.2; 4.8], the environment domain 1.7 (95 % CI 1.5; 2.0), the psychological domain 1.1 (95 % CI 0.4; 1.2) and the social domain 0.4 (95 % CI 0.0; 0.8).

Conclusions

WHOQOL-BREF scores of rehabilitation outpatients are lower and differed significantly from normal values of a Dutch population in all four domains. Therefore, the WHOQOL-BREF can be used to measure the subjective impact of their disease or injury. The subjective impact of chronic pain was found to be particularly high.

Prevalence of Strongyloides stercoralis and other intestinal parasitic infections among mentally retarded residents in central institution of southern Iran

OBJECTIVE

To determine the prevalence of intestinal parasitic infections among mentally retarded residents of rehabilitation center of Bandar Abbas, Hormozgan province, southern Iran.

METHODS

A cross-sectional study was carried out in central rehabilitation institute of Hormozgan province in summer 2010. Fecal samples of all 133 residents (72 males, 61 females) aged 3-52, were collected in triplicate. Specimens were examined by direct smear, formalin-ether concentration techniques and stained by permanent Trichrome, Ziehl-Neelsen stains. Statistical analysis was conducted by SPSS 13.5.

RESULTS

Intestinal parasitic infections were seen in 48.5% (64 out of 133 subjects: 53.4% in males and 46.6% in females). Strongyloides stercoralis with 17.3% showed the highest incidence followed by Entamoeba coli (9.8%), Blastocystis hominis (7.5%), Giardia lamblia (2.3%), Endolimax nana (2.3%), Hymenolepis nana (0.8%), Oxyuris vermicularis (0.8%), and Chilomasix mesnili (0.8%). Double infections were found to be as: Strongyloides stercoralis + Giardia lamblia (2.3%), Entamoeba coli + Giardia lamblia (1.5%), Entamoeba coli + Blastocystis hominis (1.5%), Oxyuris vermicularis + Entamoeba coli (0.8%), Strongyloides stercoralis + Entamoeba coli (0.8%), respectively.

CONCLUSIONS

Our findings reveal that strongyloidiasis is a common disease among mentally retarded population in southern Iran.