Rehabilitation in critically ill children: Findings from the Korean National Health Insurance database.

PURPOSE: Intensive care unit (ICU) survivors suffer from physical weakness and challenges returning to daily life. With the importance of rehabilitating patients in the pediatric intensive care unit being increasingly recognized, we evaluated the prevalence of physical and occupational therapy (PT/OT)-provided rehabilitation and factors affecting its use. METHODS: We conducted a retrospective cohort analysis of rehabilitation between 2013 and 2019 using the Korean National Health Insurance database. All patients aged 28 days to 18 years who had been admitted to 245 ICUs for more than 2 days were included. Neonatal ICUs were excluded. RESULTS: Of 13,276 patients, 2,447 (18%) received PT/OT-provided rehabilitation during their hospitalization; prevalence was lowest for patients younger than 3 years (11%). Neurologic patients were most likely to receive rehabilitation (adjusted odds ratio [aOR], 6.47; 95% confidence interval [CI], 5.11-8.20). Longer ICU stay (versus ≤ 1 week) was associated with rehabilitation (aOR for 1-2 weeks, 3.50 [95% CI, 3.04-4.03]; 2-3 weeks, 6.60 [95% CI, 5.45-8.00]; >3 weeks, 13.69 [95% CI, 11.46-16.35]). Mechanical ventilation >2 days (aOR, 0.78; 95% CI, 0.67-0.91) and hemodialysis (aOR, 0.50; 95% CI, 0.41-0.52) were negatively affecting factors. CONCLUSION: Prevalence of rehabilitation for critically ill children was low and concentrated on patients with a prolonged ICU stay. The finding that mechanical ventilation, a risk factor for ICU-acquired weakness, was an obstacle to rehabilitation highlights the need for studies on early preventive rehabilitation based on individual patient needs.

Designing the building space of a shopping street to use as a disaster evacuation shelter during the COVID-19 pandemic: A case study in Kobe, Japan.

This study considers the risk of a natural hazard-induced disaster occurring during a pandemic, such as the novel coronavirus (COVID-19) pandemic, and develops the idea of utilizing a shopping street with disaster-proof buildings as a temporary evacuation shelter by incorporating countermeasures against the spread of infectious diseases. Using a case study of a shopping street in Kobe, Japan, we estimate shelter capacity by considering the requirement of 6 m2 of space allotted for each person. The shelter can accommodate 1194 evacuees and provide them with food and drinks for one day, even in the worst case of lifeline disruption. This study proposes a method of designing shelter space, and demonstrates how non-homogeneous and noncontinuous spaces within shopping street buildings can be applied to prevent the spread of infection, through the classification of evacuee types and use of space and facilities designated for each type. The study further examines the liability issue of secondary infection at the shelter with reference to civic law and the roles of government in developing a distributed evacuation framework.