Does outcome of neuropsychological treatment in patients with unilateral spatial neglect after stroke affect functional outcome?

BACKGROUND: Unilateral spatial neglect (USN) after stroke is associated to severe disability and to a poor rehabilitation outcome. However it is still unclear if a reduction of USN after a specific neurophsycological treatment could also favor the functional recovery. AIM: The first aim of this study was to determine if low responders to neuropsychological treatment of unilateral spatial neglect may have a worse functional prognosis for activities of daily living. The second aim was to investigate which variables can predict a low response to neuropsychological treatment. DESIGN: Observational study. SETTING: Neurorehabilitation hospital in Italy. POPULATION: Two hundred inpatients with the diagnosis of ischemic stroke were screened in this observational study. Inclusion criteria were: patients in subacute phase of first ischemic stroke in right hemisphere. Exclusion criteria were: presence of previous and/or other disabling pathologies, medical conditions contraindicating physical therapy. Data of 73 patients who performed neurorehabilitation and visual scanning training for reducing USN were analysed, while the remaining others were excluded for at least one of the following reasons: hemorrhagic lesions, presence of other chronic disabling pathologies, contraindications for therapy. METHODS: USN was evaluated using: Letter Cancellation Test, Barrage Test, Sentence Reading Test and Wundt-Jastrow Area Illusion Test. Barthel Index (BI), Beck Depression Inventory, and Canadian Neurological Scale were also administered. According to the aim of the study, forward binary logistic regressions were performed to evaluate the effects of different factors on functional recovery. RESULTS: Three factors were identified as predictors of low effectiveness in terms of BI-score: older age (odds ratio OR=9.882, P=0.002), severity of disease at admission (OR=12.594, P=0.002) and being low responders to neuropsychological treatment (OR=3.847, P=0.027). Further, the initial barrage score (OR=3.313, P=0.027) and the initial BI-score (OR=3.252, P=0.039) effectively predict the response to neuropsychological treatment. CONCLUSION: The outcome of the whole rehabilitation resulted affected by the outcome of neuropsychological treatment in patients with USN, being a low score at Barrage test at the beginning of therapy a negative predictor of USN recovery. CLINICAL REHABILITATION IMPACT: Patients with USN after stroke can benefit of a specific training for reducing USN also in terms of functional outcome. Further, the simple use of Barrage test could provide important prognostic information about recovery.

The Rapid Alert System: implementation in NA 2 North LHA over the five-year period from 2008 to 2012.

INTRODUCTION: The Rapid Alert System was established by the European Union (EC Regulation 178/2002 Art.50, paragraph 1) for food intended for human consumption and for animal feed, with the aim of ensuring the protection of public, animal and environmental health. The purpose of the Rapid Alert System for Food and Feed (RASFF) is to provide the control authorities with the means of exchanging information on the measures taken to ensure food safety. This system allows for a rapid intervention following the discovery of food or feed already placed on the market and which represent, directly or indirectly, a serious risk for human, animal or environmental health. METHODS: Our work intends to examine all alert and information notified to the Hygiene Department of Food and Nutrition of what was formerly NA3 LHU in the last 5 years (2008-2012), and is now Naples 2 North LHU, bearing in mind that, according to regional law 16/2008 (10), the Local Health Units in Campania have been redefined. The types of risk regarding the food subject of the alerts received are: chemical, physical and biological. Food frauds (adulteration, counterfeiting, sophistication and alteration) and the poor state of preservation were considered separately. RESULTS: Out of 146 cases of non-conformity reported, 87 involved chemical risk, 28 biological risk and 17 included foreign bodies; there were also 7 food frauds and 1 case of poor state of preservation. As for the origin, the food subject of non-conformity were for the most part (61,64%) of national origin, while 34.24% came from abroad. Of these, about 66% were of non-EU origin. CONCLUSIONS: The experience gained during the period from 2008 to 2012 allows us to state that the information flow has been improved allowing local services that have been assigned the control to act more rapidly. A critical issue sometimes remains concerning the completeness of the given data, above all regarding the type of risk that, when well reported, provides a valuable contribution to the success of a comprehensive and responsible risk management programme. The encouraging fact that emerges from this study, however, is that, despite the premises made about the characteristics of the area examined, the number of alerts we received involving production sites located in the area of the LHU jurisdiction is less than what we might have expected.

COMMUNITY PERCEPTIONS OF SCHISTOSOMIASIS TRANSMISSION, PREVALENCE AND CONTROL IN RELATION TO AQUATIC HABITATS IN THE LAKE VICTORIA BASIN OF KENYA.

BACKGROUND: Intestinal schistosomiasis caused by Schistosoma mansoni and urinary schistosomiasis caused by Schistosoma haematobium are widely distributed parasites in several localities of the Lake Victoria basin of Kenya, the former being more prevalent. In Kenya, transmission of the intestinal form of bilharzia (S. mansoni) tends to be closely confined to narrow zones along the shores of large bodies of water such as Lake Victoria where it is endemic and the intermediate host is found. The prevalence of S. mansoni along the Kenyan Lake Victoria basin ranges between 40% and 80%. OBJECTIVE: To assess the community's knowledge and perceptions of schistosomiasis prevalence, transmission and control in relation to aquatic habitats in the Lake Victoria basin of Kenya. DESIGN: Community-based cross-sectional study. SETTING: The Kenyan Lake Victoria basin. SUBJECTS: Two hundred and forty three individuals (both women and men residing in the beaches and surrounding areas) were interviewed about their knowledge and perceptions regarding schistosomiasis. RESULTS: The community regarded schistosomiasis as a naturalistic disease not caused by supernatural forces but by an agent of contamination in water. Knowledge on schistosomiasis transmission and control was low, with 42% of the respondents having no idea on how schistosomiasis is contracted, while 22% and 18% of the respondents mentioned contact with contaminated water and drinking / eating dirty water / food, respectively. Most respondents were familiar with the snails' habitats, but had poor knowledge on aquatic plants harbouring snails, as 57% of the respondents did not know about aquatic plants being associated with schistosomiasis snails. Only 3% of the respondents associated snails with schistosomiasis transmission. Sixty percent (60%) of the respondents mentioned use of tablets and injections as means of treating schistosomiasis, while 38% had no idea how it is treated and 2% mentioned use of local herbs and services of medicine men. CONCLUSION: Majority of Kenyan Lake Victoria basin inhabitants had little awareness about schistosomiasis despite high prevalence of the disease in the region. There is need to adapt prevention and control strategies to the people's livelihoods. There is also need to target the less advantaged members of the community such as women, uneducated and subsistence farmers for intense health education strategies aimed at increasing participation in the control of schistosomiasis. Study to elicit divergence between biomedical and local understandings of schistosomiasis/bilharzia is suggested.

Community perceptions of schistosomiasis transmission, prevalence and control in relation to aquatic habitats in the Lake Victoria Basin of Kenya

Background: Intestinal schistosomiasis caused by Schistosoma mansoni and urinary schistosomiasis caused by Schistosoma haematobium are widely distributed parasites in several localities of the Lake Victoria basin of Kenya; the former being more prevalent. In Kenya; transmission of the intestinal form of bilharzia (S. mansoni) tends to be closely confined to narrow zones along the shores of large bodies of water such as Lake Victoria where it is endemic and the intermediate host is found. The prevalence of S. mansoni along the Kenyan Lake Victoria basin ranges between 40. Objective: To assess the community's knowledge and perceptions of schistosomiasis prevalence; transmission and control in relation to aquatic habitats in the Lake Victoria basin of Kenya. Design: Community-based cross-sectional study. Setting: The Kenyan Lake Victoria basin. Subjects: Two hundred and forty three individuals (both women and men residing in the beaches and surrounding areas) were interviewed about their knowledge and perceptions regarding schistosomiasis. Results: The community regarded schistosomiasis as a naturalistic disease not caused by supernatural forces but by an agent of contamination in water. Knowledge on schistosomiasis transmission and control was low; with 42of the respondents having no idea on how schistosomiasis is contracted; while 22 and 18of the respondents mentioned contact with contaminated water and drinking / eating dirty water / food; respectively. Most respondents were familiar with the snails' habitats; but had poor knowledge on aquatic plants harbouring snails; as 57of the respondents did not know about aquatic plants being associated with schistosomiasis snails. Only 3 of the respondents associated snails with schistosomiasis transmission. Sixty percent (60) of the respondents mentioned use of tablets and injections as means of treating schistosomiasis; while 38 had no idea how it is treated and 2 mentioned use of local herbs and services of medicine men. Conclusion: Majority of Kenyan Lake Victoria basin inhabitants had little awareness about schistosomiasis despite high prevalence of the disease in the region. There is need to adapt prevention and control strategies to the people's livelihoods. There is also need to target the less advantaged members of the community such as women; uneducated and subsistence farmers for intense health education strategies aimed at increasing participation in the control of schistosomiasis. Study to elicit divergence between biomedical and local understandings of schistosomiasis/bilharzia is suggested

Impact of participation on rehabilitation results: a multivariate study.

BACKGROUND: Participation in inpatients is commonly considered as a relevant factor influencing rehabilitation results, but its effects are still not exhaustively investigated. AIM: To clarify and quantify the impact of level of participation in rehabilitation on functional outcome in inpatients. DESIGN: Prospective, observational multivariate study. SETTINGS: Rehabilitation hospital. POPULATION: Three hundred and sixty-two patients (mean age 59.41±12.85 years) with stroke or orthopedic diseases consecutively admitted to rehabilitation hospital. METHODS: Rehabilitation program participation was assessed by means of Pittsburgh Rehabilitation Participation Scale (PRPS). Patients who scored below 4 in 25% of the physical and occupational therapy treatment were classified as "low" participants. Multiple and logistic regressions were performed to identify variables associated not only with participation but also with rehabilitation results. RESULTS: Nearly one third of patients (33.88%, primarily stroke) showed low participation. Low early participation (within the first two weeks) was associated with disability and depressive symptoms at admission, and late participation with early participation, age and years of schooling. Both early and late participation were associated with effectiveness of treatment on both ADL and mobility, even if there was much unexplained variance in both models. Patients with low early participation had a greater risk (OR=2.45, 95% CI 1.27-4.71) of a low response to treatment on mobility than the patients who had participated more. Among other prognostic factors, early start of rehabilitation treatment and the presence of cognitive and neuropsychological impairments have significant roles. CONCLUSIONS: Our results confirm the importance of participation in rehabilitation programs, which should be encouraged. Further studies are needed to improve knowledge about the overall effects of participation. CLINICAL REHABILITATION IMPACT: Early participation should be considered a treatment target as well as a prognostic factor.

Psychological features and outcomes of the Back School treatment in patients with chronic non-specific low back pain. A randomized controlled study.

BACKGROUND: Low back pain is a worldwide health problem, affecting up to 80% of adult population. Psychological factors are involved in its development and maintenance. Many clinical trials have evaluated the efficacy of different interventions for chronic non-specific low back pain. In this field, Back School program has been demonstrated effective for people with chronic non-specific low back. AIM: To evaluate the relationship between the effects of the Back School treatment and psychological features measured by MMPI-II of patients with chronic non-specific low back pain. DESIGN: A randomised controlled trial with three and six-month follow-up. SETTING: Ambulatory rehabilitative university centre. POPULATION: Fifty patients with chronic non-specific low back pain out of 77 screened patients. METHODS: Patients were randomly placed in a 3:2 form and were allocated into two groups (Treatment versus Control). The Treatment Group participated to an intensive multidisciplinary Back School program (BSG, N.=29), while the Control Group received medical assistance (CG, N.=21). Medication was the same in both groups. Then, patients were subgrouped in those with at least an elevation in one scale of MMPI-II, and those without it. The Short Form 36 Health Status Survey for the assessment of quality of life (primary outcome measure), pain Visual Analogue Scale, Waddel Index and Oswestry Disability Index were collected at baseline, at the end of treatment, and at the three and six-month follow-up. RESULTS: Only the two treated subgroups showed a significant improvements in terms of quality of life, disability and pain. Among treated subjects, only those with at least one scale elevation in MMPI-II showed also a significant improvement in terms of Short Form 36 mental composite score and relevant subscores. CONCLUSION: These results suggest that Back School program has positive effects, even in terms of mental components of quality of life in patients with scale elevations of MMPI-II. Probably these findings are due to its educational and cognitive-behavioural characteristics. CLINICAL REHABILITATION IMPACT: Because of its educational purposes, the Back School treatment can have positive effects also on the mental status of patients with low back pain when it affects their psychological features.

Quality of life improved by multidisciplinary back school program in patients with chronic non-specific low back pain: a single blind randomized controlled trial.

STUDY DESIGN: A three and six months follow-up in a randomized controlled trial. BACKGROUND: Back School has become a widespread exercise program for low back pain (LBP), since its introduction in 1969. Back School could improve quality of life (QoL), but there are controversial data regarding its effectiveness. AIM: To evaluate the effects of the Back School program on quality of life (primary outcome), disability and pain perceptions (secondary outcomes) in patients with chronic and non-specific low back pain. SETTING: Rehabilitative specialized centre. POPULATION: Seventy four patients with chronic non-specific LBP. METHODS: Patients were randomly placed in a 3:2 form and were allocated into 2 groups (treated-control). Treatment group participated in a intensive multidisciplinary Back School program including brief education and active back exercises (BSG, N.=41), while the control group received medical assistance (CG, N.=29). Medication was the same in both groups. The Short Form 36 Health Status Survey, Waddel Index, Oswestry Disability Index and Visual Analogue Scale were collected at baseline, at the end of treatment, and at the three and six month follow-up. RESULTS: Quality of life significantly improved along time more in BSG, both in Physical and Mental Composite Score (repeated measure Anova: interaction time per group: P<0.001 and P=0.002, respectively). We also observed a significant improvement in disability scores along time (P<0.001) in BSG with significant differences between groups at three and at six months for Waddell Index (P=0.006 and P=0.009 respectively) and for Oswestry Disability Index (P=0.018 and 0.011 respectively). Moreover, pain perception score VAS showed a reduction in both groups, but it was significantly lower in BSG at end of treatment and both follow-ups (P<0.001). CONCLUSION: Our Back School program can be considered an effective treatment in people with chronic non-specific LBP.

Patterns of attentional impairment following closed head injury: a collaborative European study.

A comprehensive assessment of both selective (focused attention, divided attention) and intensive (alertness and vigilance) attentional processes was performed on 106 patients with closed head injury using a computerised battery for the evaluation of attention. All patients were tested at least five months after their accident. A high percentage of patients were pathological in tests mapping the selective components of attention while only a minority were impaired on tests mapping the intensive components of attention. Three different subgroups of patients with consistent performance patterns were evidenced. The psychometric characteristics of the battery and its possible clinical usefulness are discussed.

Problems of drug surveillance--an international view.

The importance of Post Marketing Surveillance (PMS) is stressed, both to determine the therapeutic value of the drug and its adverse effects revealed in a large population of patients. A survey of such adverse effects of anti-epileptic drugs is provided: metabolic, dose-related and idiosyncratic. Problems of monotherapy and of drug interactions are discussed, as well as questions of central nervous system toxicity and of teratogenicity.