Search Results (33)

Background and Objectives: Schizophrenia is a disabling psychiatric condition, affecting around 1% of people worldwide. It has been ranked among the ten most disabling conditions globally. Alongside the psychological and social burdens imposed on individuals suffering from this disease, there are also serious complications regarding the physical health of these patients. Pneumonia is a significant cause of death in patients with schizophrenia. This group of patients also has a higher risk of developing pneumonia and all-cause mortality compared to those without schizophrenia, along with an increased overall mortality rate. A retrospective study revealed that advanced age, underweight, smoking, and the use of high-dose atypical antipsychotics increase the risk of pneumonia-related mortality in hospitalized patients. Our study aims to examine differences in factors associated with pneumonia in hospitalized patients with schizophrenia, before and after the COVID-19 pandemic, as well as to identify potential changes in clinical characteristics and outcomes. Materials and Methods: This is an observational, retrospective analysis, based on the review of medical records of psychiatric inpatients diagnosed with schizophrenia according to the DSM-5 criteria. Patients were selected according to the following criteria: both schizophrenia and pneumonia diagnoses, hospitalized in Spitalul Clinic de Psihiatrie si Neurologie Brasov during 1 March 2018–1 March 2020, and 1 March 2022–1 March 2024, respectively. Results: A total of 27 patients met the inclusion criteria; 13 patients (48%) were in the pre-pandemic group and 14 patients (52%) in the post-pandemic group. Contrary to other reports, our results showed relatively low pneumonia rates in hospitalized schizophrenia patients (1.02% pre-pandemic and 1.63% post-pandemic), and rates were higher in female patients (61.54% pre-pandemic and 71.43% post-pandemic). Post-pandemic, most cases (42.86%) were registered during summer, in a schizophrenia population with mostly urban residence and with lower smoking rates than the pre-pandemic group. Physical restraints were, however, more frequently utilized in the post-pandemic group. Conclusions: Pneumonia risk factors might register a change in the post-pandemic years. Polypharmacy and physical restraints are probably underestimated risk factors for pneumonia in schizophrenia patients, while a multidisciplinary approach and preventive measures might exert a protective role. Full article

Background: Prader–Willi Syndrome (PWS) is a rare, genetic, multi-systemic disorder. Its main characteristics are muscular hypotonia, behavioral problems, intellectual disability, endocrine deficiencies, hyperphagia, and a high risk of morbid obesity and related comorbidities. This study aimed to investigate the rate of comorbidity, prescription of endocrine medications, and mortality in individuals with PWS compared to the general population. Methods: The association between PWS and outcomes were investigated in a matched cohort study of individuals born in the period of 1930–2018 with data from Swedish national health and welfare registers. Each individual was matched with 50 non-PWS comparisons. The associations between PWS, outcomes and prescribed endocrine medications were estimated through Cox proportional hazard models, presented as Hazard Ratios (HR) with 95% Confidence Intervals (CIs). Results: Among 360 individuals (53% men) with PWS, 16% had diabetes mellitus, 6% heart failure, 4% vein thrombosis, 2% atrial fibrillation, 2% coronary heart disease, and 1% pulmonary embolism. Individuals with PWS had an increased rate of heart failure (HR: 23.85; 95% CI: 14.09–40.38), diabetes mellitus (HR: 17.49; 95% CI: 12.87–23.74), vein thrombosis (HR: 10.44; 95% CI: 5.69–19.13), pulmonary embolism (HR: 5.77; 95% CI: 2.27–14.67), atrial fibrillation (HR: 5.19; 95% CI: 2.48–10.86), and coronary heart disease (HR: 3.46; 95% CI: 1.50–7.97) compared to non-PWS individuals. Somatotropin was prescribed in 63%, antidiabetics in 18%, and thyroid hormones in 16% of the PWS individuals (<1%, 2%, and 3%, respectively, in non-PWS individuals). The rate of mortality was fifteen times higher in PWS than in non-PWS, with a mean age at death of 42 years. Conclusions: The rates of diabetes mellitus and cardiovascular comorbidities were higher in individuals with PWS. As expected, the prescription of somatotropin was high, but the endocrine prescription pattern also reflected the high prevalence of diabetes mellitus and thyroid illness. Although the mean age at death was older than previously reported, a higher awareness and intensified efforts to avoid obesity, as well as the prevention and early treatment of cardiovascular and endocrine comorbidity, are crucial aims in the care of people with PWS. Full article

This systematic review explores the potential of the gamified brain–machine interfaces (BMIs) and brain–computer interfaces (BCIs) to enhance the quality of life for individuals with disabilities. These technologies promise to solve complex problems by delivering customized interventions considering individual needs, ethical dilemmas, and practical constraints. This review follows the PRISMA statement. The search process extensively explored multiple registered databases for studies published between 2015 and 2024. Articles were selected based on strict eligibility criteria, focusing on empirical research evaluating gamified BCIs and BMIs in rehabilitation and learning. The final analysis included 56 studies. A thorough examination emphasizes the transformative potential of gamified BCIs and BMIs for people with disabilities, highlighting the need for interdisciplinary collaboration, user-centered design principles, and ethical consciousness for gamified neurotechnology. These technologies mark a significant change by providing enjoyable and effective treatments for disabled individuals. It also delves into how gamification, neurofeedback, and adaptive learning techniques can enhance motivation, engagement, and overall well-being. This evaluation underscores the efficiency of gamified BCIs and BMIs as potential instruments for improving the quality of life and empowering disabled people. However, despite their apparent potential for rehabilitation and learning, more research is needed to validate their effectiveness, accessibility, and long-term benefits. Full article

Background/Objectives: This study investigates the effects of multidisciplinary telerehabilitation for the post-COVID-19 condition. Methods: Recruitment was announced during 2021/22 through the COVID patient organisation in Sweden. The key inclusion criteria were persistent symptoms and functional impairments longer than 12 weeks after an acute SARS-CoV-2 infection, a stable health condition, and satisfactory skills to use the Internet. Participants were randomised into a rehabilitation group or a waiting list. Telerehabilitation was performed by a multidisciplinary team. Measured outcomes included health- and pain-related parameters and pain-related disability after eight weeks and when followed up after six months. Results: In total, 164 participants registered for the study. Of them, 67 participated in an eight-week group telerehabilitation programme (mean age 43, 78% women) and 42 stayed on a waiting list (mean age 47, 88% women) after eight weeks. Sixty participants from the rehabilitation group and 21 from the waiting list completed the data at the six-month follow-up. The results show greater improvements in both health- and pain-related parameters within the telerehabilitation group after eight weeks and six months than within the waiting list group (Cohen’s d effect size varied between moderate and large). However, no statistically significant differences were found between the groups, except participants being at a lower risk of anxiety measured based on the Hospital Anxiety and Depression Scale after eight weeks of telerehabilitation compared to those on the waiting list. Conclusions: The results indicate that multidisciplinary group telerehabilitation is beneficial for improving health- and pain-related parameters in people suffering from the post-COVID-19 condition and should be further developed and adapted for similar conditions, such as chronic pain, fatigue, etc. Full article

Around the world, family caregivers are an important source of support for people with intellectual disability (ID) and for those with severe mental disorder (SMD), although the level of support can be influenced by the culture and government healthcare systems in each country. However, there is little evidence about the mental health and coping mechanisms of these caregivers in low-income countries. To address this need, we aimed to elicit whether there are potential links between coping style, mental health, and perceived burden experienced by this group, using a sample from a central Asian upper middle-income country. Methods: We recruited 120 participants, of which 60 were caregivers of people with ID and 60 of people with SMD. All participants were recruited from Ulaanbaatar, the capital city of Mongolia, Central Asia, and were asked to complete of the Depression, Anxiety and Stress Scale (DASS) and the Coping Orientation to Problems Experienced inventory scale (COPE). Multiple regression analyses were used to investigate associations between these measures. Results: We found that DASS scores were significantly higher among the sample of caregivers of individuals with ID than in those of SMD. Mental and behavioral disorders were associated with higher DASS scores in the sample of caregivers of those with SMD. Good coping styles, indicated by higher scores in the COPE, were associated with increased age in caregivers of individuals with ID. Conclusion: Although overall the carers of people with SMD appeared to have better active coping skills and better acceptance of the caring role, they demonstrated comparatively high levels of stress. This study was not registered. Full article

Background: With a rising number of multiple sclerosis (MS) cases and increasing pressure on health systems, digital companion apps like Brisa, designed specifically for people with MS, can play an important role in the patient journey. These apps enable the collection of real-time longitudinal data that are critical to our understanding of the pathophysiology and progression of MS. Methods: This retrospective, descriptive analysis consists of data from Brisa users who registered between 6 August 2021 and 8 September 2022. Of the unique users, 37.7% (n = 1593) fulfilled the inclusion criteria including information about medication and demographics and tracked one or more symptoms and/or patient-reported outcomes. Users were classified as moderate-efficacy treatment users, high-efficacy treatment users and ocrelizumab users, and the reporting frequency and scores of symptoms and patient-reported outcomes were analyzed. Results: The largest cohort of Brisa users (405) reported treatment with ocrelizumab and were mostly diagnosed 2–5 years before the survey. The most reported MS symptoms were similar between OUs (ocrelizumab users), HETUs (high-efficacy treatment users) and METUs (moderate-efficacy treatment users). OUs on average reported symptoms and answered questionnaires more frequently. Baseline scores between HETUs and OUs were similar, whereas baseline scores of METUs were slightly lower in comparison. In a further analysis of OUs, disability scores increased with age; users aged 26–45 years had higher pain scores than 18–25-year-olds. No significant differences were found in quality of life, bowel control and vision between age groups. Conclusion: These findings show that the characteristics of the Brisa cohort are similar to the results of other studies and registries and can provide a representative overview of everyday disease management. Thereby, these results can bridge the gap between clinical research and real patient experience, but they also raise new questions, such as how often the hard-and-early therapy approach is already used and whether baseline characteristics and reasons for choosing a particular treatment contribute to the different outcomes over time. Answering these questions requires further research and analysis. Full article

This study investigates the outcomes and feasibility concerning the functioning and activity of multidisciplinary group telerehabilitation for a post-COVID-19 condition. Recruitment for the group rehabilitation was announced three times during 2021 and 2022 through the COVID-19 patient organization in Sweden. The key inclusion criteria were remaining symptoms and functional impairments beyond 12 weeks after SARS-CoV-2 infection; medical assessment and treatment regarding comorbidities or new postinfection symptoms; the ability to use the Internet. Participants were randomized into a rehabilitation group or onto a waiting list using an Internet program. Multiple outcomes included self-scored questionnaires and physical tests before and after eight weeks, and at six months follow-up. Here, we present the self-scored outcomes on the International Classification of Functioning and Disability questionnaire (ICF, 22 body functions and 16 activity/participation categories) and breathing scales. Of the 164 participants who registered for the study, 67 (mean age 43, 78% women) participated in an eight-week group rehabilitation compared to 42 who served as waiting list controls (mean age 47, 88% women). At six months follow-up, 60 participants from the rehabilitation group and 21 from the waiting list completed the data. The results indicate that a larger number of ICF body functions and activity/participation categories had improved in the rehabilitation group after eight weeks and six months. Overall credibility, as assessed by the Credibility Expectancy Questionnaire, was high, and the attrition rate in rehabilitation was low. The results indicate beneficial outcomes for multidisciplinary telerehabilitation in people suffering from a post-COVID-19 condition. Therefore, rehabilitation interventions should be further developed and implemented in clinical practice. Full article

This study aimed to compare vascular involvement, hand functionality, and upper limb disability between Raynaud’s phenomenon participants and controls. Also, we analyzed the relationships between vascular impairment, mobility, and strength with disability in this Raynaud population. We conducted a case–control study with fifty-seven participants. We registered sociodemographic and clinical data; vascular variables (temperature, cold test, blood flow, and oxygen saturation); functional variables (pinch strength, range of motion), and disability (Shortened Disabilities of the Arm, Shoulder and Hand Questionnaire) (Q-DASH). Raynaud participants present more disability in all Q-DASH subscales, lower hands’ temperature pre and post cold test, decreased blood flow on radial artery, decreased ranges of motions at passive extension of index finger, and active flexion and extension of thumb than the healthy controls. The multivariate regression analysis showed that extension of the index finger, lateral pinch strength, and oxygen saturation were significantly associated with disability in RP, almost the 55% of the total variance on the upper limb, 27% at sports/arts, and 42% at work. Our findings suggest that RP has a disabling effect on the upper extremities and a practice of activities in people who suffer it. Also, disability in Raynaud seems to be more related with hand mobility and strength impairment than vascular injury. Full article

Background: Cluster headache (CH) is a type of headache that has a global prevalence of 0.5–3/1000 people, provokes severe, strictly unilateral pain through the first branch of the trigeminal nerve, and is associated with observable autonomous responses. CH provokes intense pain and decreases quality of life. Objective: In this study, we aimed to carry out a systematic review of the effectiveness of non-invasive neuromodulation of the vagus nerve in patients with cluster headaches, which was registered on PROSPERO No. CRD42021265126. Methods: Six databases were used from their date of inception to February 2023 to obtain studies with the group intervention of non-invasive neuromodulation of the vagus nerve for cluster headache, with outcomes based on pain attacks, duration, and disabilities. Data on the subjects, group intervention, main outcomes, and results were collected by two authors. Results: The search provided 1003 articles, with three clinical trials being eligible for inclusion in the review. The methodological quality scores ranged from 6 to 8 points (mean: 7.3, SD: 0.8) out of a maximum of 10 points. The post-treatment results showed some positive effects using n-VNS as a treatment for cluster headache, more specifically regarding cervical neuromodulation of the vagus nerve. Conclusions: The systematic review found moderate-to-high-quality evidence supporting that n-VNS and cervical n-VNS may have some positive effects at the end of the treatment being effective to relieve the frequency and intensity of cluster headaches. The poor quantity of studies available and the lack of homogeneity in the study protocols did not allow the pooling of data for a meta-analysis. Full article

Migration is commonly described as a threat through images of invasion and flood in Western media. Migrants and asylum seekers tend to be the target of hate speech together with other vulnerable groups and minorities, such as disabled people, and definitions and labels have precise implications in terms of social justice and human rights. Migrant is an umbrella term used to refer to a variety of people who leave their countries of origin. Out-of-quota and dubliner are further labels, together with asylum seekers. Through an interdisciplinary approach, adopting a translation perspective on social justice, I would like to focus on the ways these labelling practices affect migrants’ and asylum seekers’ lives to the point of violating their rights. A clear example is represented by the English term dublined, translated as dublinati/dublinanti into Italian, and with no translation into German. It derives from the Dublin regulations, signed in 2013 and still valid, and indicates those people who want to apply for asylum in a given country but cannot do so because their fingerprints have been taken and registered in another EU country. Classifications of this kind, combined with further categorisations, such as “ordinary” or “vulnerable”, are applied throughout EU countries and languages to determine whether asylum seekers deserve, and are thus granted, asylum or not. They are informed by a dehumanizing view of migration and translate into “bordering practices” which prevent access to reception systems and welfare services. Resistant translation practices, a new language and art activism can contribute to reversing dehumanizing practices by putting displaced people’s identities at the centre. The Sicilian artist Antonio Foresta is the author of the installation Pace Nostra, a symbolic wave made of migrants’ clothes and Caltanissetta inhabitants’ bedsheets, with both an Italian and Arabic title, which translates migration, commonly perceived as “their” drama, into “our” drama, a common human experience, leading to a common goal: peace. Full article

Background: The efficacy of upper limb (UL) robot-assisted therapy (RAT) on functional improvement after stroke remains unclear. However, recently published randomized controlled trials have supported its potential benefits in enhancing the activities of daily living, arm and hand function, and muscle strength. Task-specific and high-intensity exercises are key points in facilitating motor re-learning in neurorehabilitation since RAT can provide an assisted-as-needed approach. This study aims to investigate the clinical effects of an exoskeleton robotic system for UL rehabilitation compared with conventional therapy (CT) in people with subacute stroke. As a secondary aim, we seek to identify patients’ characteristics, which can predict better recovery after UL-RAT and detects whether it could elicit greater brain stimulation. Methods: A total of 84 subacute stroke patients will be recruited from 7 Italian rehabilitation centers over 3 years. The patients will be randomly allocated to either CT (control group, CG) or CT plus UL-RT through an Armeo^®Power (Hocoma AG, CH, Volketswil, Switzerland) exoskeleton (experimental group, EG). A sample stratification based on distance since onset, DSO (DSO ≤ 30; DSO > 30), and Fugl–Meyer Assessment (FM)-UL (FM-UL ≤ 22; 22 < FM-UL ≤ 44) will be considered for the randomization. The outcomes will be recorded at baseline (T0), after 25 + 3 sessions of intervention (T1), and at 6 months post-stroke (T2). The motor functioning assessed by the FM-UL (0–66) will be considered the primary outcome. The clinical assessments will be set based on the International Classification of Function, Disability and Health (ICF). A patient satisfaction questionnaire will be evaluated in the EG at T1. A subgroup of patients will be evaluated at T0 and T1 via electroencephalography. Their brain electrical activity will be recorded during rest conditions with their eyes closed and open (5 min each). Conclusion: The results of this trial will provide an in-depth understanding of the efficacy of early UL-RAT through a whole arm exoskeleton and how it may relate to the neural plasticity process. The trial was registered at ClinicalTrial.gov with the registration identifier NCT04697368. Full article

Background: A large proportion of people who sustain a whiplash injury will have persistent pain, disability, and participation problems. Several prognostic factors for functional recovery have been reported in the literature but these factors are often evaluated based on differing implementations in clinical practice. Additionally, physiotherapists also rely on their clinical intuition to estimate the functional prognosis of their patients, but this is seldom measured in experimental research. Furthermore, no study to date has explored the associations between clinical intuition, clinically estimated factors, and objectively measured factors for functional recovery of patients with Whiplash-Associated Disorders (WAD). Aim: The aim of this exploratory study is to evaluate associations between prognostic factors for functional recovery, based on routinely collected data in a specialized primary care physiotherapy practice in a consecutive sample of patients (n = 523) with WAD. Methods: Three sources of prognostic factors were selected: (1) physiotherapists’ synthesis of clinical intuition in terms of high-risk, inconclusive risk, or low-risk for functional recovery, (2) patient-registered factors from history taking, and (3) patient-reported prognostic factors derived from questionnaires. Prognostic factors were selected based on the literature, recommendations in Dutch clinical practice guidelines, and consensus between experts. Spearman’s rank correlation coefficients were calculated to explore the associations between sources of prognostic factors, using a cutoff ≥0.25 for acceptable association. Results: Associations between physiotherapists’ intuitive synthesis and patient-registered variables were substantial (r_s = 0.86), between patient-registered variables and patient-reported variables fair (ranging from 0.30 to 0.41) to substantial (ranging from 0.69 to 0.73), and between physiotherapists intuitive synthesis and patient-reported variables fair (ranging from 0.30 to 0.37). Conclusion: When estimating prognosis for functional recovery using clinical reasoning, physiotherapists should integrate patients’ registered experience of their course of recovery, as well as the timeline after an accident, with their own synthesis of clinical intuition regarding prognostic factors in patients with WAD. Full article

International current best practice recommends the discontinuation of antipsychotics for challenging behaviours in people with intellectual disabilities (ID), due to lack of evidence of efficacy and risks of harmful side-effects. In clinical practice, discontinuation may be difficult. The aim of this study was to gain insight into prescribers’ practice by investigating their experiences with the discontinuation of long-term antipsychotics for challenging behaviour. From professionals’ associations thirty-four registered ID physicians, psychiatrists and specialist mental healthcare nurses were recruited who completed an online questionnaire in this survey–study. Almost all participants had attempted to deprescribe antipsychotics for their patients with ID. Sixty-five percent of participants achieved complete discontinuation in 0–25% of their patients, but none in over 50%. Barriers were a lack of non-pharmaceutical treatments for challenging behaviours and caregivers’ and/or family concern. Seventy percent of participants indicated that their institutions had encouraged implementing their discontinuation policies in line with the new Dutch Act on Involuntary care and a new Dutch multidisciplinary guideline on problem behaviour in adults with ID. Support and facilitation of clinicians from institutions’ managers and political and professional bodies may be helpful in further implementation of best practice in the treatment of challenging behaviour in people with ID. Full article

Innovative technologies can support older adults with or without disabilities, allowing them to live independently in their environment whilst monitoring their health and safety conditions and thereby reducing the significant burden on caregivers, whether family or professional. This paper discusses the design of a study protocol to evaluate the acceptance, usability, and efficiency of the SAVE system, a custom-developed information technology-based elderly care system. The study will involve older adults (aged 65 or older), professional and lay caregivers, and care service decision-makers representing all types of users in a care service scenario. The SAVE environmental sensors, smartwatches, smartphones, and Web service application will be evaluated in people’s homes situated in Romania, Italy, and Hungary with a total of 165 users of the three types (cares, elderly, and admin). The study design follows the mixed method approach, using standardized tests and questionnaires with open-ended questions and logging all the data for evaluation. The trial is registered to the platform ClinicalTrials.gov with the registration number NCT05626556. This protocol not only guides the participating countries but can be a feasibility protocol suitable for evaluating the usability and quality of similar systems. Full article

This study aimed to diagnose the health characteristics of people with grade 1–4 physical disability (but without intellectual disability) by analyzing factors affecting their health through social, epidemiological, behavioral, and ecological diagnoses by partially applying the PRECEDE model. Those registered with physical disability in 2022 and attending a welfare center were selected, with samples extracted from Seoul, Gyeonggi-do, Chungcheong-do, Jeolla-do, and Gyeongsang-do. A total of 1200 people were selected, and the data of 1000 people were finally analyzed. A frequency analysis was performed to identify the participants’ characteristics. An independent t-test and one-way analysis of variance were performed to verify the hypotheses. To clarify the relationship between each variable, normality verification, confirmatory factor analysis, and structural equation model analysis were performed. First, the differences in factors influencing health promotion according to personal background variables (gender, age, and income level), including quality of life, showed partial differences according to age and income level. Second, according to disability-related variables (time of onset and disability grade), quality of life and health status showed partial differences. These results can be used as basic data or indicators to build a health promotion system that considers the health characteristics of individuals with a physical disability. Full article