Stroke Patients’ Reintegration into Normal Living Post-Discharge from Inpatient Rehabilitation: An Integrative Review

Background: Stroke rehabilitation professionals have historically focused rehabilitation on physical functions and overlooked the concept of community reintegration after discharge from inpatient rehabilitation. The lack of focus on psychosocial functions post-stroke may lead to lower levels of satisfaction during community reintegration. Methods: This integrative review synthesized findings from research literature on stroke patients’ reintegration into the community after inpatient rehabilitation to address three research questions: a) What specific physical and psychosocial functions have been identified as predictors of successful reintegration into normal living after stroke?, b) How do physical and psychosocial functions promote successful reintegration into normal living after stroke?, and c) What factors have been identified that hinder stroke patients’ reintegration into normal living after stroke? Results: A systematic search of literature identified sixteen studies that provided significant context for the research questions. What physical and psychosocial functions of stroke patients included, for example, improved mobility, independence in daily activities, reduced disability, psychological well-being, self-efficacy, social support, and personal relationships. How physical and psychosocial functions promote reintegration included, for example, disability management, emotional well-being, self-care independence, sense of purpose, and employment influence. Factors that hinder stroke patients’ reintegration consisted of longer stride time, impaired balance/mobility, activities limitation, severe stroke, presence of comorbidity, depressive symptoms, speech and language challenges, inadequate self-efficacy, fear of falling, older age, low educational level, lack of social support, and social isolation. Conclusion: Successful community reintegration after stroke requires a shift of focus from rehabilitation interventions that target physical functions to include interventions that address psychosocial functions.

Executive functioning in TBI from rehabilitation to social reintegration: COMPASS^(goal), a randomized controlled trial(grant: 1I01RX000637-01A3 by the VA ORD RR&D, 2013–2016)

Background: Traumatic brain injury is a major health problem that frequently leads to deficits in executive function. Self-regulation processes, such as goal-setting, may become disordered after traumatic brain injury, particularly when the frontal regions of the brain and their connections are involved. Such impairments reduce injured veterans' ability to return to work or school and to regain satisfactory personal lives. Understanding the neurologically disabling effects of brain injury on executive function is necessary for both the accurate diagnosis of impairment and the individual tailoring of rehabilitation processes to help returning service members recover independent function.Methods/design: The COMPASSgoal(Community Participation through Self-Efficacy Skills Development) program develops and tests a novel patient-centered intervention framework for community reintegration psychosocial research in veterans with mild traumatic brain injury. COMPASSgoal integrates the principles and best practices of goal self-management. Goal setting is a core skill in self-management training by which persons with chronic health conditions learn to improve their status and decrease symptom effects. Over a three-year period, COMPASSgoal will recruit 110 participants with residual executive dysfunction three months or more post-injury. Inclusion criteria combine both clinical diagnosis and standardized scores that are >1 SD from the normative score on the Frontal Systems Rating Scale. Participants are randomized into two groups: goal-management(intervention) and supported discharge(control). The intervention is administered in eight consecutive, weekly sessions. Assessments occur at enrollment, post-intervention/supported discharge, and three months post-treatment follow-up.Discussion: Goal management is part of the "natural language" of rehabilitation. However, collaborative goal-setting between clinicians/case managers and clients can be hindered by the cognitive deficits that follow brain injury. Re-training returning veterans with brain injury in goal management, with appropriate help and support, would essentially treat deficits in executive function. A structured approach to goal self-management may foster greater independence and self-efficacy, help veterans gain insight into goals that are realistic for them at a given time, and help clinicians and veterans to work more effectively as true collaborators.

Advantages of an ICF-Based Approach in School Reintegration of Pediatric Brain Tumor Patients: The School Participation Scales (S-PS-24/7)

Survivors of pediatric central nervous system (CNS) cancer are at risk for long term sequelae concerning school participation. Therefore, the purpose of the study was to develop and evaluate a school-participation questionnaire for patients and parents based on the International Classification of Functioning, Disability and Health (ICF). The items of the School Participation Scales-24/7 (S-PS-24/7) meet different functions, activities and participation aspects, as well as environmental factors listed in the ICF, using everyday language. The study sample consisted of 48 pediatric brain tumor patients and their parents. Reliability scores for the S-PS-24/7 components were acceptable or high. For investigating validity, items were correlated with data from a neurocognitive assessment battery with promising results. This approach enables a description of educational outcome on a functional level instead of using global measures. This facilitates counseling of patients, parents and teachers with respect to academic achievement and specific intervention programs.

Modularity,module reintegration and industry landscape remaking

The turn-key solution originated by Media Tek Inc.(MTK) changed the degree of handset modularity and sparked therise of "knockoff handsets’’ This paper holds that modularity is not a product of independent evolution and that thechange in the degree of product modularity will lead to a change in the product’s organizational structure.Modulereintegration has reduced the industry’s knowledge barrier and made it possible for a large number of low-tech firms toenter the industry in China.As a result, it has altered the industry’s competitive landscape.Module reintegration can betaken as an important path for industrial upgrade, and the industry regulatory policies shall also be adjusted accordingto the changes in this industry’s characteristics.

Influencing Factors for Social Acceptance of Noma (Cancrum Oris) Patients in Niger: A Hospital-Based Cross-Sectional Study

Background: Noma, mostly identified in malnourished young children in the world’s low-income countries, causes severe orofacial disfigurement and significant mortality and morbidity. The majority of noma patients surviving with aesthetical effects are exposed to stigmatization and social rejection. Studies focusing on the socio-psychological impact of noma survivors have rarely been done. Our study aimed to identify the differences in social acceptance/rejection and the influencing factors associated with social acceptance in noma patients. Methods: A cross-sectional study was conducted at the NGO-Sentinelles (Niger) reception center on patients with noma from Zinder, Maradi, and Tahoua regions between 9th May 2017 and 2nd June 2017. The survey was conducted through a face-to-face interview on patients admitted to the center and those discharged from the centre after the treatment. The interview questionnaire comprised 45 questions (Cronbach’s alpha coefficient = 0.812) with pathological information, sociodemographic characteristics, and socio-psychological qualitative information. Findings: We recorded 50 noma patients (43 from Zinder and 7 from Maradi and Tahoua). The younger patients (1 - 5 years old), noma patients who stayed in school during follow-up treatment, patients who were referred by a health structure, patients enrolled into the centre in a short time (<30 days), and patients in the acute phase of noma had a significantly high social acceptance rate with 60.0%, 82.9%, 60.0%, 57.1% and 94.3% respectively;whereas single adults and cheek lesion site had the highest social rejection rate when compared to their corresponding factors with 60.0% and 86.7% respectively. There were significant differences in victims’ perception of noma [χ2 = 45.536, (P < 0.001)] and acceptance of their new faces [P = 0.023], between the social acceptance and social rejection rate, therefore all patients who accepted their new faces felt social acceptance. Social acceptance was significantly highly correlated with pathological history (admission method, phase of noma, care, and treatment received at center) with rs ranging from 0.609 to 0.810, moderately correlated with patient’s sociodemographic characteristics (age, marital status, and region) with rs ranging from 0.381 to 0.474. Lowly correlated with clinical evolution after treatment (rs = 0.293). Logistic regression results showed that the likelihood of social acceptance increased when the patient’s age was young (≤15 years), their marital status was minor, they were enrolled at the school before noma appearance, they were referred to the centre after diagnosis, the admission time to the centre was short (≤30 days), acute phase of noma, and care received at the centre was non-surgery. The location of the lesion on the cheek was a risk factor for social acceptance, indicating cheek lesions from noma increased the likelihood of social rejection in our study. Conclusion: The sociodemographic characteristics, pathological history, and psychological aspects of noma patients were correlated and were found to be important factors influencing their social acceptance/rejection rate.

Individual Care Pathways in the Context of Complex Therapeutic System--Therapeutic Model and Case Report

A complex multifactorial therapeutic system was established and developed during the past three years. Here present the basic approach and the individualized therapeutic strategies of this therapeutic system by examples of specific case reports. The aim of the study is to point out to the real mission of our outpatient care, namely psycho-social reintegration that is achieved by a therapy with a unique pattern. Case reports： 1. A 59-year-old female patient suffering from psychosomatic muscular tension, which started two years ago. After a partially effective cognitive-behavioral therapy a severe traumatic event in the patient＇s past in connection with the symptoms was revealed, then the trauma was processed via psychodynamic approach. 2. A 56-year-old female patient suffering from psychosomatic symptoms and depression went through a therapeutic healing process, which focused on the development and maturation of her personality （from a ＂child＂ to an ＂adult＂）. Conclusion： All the processes of the complex group-centered dynamic therapy proved more effective compared to the classic static relationship between the psychiatrist and the patient. The multifocal therapy is appreciated more and more in parallel to the experiences gained, making it easier to establish and strengthen the therapeutic alliance. The patients have positive feelings about the help given and the possibilities offered. The author＇s therapeutic team is appreciated by the patients and they regard the author＇s center as a peaceful location of their lives being under cover, where voluntarily and willingly they can participate in the individualized therapy with great success.

Reducing Recidivism With the Chances Program:Immigrant Juvenile Delinquents in Israel

This study aimed to examine the effectiveness of the Chances program,a program that was established in 2004 in order to prevent juvenile delinquency among immigrant youth in Israel.Previous research showed that immediately after the program ended,all participants stopped their delinquent behavior.The current research tested the effectiveness of the program two and a half years later and explored the risk of or immunity to recidivism among graduates of the program.A sample of 145 graduates was asked to fill out a closed questionnaire examining the effectiveness of the program through self‐report questions about recidivism.The results were significant,showing that only three of the graduates(14%of the sample)continued to commit felons,while the great majority(86%)reintegrated into normative life within the community including school,employment,and army service.Fears of disappointing their tutor were found central to the discontinuation of delinquency.The graduates also attributed other elements of the Chances program to their normative behavior and reintegration into normative society.The implications of this study demonstrate that although the Chances program was designed to treat immigrant delinquent youth,its success can be relevant for treating native‐born delinquent youth as well.

GREEN AGRICULTURE AND BLUE WATER IN CHINA:REINTEGRATING CROP AND LIVESTOCK PRODUCTION FOR CLEAN WATER

Crop and livestock production are essential to maintain food security.In China,crop and livestock production were integrated in the past.Today,small backyard systems are still integrated but the larger livestock farms are landless and largely geographically separated from crop production systems.As a result,there is less recycling of animal manures and there are lower nutrient use efficiencies in the Chinese food production systems.This,in turn,results in considerable losses of nutrients,causing water pollution and harmful algal blooms in Chinese lakes,rivers and seas.To turn the tide,there is a need for agricultural“green”development for food production through reintegrating crop and livestock production.An additional wish is to turn the Chinese water systems“blue”to secure clean water for current and future generations.In this paper,current knowledge is summarized to identify promising interventions for reintegrating crop and livestock production toward clean water.Technical,social,economic,policy and environmental interventions are addressed and examples are given.The paper highlights recommended next steps to achieve“green”agriculture and“blue”water in China.

The ＂narrative sincerity＂ in museums, architectural and archaeolosical restoration of Franco Minissi

The Italian historiography of the architecture of the second half of the Twentieth century has not given due weight to the dialectic qualities of work of Franco Minissi on ancient structures. He became known for the debate on the use of innovative materials in archaeological sites and not for the extent of his contributions. The world do not know his museums, Italian and not, his many conservation and restoration projects, his archaeological parks, redevelopments of historic centres, new buildings, interior design projects, shops and exhibitions. A reading of his museological works alongside of his experiments on archaeological sites, can help highlight the conceptual congruence with which Minissi tried to meet the needs of the present and the preservation of antiquities, as a dialogue with the past, of refined sensibility and intended to a reversibility respectful of preexistence. This places him among the key figures of the origins of the critical restoration, as an inspiration that continues to offer fruitful ideas to the new generations.