Family Caregivers’ Experiences and Coping Strategies in Managing Stroke Patients during the COVID-19 Pandemic: A Qualitative Exploration Study

Background: Stroke is a chronic disease that requires stroke survivors to be supported long-term by their families. This is especially because of the inaccessibility to post-stroke rehabilitation outside hospitals. The Corona Virus Disease 2019 (COVID-19) crisis and the pandemic restrictions in Malaysia are expected to exponentially increase the demand from family caregivers in supporting stroke survivors. Thus, this study aims to explore the burden, experience, and coping mechanism of the family caregivers supporting stroke survivors during the COVID-19 pandemic. Methodology: A phenomenological qualitative study was conducted from November 2020 to June 2021 in Malaysia. A total of 13 respondents were recruited from two public rehabilitation centers in Kota Bharu, Kelantan. In-depth interviews were conducted with the participants. Comprehensive representation of perspectives from the respondents was achieved through purposive sampling. The interviews were conducted in the Kelantanese dialect, recorded, transcribed, and analyzed using thematic analysis. Results: Three themes on burdens and experiences were identified. They were worsening pre-existing issues, emerging new issues, and fewer burdens and challenges. Two themes on coping strategies were also identified. They were problem-focused engagement and emotion-focused engagement. Conclusions: The COVID-19 pandemic has changed the entire system of stroke management. While family caregivers mostly faced the extra burden through different experiences, they also encountered some positive impacts from the pandemic. The integrated healthcare system, especially in the era of digitalization, is an important element to establish the collaborative commitment of multiple stakeholders to compensate burden and sustain the healthcare of stroke survivors during the pandemic.

Epidemiological characterization of stroke cases under rehabilitation on the Brazilian Unified Health System in Mossoró, Rio Grande do Norte

Objectives: To identify the clinical and epidemiological characteristics of patients undergoing treatment for a stroke at the only public rehabilitation clinic in Mossoró/RN (Doctor Ozias Alves de Souza Rehabilitation Center). Methods: Quantitative, prospective, descriptive, cross-sectional, exploratory study, structured from responses to a clinical-epidemiological and sociodemographic questionnaire with 39 items, to assess aspects concerning the profile of patients affected by stroke and undergoing rehabilitation treatment. Results: Twenty-eight individuals with stroke sequelae undergoing treatment at the rehabilitation center were identified, whose clinical-epidemiological characteristics revealed equivalence concerning gender (50% male:female), the predominance of white and brown color/race (46.4% each), and overweight (35.7%). Most of the patients lived in a family environment with a spouse (64.3%), were retired (71.4%), with monthly income between one and two minimum wages (64.3%), with hemiplegic sequelae resulting from the stroke (85.7%) and difficulties in adapting to the current way of life (75%). Conclusion: The present study allows an initial scrutiny of stroke cases in Mossoró/RN and their rehabilitation process. Such data may contribute to a better understanding of issues concerning stroke by government sectors, aiming to improve care and multidisciplinary interventions to provide patients with reinsertion in both work practice and in everyday social relationships.

Exploring prevention and management of secondary health conditions in people with spinal cord injury in South Africa

Background/Aims Preventative care for people with spinal cord injury is neglected, even though secondary health conditions are prevalent among this group. There is limited information on preventative care for secondary health conditions among people with spinal cord injury. This study aimed to explore how people with spinal cord injury prevent and manage secondary health conditions. Methods A total of 17 individuals with spinal cord injury attending an outpatients clinic at a public rehabilitation hospital were interviewed face to face. All the interviews were transcribed verbatim and analysed using thematic content analysis. Results The participants used different strategies to prevent and manage secondary health conditions, such as medication, assistive devices, self-management, resilience coping strategies and therapeutic approaches. The participants found prevention of secondary health conditions ‘challenging’ and some of the strategies were ineffective. Conclusions Although many strategies are used by people with spinal cord injury to prevent and manage secondary health conditions, the experience is difficult. To minimise the occurrence and the consequence of secondary health conditions among people with spinal cord injury, health professionals must promote and support preventative care for secondary health conditions.

Perspektywy renesansu publicznego stosowanej pedagogiki społecznej w postindustrialnej przestrzeni

The author takes up a critical approach to several concepts presented in the literature of social sci- ences, on so expected problems of public rehabilitation and revitalisation during the active enggement of such subdiscipline as modern social pedagogy. He analyses the local urban space, opposed to spontaneoulness chaos and anomia accured in public structures. The paper warns againt the relin- quishment in local communities of earlier order and the whole social network. It could becme in each posttransformated cociety during the social change. The aim of the paper was to mobilise on future a public support across education and prophylaxis to avoid a lot of individual and collective traumatic and neurostic feelings.

The struggle for memory: Jian Bozan on historical materialism

This paper offers a first analysis of the philosophy of history developed by Jian Bozan (1898–1968), the author of China's earliest comprehensive exposition of historical materialism. Despite his central importance for the establishment of professional historical studies in PRC, the existing studies neglect Jian's original contribution to the development of Chinese Marxism and his pre-war works in general, focusing solely on his participation in the debate over the relation between history and theory in the 1960s. The paper seeks to fill this lacuna by providing a critical account of Jian Bozan's understanding of historical laws, progress, the stages of history, human freedom and the class struggle. Jian's synthesis of historicism and historical materialism, which at a time was seen as an alternative to the Maoist view of history, was officially condemned during the Cultural Revolution and led to his premature death. However, this paper demonstrates that, following the public rehabilitation of the thought of Jian Bozan in 1978, it was his system that had an important impact on the historiography in Dengist China. Furthermore, the paper argues that Jian's approach to historical materialism brought many novelties in relation to the preceding Sino-Marxist views of history.

Regional Organization of the Rehabilitation Service in Coronavirus Epidemic

The COVID-19 pandemics has dramatically changed the organization of public rehabilitation services around the world. Rehabilitation managers and doctors have faced different challenges at all stages of patient management from acute departments to home, especially in the periphery of the country. Aim. To analyze and present the regional experience of rehabilitation system reorganization during pandemics. Materials and methods. The Southern region of Israel is a big part of the country with about one million of population. The Physical Medicine and Rehabilitation department at the Soroka University Hospital is a part of the regional rehabilitation network, and was forced to find optimal solutions to all kinds of organizational challenges from the first days of the crisis. Most of those solutions, which, in our opinion, showed their effectiveness in managing our patients in this confused situation are presented and discussed in the article. Results. COVID-19 pandemics crisis had mostly a negative input on the whole system organization. The normal regular flow of multistage rehabilitation process was interrupted, serious part of professional staff was out of system due to quarantine and pandemic restrictions. The whole system was forced to change the management algorithms very quickly, sometimes as an immediate response to everyday changes. However, some changes that have occurred in response to the changed conditions may have a positive impact on the work of the rehabilitation system in the future and will also be discussed in the article. Conclusion. Our regional professional situation, of sure, is a combination of local rehabilitation organization and characteristics of Israeli health system, and from that point of view it is quite unique. But the problems of periphery are almost the same in every country so our local experience can help professionals in other regions.

How do Romanian patients perceive and experience public and private rehabilitation services?

The quality of medical and rehabilitation services is a constant topic of debate. Health service quality is defined as the degree and direction of discrepancy between patients’ perceptions and expectations. The present study is a conclusive direct investigation that aims, among other things, to record the differences between private and public rehabilitation systems, and compare the results obtained from questionnaires applied to patients. The main hypothesis from which we started this research was that there were differences in terms of patient-physiotherapist relationship and quality of services between public and private rehabilitation systems. This research was carried out using the following methods: bibliographic study method, observation method, questionnaire method, mathematical and statistical processing method, and graphical method. The study was conducted over a period of ten months (June 2018 - April 2019) in seven private rehabilitation institutions and two public rehabilitation institutions in Târgu Mureș, Romania, on a total of 260 patients. Data analysis revealed statistically significant quality gaps between rehabilitation services offered by private versus public institutions. Following the investigation, interpretation, and analysis of recorded results, we can say that the hypothesis has been confirmed. Public rehabilitation institutions failed to meet patients’ expectations in all major areas of service quality.

(In)visibility of children with special health needs and their families in primary care

ABSTRACT Objectives: to discuss the (in)visibility of children with special healthcare needs and their families in the Primary Health Care scenario. Methods: experience report about the difficulties faced by researchers from different regions of Brazil to locate children with special healthcare needs in the scope of primary care. Results: the main reason for these children and their families to be “unknown” and, therefore, not assisted in PHC, is the fact that they are followed-up by institutions/outpatient clinics and specialized and/or public rehabilitation clinics, or even because they have private health insurance. Final Considerations: transferring care responsibility to the Primary Health Care teams to specialized and rehabilitation institutions may be related to the lack of knowledge of the care demands of this group, as well as to the relevance of care centered on rehabilitation and the specialty instead of the long-term care, one of the features of primary health care.