Reuben Eldar

Stroke in the Young in Israel Incidence and Outcomes

BACKGROUND AND PURPOSE Data on stroke in the young in Israel are fragmentary. To obtain an overall perspective and to assess the nature and magnitude of the problem, a study was conducted on stroke occurrence in the young population during 1 year. Incidence and outcomes are reported in this communication. METHODS We conducted a prospective ascertainment of first stroke in all permanent residents of Israel aged 17 to 49 years who were referred to all acute-care hospitals in the country or died before reaching them. RESULTS We identified 253 first stroke victims in the studied population; 62.8% were male. The age- and sex-adjusted incidence rate for all types of stroke was 10.36/100 000 per year (males, 13.00; females, 7.71). The majority of strokes (80.6%) were cerebral infarctions, with 9.9% intracerebral hemorrhages, 7.9% subarachnoid hemorrhages, and 1.6% strokes of unspecified type. The case-fatality rate for all types of stroke was 9.9% (mortality within the first 4 weeks after the event, on average 6 days). The survival rate was 95% for cerebral infarctions, 64% for intracerebral hemorrhages, and 80% for subarachnoid hemorrhages; 86.7% of all survivors remained with an impairment resulting in a disability. CONCLUSIONS Incidence rates were similar to those reported from developed Western countries. The case-fatality rate of 9.9% and the considerable percentage of survivors with a disability in a population at the beginning of their family, professional, and social lives indicate the magnitude of the problem.

Tai Chi Chuan practice in community-dwelling persons after stroke.

Eighteen community-dwelling first-stroke survivors, aged 45 to 65, underwent following examinations: Rombergs Test, standing on the unaffected leg, Emory Fractional Ambulation Profile, the Berg Balance Test, the Timed ‘Up and Go’ Test and the Duke Health Profile. They were then randomly divided into two matched groups of 9 subjects each. The study group (SG) received Tai Chi exercises and the control group (CG) physiotherapy exercises focused on improvement of balance, both groups for 1 h twice weekly for 12 weeks. On completion of exercises, SG subjects showed improvement in social and general functioning whereas CG subjects showed improvement in balance and speed of walking. It is concluded that there are potential and no adverse effects in Tai Chi practice in stroke survivors.

Rehabilitation medicine in countries of Central/Eastern Europe

Purpose. To describe attributes of rehabilitation medicine common to the five countries of Central Eastern Europe (CEE) and their implications for future challenges. Methods. Critical collection and study of pertinent data on evolvement and present state of rehabilitation medicine in CEE countries by a coordinated team of rehabilitation experts from each of the relevant countries. Results. CEE countries are similar in their need for rehabilitation medicine, its evolvement, present state and current practice. Settings largely emerged without strategic planning on the national level and lagged behind those in Central and Western Europe both in time and content. Conclusion. The framework that evolved in all except Slovenia is not appropriate to needs. In order to meet future challenges all five CEE countries need the incorporation of inpatient, outpatient and community-based rehabilitation into one system.

Rehabilitation medicine in Croatia -- sources and practice.

Sources of rehabilitation medicine, the need for rehabilitation and its practice in Croatia were studied, based on available data. The study revealed that current practice has advanced since the countrys independence, but that there are many shortcomings; adequate care is not provided to all who could benefit from it, and there is wastage of resources.

The system for medical rehabilitation in Croatia

Purpose. To describe the framework for medical rehabilitation in Croatia and to discuss its influence on the practice of the specialty. Methods. Collection, analysis and interpretation of data pertaining to the need for medical rehabilitation in the country and to its elements of structure, process and outcome of care. Results. The practice of medical rehabilitation in Croatia has evolved without strategic planning on the national level and therefore without a designed system. This lack in the present framework causes shortcomings in all three elements of rehabilitation care and impedes the advancement of the specialty. Conclusion. Medical rehabilitation in Croatia needs a national strategic plan for a three-level system that incorporates inpatient, outpatient and community-based rehabilitation.

Process and outcome of care: comparison of two inpatient geriatric rehabilitation settings

The objective of this study was to compare the process of care and outcome of rehabilitation in geriatric hospitals and in geriatric wards of general hospitals. It was longitudinal in design. Patients were interviewed on admission and on discharge. Data were retrieved from medical records and a questionnaire on the process of care was administered to staff members. Geriatric wards in four general hospitals and four independent geriatric hospitals in Israel provided the setting and approximately 50 consecutive admissions of patients with hip fracture or stroke, a total of 410 patients, were recruited from each setting. Four process indices and three outcome indices were used to measure quality of care. % The main outcome showed that the functional status of the study population was higher on discharge than on admission and most patients were discharged to their former residence. When controlling for other variables, geriatric hospitals contributed more to higher functional status on discharge than did geriatric wards in general hospitals. Yet satisfaction with treatment was higher in geriatric wards in general hospitals than in geriatric hospitals. The main factors affecting patient satisfaction were functional status on discharge and the amount of rehabilitative treatment given.

Minor injury resulting in lower-limb loss in diabetic patients

Objective: to identify diabetic patients who had undergone recent amputation of the lower limb, and in whom a possibly avoidable minor injury to the foot had caused infection and gangrene necessitating surgical intervention. Design: questionnaires, administered to consecutively admitted recent lower-limb amputees, addressing demographic, socio-economic and medical data and containing specific questions on circumstances or events that might have caused a foot lesion that started the infection, gangrene and eventually amputation. Setting: department of orthopaedic rehabilitation in a rehabilitation hospital. Patients: 218 recent, lower-limb amputees - due to occlusive arterial disease, with or without diabetes - admitted for prosthetic rehabilitation during 30 months (January 1989 to June 1991). Results: 56 diabetic and 10 non-diabetic amputees were identified in whom a minor injury had caused the sequence leading to amputation which could have been avoided by adequate attention to the feet and their care. Conclusions: All diabetic individuals need education regarding self-care and attention to the feet, irrespective of their demographic or socio-economic variables and disease severity. The view is expressed that such an education — particularly when linked to the provision of necessary health services - would be able to reduce the risk of amputation in diabetes mellitus considerably.