Eco-Innovation and IT Technologies for Sustainable Development of Health and Recreational Tourism of Serbia

The aim of the chapter is to point the importance of eco-innovation and IT technologies for the sustainable development of health and recreational tourism in Serbia. The subject of the research is the rehabilitation center in Eastern Serbia. The main idea of the chapter is to show how those hospital institutions use artificial intelligence-IT technologies for improving recovery services to patients in the post-COVID condition. The chapter will discuss the most common types of support and measures to facilitate the functioning of eco-tourism in Serbia with the aim to adopt good practices of developed countries (Hungary). Ecological tourism takes place in areas of pure and preserved nature. The contribution of the chapter is to point to new strategies in spa tourism, to shorten the time and reduce business costs. This would contribute to the sustainability of tourism.

Screening for Hypothyroidism in children with severe acute malnutrition at Nutrition Rehabilitation Center, Children’s Hospital and Institute of Child Health Multan.

Objective: To determine the percentage of Hypothyroidism in children with severe acute malnutrition. Study Design: Cross Sectional study. Setting: Nutrition Rehabilitation Center, Children’s Hospital and Institute of Child Health Multan. Period: January 2019 to December 2019. Material & Methods: A total of 255 malnourished patients (as per inclusion criteria) were included in current study. A written Performa was designed to collect history, anthropometric measurements and systemic examination. Taking aseptic measures venous blood was sent for baseline tests as well as for T3, T4 and TSH, total serum protein albumin and total ferritin levels to hospital laboratory. Correlation between serum thyroid concentrations and total protein, albumin, hemoglobin and serum ferritin were estimated by using t-test and p-vlaue less than 0.05 was considered as significant. Total collected data was entered and analyzed in SPSS version 21.0. Results: A total of 255 malnourished children were included in this study. Majority of studied subjects were male (52.5%) with 83.92%, 3-5 years of age. Amongst the 255 children mean values of T3 in MAM and SAM patients were 105.4 ng/dl and 89.7 ng/dl respectively. There was a statistically significant (p <0.001) association between decreased T3 and type of malnutrition. Similarly, mean values of T4 in MAM and SAM patients were 6.3 ug/dl and 5.7 ug/dl respectively that was statistically significant (p <0.05). Lower values of T4 were higher among SAM children in 1 to 3 years age group compared to respective MAM children with p value .0.05 and high T4 value in 3-5 years age group of MAM children were both statistically insignificant. Higher mean Values of TSH was found in SAM compared to MAM children both age groups. Conclusion: Severe acute malnutrition (SAM) is associated with reduction in T3 and T4 levels and higher levels of TSH in SAM children as compared to MAM. The altered thyroid hormone status in children with PEM is perhaps a protective phenomenon to limit protein catabolism and lower energy requirements.

Enhanced Recovery After Surgery Pathway: Association with Lower Incidence of Wound Complications and Severe Hypoalbuminemia in Patients Undergoing Posterior Lumbar Fusion Surgery

Background. Wound complications were associated with worse satisfaction and additional costs in patients underwent posterior lumbar fusion(PLF) surgery ,the relationship between enhanced recovery after surgery(ERAS)pathway and wound complications remains poorly characterized.Methods. In this retrospective single-center study, we compared 530 patients receiving ERAS pathway care with previous 530 patients in non-ERAS group. The primary aim of our study was to identify the relationship between ERAS program and the incidence of postoperative wound related complications and other complications following PLF surgery, other outcomes included the length of stay(LOS), 90-day hospital and rehabilitation center readmission.Results. Average patient age was 65yr. There were more patients with old cerebral infarction in ERAS group (p<0.01), other demographics and comorbidities were similar between both groups. Patients in ERAS group had a lower incidence of postoperative wound-related complications compared with non-ERAS group(12.4 vs 17.8%, p=0.02).The non-ERAS group had a significantly higher rate of wound dehiscence or poor wound healing(6% vs 3%, p=0.02). ERAS group had a lower incidence of server postoperative hypoalbuminemia(serum albumin less than 30g/L)(15.8% vs 9.0% p<0.01).Additionally, ERAS patients had a shorter postoperative LOS (8.0±1.5 vs 9.5±1.7 p<0.01), lower rate of readmission within 90 days (1.9% vs 6.4%, p<0.01) and discharge to rehabilitation center (4.2% vs 1.0%, p<0.01).Conclusion. ERAS pathway may help to decrease the rates of postoperative wound complications and server hypoalbuminemia following PLF surgery, additionally, we demonstrated that ERAS pathway was also associated with shorter LOS and lower rate of readmissions within 90-day.

Investigating the Development of Individuals with Mental and Physical Problems Receiving Water Therapy in a Special Education and Rehabilitation Center

Investigation of the physical and psychological development challenged individuals receiving water therapy in a private education rehabilitation center. The aim of this study is to investigate the physical and psychological development challenged individuals receiving water therapy in a private education rehabilitation center.5 children with mentally and physically problems who took water therapy in the Special Education Rehabilitation Center participated in the study. Children aged between 3-8. Children who have mentally problematic, who have participated in the research, have severe, moderate and mild mental problems and who have problems physically also have placenta, quatri plaque, spina bifida etc. children with orthopedic insufficiency.Special mobility training program was prepared for the children to be able to make joint problems for children with mental problems and physical problems. While the program was being prepared, support was received from special educator, water therapist and repertoire people.The study was administered 4 months, 2 days a week and 60-90 minutes. At the beginning of the research, the children who had mental problems were afraid of entering the water, they did not comply with the commands, they did not want to be separated from the mother and father.At the end of the research process, children with mental problems enter the water comfortably and even hurry to enter, they are not afraid of water, they are more adaptable to the commands, they continue to work separately from their parents, they are more willing to enter the water in children who have problems with orthopedic problems. It was observed that most of the children who wanted to move in the water, they were mostly able to perform the movements, and the majority of the children (90%) who had walking pants had walking exercises.

Health Status Stability of Patients in a Medical Rehabilitation Program: What Are the Roles of Time, Physical Fitness Level, and Self-efficacy?

Background Individuals’ physical and mental health, as well as their chances of returning to work after their ability to work is damaged, can be addressed by medical rehabilitation. Aim This study investigated the developmental trends of mental and physical health among patients in medical rehabilitation and the roles of self-efficacy and physical fitness in the development of mental and physical health. Design A longitudinal design that included four time-point measurements across 15 months. Setting A medical rehabilitation center in Germany. Population Participants included 201 patients who were recruited from a medical rehabilitation center. Methods To objectively measure physical fitness (lung functioning), oxygen reabsorption at anaerobic threshold (VO2AT) was used, along with several self-report scales. Results We found a nonlinear change in mental health among medical rehabilitation patients. The results underscored the importance of medical rehabilitation for patients’ mental health over time. In addition, patients’ physical health was stable over time. The initial level of physical fitness (VO2AT) positively predicted their mental health and kept the trend more stable. Self-efficacy appeared to have a positive relationship with mental health after rehabilitation treatment. Conclusions This study revealed a nonlinear change in mental health among medical rehabilitation patients. Self-efficacy was positively related to mental health, and the initial level of physical fitness positively predicted the level of mental health after rehabilitation treatment. Clinical Rehabilitation More attention could be given to physical capacity and self-efficacy for improving and maintaining rehabilitants’ mental health.

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.

The Effects of live- in rehabilitation on ARV adherence, abstinence from drugs and lifestyle modification in people who inject drugs (PWID) Living with HIV – A clinic review

Background & Objective: HIV/AIDS is mostly seen in people who inject recreational drugs (PWID). Adherence has to be optimum for its treatment to be effective. Compliance to HIV medication has been problematic in PWID making HIV control difficult. Many studies in the past have validated educational activities like rehabilitation programs beneficial in maintaining regularity in medication intake. This brought us to the question of looking at such programs and its effects on our population. This study was conducted to assess the impact of other perspectives of abstinence and adherence including family support and employment status on a person’s willingness for treatment continuation and avoidance of drugs. Methods: A retrospective chart review of 241 PWID was conducted to assess adherence to antiretroviral agents (ARVs) and abstinence from recreational drugs post visit to the rehabilitation center. Associations with family support, marital status, employment, income and back to work status were also assessed. Results: Adherence to ARVs had significant statistical association with marital status (p=0.025), starting work again (p=0.001), family support (p=0.009), employment status (p=0.009) and monthly income (p=0.025). While family support (p=0.033), employment status (p<0.0001), Going back to work (p<0.0001), mode of travel to Rehabilitation center (p<0.0001) and monthly income (p=0.004) were associated with abstinence from drugs. Duration of rehabilitation or age had no effect on adherence or abstinence in our patient population of PWID. Conclusion: Family and spousal support and employment promote optimal ARV compliance and should be encouraged when starting ARVs. Enrollment in a long-term complementing educational program would further enhance ARV intake and abstinence. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5780 How to cite this:Hussain A, Rahim A, Sheikh A, Jiwani A. The Effects of live- in rehabilitation on ARV adherence, abstinence from drugs and lifestyle modification in people who inject drugs (PWID) Living with HIV – A clinic review. Pak J Med Sci. 2022;38(2):411-416. doi: https://doi.org/10.12669/pjms.38.ICON-2022.5780 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Imposing criminal liability on juveniles: problem issues and ways to address them

The article highlights the issues of how to impose criminal liability on juveniles. Based on the analysis of consistency between the effective Criminal Code of Ukraine and the international standards of juvenile rights protection, the author has outlined the ways of how to improve the existing legal standards of such imposing. More specifically, the grounds for punishment mitigation have been determined depending on the gravity of offence. The punishment should be consistent with the offence committed. And the best way to match the punishment and the offence is when the punishment derives from the offence itself, from its nature. A fine will be a good enough response, because it makes the committed offence kind of unprofitable for the convicted individual. One of the punishments that the Criminal Code of Ukraine anticipates for juveniles is a fine. However, Article 99 of the Criminal Code of Ukraine mentions no minimum fine amount allowed for juveniles. As these specific standards are absent, juveniles should be subject to the general standards available, i.e. the minimum fine amount is equal for both juveniles and adults. It would be reasonable to decrease the minimum fine amount for juveniles in the Criminal Code of Ukraine. The author believes that the only guarantee for this fine to be paid can be the standalone property owned by the convicted individual, which could be foreclosed. An important type of punishment for juveniles is correction works. However, no specific conditions of its imposing on juveniles exist. One of the major ways to influence the individual convicted to correction works is labor and disciplinary impact of the labor collective (employees), which is but unfeasible today. In fact, no legal pattern exists to ensure that the employees will fulfill their obligations to rehabilitate the convicted individuals. Yet another type of punishment that Article 98 of the Criminal Code of Ukraine anticipates for juveniles is arrest. That arrest is considered a milder type of punishment in the punishment list than restraint can be deemed a disadvantage of the Criminal Code of Ukraine, 2001. At the same time, it is proposed to impose the so-called “youth arrest” on the juveniles of fourteen and on older ones, i.e. the service of punishment on days-off or holidays. The analysis of the system of punishments imposed on juveniles for the committed offences, which has been made in this article, shows that this system not always makes it possible to select the punishment consistent with the action committed. That is why the author has proposed to add new types of punishment to the already existing statutory system of punishments, such as obligating a juvenile to recover the caused damage or to execute certain works in favor of the affected party to compensate it for the damage caused; depriving a juvenile of the right to be engaged in certain activities; sending a juvenile to a special custodial rehabilitation center.

METHODICAL ASPECTS OF THE DEPLOYMENT OF A MEDICAL REHABILITATION CENTER BASED ON THE MILITARY SPA ORGANIZATION

One of the areas of use of military sanatoriums in peacetime and wartime is the organization of medical rehabilitation centers (CMR) at their base. The medical staff of medical and preventive institutions at the stages of rehabilitation should have a clear understanding of the place and importance of medical measures in the overall task of protecting troops, effectively interact with other specialists in the tasks of providing military personnel, carrying out rehabilitation of the affected and sick for the rapid return of the reconvalescenes, medical rehabilitation of patients after routine operations, ensuring the observation regime and effective postcovid rehabilitation of patients.