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There are no national Telerehabilitation Services in Pakistan: a Rehabilitation standards on the reasonable length of time for a call bell to be Professional’s Perspective answered discount slip inn 1pack online. The objective of this study is to understand staff per- ception on why patients use their call bell system and to ascertain *Z cheap slip inn 1pack otc. Design: An exploratory, qualitative study over 2 weeks involving feedback from neurological rehabilitation staff. Introduction/Background: Physical Rehabilitation Services allows Setting: Level 1 Neurological Rehabilitation Unit. Participants: disables to restore their normal life and to play role in develop- Voluntarily participation staff. Use of Tele-Medicine for provision of rehabil- J Rehabil Med Suppl 54 E-Posters 455 itation services at community level is very in. This study is aimed to assess Sensor Networks on Activity of Daily Living in Hemiple- the need and scope of Tele-Rehabilitation Services in Pakistan ac- gic Patients after Stroke cording to the Different Rehabilitation Professionals working in feld. Results: About 7% graded existing Rehabilitation Services System in Pakistan as v. Introduction/Background: To home rehabilitation training based on More than 20% graded existing number of Rehabilitation Centers body sensor networks on activity of daily living in hemiplegic pa- as “Somewhat Satisfactory”. Material and Methods: Forty-eight hemiplegic ing good Computer Knowledge with signifcant knowledge about patients were divided randomly into treatment (n=24) and control Telemedicine and Telerehabilitation. Both groups were treated with medicine and reha- that Telerehabilitation programs will be very useful in provision of bilitation guide, the treatment group also was added with the home Rehabilitation Services in Pakistan with maximum social accept- rehabilitation training, training lasted for 10~20 min/d, 6 d/week ance and will reduce the disables visits to big cities. Results: Before intervention, there were no signifcant differ- may have some limitation in developing good doctor, patient re- ences between the two groups in any of the assessment, 12 weeks lationship. Conclusion: In this control group Conclusion: The application of home rehabilitation study it is concluded that Telerehabilitation Services will be very training based on body sensor networks can distinctly improve the useful and socially acceptable in Pakistan and will help to reduce motor function of upper limb and activity of daily living. From these, par- ticipating in community activities is important for elderly’s health Objective: To design and develop a type of comprehensive rehabil- as well as preventing becoming homebound elderly. Methods: A distributed database system was designed garding the demands for urban development, and eight questions and established after a systematic analysis of the rehabilitation regarding the usage of pubic transports, and were sent to partici- work fow and the data need to be disposed, then we developed pants by mail. Only those classi- some appropriate application modules based on the database, such fed as ‘‘not-homebound elderly’’ were included in the study, the as treatment planning module, effcacy evaluation module, out- subjects were 1,201. Subjects were divided into two groups by come prediction module and performance appraisal module. In other words, it was revealed that that the patient related factors (motivation, illness perception, pain some of use situation and demands of the public transport was not level. Additionally the organizational settings and the individual ment should spend a budget preferentially. To incorporate the patients beliefs in the selection of therapeutical regimes may also ensure a effcient as well as an *C. Furthermore Background: It is forecasted that persons aged 60 years and older organizational factors as well as communicational skills are major will exceed 2 billion by 2050, approximating 21% of the world’s markers for compliance with the prescribed therapies. However, demand for healthcare services Analysis of Scores Obtained in Games of Balance of Vide- among older population is expected to rise, especially among those who are living with disabilities. This study aims to estimate the ogame in Patients with Stroke during 24 Weeks – Pre- prevalence rate and identify social demographic factors associ- liminary Datas ated with healthcare service use among Chinese elderly with dis- *F. The weighted prevalence rate of healthcare ser- ing force platforms introduce the proposal of improving the bal- vice use was 36. However, it healthcare services was observed among older age groups, males, is not known if the users get a better score with this training and less educated, singles, rural dwellers, non-eastern residents, with how would be the progression of the score obtained in the interven- the lower annual family income, without medical insurance cover- tions. The study proposes to investigate the behavior of this score in age, without a disability certifcate, with a single disability, and individuals with stroke during 24 weeks of experimental protocol. Conclusion: Low use of healthcare Material and Methods: Seven patients with stroke underwent exper- services indicates an unmet need among Chinese elderly with disa- imental protocol (2 x/week, 60 minutes) in which were elected the bilities especially for the old-old. Scores were collected to enhance healthcare service use among the elderly with disabili- during 24 weeks for observational analysis. Vocational rehabilitation of the tribution, the values of the initial and fnal points were compared older disabled person[J]. Comparing the two scores – frst and last - a signifcant gain was verifed in both of the games: Penguin Slide (p=0. Conclusions: The subjects showed (Pilot Study) improvement in the scores of games during the experimental pro- 1 2 1 2 tocol, indicating that learning was achieved in the realization of *E. Material Comparison of Scores Obtained by Videogame with Bio- and Methods: All patients (n: 558) receiving more than 3 therapies mechanical Variables in Stroke – Preliminary Data either in an ambulatory or clinical setting flled out 2 questionnaires. Patient who terminated preliminary their therapy (drop sive and repetitive training that enables motor learning and may in- outs) were documented and counted as non- compliant patients. Material after Lu Shan Earthquake and to provide informations for the fur- and Methods: Four patients with stroke participated in experimental ther clinical researches in this feld. The both groups have signifcant subjects should be conducted to confrm the results. The effects are infuenced by other factors such as Support From Hong Kong to Launch and Upgrade Oc- funding for earthquake and social support.

This a very conservative approach to asses risk of adverse outcomes after exposure to medications slip inn 1pack. Moreover purchase slip inn 1pack with amex, it has been demonstrated that most filled prescriptions by pregnant women are taken [278]. Assessment of outcome In study 3, we did not have statistical power to analyze preterm birth in the three subgroups (moderate or late preterm birth – 32 to 36 completed weeks of gestation, very preterm – between 28 and 32 weeks of gestation, and extreme preterm – delivery occurring before 28 weeks). The curve is based on the birth weights of different infants born at different gestational ages, rather than longitudinal measurements of the same infants over the course of gestation [263]. The linkage between data on the mother and child’s birth weight is not possible for 4% of pregnant women included in the Registry. Information bias In case-control studies, in which information is obtained from past records, information bias can be introduced if the quality and extent of information obtained is different for cases when compared to controls. If a confounding variable is misclassified, the ability to control in the analysis is compromised. If nondifferential classification was present for these variables, residual confounding by indication cannot be ruled out. In study 3, if women selected as cases of preterm birth did not actually take their anti-infective drugs, the results of this study could reflect an underestimation of the protective effect of the exposure to anti-infective drugs on the risk of preterm birth. In addition, women considered not having sucg diagnosis can actually have less severe asymptomatic forms of infections. However, misclassification for these ariables, if exists, is probably nondiferential. Independent nondifferential misclassification of a dichotomous confounding variable reduce the extent to which the confounder can be controlled, causing a bias in the direction of the confounding variable [279]. This fact may generate distortions produced by uncorrect ascertainement of subjects into different analisys strata, which can partly explain some of the associations found in studies 3 and 4. However, given the low prevalence of asymptomatic cases, and the results of the sensitivity analises (Study 3), we don’t believe that these limitation undermine our conclusions. Confounding by indication and lack of data on life styles factors and socio-demographic characteristics Confounding by indication occurs when a potential association between exposure to a medication and a given outcome is masked or enhanced by severity of the indication for which the medication was prescribed. To handle the problem of confounding by indication in our studies, we used multivariate logistic regression models to generate adjusted odds ratio, by simultaneously controlling for diagnosis of infections. However, given that we did not have information on severity of infections, it is possible that confounding by indication could partially explain some results of study 3 and 4. Confounding by indication can also explain the increased risk of preterm birth after exposure to metronidazole (Study 3). In these trials, the 257 reference group consisted of women with infections (and therefore, at risk of preterm delivery) treated with an anti-infective drug, against which the agent of interest was compared. These studies did not explore the use of all combined anti-infective drugs; 2) Study 3 is a case-control study where the reference category consists of pregnant women without preterm birth. It is possible that women treated with different anti-infective drugs had different severity of infections, and therefore different baseline risk for preterm birth. As stated before, the results of study 3 can have the influence of confounding by indication. Administrative databases are a cost-effective source of data for health services research, but lack of data on life styles factors and socio- demographic characteristics are the main criticisms. In study 3, there is a possibility of residual confounding due to the absence of adjustement for previous history of preterm birth, a known risk factors for preterm birth and that can also be associated with infections. Data on maternal height and weight are also lacking in the Quebec Pregnancy Registry. Therefore, this cohort may over represent women with lower socioeconomic status, which might affect the generalisability of some findings that may be more strongly associated with socio-demographic factors. However, it has been previously shown that in the Quebec Pregnancy Registry, socioeconomic status is an effect modifier, and thus doesn’t affect internal validity of the etiologic studies presented in this thesis (Study 3 and 4) [257]. External validity and selection bias can be tanglible limitations for Study 1 and 2, which are based in prescription practices and the use of anti-infectives among women of lower socio-economical status. Individuals of lower socio- economical status have a higher probability of having infections and therefore, used more anti-infective drugs, implying that the results of Study 1 and 2 are overrepresented. As stated before, there are substantial differences between pregnant women insured by the Quebec’s Public Drug Insurance Plan and those insured by private drug insurance plans (see section 4. For this reason, results for predictors and trends of use, and types of anti-infective drugs found in these studies cannot be extrapolated for international comparisons. Multiple testing Finally, we cannot exclude the possibility of chance findings for 5% of our statistically significant associations due to the number of comparisons made in our studies. Given the social and economic burden of these adverse pregnancy outcomes, the development of strategies to improve access to effective anti-infective treatment of maternal infections must remain a top research and operational priority. Developing such strategies will depend on the design of evidence- based studies that furnish improved estimates of the impact of such use on the health of the mother and children [174]. This thesis provided knowledge on the use of anti-infective drugs during pregnancy that can be useful for health care professionals and pregnant women.

De omgevingsfactoren zijn mogelijk verantwoordelijk voor de grote aantallen auto- immuunziekten in de Westerse wereld order 1pack slip inn. Uit verscheidene onderzoeken is gebleken dat bepaalde geneesmiddelen gerelateerd zijn aan het ontwikkelen van auto- immuunziekten 1pack slip inn with amex. Ook worden deze medicijnen voor- geschreven aan patiënten die al bekend zijn met hart- en vaatziekten (secundaire preventie). Naast de cholesterol- en bloeddruk verlagende effecten, laten veel onderzoeken zien dat deze drie geneesmiddelen ook ontstekingsremmende en immuun-modulerende (effect op het immuunsysteem) eigenschappen hebben. Deze eigenschappen kunnen effectief zijn in het behandelen van bepaalde auto-immuun- ziekten. De immuun-modulerende eigenschappen van deze drie geneesmiddelen kunnen naast de behandelingseffecten ook een ongewenste invloed hebben op het immuunsysteem. Op het moment van toelating van een geneesmiddel op de markt is niet alles bekend over de veiligheid van het geneesmiddel. Pas jaren nadat het geneesmiddel op de 8 markt gebracht is, kan het volledige veiligheidsprofel verkregen worden. Dit gebrek aan kennis kan mogelijk liggen aan de tekortkomingen van een klinische trial. Mogelijke tekortkomingen van klinische trials kunnen zijn dat ze een te kleine groep patiënten bevatten of alleen patiënten bevatten die nagenoeg dezelfde karakteristieken en medische geschiedenis hebben. Een andere oorzaak kan zijn dat ze een beperkte duur hebben en er geen rekening wordt gehouden met hoe het geneesmiddel in de dagelijkse praktijk wordt gebruikt door de patiënten. In de praktijk blijkt het ook nog eens een uitdaging te zijn om een auto-immuun gerelateerde bijwerking op te sporen, aangezien deze bijwerkingen vrij zeldzaam zijn, ze pas na langdurig geneesmiddelen gebruik verschijnen en niet altijd verdwijnen na het stoppen met het geneesmiddel. Om onze hypothese kracht bij te zetten hebben we drie onderzoeken uitgevoerd met gegevens uit een database van spontaan gerapporteerde bijwerkingen tijdens het gebruik van statines in de dagelijkse praktijk (hoofdstuk 2). In dit onderzoek vonden we dat het statinegebruik vaker was gerapporteerd in patiënten met een lupusachtig syndroom dan in patiënten die een andere bijwerking hadden doorgemaakt. Deze bevinding ligt in lijn met een eerder uitgevoerd onderzoek, dat gebruik maakte van gegevens uit de Franse bijwerkingen database. We hebben onze hypothese getest door gebruik te maken van databases met elektronische medische patiëntengegevens. In deze database staan van de patiënten de voorgeschreven medicatie, ziekten en verwijzingen naar specialisten beschreven. Wanneer we de statine-gebruikers indelen in nieuwe gebruikers en voormalige gebruikers vinden we dezelfde resultaten. We hebben dit aangetoond in een proefdieronderzoek, dat later zal worden besproken. In een onderzoek van verscheidene patiëntenrapporten van statinegerelateerde lupusachtig 8 syndroom, laat het grootste deel van deze patiënten zien dat de periode tot het ontstaan van lupusachtige syndroom minder dan een jaar is. Een mogelijke verklaring voor het verschil in de resultaten van onze studies (hoofdstuk 3. Ook al gebruikten wij twee verschillende onderzoeksopzetten en databases in hoofdstuk 3. Bewijs voor de relatie tussen deze twee geneesmiddelen en de aanwezigheid van auto-immuunziekten komt voort uit patiëntenrapporten, proefdierstudies en patiënten met een bepaalde auto-immuunziekte. Er wordt algemeen gedacht dat statines, naast een ontstekingsremmende werking, ook een directe immuun-modu- lerende werking hebben op T-cellen. T-cellen zijn afweercellen die verantwoordelijk zijn voor de cellulaire immuniteit. Cellulaire immuniteit is een immuunreactie die gericht is op het onschadelijk maken van virussen en bacteriën. Eén van de typen T-cellen zijn de T-helper cellen die vervolgens weer onderverdeeld zijn in onder andere T-helper (Th) 1 en Th2 cellen. Statines kunnen ook een verschuiving van Th1 naar Th2 immuunreactie bevorderen, met als gevolg een ontregeling in de immuun homeostase. Homeostase is het in evenwicht zijn van allerlei functies (zoals temperatuur- en zuurgraad) en het vermogen van het lichaam om dit evenwicht te behouden, ondanks omgevingsinvloeden. In hoofdstuk 4 hebben we de effecten van statinegebruik op de aangeboren (“innate”) en verworven (“adaptive”) afweer (immuniteit) en zelfs de tolerantie van het immuunsysteem onderzocht. Het onderzoek werd uitgevoerd onder personen uit de algemene bevolking die al of niet waren blootgesteld aan statines. Verder vonden we in de statine-gebruikers een trend naar een hogere concentratie IgE antilichamen, dat is een merkstof voor een Th2 immuunreactie. Er werden geen verschillen waargenomen in de concentraties neopterine, een merkstof voor een Th1 immuunreactie, en de aanwezigheid van de autoantilichamen tussen de statine-ge- bruikers en niet-gebruikers. Onze bevindingen suggereren dat de statines een ont- stekingsremmende werking hebben, maar er is niet voldoende bewijs dat de statines een effect uitoefenen op een Th1 immuunreactie en/of het verlies van zelf-tolerantie van het immuunsysteem. Een immuun-modulerend effect op een Th2 immuunreactie kan echter niet worden uitgesloten. Onze bevinding van de Th2 reactie komt overeen met twee eerdere studies die beide aantonen dat statines een Th2 immuunreactie bevorderen.

When compared the results by technique of division of the liver graft (ex situ vs in situ)did not obtained statiscally differences purchase slip inn 1pack online. Nevertheless when divided the sample between urgent or not urgent transplantation generic slip inn 1pack with visa, we obtained statiscally differences about the incidence of acute respiratory insufficiency , portal thrombosis and need to retransplantation. Actuarial Abstract# P-273 survival and graft recipient per year was 67 and 63% respectively. Actuarial survival of graft and recipient Urbina1, Javier Bustamante2, Miguel Montejo1, Jose R. Conclusions: Liver transplantation using grafts from Mikel Gastaca1, Patricia Ruiz1, Javier Gonzalez2, Alberto Ventoso1, split expanding the pool of donors. Transplantation Transplant Unit, Hospital Cruces, Bilbao-Baracaldo, Vizcaya, in non-emergency situation showed better results. Marco Senzolo1, Cecilia Ferronato1, according to pathologic data and underlying disease. Average time on the waiting list was 122 days, Padua, Italy; 3Interventional Radiology Unit, General Hospital, without any preference. Institute of Liver Studies, King’s College Hospital, and contraindicated when high risk varices despite prophylaxis or stabilized London, United Kingdom presence of cavernous transformation with recanalization were present. There were 77 live births, 17 spontaneous risk factors were identified in 5/12 patients (40%). Anticoagulation was abortions, 12 planned terminations, 1 molar pregnancy and 1 intrauterine initiated in 8 patients whereas in 4 it was contraindicated. Maternal complications during pregnancy included renal failure (n = anticoagulated patients had ricanalization (2 partial, 2 total), whereas 2 of 9, 8%), hypertension (n = 27, 25%) and pre eclampsia (n = 16, 15%). Seventy the non-anticoagulated patients had thrombosis progression in all splancnic six patients were on tacrolimus, 31 on cyclosporine and 1 on mycophenolate. In this group, there were 12 live births, 2 terminations of pregnancy and 1 Abstract# P-276 miscarriage. The disease is characterized by a fatal progressive sensorimotor neuropathy with autonomic dysfunction. The mean survival rates at 1-, 3- and 5-years were subsequently developed end-stage liver disease. Patient demographics, pre-, intra- and post- of the disease, nutritional status and duration of disease before transplantation operative details, and outcome were documented. A patients received a whole liver, of which 2 were non-heart-beating, and 2 recent published data from a Swedish group showed a 5-year survival over received a right lobe split graft. Graft shortage and increasing death rates on the waiting lists prompt alternative approaches to provide grafts. University positions while inhaling room air, and after exposure of hyperoxic mixture. Hospital death, rate of re-tx within 14 days of initial tx and rate Abstract# P-280 of relisting within 30 days of tx were similar (p>0. Further analysis is needed to possibly Ana-Paula Barreiros , Rosa Walz , Christian Geber , Frank identify particular subgroups of recipients and donors for whom a particular Birklein3, Peter R. The immunosuppressive regimen consisted pain and progressive sensory loss at the lower limbs occured. In March of calcineurin inhibitor associated with steroids usually discontinued within 2008 amyloid deposition was detected in the gastrointestinal wall reflecting 6 months from the transplant. Donor age was 46 (range Interestingly, in our patient as well as in the second reported patient, 19-73) vs 55 (range 17-75) (p=0. The median follow-up was 21 months (range 2-47) and 29 alcoholic (74%) or virus-related cirrhosis (71%)(p<0. The estimated 1, 2 and 4 years patients 5-yr survival in pediatric recipients was 79%. Conclusion: Over time, refined indications, improved surgical technique, and more effective immunosuppression have lead to 10 to 20% gain in survival Abstract# P-283 according to indication. In particular, histological Kwon, Jae-Won Joh, Ju Ik Moon, Mill Jae Shin, Jae Min Chun, data of donor organs do not exist so far. Jung, Jae Berm Park, Gyu-Seong Choi, Sung-Joo Kim, old donor livers, their impact on long-term survival might be more and Suk-Koo Lee. Donor data of 121 patients and histological Sungkyunkwan University School of Medicine, Seoul, Republic findings of 69 donor liver grafts were assessed according to preoperative of Korea status and criteria as inflammation,fibrosis, fatty degeneration, and necrosis. From 1997 to 2007, 12 patients who had liver transplantation, and 86 patients, Whereas, grafts from donors with liver fibrosis (p<0. However, multivariate analysis of donor data showed each tumor ≤5cm on basis of initial radiologic findings.