Residential Rehabilitation Center Research Articles

Improvement of endothelial function parameters during cardiac rehabilitation predicts cardiovascular death and heart failure hospitalization in patients with HFpEF: 3 years follow up

Abstract Purpose To evaluate the effects of cardiac rehabilitation on Dipeptidyl peptidase 4 (DPP4), circulating Insulin-like growth factor binding protein 1 (IGF BP1) levels and circulating blood marker of endothelial function, nitric oxide (NOx) and to assess their prognostic significance on composite endpoint cardiovascular death (CVD) and heart failure (HF) hospitalization. Methods 88 patients (pts) (62,3±5,7 years) with HFpEF who were admitted at residential rehabilitation center were enrolled in the study. All pts underwent a supervised 3 weeks exercise training. At baseline and after 3 weeks values of DPP4, IGF BP1 and NOx were determined and exercise test was performed. Clinical long-term follow-up (3 years) was performed. All medical therapy was documented, and for this analysis, we focused on CVD death and HF hospitalization. Results After follow-up period, 34 (38,6%) patients experienced composite endpoint (CE group: 11 CVD and 23 HF hospitalization), while 54 (61,4%) pts did not report any deterioration in health status (non-CE group). Baseline values of DPP4, IGF BP1 and NOx did not differ between the examined groups. After 3 weeks of exercise training DPP4 decreased significantly in both group (CE group, from 782,14±124,76 to 642,17±110,53 μg/L, p<0,001; non-CE group, from 774,12±98,65 to 554,71±88,12 μg/L, p<0,001); also IGF BP1 (CE group, from 904,77±115,34 to 689,14±96,55 ng/mL, p<0,001; non-CE group from 898,17±108,55 to 558,18±88,62 ng/mL, p<0,001); and NOx increased (CE group, from 35,4±6,5 to 41,4±5,2 µmol/L, p<0,001; non-CE group, from 36,1±5,2 to 47,2±4,7 µmol/L, p<0,001). All second values od DPP4, IGF BP1 and NOx differ significantly between the examined groups (p<0,001 for all). Exercise capacity (METs) has increased significantly in both groups, but second value in CE group was significantly lower than in non-CE group (P<0.001). A positive correlation was found between IGF BP1 decrease and NOx increase (r=0.554, P<0.01), between IGF BP1 decrease and DPP 4 decrease (r=0.685, P<0.01), between IGF BP1 decrease and METs increase (r=0.653, P<0.01), between DPP4 decrease and NOx increase (r=0.775, P<0.001), between DPP 4 decrease and METs increase (r=0.708, P<0.01), and between METs increase and NOx increase (r=0.746, P<0.001). After adjusment for age and gender, univaried COX-regression analyses showed that NOx increase (OR 0.832, CI 0.462-0.994, p<0.01), DPP4 decrease (OR 0.718, CI 0.614–0.926, p=0.01), IGF BP1 decrease (OR 0.952, CI 0.889–0.999, p=0.002) and METS increase (OR 0.921, CI 0.774-0.977, p=0.014) significantly predict composite endpoint (CV death and HF hospitalization). Conclusion Residential CV rehabilitation, in patients with HFpEF, improved endothelial function. Pts with higher increase of NOx and METs, and greater reduction in DPP4 and IGF BP1 after 3 weeks of specialized cardiac rehabilitation, during 3 years follow up, were at lower risk of CV death and HF hospitalization.

Development, validation, and feasibility testing of a yoga module for substance use disorder

ABSTRACT Introduction: Research evidence and theoretical models point to the need to implement yoga and mindfulness interventions as they impact different physiological and psychological functioning associated with addiction and relapse. To ensure the safe application of yoga, a standardized yoga module that can be practiced across any drug type of substance addiction is required. This study focuses on developing, validating, and testing a yoga module’s feasibility for the management of substance use disorder (SUD). Materials and Methods: The yoga module was developed for SUD by including specific yogic practices derived from research evidence from Google Scholar, PubMed, and traditional literature targeting symptoms related to SUD. Yoga experts validated the module using a 3-point Likert scale. Practices which scored a content validity ratio (CVR) score ≥0.33 were retained in the yoga module for SUD. A pilot assessment was done online to test the module’s feasibility. Participants in a 9-week residential rehabilitation center participated in the study. The module was taught as an add-on to their existing treatment. The motivation for seeking treatment was assessed at baseline, and quality of life was assessed at pre- and post-intervention using the questionnaire de motivation au traitement des toxicomanies and the World Health Organization Quality of Life BREF (WHOQOL BREF), respectively. Results: Thirty experts validated the developed module. Based on the CVR scoring, 37 yoga practices were retained. The final list of practices included breathing exercises, sukshmāvyāyāma (loosening exercise), āsana (postures), prāṇāyāma (breathing exercise), and dhyāna (meditation). In the feasibility study, all participants (n = 12) reported satisfaction and mentioned no adverse effects of the yoga intervention. The participants’ mean ± standard deviation (SD) of identified motivation was 26.6 ± 1.9, introjected amotivation 22.7 ± 5.1, external motivation 16.4 ± 6.2, and a motivation 15.1 ± 5.7. The Global score or Internalization coefficient mean ± SD was 29.1 ± 18.1. The participant’s total score on the WHOQOL-BREF was significant post intervention (P = 0.004). With the practice of the module, there was a significant change in the participant’s psychological (P = 0.008), social (P = 0.002), and environmental domains (P < 0.001) but not in physical health (P = 0.17). At 1 month follow-up, 11 participants (n = 12) maintained abstinence. Conclusion: The designed yoga module for SUD was validated by yoga experts and was considered safe and feasible by patients with SUD. In addition, patients reported an increase in their quality of life. This can be further studied in randomized controlled trials.

Health-related quality of life in patients with substance use disorders enrolled to the residential treatment in Sri Lanka: a retrospective cross-sectional study.

Substance use disorder (SUD) is a serious public health concern that requires continuum care with effective treatment modalities such as residential rehabilitation. Improvement in health-related quality of life (HRQoL) is one of the determinants of treatment and rehabilitation effectiveness. Therefore, a retrospective cross-sectional study was carried out in seven residential rehabilitation centres in Sri Lanka to determine the HRQoL of the rehabilitees with SUD. The HRQoL of 464 individuals at their enrolment and during the rehabilitation period was assessed using EuroQol five-level five-dimensional questionnaire (EQ-5D-5L). Data were analysed using IBM SPSS version 26. The majority of the participants were Sinhala (n = 419, 90.3%) and Buddhist (n = 368, 79.3%) males (n = 461, 99.4%). Most were unmarried (n = 302, 65.1%), young adults (n = 385, 83.0%) who have pursued secondary or higher education (n = 276, 59.5%) and 87.3% were employed (n = 405). Most of the selected centres use biopsychosocial model (n = 4, 57.1%) as the rehabilitation approach while rest practice therapeutic community (n = 3, 42.9%). The average EQ-5D-5L index [range =( - 0.45)-1.00] of the rehabilitees at their enrolment was 0.52 ± 0.28 and the EQ-5D-5L Visual Analogue Scale (EQ-5D-5L VAS) score (range = 0-100%) was 47.17% ± 23.48%. The values were increased up to 0.83 ± 0.18 (EQ-5D-5L index) and 84.25% ± 16.79% (EQ-5D-5L VAS) during the rehabilitation period. Only 19.4% of the rehabilitees had a normal or upper normal HRQoL (≥ 0.75 EQ-5D-5L Index) at their enrolment and 72.2% of rehabilitees reported normal or upper normal HRQoL during the rehabilitation period. A significant improvement in the HRQoL of the participants was observed during the residential treatment in comparison to the enrolment, despite the differences in the rehabilitation programs.

Evaluation of feasibility and user acceptance of lateral-flow self-testing for viral illness in a residential treatment rehabilitation facility

BackgroundThe role of rapid testing has proven vital in reducing infection incidence in communities through swift identification and isolation of infected individuals. The COVID-19 pandemic has been particularly catastrophic for residential carceral and rehabilitation facilities that are high-risk settings for transmission of contagious diseases. Centralized provider-based viral testing employing conventional diagnostic techniques is labor-intensive and time-consuming. There is a marked unmet need for quick, inexpensive, and simple viral testing strategies. We hypothesized that rehabilitation residents could successfully test themselves employing inexpensive, disposable, antigen-based influenza lateral-flow tests and would be willing to self-isolate and self-report to health authorities if positive.MethodsWe evaluated self-testing among 50 rehabilitation residents ages 18 and older in Pomona, California, where participants self-administered influenza lateral-flow diagnostic test (without specimen collection) with the goal of appropriately observing a control line and completed two brief written surveys on self-testing and COVID-19, one before self-administering the lateral-flow test and one after, to determine the overall feasibility of viral self-testing and to characterize attitudes comparing self-testing and provider-based testing.FindingsA total of 50 rehabilitation residents were enrolled in this study and all 50 conducted a lateral-flow test and answered the provided surveys. Among the participants, 96% (48 of 50) achieved a positive-control line from their lateral-flow test. Most participants, 83% (34 of 41) indicated that they would prefer to perform their own rapid test instead of having a health care provider administer the test. Notably, 98% (49 of 50) indicated that they would self-isolate if the lateral-flow test returned a positive indicator suggesting the presence of a viral infection and 96% (48 of 50) would report positive results to their corresponding public health department.InterpretationResidents in a residential rehabilitation center were widely able to successfully self-administer standard lateral-flow antigen-based rapid diagnostic kits. Self-testing was strongly preferred over tests administered by a healthcare provider. Reassuringly, almost every resident indicated that they would report any positive test result to the health department and self-isolate accordingly. Self-testing offers a promising adjunct to centralized testing, potentially better enabling swift and effective management of life-threatening infectious outbreaks among those living in high-risk congregate living settings.

Community-Based Psychiatric Services in Sri Lanka: a Model by WHO in the Making.

Sri Lanka is a lower middle-income, small island nation in the Indian Ocean, with a multi-ethnic population of 22 million. The healthcare system of the country is well established and relatively advanced, the delivery of which is free to the consumer. The health indicators of the country are impressive compared to regional figures. Psychiatric care in Sri Lanka has witnessed a rapid development over the last four decades, as the care model transformed from an asylum-based model, established during the British colonial times, to a district-wise hospital-based, care delivery model. Gradually, the teams that provided inpatient and outpatient services at the hospitals also started to provide community-based care. The newly added community-based services include outreach clinics, residential intermediate rehabilitation centres, home-based care, community resource/support centres and telephone help lines. There is no or very little funding dedicated to community-based care services. The teams that deliver community services are funded, mostly indirectly, by the state health authorities. This is so, as these community teams are essentially the same psychiatry teams that are based at the hospitals, which are funded and run by the state health authorities. This lack of separation of the community and hospital teams without separate and dedicated funding is an impediment to service development, which needs to be addressed. However, paradoxically, this also constitutes an advantage, as the provision of care delivery from the hospital to the community is continuous, since the same team provides both hospital- and community-based care. In addition to the essential mental healthcare provision in the community with this basic infrastructure, each community service has improvised and adapted the utilization of other resources available to them, both formally as well as informally, to compensate for their financial and human resource limitations. These other resources are the community officials and the community services of the non-health sectors of the government, mainly the civil administration. Although sustainability may be questionable when services involve informal resources from the non-health sectors, these have so far proven useful and effective in a resource-poor environment, as they bring the community and various sectors together to facilitate services to support their own community.

Factors influencing the provision of care for Inuit in a mainstream residential addiction rehabilitation centre in Southern Canada, an instrumental case study into cultural safety

BackgroundProvision of culturally safe care has been proposed to address health inequity, including in the areas of mental health and addiction. The factors that influence the provision of culturally safe care remain understudied. This paper explores the factors influencing the efforts of a mainstream residential addiction rehabilitation centre to provide culturally appropriate and quality care for Inuit.MethodsAn instrumental case study was conducted, informed by ethnographic and creative research methods. Over 700 h of participant observation were carried out between March 2018 and January 2020, in addition to qualitative semi-structured interviews (34 participants) and/or member-checking activities (17 participants) conducted with a total of 42 individuals: 20 Inuit residents, 18 clinical/specialized staff, and 4 clinical/administrative managers. An interpretive thematic analysis was performed to examine the factors that may influence the provision of culturally safe care for Inuit residents.ResultsTen categories of interrelated factors were identified and classified according to whether they relate to individual, programmatic, organizational, or systemic levels. These categories covered: (1) residents’ and staff’s life experiences; (2) personal and relational qualities and skills; (3) the model of care; (4) model flexibility; (5) ways in which relational aspects were considered; (6) sensitivity of the organization towards the population served; (7) human resources and professional development issues; (8) social climate; (9) political, relational, and funding climate; and (10) legislative, regulatory, and professional environment. While system-level factors generally had a negative effect on experiences of cultural safety, most factors at other levels had both favourable and unfavourable effects, depending on the context and dimensions examined.ConclusionsThe results offer insight into the interplay between the challenges and barriers that mainstream organizations face when working with Inuit, and the opportunities and enablers that organizations can build on to improve their services. This paper contributes to a better understanding of the challenges and opportunities to providing culturally safe addiction programs to Inuit within a complex intervention setting. It concludes by highlighting some areas for improvement to advance cultural safety in this context.

Feeling at Home in the Clinic: Therapeutic Dwelling in an Addiction Rehabilitation Center in Tehran, Iran

AbstractThis article describes community life in a free residential rehabilitation center for women in Tehran, Iran. In a social context that stigmatizes drug use, especially by women, this rehabilitation center provides poor and homeless drug users a much‐needed opportunity to engage in recovery. I argue that the treatment team's emphasis on “therapeutic dwelling” had significant ramifications on the rehabilitation outcomes of their patients. I use the term “therapeutic dwelling” to refer to a patient's ability to form mutual relations of care and concern with others in therapeutic settings. A therapeutic culture that emphasizes dwelling can have multiple effects on the healing trajectories of patients. It can create a supportive community that extends the rehabilitation process while also further marginalizing patients who are unable to properly exhibit care toward others. Ultimately, this article highlights that dwelling should be approached as a malleable—rather than a purely positive—form of sociality that has the power to both exclude and welcome, to provide and withhold personal connection and intimacy

Evaluation of Feasibility and User Acceptance of Lateral-Flow Self Testing for Viral Illness in a Correctional Center Rehabilitation Facility

Background: The role of rapid testing has proven vital in reducing infection incidence in communities through swift identification and isolation of infected individuals. The COVID-19 pandemic has been particularly catastrophic for residential carceral and rehabilitation facilities that are high-risk settings for transmission of contagious diseases. Centralized provider-based viral testing employing conventional diagnostic techniques is labor-intensive and time consuming. There is a marked unmet need for quick, inexpensive, and simple viral testing strategies. We hypothesized that rehabilitation residents could successfully test themselves employing inexpensive, disposable, antigen-based lateral-flow tests and would be willing to self-isolate and self-report to health authorities if positive.Methods: We evaluated self-testing among 50 rehabilitation residents ages 18 and older in Pomona, California, where participants self-administered an influenza lateral-flow diagnostic test (without specimen collection) with the goal of appropriately observing a control line and completed two brief written surveys, one before self-administering the lateral-flow test and one after, to determine the overall feasibility of viral self-testing and to characterize attitudes comparing self-testing and provider-based testing.Findings: A total of 50 rehabilitation residents were enrolled in this study and all 50 conducted a lateral-flow test and answered the provided surveys. Among the participants, 96% (48 of 50) achieved a positive-control line from their lateral-flow test. Most participants, 83% (34 of 41) indicated that they would prefer to perform their own rapid test instead of having a health care provider administer the test. Notably, 98% (49 of 50) indicated that they would self-isolate if the lateral-flow test returned a positive indicator suggesting the presence of a viral infection and 96% (48 of 50) would report positive results to their corresponding public health department.Interpretation: Residents in a residential rehabilitation center were widely able to successfully self-administer standard lateral-flow antigen-based rapid diagnostic kits. Self-testing was strongly preferred over tests administered by a healthcare provider. Reassuringly, almost every resident indicated that they would report any positive test result to the health department and self-isolate accordingly. Self-testing offers a promising adjunct to centralized testing, potentially better enabling swift and effective management of life-threatening infectious outbreaks among those living in high-risk congregate living settings.Funding: This study was funded by a grant awarded to Benjamin Sievers from the Pitzer College Racial Justice Initiative.Declaration of Interest: None to declare. Ethical Approval: This study was approved by both the Institutional Review Board at Pitzer College and HealthRIGHT 360’s IRB committee, project number: 2020-32R1. Pitzer College’s institutional review board’s review was carried out in accordance with the requirements of Part 46, “Protection of Human Subjects” of Title 45 of the Code of Federal Regulations and the “US Department of Health and Human Services (DHHS) Federal-Wide Assurance (FWA) for the Protection of Human Subjects for Domestic (US) Institutions,” Pitzer College Assurance #FWA00001138.

RoboDoc: Semiotic resources for achieving face-to-screenface formation with a telepresence robot

Abstract Face-to-face interaction is a primordial site for human activity and intersubjectivity. Empirical studies have shown how people reflexively exhibit a face orientation and work to establish a formation in which everyone is facing each other in local participation frameworks. The Face has also been described by, e.g., Levinas as the basis for a first ethical philosophy. Humans have established these Face-formations when interacting since time immemorial, but what happens when one of the participants is present through a telepresence robot? Based on ethnomethodology, Peircean/Goodwinian semiotics, multimodal conversation analysis and video data from a Danish residential rehabilitation center, the article shows the ways in which participants manage to interactively, cooperatively, and moment by moment achieve an F-formation in situ. The article contributes a detailed analysis and discussion of the kind of participant a telepresence robot is, in and through situated interactions: I propose that we term this participant the RoboDoc, given that it is an assemblage of a doctor who controls a robot. By focusing on the affordances of mobility, the article contributes to a renewed understanding of the importance and relevance of establishing Face-orientations in an increasingly technofied telepresence world.

Validación del Cuestionario Breve de Confianza Situacional en muestra clínica con drogodependencia

Introduction: many studies have concluded that self-efficacy is an essential variable within the area of drug addictions and a key to maintaining abstinence and preventing relapses. The Situational Confidence Questionnaire by Annis et al. (1987), is one of the most used instruments to measure self-efficacy and has had various modifications. The Brief Situational Confidence Questionnaire (CBCS), is the shortest version with only 8 items. Objective: to obtain the factor validity and reliability of the CBCS with a clinical sample in residential modality. Method: the study was carried out with a sample of 41 volunteers patients, adolescents, and adults interned in a residential rehabilitation center. The evaluation met the standards for the development and review of instrumental studies. Results: after carrying out the exploratory factor analysis, the eight original items were left within a single factor which explains 71.39% of the variance, with a factor load between the ranges of .76 and .91, and with an internal consistency of .941. Discussion and conclusions: the Brief Situational Confidence Questionnaire presents an internal consistency with high reliability and acceptable factor loads, such as was found in other studies. Therefore, its use in Mexico is suggested as an evaluation tool in a clinical setting, with patients who are interned in a rehabilitation center. It is recommended to carry out replications with more representative and randomly selected samples. Furthermore, it is suggested to include confirmatory factor analysis to obtain greater certainty in the results.

Design and Implementation of a Regional Inpatient Psychiatry Unit for Patients who are Positive for Asymptomatic SARS-CoV-2

BackgroundPatients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet-spread organisms such as SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow up behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Furthermore, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion.ObjectiveWith this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for patients infected with asymptomatic SARS-CoV-2 and share key points for consideration in implementing future units elsewhere.ConclusionA major takeaway point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating patients infected with SARS-CoV-2.

Following severe childhood stroke, specialised residential rehabilitation improves self-care independence but there are ongoing needs at discharge

Introduction Stroke is a major cause of mortality and disability in childhood. There is a false belief that children will recover better than adults and recent research confirms that younger age at injury can have a negative impact on rehabilitation outcomes, resulting in lifelong disability. Self-care is a key rehabilitation outcome for children and young people. Methods This service evaluation reviews routinely collected clinical self-care data from one specialised residential rehabilitation centre in the United Kingdom. Admission and discharge scores from the United Kingdom Functional Independence Measure +Functional Assessment Measure, Rehabilitation Complexity Scale – E and Northwick Park Nursing Dependency Scale were analysed. Results Twenty-six children and young people age 8 years and over with severe stroke were included. Mean scores of independence increased and mean scores of complexity and dependency decreased. A proportion of the sample had ongoing self-care needs in relation to support needed in washing, dressing and bathing. A small number remained highly dependent, requiring assistance from two carers. Conclusion Children and young people make significant gains in self-care independence during specialised rehabilitation. However, a proportion return to the community with high self-care needs. Occupational therapists and the wider care team should address ongoing self-care needs in this population.

Psychosocial rehabilitation of people living with mental illness: Lessons learned from community-based psychiatric rehabilitation centres in Gujarat.

Introduction:Psychosocial rehabilitation is the process that facilitates opportunities for persons with chronic mental illness to reach their optimal level of independent functioning in society and for improving their quality of life. However, such psychosocial rehabilitation centers are limited in India.Aims:The present study assesses psychosocial rehabilitation centers (of urban day-care and rural residential rehabilitation center) operated by Ashadeep Charitable Foundation, a civil service organization and its effect on health outcomes of patients living with chronic mental illness.Materials and Methods:Records of 170 cases were retrieved for secondary analysis of demographic information, diagnosis, duration of stay, and health outcomes.Results:Rehabilitation activities included yoga, light physical exercises, group discussion, training for daily living skills, social skills, life skills, vocational training, individual, and family counseling. In addition, extensive outreach activities, mental health camps were also integral part of the rehabilitation activities. Patients who have accessed rehabilitation services were diagnosed with schizophrenia, psychosis, bipolar disorder, depression, and intellectual disability. The average duration of rehabilitation of patients (other than persons with intellectual disability) was ranged from three to four months. Out of those rehabilitated, 69% of them were successfully re-integrated with the family.Conclusion:Combination of pharmacological and psychosocial interventions are effective for re-integrate patients with mental illness to the family. This model of community-based rehabilitation has potential for scale-up.

P.027 Relation between functional and cognitive impairments in remitted patients with bipolar disorder and suggestions for trials targeting cognition

Targeted cognitive training (TCT) has been reported to improve verbal learning deficits in patients with schizophrenia (SZ). Despite positive findings, it is not clear whether demographic factors and clinical characteristics contribute to the success of TCT on an individual basis. Medication-associated anticholinergic burden has been shown to impact TCT-associated verbal learning gains in SZ outpatients, but the role of anticholinergic medication burden on TCT gains in treatment refractory SZ patients has not been described. In this study, SZ patients mandated to a locked residential rehabilitation center were randomized to treatment as usual (TAU; n = 22) or a course of TAU augmented with TCT (n = 24). Anticholinergic medication burden was calculated from medication data at baseline and follow-up using the Anticholinergic Cognitive Burden (ACB) Scale. MATRICS Consensus Cognitive Battery Verbal Learning domain scores were used as the primary outcome variable. The TAU and TCT groups were matched in ACB at baseline and follow-up. While baseline ACB was not associated with verbal learning in either group, increases in ACB over the course of the study were significantly associated with deterioration of verbal learning in the TAU group (r = −0.51, p = 0.02). This was not seen in subjects randomized to TCT (r = −0.13, p = 0.62). Our results suggest that TCT may blunt anticholinergic medication burden associated reduction in verbal learning in severely disabled SZ inpatients.

P638High intensity interval exercise training improves endothelial function in patients with heart failure with preserved ejection fraction

Abstract Background Cardiac rehabilitation has traditionally invoved low-to moderate intensity continuous exercise training (MICT). There is growing evidence that high intensity interval exercise training (HIIT) shows similar or greater efficacy compared with MICT. However, the relationship between the training modality and its effects on endothelial function still remains to be elucidated. Purpose To evaluate the impact of high intensity interval exercise training versus low-to moderate intensity continuous exercise training on circulating blood markers of endothelial function: the stable end product of nitric oxide (NOx), S–nitrosothiols (RSNO–reservoir for bioavailable nitric oxide), dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA) in patients (pts) with heart failure with preserved ejection fraction (HFpEF). Methods A total of 43 pts with HFpEF (mean age 57.5±6.8y) admitted at residential rehabilitation center were enrolled in the study. Patients were randomized to HIIT, (HIIT group, n=20) and MICT, (MICTgroup, n=23). At baseline and 3 weeks later, in all pts values of NOx, RSNO, ADMA and SDMA were determined and exercise test was performed. Results After 3 weeks NOx increased significantly in both groups: in HIITgroup (from 34.7±7.5 to 48.5±8.3 μmol/l, P<0.0001), in MICTgroup (from 35.0±9.5 to 42.5±10.0 μmol/l, P<0.05), and value of NOx after 3 weeks was higher in HIIT than in MICT group (P<0.05). Value of ADMA as well of SDMA decreased in both groups after 3 weeks, and this decrease was significant in HIIT group: ADMA in HIIT group (from 0.305±0.055 to 0.250±0.077 μmol/l, P<0.005) and in MICT group (from 0.325±0.069 to 0.280±0.140 μmol/l, ns); SDMA in HIIT group (from 0.285±0.050 to 0.240±0.060 μmol/l, P<0,005) and in MICT group (from 0.270±0.080 to 0.247±0.063 μmol/l, ns). Value of RSNO significantly increased in both groups, with higher increase in HIIT group: in HIIT group (from 3.0±1.5 to 5.1±1.7 μmol/l, P<0.001), in MICTgroup (from 3.2±1.7 to 4.5±2.3 μmol/l, P<0.05). Compared to the baseline, at the end of the study, exercise capacity (METs) was significantly higher in both groups (P<0.0001). Higher increase in METs in HIIT group during exercise training (by 39.8%), compared to increase in MICT group (by 27.2%), resulted in significantly higher exercise tolerance in HIIT than in MICT group at the end of the study (P<0.02). In both groups, adverse events during or after exercise training, were not occurred. Conclusions In pts with HFpEF high intensity interval exercise training as well as low-to moderate intensity continuous exercise training induced favorable modification of endothelial function, expressed through increase of NOx and RSNO, and decrease of ADMA and SDMA. More significant increase of NOx and RSNO, and significant decrease of ADMA and SDMA gives an advantage to HIIT over MICT exercise training in patients with HFpEF.

An Architectural Model on Employment Opportunities as Aftercare Program

The aftercare program of a drug rehabilitation center is a continuing treatment receive by ex-drug abusers immediately after being discharged from a residential rehabilitation center. This program caters services that help in the development of skills of ex-drug abusers as they move out from the facility of the rehabilitation center for them earn for living. The rehabilitation centers offer opportunities for employment as they allow other agencies to offer job and training and seminar services for ex-drug abusers. In the implementation of the job opportunities as an aftercare program, the selection of ex-drug abuser who is ready to work, ready to be trained, and ready for a further referral is a crucial decision. To this end, an architectural model that can match ex-drug users profile and relevant jobs, training, and referrals were needed. The developed architecture will serve as their basis for a decision support system development

Effectiveness of Transcranial Direct-Current Stimulation (tDCS) and Emotion Regulation Training in Reducing Current Drug Craving and Drug-Use Thoughts and Fantasies in Opioid-Dependent Patients: The Issue of Precedence

Background: Craving is an important factor in predicting relapse in opioid-dependent patients. Objectives: The aim of the present study was to determine which combination therapy, including emotion regulation training followed by tDCS or tDCS followed by emotion regulation training, is more effective in reducing current drug craving and drug-use thoughts and fantasies in opioid-dependent patients in Zahedan, Iran. Patient and Methods: A quasi-experimental study with a pretest-posttest design and two intervention groups was conducted. From eight randomly-selected centers, asample of 28 patients was selected based on the inclusion and exclusion criteria. They were randomly divided into two intervention groups. The first group received eight sessions of tDCS, followed by eight sessions of emotion regulation training. The second group received eight sessions of emotion regulation training followed by eight sessions of tDCS. The statistical population included all opioid-dependent patients at medium-term residential drug rehabilitation centers in Zahedan, Iran, in 2018 - 2019. The data were gathered using the personal drug use questionnaire, the desires for drug questionnaire (DDQ), and the drug use thoughts, fantasies, and temptations questionnaire. All analyses were performed using SPSS-16. Results: The results of repeated measures ANOVA showed that both sequences had a significant, long-term effect on the reduction of current drug craving and drug-use thoughts and fantasies in opioid-dependent patients. In addition, emotion regulation training followed by tDCS was more effective in reducing current drug craving and drug-use thoughts and fantasies than tDCS followed by emotion regulation training. Conclusions: Combination therapy can significantly reduce drug craving in opioid-dependent patients and starting treatment with emotion regulation training followed by tDCS can lead to better results.

Verbal learning deficits associated with increased anticholinergic burden are attenuated with targeted cognitive training in treatment refractory schizophrenia patients

Targeted cognitive training (TCT) has been reported to improve verbal learning deficits in patients with schizophrenia (SZ). Despite positive findings, it is not clear whether demographic factors and clinical characteristics contribute to the success of TCT on an individual basis. Medication-associated anticholinergic burden has been shown to impact TCT-associated verbal learning gains in SZ outpatients, but the role of anticholinergic medication burden on TCT gains in treatment refractory SZ patients has not been described. In this study, SZ patients mandated to a locked residential rehabilitation center were randomized to treatment as usual (TAU; n=22) or a course of TAU augmented with TCT (n=24). Anticholinergic medication burden was calculated from medication data at baseline and follow-up using the Anticholinergic Cognitive Burden (ACB) Scale. MATRICS Consensus Cognitive Battery Verbal Learning domain scores were used as the primary outcome variable. The TAU and TCT groups were matched in ACB at baseline and follow-up. While baseline ACB was not associated with verbal learning in either group, increases in ACB over the course of the study were significantly associated with deterioration of verbal learning in the TAU group (r=−0.51, p=0.02). This was not seen in subjects randomized to TCT (r=−0.13, p=0.62). Our results suggest that TCT may blunt anticholinergic medication burden associated reduction in verbal learning in severely disabled SZ inpatients.

Targeted cognitive training improves auditory and verbal outcomes among treatment refractory schizophrenia patients mandated to residential care

Computerized targeted cognitive training (TCT) of auditory processing has been shown to improve verbal learning in several clinical trials of schizophrenia outpatients. Less is known, however, about the effectiveness of this promising intervention in more chronic, treatment-refractory patients who are treated in non-academic settings. This study aimed to determine whether TCT improves auditory processing, verbal learning, and clinical symptoms in SZ patients mandated to receive care at a locked residential rehabilitation center. Secondarily, potential factors that moderate TCT's effectiveness including age, symptom severity, antipsychotic medication load, and duration of illness were examined. Schizophrenia patients were randomized to treatment as usual (TAU; n = 22) or TAU augmented with TCT (TAU + TCT; n = 24). Outcomes included a measure of auditory perception (Word-In-Noise test, WIN), verbal learning domain scores from the MATRICS Consensus Cognitive Battery (MCCB), and clinical symptoms (Scale for the Assessment of Positive Symptoms, SAPS; Scale for the Assessment of Negative Symptoms, SANS). TCT produced significant improvements in auditory perception (d = 0.67) and verbal learning (d = 0.65); exploratory analyses revealed a statistically significant reduction in auditory hallucinations (d = −0.64). TCT's effects were only weakly, and mostly non-significantly, moderated by age, clinical symptoms, medication, and illness duration. These findings indicate that even highly symptomatic, functionally disabled patients with chronic illness benefit from this emerging treatment. Ongoing studies will examine the predictive utility of neurophysiological biomarkers and other characteristics assessed at baseline.

Great expectations: The bureaucratic handling of Swedish residential rehabilitation in the 21st century.

Background and aims:Increasingly, efforts to counteract perceived problems in drug treatment at residential rehabilitation centres have come to rely on measures drawing on evidence-based practice (EBP). However, the Swedish media, government inquiries, and international research have identified a number of problems regarding both residential rehabilitation and EBP. This suggests that caution should be exercised when placing expectations on EBP. The aim of this study is to investigate how the responsible authorities have handled increasing demands for EBP with administrative control while facing critical evaluations of their steering and implementation efforts. The study examines the maturation of a widespread treatment ideology, which aims to be based on evidence, in a country known for its restrictive drug policy and its goal of becoming a drug-free society.Methods:Through a qualitative textual analysis of 17 years (2000–2016) of inquiries, directives, and authority archives we have traced the interplay between problem descriptions, intended goals, and implemented solutions.Findings:The analysis shows that the ambition to provide care and welfare based on EBP is still an ambition. Also, the authorities’ control over the care actually provided still leaves room for improvement. Recurring criticism and the empirical material indicate that the expectations have not been met.Conclusions:We would like to suggest that continued frustration can be traced to the misconception that EBP is the opposite of values and ideology, and hence preferable. As drug treatment strives for scientific credibility to give it legitimacy, some types of “evidence” are preferred above others. We would like to suggest that we need to bring ideology to the fore, and openly discuss our restrictive policy goals and choices of “evidence”.