This article describes the development of the rehabilitation counseling profession in the United States. Early roles as a government agent providing simple vocational advice and guidance to individuals with physical injuries grew into a complex professional role. That role now demands knowledge of occupations, disability issues, psychological testing and evaluation, legal issues related to employment as well as personal counseling skills. Specialized university educational programs at the master's degree level now prepare individuals for this profession. While early employment tended to be exclusively with public and government agencies, current rehabilitation counselors work in a variety of public, community, and private rehabilitation agencies as well as in educational and school settings. While a uniquely American profession in development, the skills and training of this profession may have application to other cultures as well.

OBJECTIVETo compare clinical efficacy of individual osteotomy instrument and total knee arthrolplasty (TKA) in treating patients with knee osteoarthritis.

METHODSFrom June 2014 to December 2014, 40 patients with unilateral knee osteoarthritis were randomly divided into two groups and 20 cases were in each group. One group (individual group) were treated with TKA with individual osteotomy instrument,including 5 males and 15 females with an average age of (67.3 ± 6.5) years old; 8 cases on the left side and 12 cases on the right side. Another group (conventional group) were treated with conventional TKA , including 6 males and 14 females with an average age of (66.8 ± 7.3) years old; 9 cases on the left side and 11 cases on the right side. Operative time, blood loss, postoperative HSS score at 6 months, and changes of mechanical alignment before and after operation were analyzed.

RESULTSOperative time in individual group was (79.3 ± 4.7) min, and (83.5 ± 3.2) min in conventional group; blood loss in individual group was (287.1 ± 24.9) ml and (363.4 ± 47.2) ml in conventional group, there were statistical differences between two groups in these two items. There was no significant difference in postoperative HSS score at 6 months between individual group (84.8 ± 3.2) and conventional group (84.2 ± 2.5). Postoperative limb alignment in individual group was (2.8 ± 0.6)°, and (2.8 ± 0.6)° in conventional group, with no significant difference between two groups.

CONCLUSIONTKA with individual osteotomy instrument could reduce operative time and blood loss, but there was no differences in knee function, changes of mechanical alignment compared with TKA.

Adult ; Aged ; Arthroplasty, Replacement, Knee ; methods ; Case-Control Studies ; Female ; Humans ; Knee Joint ; surgery ; Male ; Operative Time ; Osteoarthritis, Knee ; surgery ; Osteotomy ; instrumentation ; methods ; Treatment Outcome

We investigated the circulation of avian influenza viruses in poultry populations throughout Papua New Guinea to assess the risk to the poultry industry and human health. Oropharyngeal swabs, cloacal swabs and serum were collected from 537 poultry from 14 provinces of Papua New Guinea over an 11–month period (June 2011 through April 2012). Virological and serological investigations were undertaken to determine the prevalence of avian influenza viruses. Neither influenza A viruses nor antibodies were detected in any of the samples. This study demonstrated that avian influenza viruses were not circulating at detectable levels in poultry populations in Papua New Guinea during the sampling period. However, avian influenza remains a significant risk to Papua New Guinea due to the close proximity of countries having previously reported highly pathogenic avian influenza viruses and the low biosecurity precautions associated with the rearing of most poultry populations in the country.

INTRODUCTION: This study aimed to determine the 5-year incidence of albuminuria among Asian persons with newly diagnosed type 2 diabetes mellitus (DM), and to identify the risk factors at diagnosis for progression to albuminuria. MATERIALS AND METHODS: A retrospective 5-year closed cohort study was conducted among 1016 persons aged ≥18 years old who were diagnosed with type 2 DM between 1 January 2007 and 31 December 2009 at primary care facilities in Singapore. The cumulative incidence of progression from normoalbuminuria to albuminuria-termed "progression"-was determined. The risk factors associated with progression were evaluated using multiple logistic regression analysis. RESULTS: A total of 541 (53.2%) participants were men. The mean (SD) onset age of type 2 DM was 54 (11) years. From diagnosis of type 2 DM, the 5-year cumulative incidence of progression was 17.3% and mean (SD) duration to progression was 2.88 (1.23) years. Higher onset age (OR 1.02; 95% CI, 1.00-1.04), history of hypertension (OR, 1.88; 95% CI, 1.32-2.70) and higher glycated haemoglobin (HbA1c) (OR, 1.17; 95% CI, 1.09-1.26) at diagnosis were associated with progression. In addition, being on angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) treatment at baseline modified the effect of hypertension on progression. CONCLUSION This study highlighted the importance of early screening and treatment of diabetes as well as prevention of hypertension, which could potentially delay the onset of microalbuminuria in persons with type 2 DM. Persons on ACEI or ARB treatment should continue to be monitored regularly for progression to albuminuria.
Adult ; Age of Onset ; Aged ; Albuminuria ; epidemiology ; Angiotensin Receptor Antagonists ; therapeutic use ; Angiotensin-Converting Enzyme Inhibitors ; therapeutic use ; Cohort Studies ; Diabetes Mellitus, Type 2 ; diagnosis ; epidemiology ; metabolism ; Disease Progression ; Female ; Glycated Hemoglobin A ; metabolism ; Humans ; Hypertension ; drug therapy ; epidemiology ; Logistic Models ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology

Background: Charles Bonnet syndrome (CBS) is a condition characterized by vivid, complex visual hallucinations in individuals with visual impairment. Despite its prevalence among the elderly and those with degenerative eye diseases, CBS remains underdiagnosed and undertreated due to a lack of awareness and misconceptions surrounding its etiology and management.Case Report: A 51-year-old man presented to the emergency room after falling off his bicycle without wearing a helmet. Head imaging revealed a small right frontoparietal traumatic subarachnoid hemorrhage with an associated trace subdural hematoma along the right parietal convexity. Subsequently, he developed non-light perceiving vision loss, after which he began experiencing visual hallucinations. Conclusion CBS is frequently overlooked or left untreated. Research on diagnosing and managing CBS following head trauma is limited. Therefore, clear diagnostic criteria for CBS and a better understanding of its underlying mechanisms are needed to improve diagnosis and management strategies.

OBJECTIVE: To determine the feasibility of using T2 mapping as a quantitative method to longitudinally follow the disease activity in children with Duchenne muscular dystrophy (DMD) who are treated with steroids. MATERIALS AND METHODS: Eleven boys with DMD (age range: 5-14 years) underwent evaluation with the clinical functional score (CFS), and conventional pelvic MRI and T2 mapping before and during steroid therapy. The gluteus muscle inflammation and fatty infiltration were evaluated on conventional MRI. The histograms and mean T2 relaxation times were obtained from the T2 maps. The CFS, the conventional MRI findings and the T2 values were compared before and during steroid therapy. RESULTS: None of the patients showed interval change of their CFSs. On conventional MRI, none of the images showed muscle inflammation. During steroid treatment, two boys showed increased fatty infiltration on conventional MRI, and both had an increase of the mean T2 relaxation time (p < 0.05). The remaining nine boys had no increase in fatty infiltration. Of these, three showed an increased mean T2 relaxation time (p < 0.05), two showed no change and four showed a decreased mean T2 relaxation time (p < 0.05). CONCLUSION: T2 mapping is a feasible technique to evaluate the longitudinal muscle changes in those children who receive steroid therapy for DMD. The differences of the mean T2 relaxation time may reflect alterations in disease activity, and even when the conventional MRI and CFS remain stable.
Adolescent ; Anti-Inflammatory Agents/therapeutic use ; Buttocks ; Child ; Child, Preschool ; Feasibility Studies ; Follow-Up Studies ; Humans ; Longitudinal Studies ; Magnetic Resonance Imaging/*methods ; Male ; Muscle Strength/drug effects ; Muscle, Skeletal/*drug effects/*physiopathology ; Muscular Dystrophy, Duchenne/*drug therapy/*physiopathology ; Observer Variation ; Pregnenediones/therapeutic use ; Prospective Studies

INTRODUCTIONDensiron is a novel long-term tamponade. Its specific gravity is 1.06 g/mL and as such it is heavier than water and provides support for the inferior retina. As proliferative vitreoretinopathy (PVR) has a propensity for the inferior retina, we used Densiron on a consecutive series of 97 cases with inferior pathology. We hypothesised that the sequential use of conventional and heavy silicone oil is a strategy for the management of PVR.

MATERIALS AND METHODSA consecutive interventional case series involving the use of Densiron for PVR cases was studied. Patients were selected if conventional silicone oil and Densiron were used sequentially. Anatomical success was defined as total re-attachment in the absence of any tamponade agent for at least 3 months post oil removal.

RESULTSOf the 97 patients, 10 patients fulfilled the criteria. Surgery involving Densiron was successful in re-attaching the retina in 7 of 10 cases, with one sequence of alternating light then heavy oil operation, and with one further surgery using silicone oil in the remaining 3 cases. The mean LogMAR preoperative vision was 1.57 and the postoperative vision was 0.82. In 8 of 10 patients, the final vision was 20/200 or better; in 5 of 10 patients, 20/80 or better. The mean follow-up was 19.5 months (range, 9 to 45).

CONCLUSIONSThe sequential use of conventional silicone oil and Densiron may be a strategy in reducing the number of re-operations. Our case series shows that despite multiple surgical procedures, favourable visual outcome can be achieved.

Adult ; Aged ; Female ; Humans ; Male ; Middle Aged ; Retinal Detachment ; therapy ; Silicone Oils ; administration & dosage ; Vitreoretinopathy, Proliferative ; therapy

Arthroscopy ; adverse effects ; instrumentation ; methods ; Diagnostic Equipment ; adverse effects ; microbiology ; Disinfection ; methods ; Equipment Failure ; Humans ; Materials Testing ; methods ; Orthopedic Equipment ; adverse effects ; microbiology ; Postoperative Complications ; etiology ; prevention & control

INTRODUCTIONThis prospective observational case series aimed to determine whether the lateral decubitus position, which is commonly adopted during sleep, has an effect on intraocular pressure (IOP) in normal controls.

METHODSPatients without glaucoma were recruited from those visiting outpatient clinics for non-glaucomatous conditions. The left eye of each patient was included. IOP was first measured using Tono-Pen® XL applanation tonometer in the supine position, following which a second measurement was immediately obtained for the left lateral head position. Measurements were obtained with the patient lying on one soft and one hard pillow for each position, and patients remained awake during these measurements. One tonometry reading was obtained for each position. Readings were recorded only when the average of four independent readings produced a statistical confidence index of 5%. Results were analysed using the paired Student's t-test for comparison of the means.

RESULTSIOP in the left lateral decubitus position (17.48 ± 3.18 mmHg) was significantly higher than in the supine position (14.48 ± 3.09 mmHg) when using soft pillows (p < 0.001). When hard pillows were used, IOP in the left lateral decubitus position also exceeded that measured in the supine position (16.65 ± 3.54 mmHg vs. 13.65 ± 3.58 mmHg; p < 0.001). There was no statistically significant difference in the IOPs measured for the same position when different kinds of pillows were used.

CONCLUSIONThe lateral decubitus position adopted during sleep is associated with changes in IOP in healthy volunteers.

Adult ; Aged ; Female ; Glaucoma ; Humans ; Intraocular Pressure ; Male ; Middle Aged ; Posture ; Prospective Studies ; Sleep ; Tonometry, Ocular ; Wakefulness

INTRODUCTIONSingapore was substantially affected by three 20th Century pandemics. This study describes the course of the pandemics, and the preventive measures adopted.

MATERIALS AND METHODSWe reviewed and researched a wide range of material including peer-reviewed journal articles, Ministry of Health reports, Straits Settlements reports and newspaper articles. Monthly mortality data were obtained from various official sources in Singapore.

RESULTSThe 1918 epidemic in Singapore occurred in 2 waves--June to July, and October to November--resulting in up to 3500 deaths. The 1957 epidemic occurred in May, and resulted in widespread morbidity, with 77,000 outpatient attendances in government clinics alone. The 1968 epidemic occurred in August and lasted a few weeks, with outpatient attendances increasing by more than 65%. The preventive measures instituted by the Singapore government during the pandemics included the closure of schools, promulgation of public health messages, setting up of influenza treatment centres, and screening at ports. Students, businessmen and healthcare workers were all severely affected by the pandemics.

CONCLUSIONSTropical cities should be prepared in case of a future pandemic. Some of the preventive measures used in previous pandemics may be applicable during the next pandemic.

Disease Outbreaks ; history ; statistics & numerical data ; History, 20th Century ; Humans ; Influenza, Human ; epidemiology ; history ; mortality ; Public Health ; history ; Singapore ; epidemiology