Determinants of rehabilitation assessment and referral following acute stroke. Early results from Building Efficient and Effective Pathways to and through Rehabilitation after Stroke (BEEPRS)

Background: National guidelines and standards recommend that stroke survivors be assessed for, and receive rehabilitation. However available data suggests variable practice. Aims: To describe current practice and determinants of rehabilitation assessment and referral following acute stroke in Queensland. Methods: Prospective multi-centre observational cohort study of consecutive patients surviving acute stroke in six Queensland hospitals with acute stroke units. We collected demographics, clinical history, initial stroke impairments, modified Rankin Scale (mRS) (premorbid and 72- hours post stroke), and rehabilitation assessment and referral details. Descriptive statistics were used to quantify assessment and referral patterns. Multivariable logistic regression models were derived to determine predictors of rehabilitation assessment and referral, including age, gender, premorbid conditions, premorbid mRS, 72-hour mRS, early post stroke impairments, and clustering by hospital. Results: Data from the first 205 patients (mean age 72 þ/ 14 years, 42% female) were available. 90% were assessed (inter-site range 68% 100%, p < 0.001) and 78% were referred for rehabilitation (range 67% - 91%, p ¼ 0.09). Predictors of assessment for rehabilitation were: pre morbid independence (mRS 0–2) (OR 5.8, CI 1.0, 28.8 p ¼ 0.04); and functional dependence at 72-hours (mRS > 2) (OR 5.8, CI 1.3, 25.8 p ¼ 0.02). Predictors of referral for rehabilitation were: assessment (OR 104.7, CI 15.4, 711.3 p < 0.001), functional dependence at 72-hours (OR 20.6, CI 6.1, 70.3 p < 0.001) and presence of a cognitive or perceptual deficit (OR 4.0, CI 1.4, 10.9 p < 0.005). Conclusions: Rehabilitation assessment practices vary significantly. Assessment for rehabilitation is the primary determinant of subsequent referral and should be the target for efforts to improve access

Immunization of Mice with Lactobacillus casei Expressing a Beta-Intimin Fragment Reduces Intestinal Colonization by Citrobacter rodentium ▿ †

Enteropathogenic Escherichia coli (EPEC) is a common cause of diarrhea in children from developing countries. Intimate adhesion of the bacteria to intestinal cells occurs via binding of the adhesin intimin to the TIR receptor exposed on cell surfaces. Here, Lactobacillus casei expressing a fragment of β-intimin (L. casei-Intcv) was tested as mucosal vaccines in mice against intestinal colonization with the murine pathogen Citrobacter rodentium. Oral or sublingual immunization of C57BL/6 mice with L. casei-Intcv induced anti-Intcv IgA in feces but no IgG in sera. Conversely, anti-Intcv IgG was induced in the sera of mice after sublingual immunization with purified Intcv. All vaccines were able to decrease C. rodentium recovery from feces. However, this reduction was more evident and sustained over time in mice immunized with L. casei-Intcv by the sublingual route. These mice also displayed an increase in interleukin 6 (IL-6) and gamma interferon (IFN-γ) secretion by spleen cells 10 days after infection. Additionally, oral or sublingual immunization of C3H/HePas mice, which are highly susceptible to C. rodentium infection, with L. casei-Intcv induced anti-Intcv antibodies and significantly increased survival after challenge. Immunohistological analysis of colon sections revealed that C. rodentium was located in deep fractions of the tissue from C3H/HePas mice immunized with L. casei whereas superficial staining was observed in colon sections from mice immunized with L. casei-Intcv. The results indicate that vaccines composed of L. casei expressing intimin may represent a promising approach and that the C3H/HePas infection model with C. rodentium can be used to evaluate potential vaccines against EPEC