Relevant bibliographies by topics / Clinical health not elsewhere classified

Academic literature on the topic 'Clinical health not elsewhere classified'

Author: Grafiati
Published: 10 December 2022
Last updated: 28 January 2023

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Journal articles on the topic "Clinical health not elsewhere classified"

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Fountoulakis, Konstantinos N. "The Contemporary Face of Bipolar Illness: Complex Diagnostic and Therapeutic Challenges." CNS Spectrums 13, no. 9 (September 2008): 763–79. http://dx.doi.org/10.1017/s1092852900013894.

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AbstractManic depression, or bipolar disorder, is a multifaceted illness with an inevitably complex treatment. The current article summarizes the current status of our knowledge and practice concerning its diagnosis and treatment. While the prototypic clinical picture concerns the “classic” bipolar disorder, today mixed episodes with incomplete recovery and significant psychosocial impairment are more frequent. The clinical picture of these mixed episodes is variable, eludes contemporary classification systems, and possibly includes a constellation of mental syndromes currently classified elsewhere. Treatment includes the careful combination of lithium, antiepileptics, atypical antipsychotics, and antidepressants, but not all of the agents in these broad categories are effective for the treatment of bipolar disorder.
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Ridgway, Jessica P., Jessica Schmitt, Ellen Almirol, Monique Millington, Erika Harding, and David Pitrak. "Electronic data sharing between public health department and clinical providers improves accuracy of HIV retention data." Open Forum Infectious Diseases 4, suppl_1 (2017): S421—S422. http://dx.doi.org/10.1093/ofid/ofx163.1059.

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Abstract Background Retention in care is critical for treatment and prevention of HIV. Many HIV care clinics measure retention rate, but data are often incomplete for patients who are classified as lost to follow-up but may be actually in care elsewhere, moved, or died. The Data to Care (D2C) initiative supports data sharing between health departments and HIV providers to confirm patient care status and facilitate reengagement efforts for out of care HIV patients. Methods The University of Chicago Medicine (UCM) provided an electronic list to the Chicago Department of Public Health (CDPH) of adult HIV-positive patients whose retention status was not certain. Retention in care was defined as at least 2 visits >90 days apart within the prior 12 months. CDPH matched this list of patients with data from the Chicago electronic HIV surveillance database. Matches were based on patient name, including alternative spellings and phonetics, and birth date. CDPH also cross-checked patient names with the CDC’s national enhanced HIV-AIDS Reporting System (eHARS) database. CDPH provided UCM with patient current care status, i.e., patient was in care elsewhere (as verified by lab data), moved out of state, or deceased. Results 780 HIV-positive patients received care in the UCM adult HIV clinic from January 1, 2013 to March 31, 2017. Of these, 360 were retained in care as of March 2017. We shared data with CDPH for 492 patients. Of these, 294 (59.8%) were matched, and 168 (34.1%) had a date of last medical care provided. See Table 1 for patient dispositions, before and after data sharing. 24 (13.4%) of patients believed to be lost to follow up according to UCM records were confirmed either transferred care or deceased according to health department data. Conclusion Data sharing between the health department and HIV providers can improve data accuracy regarding retention in care among people living with HIV. Disclosures J. P. Ridgway, Gilead FOCUS: Grant Investigator, Grant recipient; D. Pitrak, Gilead Sciences FOCUS: Grant Investigator, Grant recipient
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Matthews, Peter C. "Pathological Habit Disorder?" Canadian Journal of Psychiatry 33, no. 9 (December 1988): 826–29. http://dx.doi.org/10.1177/070674378803300908.

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This paper outlines a diagnostic entity called ‘Pathological Habit Disorder’ which is suggested for inclusion in the DSM as an Axis II option. Specific areas of concern, either mental (Axis I) or physical (Axis III), would delineate the syndrome. Pathological Habit Disorder (PHD) points to treatment options where the syndrome is wholly or partly habit-driven. Whether the syndrome is habit-driven or not will remain a clinical judgement even though many conditions, previously thought immutable except by medication, are proving accessible to behavioural engineering. In the ICD system, PHD seems to fit in “Special Symptoms or Syndromes not elsewhere Classified”. It is demonstrably useful to have a diagnosis such as PHD and to incorporate it into the body of medical classification, recognizing current practices for dealing with unwelcome or damaging habits.
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Pogorzelczyk, Katarzyna, Joanna Synoweć, Andrzej Basiński, Daniel Ślęzak, Marlena Robakowska, Przemysław Żuratyński, and Wioletta Mędrzycka-Dąbrowska. "Cost analysis of treating pain patients on the example of the Clinical accident ward Of university Clinical Centre in Gdańsk." BÓL 20, no. 2 / Zjazd PTBB (September 17, 2019): 1–6. http://dx.doi.org/10.5604/01.3001.0013.4614.

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The cost analysis of pain treatment is not a topic often taken up by the health economists community. The subjective dimension and pain assessment by the patient is one of the main determinants of the lack of interest in this topic. Work carried out on this topic currently includes analysis accompanying the process of pharmacotherapy treatment, care provided by medical personnel as well as costs resulting from administrative services. The aim of the work is to present the cost analysis of care for a „pain” patient and to indicate the most optimal financial package of these activities. The study was performed on the basis of financial data of the Clinical Emergency Department of the University Clinical Center in Gdańsk for the last year. We analyzed the cases of patients complaining of pain who received pharmacotherapy. Results The total cost for 2017 amounted to 1.128.668 PLN. The largest amount of money was allocated to the group of patients qualified to the group R: „Symptoms, disease features and abnormal results of clinical trials not classified elsewhere” – 327.313.72 PLN. The symptom of pain is one of the most frequently indicated symptoms among patients who receive medical help at the Clinical Emergency Department of the University Clinical Center in Gdańsk, which should be associated with a greater degree of involvement in analgesic therapy in patients who require it.
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DeVivo, Renée, Lauren Zajac, Asim Mian, Anna Cervantes-Arslanian, Eric Steinberg, Michael L. Alosco, Jesse Mez, Robert Stern, and Ronald Killany. "Differentiating Between Healthy Control Participants and Those with Mild Cognitive Impairment Using Volumetric MRI Data." Journal of the International Neuropsychological Society 25, no. 08 (May 27, 2019): 800–810. http://dx.doi.org/10.1017/s135561771900047x.

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AbstractObjective:To determine whether volumetric measures of the hippocampus, entorhinal cortex, and other cortical measures can differentiate between cognitively normal individuals and subjects with mild cognitive impairment (MCI).Method:Magnetic resonance imaging (MRI) data from 46 cognitively normal subjects and 50 subjects with MCI as part of the Boston University Alzheimer’s Disease Center research registry and the Alzheimer’s Disease Neuroimaging Initiative were used in this cross-sectional study. Cortical, subcortical, and hippocampal subfield volumes were generated from each subject’s MRI data using FreeSurfer v6.0. Nominal logistic regression models containing these variables were used to identify subjects as control or MCI.Results:A model containing regions of interest (superior temporal cortex, caudal anterior cingulate, pars opercularis, subiculum, precentral cortex, caudal middle frontal cortex, rostral middle frontal cortex, pars orbitalis, middle temporal cortex, insula, banks of the superior temporal sulcus, parasubiculum, paracentral lobule) fit the data best (R2= .7310, whole model test chi-square = 97.16,p< .0001).Conclusions:MRI data correctly classified most subjects using measures of selected medial temporal lobe structures in combination with those from other cortical areas, yielding an overall classification accuracy of 93.75%. These findings support the notion that, while volumes of medial temporal lobe regions differ between cognitively normal and MCI subjects, differences that can be used to distinguish between these two populations are present elsewhere in the brain.
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Patten, Scott B., and Joel Paris. "The Bipolar Spectrum—A Bridge Too Far?" Canadian Journal of Psychiatry 53, no. 11 (November 2008): 762–68. http://dx.doi.org/10.1177/070674370805301108.

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Objectives: To review the literature evaluating outcomes resulting from expansion of the bipolar disorder (BD) diagnostic category. We were particularly interested in identifying high-level evidence for improved clinical outcomes as documented by randomized controlled trials (RCTs) or cohort studies. Methods: The English-language literature was searched using Ovid MEDLINE for studies of BD referenced against the key word spectrum. We used bibliographies and other databases to extend this search when no relevant RCTs or relevant cohort studies were identified. Results: In the MEDLINE searches, abstracts and titles of 86 studies were examined and 48 were found to be related to the topic of bipolar spectrum disorders (BSD). No RCTs or prospective cohort studies evaluating modified diagnostic or therapeutic practices were identified. The literature about the BSD consists mostly of expert opinion emphasizing: various links between bipolar and unipolar mood disorders; a proposal that a greater proportion of the population without a mood disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders should be diagnosed under the BD category; and, proposals that syndromes currently classified elsewhere should be subsumed under the BD category. Conclusions: Our search failed to uncover high-level evidence demonstrating the clinical utility of proposed diagnostic realignments. The widespread acceptance of the expanded spectrum concept appears to be based on interpretation of descriptive epidemiologic data by high-profile experts.
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Telemi, Edvin, Nikolay L. Martirosyan, Mauricio J. Avila, Ashley L. Lukefahr, Christopher Le, and G. Michael Lemole. "Suprasellar pleomorphic xanthoastrocytoma: A case report." Surgical Neurology International 10 (April 24, 2019): 72. http://dx.doi.org/10.25259/sni-83-2019.

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Background: Pleomorphic xanthoastrocytoma (PXA) is a rare form of astrocytic neoplasm most commonly found in children and young adults. This neoplasm, which is classified as a Grade II tumor by the World Health Organization classification of tumors of the central nervous system, carries a relatively favorable outcome. It is usually found supratentorially in cortical regions of the cerebral hemispheres, and as such, presenting symptoms are similar to other supratentorial cortical neoplasms; with seizures being a common initial symptom. Due to the rarity of this type of neoplasm, PXA arising elsewhere in the brain is often not included in the initial differential diagnosis. Case Description: This report presents an extremely rare patient with PXA arising in the suprasellar region who presented with progressive peripheral vision loss. Magnetic resonance imaging of the brain demonstrated a heterogeneous suprasellar mass with cystic and enhancing components initially; the most likely differential diagnosis was craniopharyngioma. The patient underwent endoscopic endonasal resection of the tumor. Microscopically, the tumor was consistent with a glial neoplasm with variable morphology. Based on these findings along with further immunohistochemical workup, the patient was diagnosed with a PXA arising in the suprasellar region. At the 1-year follow-up, the patient remained free of recurrence. Although rare PXA originating in other uncommon locations, such as the spinal cord, cerebellum, the ventricular system, and the pineal region have been previously described. Conclusion: Although rare, PXA should be included in the differential diagnosis for solid-cystic tumors arising in the suprasellar region in young adults.
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Söderström, Lisa, Andreas Rosenblad, Eva Thors Adolfsson, and Leif Bergkvist. "Malnutrition is associated with increased mortality in older adults regardless of the cause of death." British Journal of Nutrition 117, no. 4 (February 28, 2017): 532–40. http://dx.doi.org/10.1017/s0007114517000435.

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AbstractMalnutrition predicts preterm death, but whether this is valid irrespective of the cause of death is unknown. The aim of the present study was to determine whether malnutrition is associated with cause-specific mortality in older adults. This cohort study was conducted in Sweden and included 1767 individuals aged ≥65 years admitted to hospital in 2008–2009. On the basis of the Mini Nutritional Assessment instrument, nutritional risk was assessed as well nourished (score 24–30), at risk of malnutrition (score 17–23·5) or malnourished (score <17). Cause of death was classified according to the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, into twenty different causes of death. Data were analysed using Cox proportional hazards regression models. At baseline, 55·1 % were at risk of malnutrition, and 9·4 % of the participants were malnourished. During a median follow-up of 5·1 years, 839 participants (47·5 %) died. The multiple Cox regression model identified significant associations (hazard ratio (HR)) between malnutrition and risk of malnutrition, respectively, and death due to neoplasms (HR 2·43 and 1·32); mental or behavioural disorders (HR 5·73 and 5·44); diseases of the nervous (HR 4·39 and 2·08), circulatory (HR 1·95 and 1·57) or respiratory system (HR 2·19 and 1·49); and symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (HR 2·23 and 1·43). Malnutrition and risk of malnutrition are associated with increased mortality regardless of the cause of death, which emphasises the need for nutritional screening to identify older adults who may require nutritional support in order to avoid preterm death.
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Asah, Cresta, Rune Frandsen, Rikke Ibsen, Jakob Kjellberg, and Poul Jennum. "Morbidity, Mortality, and Conversion to Neurodegenerative Diseases in Patients with REM Sleep Behavior Disorder and REM Sleep without Atonia." Neuroepidemiology 55, no. 2 (2021): 141–53. http://dx.doi.org/10.1159/000514175.

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<b><i>Introduction:</i></b> The underlying pathophysiology of idiopathic REM sleep behavior disorder (iRBD) is not fully understood, although the condition is currently recognized as an early-stage alpha-synuclein disorder. We evaluated the morbidity, mortality, and rate of conversion to a neurodegenerative disorder in a national group of patients. <b><i>Methods:</i></b> All patients in Denmark with a diagnosis of RBD between 2006 and 2013 were identified from the Danish National Patient Registry (NPR) records. We excluded patients who had received a diagnosis of narcolepsy or any of the following neurodegenerative diseases before their diagnosis of RBD: Parkinson’s disease, multiple system atrophy, progressive supranuclear paralysis, Alzheimer’s, and Lewy body dementia. We used randomly chosen controls matched for age, gender, and municipality. <b><i>Results:</i></b> In total, 246 iRBD patients and 982 matched controls were analyzed. The mortality rate was the same in both groups. The morbidity rate was significantly higher in the years before and after an RBD diagnosis, due to a wide variety of disorders in the following major disease groups: mental/behavioral disorders; endocrine/metabolic diseases; diseases of the eye; diseases of the nervous, digestive, musculoskeletal, circulatory, and respiratory systems; abnormal findings not classified elsewhere; external causes; and factors influencing health status. The conversion rate from RBD to a neurodegenerative disease was 13% over the 8 years after a diagnosis of RBD. <b><i>Conclusions:</i></b> A diagnosis of RBD is associated with increased morbidity several years before and after a diagnosis is made. Patients have a higher risk of converting to a neurodegenerative disorder than matched controls. Mortality rates are unchanged.
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Ovadia, Yaniv S., Dov Gefel, Dorit Aharoni, Svetlana Turkot, Shlomo Fytlovich, and Aron M. Troen. "Can desalinated seawater contribute to iodine-deficiency disorders? An observation and hypothesis." Public Health Nutrition 19, no. 15 (May 6, 2016): 2808–17. http://dx.doi.org/10.1017/s1368980016000951.

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AbstractObjectiveOver 300 million people rely on desalinated seawater and the numbers are growing. Desalination removes iodine from water and could increase the risk of iodine-deficiency disorders (IDD). The present study assessed the relationship between iodine intake and thyroid function in an area reliant on desalination.DesignA case–control study was performed between March 2012 and March 2014. Thyroid function was rigorously assessed by clinical examination, ultrasound and blood tests, including serum thyroglobulin (Tg) and autoimmune antibodies. Iodine intake and the contribution made by unfiltered tap water were estimated by FFQ. The contribution of drinking-water to iodine intake was modelled using three iodine concentrations: likely, worst-case and best-case scenario.SettingThe setting for the study was a hospital located on the southern Israeli Mediterranean coast.SubjectsAdult volunteers (n102), 21–80 years old, prospectively recruited.ResultsAfter screening, seventy-four participants met the inclusion criteria. Thirty-seven were euthyroid controls. Among those with thyroid dysfunction, twenty-nine were classified with non-autoimmune thyroid disease (NATD) after excluding eight cases with autoimmunity. Seventy per cent of all participants had iodine intake below the Estimated Average Requirement (EAR) of 95 µg/d. Participants with NATD were significantly more likely to have probable IDD with intake below the EAR (OR=5·2; 95 % CI 1·8, 15·2) and abnormal serum Tg>40 ng/ml (OR=5·8; 95 % CI 1·6, 20·8).ConclusionsEvidence of prevalent probable IDD in a population reliant on desalinated seawater supports the urgent need to probe the impact of desalinated water on thyroid health in Israel and elsewhere.
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Dissertations / Theses on the topic "Clinical health not elsewhere classified"

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Su, QingLang. "Automatic image alignment for clinical evaluation of patient setup errors in radiotherapy." Thesis, University of Central Lancashire, 2004. http://clok.uclan.ac.uk/20692/.

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In radiotherapy, the treatment is typically pursued by irradiating the patient with high energy x-ray beams conformed to the shape of the tumour from multiple directions. Rather than administering the total dose in one session, the dose is often delivered in twenty to thirty sessions. For each session several settings must be reproduced precisely (treatment setup). These settings include machine setup, such as energy, direction, size and shape of the radiation beams as well as patient setup, such as position and orientation of the patient relative to the beams. An inaccurate setup may result in not only recurrence of the tumour but also medical complications. The aim of the project is to develop a novel image processing system to enable fast and accurate evaluation of patient setup errors in radiotherapy by automatic detection and alignment of anatomical features in images acquired during treatment simulation and treatment delivery. By combining various image processing and mathematical techniques, the thesis presents the successful development of an effective approach which includes detection and separation of collimation features for establishment of image correspondence, region based image alignment based on local mutual information, and application of the least-squares method for exhaustive validation to reject outliers and for estimation of global optimum alignment. A complete software tool was developed and clinical validation was performed using both phantom and real radiotherapy images. For the former, the alignment accuracy is shown to be within 0.06 cm for translation and 1.14 degrees for rotation. More significantly, the translation is within the ±0.1 cm machine setup tolerance and the setup rotation can vary between ±1 degree. For the latter, the alignment was consistently found to be similar or better than those based on manual methods. Therefore, a good basis is formed for consistent, fast and reliable evaluation of patient setup errors in radiotherapy.
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Tam, B. K. Y. "A novel actuated digit with tactile feedback for clinical applications." Thesis, Aston University, 2006. http://publications.aston.ac.uk/12247/.

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This thesis describes the work carried out on the development of a novel digit actuator system with tactile perception feedback to a user and demonstrated as a master-slave system. For the tactile surface of the digit, contrasting sensor elements of resistive strain gauges and optical fibre Bragg grating sensors were evaluated. A distributive tactile sensing system consisting of optimised neural networking schemes was developed, resulting in taxonomy of artificial touch. The device is suitable for use in minimal invasive surgical (MIS) procedures as a steerable tip and a digit constructed wholly from polymers makes it suitable for use in Magnetic Resonance Imaging (MRI) environments enabling active monitoring of the patient during a procedure. To provide a realistic template of the work the research responded to the needs of two contrasting procedures: palpation of the prostate and endotracheal intubation in anaesthesia where the application of touch sense can significantly assist navigation. The performance of the approach was demonstrated with an experimental digit constructed for use in the laboratory in phantom trials. The phantom unit was developed to resemble facets of the clinical applications and digit system is able to evaluate reactive force distributions acting over the surface of the digit as well as different descriptions of contact and motion relative to the surface of the lumen. Completing control of the digit is via an instrumented glove, such that the digit actuates in sympathy with finger gesture and tactile information feedback is achieved by a combination of the tactile and visual means.
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Kane, Ros. "Providing sexual health services in England : meeting the needs of young people." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2005. http://eprints.lincoln.ac.uk/11992/.

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There is an on-going debate among health professionals, policy-makers and politicians, as to the optimal way of delivering sexual health services to young people. There is as yet, no consensus on their best patterns of organisation or configuration. This study uses qualitative and quantitative research methods, to explore both the views of young people accessing sexual health services, expressed through in-depth interview, and variations in client satisfaction with different characteristics of service delivery, expressed through completion of a questionnaire. The key research questions are:  How does young people’s satisfaction with sexual health services vary with the age-dedication of the service; that is, whether it serves young people only, or all ages?  How does young people’s satisfaction with sexual health services vary with the integration of the service; that is, whether family planning and genito-urinary services are offered separately, or together?  How does young people’s satisfaction with sexual health services vary with the location of the service; that is, in community or hospital based services? In the qualitative component, in-depth interviews were conducted with 25 young people recruited from a purposively selected sample of young people’s services. In the survey, a total sample of 1166 was achieved. Of these, 36% were attending an integrated contraceptive and STI service and 64% were attending a more traditional ‘separate’ service. 48% attended a service dedicated to young people and 52% an all-age service. 50% attended a hospital-based service and 50% a service located in the community. Of the total sample, 22% were male and 78% female. The analysis has been done not on a comparison of services in their entirety, but on a comparison of key features of their organisation, that is, whether they are provided separately as contraceptive and STI sessions or services, or whether these aspects of sexual health provision are integrated in sessions or services (integration); on whether they are run exclusively for young people or for all ages (dedication); and on whether they are located in the community or in a hospital setting (location). Recommendations are made for future service development and delivery and implications for policy are discussed.
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Desmarais, Sarah. "Affective materials : a processual, relational, and material ethnography of creative making in community and primary care groups." Thesis, University of the Arts London, 2016. http://ualresearchonline.arts.ac.uk/12308/.

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This research concerns neglected affective, relational, material, and processual dimensions of amateur crafts practice in an arts-for-health context. Existing studies on the social impacts of the participatory arts are prone to blur the borders between advocacy and research, and are vulnerable to accusations of ‘policy-based evidence making’ (Belfiore and Bennett, 2007, p.138). Researchers have relied predominantly on interview material and surveys, and there is a lack of finegrained, long-term, ethnographic work based on participant observation. The distinctive potentials of making in this context, furthermore, have barely been investigated. This thesis addresses these deficits through a sustained ethnographic study of two wellbeing-oriented crafts groups supported by Arts for Health Cornwall (AFHC). One group was based in the community, the other in primary care. Observation produces novel understandings of the potential benefits of crafting for health as emergent properties of particular locations, relationships, and practices organized in distinctive ways around creative making. Firstly, as a counterweight to normative views of amateur crafts creativity as soothing and distracting, this study highlights a range of transformative affects including frustration, creative ambition, and enchantment. Secondly, countering an atomistic, stable depiction of such affects, this study describes them as fluid aspects of making processes. Thirdly, these unfolding processes are seen to be inseparable from the intersubjective (peer-to-peer and participant-facilitator) dimensions of creative groups. Lastly, this in vivo perspective problematizes a view of materials as an inert substratum upon which makers exercise their creative powers, and highlights the relevance of a ‘vital materialism’ (Bennett, 2010) for understanding the potential benefits of manual creativity. Sustained observation also produces a situated, spatial account of the extended networks of community belonging produced by the activities of such groups. Fieldwork is contextualized within a wider field using interviews with nine UK arts for health organizations. Consideration is also given to the influence of contemporary discourses of wellbeing, agency, and creativity on policy making in the area of arts for health. Findings have implications for good practice in the field, and for further research to inform political leadership concerning the role of the arts in health. These implications are drawn out in relation to the potential future contribution of the arts within a UK health economy undergoing rapid, crisis-driven transformation.
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(6989891), Carrie Lynn Shorey. "Multimorbidity and Cognitive Decline in Aging Adults." Thesis, 2019.

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This study explored longitudinal change in executive function (EF) and episodic memory (EM) related to multimorbidity, number of chronic conditions, change in chronic conditions overtime in a nationally representative sample of young, middle-aged,and older adults. Participants were from the second (2004-2006) and third (2013-2015) waves of the Survey of Midlife Development in the United States (MIDUS; N=2,532). Participants completed telephone interviews and questionnaires providing information on demographics and chronic conditions. The Brief Test of Adult Cognition by Telephone (BTACT) assessedcognitive function. The BTACT includes measures of EM (ex. word list recall) and EF (ex. digits backward, category fluency, etc.).Overall, only change in chronic conditions was associated with EF decline in the whole sample. In young adults multimorbidity and number of chronic conditions was significantly associated with both EF and EM decline, whereas only change in number of chronic conditions was significantly associated with EF decline in middle aged adults.Future research is needed to assess a broader range of chronic conditions to determine their overall burden on EF and EM over time.
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(9166931), Kerri E. Rodriguez. "The Effects of Service Dogs on Individuals with Physical Disabilities and Mental Disorders: A Multimethod Examination." Thesis, 2020.

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An increasing number of individuals with physical disabilities or mental disorders are incorporating specially trained service dogs as an assistance aid to improve functionality. In addition to the tasks that service dogs are rained for, studies also suggest that service dogs may benefit psychosocial health and wellbeing. However, current knowledge on these potential benefits is limited by methodological weaknesses without multi-method assessment. There remains a need for empirical and replicable quantification the psychosocial outcomes of service dog assistance and companionship.

The objective of Chapters 1-3 was to summarize, evaluate, and quantify the effects of service dogs on psychosocial health among individuals with physical disabilities. Chapter 1 conducted a systematic literature review of N=24 articles describing the effects of guide, hearing, mobility, and medical service dogs on standardized measures of psychosocial functioning. Chapters 2 and 3 conducted an empirical investigation using quantitative and qualitative methods to quantify the psychosocial effects of mobility and medical service dogs among N=154 individuals with physical disabilities. Results identified specific psychological, social, and emotional benefits that are associated with having an assistance dog or service dog among diverse populations with physical disabilities or chronic conditions.

The objective of Chapters 4-6 was to quantify the role of psychiatric service dogs for post-9/11 military veterans with PTSD. Chapter 4 quantified the perceived importance, frequency of use, and therapeutic value of service dog behaviors for N=216 military veterans with PTSD. Chapters 5 and 6 then quantified the effects that PTSD service dogs on psychosocial outcomes and physiological indicators of functioning, respectively, among a sample of N=141 military veterans with PTSD. Results identified therapeutic components, tangible psychosocial benefits, and potential physiological mechanisms of psychiatric service dogs for military veterans with PTSD.

Overall, this research combined quantitative, qualitative, and physiological measurement to describe outcomes of service dog pairings in two different at-risk populations. Results provide non-causational evidence of psychosocial benefits from service dogs for individuals with physical disabilities or mental disorders. Findings provide a basis for further large-scale research to disentangle active components of the assistance dog-human partnership and identify potential mediating variables of effects.
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(6630641), Mackenzie M. Sullivan. "The Role of Differentiation of Self and Gender on the Experience of Psychological Aggression by a Romantic Partner." Thesis, 2019.

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The study aimed to understand and advance the dynamics that influence psychological aggression. Psychological aggression can be defined as, verbal and non-verbal communication with the intent to harm another person mentally or emotionally, and/or control another person. In our society, the occurrence of psychological aggression in relationships is far more tolerated then physical aggression, but the effects can be more long term and harmful. The study hypothesized that an individual’s level of differentiation of self--a person’s ability to differentiate between feeling and thinking in times of stress--and their gender have a role in the severity of psychological aggression. The study was approved by IRB and using an online survey through MTurk asked participants about experiencing and perpetrating psychological aggression in their romantic relationships. The study had 192 participates in the multiple regression analyses, who provided some support that the level of differentiation of self and severity of psychological aggression, experiencing and perpetrating, have a negative significant relationship. Gender was found to not impact the relationship between differentiation of self and severity of psychological aggression. Clinical implications, limitations, and future directions for research were addressed.

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Kearney, Penelope. "Reconfiguring the future : stories of post-stroke transition." 2009. http://arrow.unisa.edu.au:8081/1959.8/92288.

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Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld.
Thesis (PhD)--University of South Australia, 2009
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(5930504), Ran Zou. "POINT-OF-CARE CLINICAL DIAGNOSIS USING MASS SPECTROMETRY SYSTEM." Thesis, 2019.

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Point of care (POC) diagnosis is essential in personalized treatment to obtain effective clinical outcomes when the patient is on site. And Mass spectrometry (MS) system promotes the applications of rapid sampling ionization, which could be a tool for fast disease determination. In this thesis, a miniature MS system was firstly developed for POC tissue analysis. Lipid profile in rat organs were demonstrated. By coupling with online Paternò–Büchi (PB) reaction, fast determination of lipid C=C bond location isomers was realized. The system was applied to quantitatively analyze the change of lipid C=C location isomers between mouse normal and cancerous samples. The intensity ratio of fatty acid 18:1 (D9) and 18:1 (D11) in wild type breast tissue was calculated to be 2.881, while the ratio in tumor breast tissue was 0.667. The direct sampling-based miniature MS system is potential for POC analysis of lipid profiles and lipid biomarkers discovery.

Secondly, an integration of paper-capillary spray and MS make it possible to analyze dried blood samples instantly in clinical laboratory and hospital. Quantitation of ratio between deuterate Phenylalanine and deuterate Tyrosine was achieved by using paper spray and paper-capillary spray MS directly, without any pretreatment of blood samples. Furthermore, these methods could generate calibration curves which enable the calculation of Phenylalanine concentration in whole human blood within 60 seconds. This disposable design is a promising application for point-of-care (POC) PKU analysis in newborn screening.

At last, an increased in free fatty acids (FFAs) of cereals was observed during storage, and a simple and direct rice quality assessment was performed using nanoESI (Nano-Electrospray Ionization) mass spectrometry method. Six fatty acids including palmitic, oleic, and linoleic acids were compared between different rice species, growth regions and harvest years. 2D and 3D linear discriminant analysis (LDA) methods were deployed and a good sample separation was achieved. This direct sampling method of extracting FAs from rice surface combined with MS is suitable for industrial use in rapid identification for large number of samples.

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Books on the topic "Clinical health not elsewhere classified"

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Grant, Jon E., and Marc N. Potenza. Overview of the Impulse Control Disorders Not Elsewhere Classified and Limitations of Knowledge. Edited by Jon E. Grant and Marc N. Potenza. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195389715.013.0012.

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Several disorders have been classified together in the American Psychiatric Association’s Diagnostic and Statistical Manual (4th ed.; DSM-IV) as impulse control disorders not elsewhere classified. These impulse control disorders have been grouped together based on perceived similarities in clinical presentation and hypothesized similarities in pathophysiologies. The question exists whether these disorders belong together or whether they should be categorized elsewhere. Examination of the family of impulse control disorders generates questions regarding the distinct nature of each disorder: whether each is unique or whether they represent variations of each other or other psychiatric disorders. Neurobiology may cut across disorders, and identifying important intermediary phenotypes will be important in understanding impulse control disorders and related entities. The distress of patients with impulse control disorders highlights the importance of examining these disorders. More comprehensive information has significant potential for advancing prevention and treatment strategies for those who suffer from disorders characterized by impaired impulse control.
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Mitchell, Stuart, Marc Sampson, and Anthony Bateman, eds. Structured Clinical Management (SCM) for Personality Disorder. Oxford University Press, 2021. http://dx.doi.org/10.1093/med-psych/9780198851523.001.0001.

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The original manual for structured clinical management (SCM) was first published 8 years ago. Since then, there have been changes in classification, understanding, and treatment of borderline personality disorder (BPD). In parallel to these changes, generalist treatments for BPD such as SCM have been fully implemented in many organizations across the United Kingdom, Europe, and elsewhere. However, implementation of treatments and treatment approaches in clinical services are fraught with difficulties and clinical leads, operational managers, and practitioners alike grapple with how to implement SCM across complex mental health systems. The aim of this book is to provide guidance on how clinical teams, services, and organizations may implement SCM in clinical services. A range of clinical experts, researchers, service users, carers, and practitioners of SCM have contributed chapters from across the United Kingdom and Europe. Each chapter outlines a core aspect of the SCM model or its adaptation and delivery in clinical services. Key principles are highlighted in each chapter with clinical examples of application.
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Mataix-Cols, David, and Odile A. van den Heuvel. Neuroanatomy of Obsessive Compulsive and Related Disorders. Edited by Gail Steketee. Oxford University Press, 2012. http://dx.doi.org/10.1093/oxfordhb/9780195376210.013.0027.

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Obsessive-compulsive disorder (OCD) shares features and often co-occurs with other anxiety disorders, as well as with other psychiatric conditions classified elsewhere in the Diagnostic and Statistical Manual (DSM-IV), the so-called “OCD spectrum disorders.” Neurobiologically, it is unclear how all these disorders relate to one another. The picture is further complicated by the clinical heterogeneity of OCD. This chapter will review the literature on the common and distinct neural correlates of OCD vis-à-vis other anxiety and “OCD spectrum” disorders. Furthermore, the question of whether partially distinct neural systems subserve the different symptom dimensions of OCD will be examined. Particular attention will be paid to hoarding, which is emerging as a distinct entity from OCD. Finally, new insights from cognitive and affective neuroscience will be reviewed before concluding with a summary and recommendations for future research.
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Hovinga, K. E., Y. Esquenazi, and P. H. Gutin. Meningiomas. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190696696.003.0011.

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Meningiomas are the most common primary central nervous system tumors and account for about one third of all primary brain and spinal tumors. They are classified according to the World Health Organization into 3 groups (I–III). Treatment strategies range from observation, surgery, and/or a radiation therapy. Many meningiomas are slow growing and discovered incidentally. Symptoms can vary widely, depending on the location. Patient’s specific factors and the location of the meningioma in relation to critical brain structures are all important factors in determining the optimal treatment. This chapter presents common clinical scenarios of meningioma. Differential diagnosis, perioperative workup, surgical nuances, and postoperative complications are discussed.
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Milcu, Marius, Saul Neves de Jesus, and Michael Stevens. Rethinking applied psychology. Research paradigms vs. practical approaches. Editura Universitara, 2020. http://dx.doi.org/10.5682/9786062812195.

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Rethinking Applied Psychology: Research Paradigms vs. Practical Approaches is the 2020 edition of proceedings drawn from the annual meeting of the Association for Qualitative and Intercultural Studies. Ordinarily held in Sibiu, Romania, this year’s conference was entirely online. By any measure, it was an outstanding success, due to the ingenuity and industry of conference President, Conf. univ. dr. habil. Marius Milcu. Given the demands and unpredictability of COVID 19, Rethinking Applied Psychology must be seen as a triumph, keeping intact the 14-year tradition of uninterrupted publication of conference proceedings that feature integrative and applied research. This year’s volume is the culmination interdisciplinary and interprofessional collaboration on a wide range of contemporary topics of interest to participants from Romania and elsewhere. These topics covered innovative research methods and practices in clinical psychology and psychotherapy; educational psychology and pedagogical science; work, organizational, and transportation psychology; forensic and military psychology; and social and transcultural psychology. The contributors to this book are highly regarded experts and aspiring young scholars in psychology and allied fields of sociology, education, and health sciences. Rethinking Applied Psychology is proof of the value of research with a social conscience, research that is of benefit to the individual and society.
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Walsh, David A. Cervical and lumbar spine. Oxford University Press, 2013. http://dx.doi.org/10.1093/med/9780199642489.003.0157.

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Cervical and lumbar spine pain are major causes of disability and distress. Careful assessment is needed of the nature and extent of the problem, for diagnosis and exclusion of important (treatable) differential diagnoses, and for the formulation and engagement of the patient in an appropriate treatment plan. Acute spinal pain frequently does not indicate underlying joint pathology. Chronic spinal pain is often associated with intervertebral disc disease or which is often classified together with facet joint osteoarthritis as spondylosis. Sciatica, brachalgia, or spinal claudication may each be a consequence of either spondylosis or intervertebral disc prolapse. Simple mechanical low back and neck pain may respond well to conservative management with analgesics and physiotherapy. Specific spinal problems, such as neuronal compromise, may require additional treatments. The roles of injections and surgery in the management of spinal pain continue to evolve. Although ongoing management is largely determined by the individual's clinical response, comprehensive health economic analyses inform healthcare policies which may limit treatment availability. Many people with spinal problems suffer long-term or recurrent pain and disability, with significant psychological and social impact. Multidisciplinary approaches are needed to facilitate pain management and enable people with spinal pain to lead fulfilling lives when the underlying condition cannot be cured.
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PSYCHOLOGICAL RESEARCH AND PRACTICE. Filozofski fakultet Niš, 2020. http://dx.doi.org/10.46630/dpp.2020.

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The International Thematic Proceedia titled „Psychological research and practice” is a publication from the 15th International Conference “Days of Applied Psychology” held on September 27th & 28th 2019 at the Faculty of Philosophy, University of Niš. This is a traditional annual nonprofit conference which has been organized since 2005 by the Department of Psychology of the Faculty of Philosophy, University of Niš, with the support and co-financing of the Ministry of Education, Science and Technological Development of the Republic of Serbia. The conference started with the idea of gathering researchers and practitioners who discuss the link between science and practice in different psychological areas. From the very start, this gathering has welcomed international participants, and year after year this number is on the rise. This scientific publication contains 18 reviewed articles which can be classified as original scientific papers. The authors of these manuscripts come from five countries: Italy, Slovakia, Bulgaria, Bosnia and Herzegovina, and the Republic of Serbia. Papers belong to the different areas of psychology, reflecting the scope of interest of the authors as well as the topic of the conference. This publication is organized into the following thematic sections: 1) Plenary lecture; 2) Developmental and Educational psychology 3) Social Psychology; 4) Psychology of Personality and Individual Differences and Psychological Measurement; 5) Clinical and Health Psychology; 6) Organizational and Marketing Psychology, and 7) Symposium: Understanding sexual related behavior in students: Personality, emotions and attitudes.
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PSYCHOLOGICAL RESEARCH AND PRACTICE. Filozofski fakultet Niš, 2020. http://dx.doi.org/10.46630/dpp.2020.

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The International Thematic Proceedia titled „Psychological research and practice” is a publication from the 15th International Conference “Days of Applied Psychology” held on September 27th & 28th 2019 at the Faculty of Philosophy, University of Niš. This is a traditional annual nonprofit conference which has been organized since 2005 by the Department of Psychology of the Faculty of Philosophy, University of Niš, with the support and co-financing of the Ministry of Education, Science and Technological Development of the Republic of Serbia. The conference started with the idea of gathering researchers and practitioners who discuss the link between science and practice in different psychological areas. From the very start, this gathering has welcomed international participants, and year after year this number is on the rise. This scientific publication contains 18 reviewed articles which can be classified as original scientific papers. The authors of these manuscripts come from five countries: Italy, Slovakia, Bulgaria, Bosnia and Herzegovina, and the Republic of Serbia. Papers belong to the different areas of psychology, reflecting the scope of interest of the authors as well as the topic of the conference. This publication is organized into the following thematic sections: 1) Plenary lecture; 2) Developmental and Educational psychology 3) Social Psychology; 4) Psychology of Personality and Individual Differences and Psychological Measurement; 5) Clinical and Health Psychology; 6) Organizational and Marketing Psychology, and 7) Symposium: Understanding sexual related behavior in students: Personality, emotions and attitudes.
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Book chapters on the topic "Clinical health not elsewhere classified"

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Lopes, Ana Cristina, and Diogo Telles Correia. "Spiritual, Religious and Ethical Values in a Suicidal Individual." In International Perspectives in Values-Based Mental Health Practice, 109–15. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-47852-0_13.

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AbstractReligious and spiritual experiences can appear in mental health practice as far as they often structure what aspects of psychopathological phenomena are present, sometimes making it difficult to determine whether some experiences should be classified as symptoms of a psychiatric disorder or crises within spiritual life.We present a clinical vignette of a 62-year-old sacristan who was admitted to the Psychiatric Emergency Room for suicidal thoughts in the context of physical sequelae of a cardiac episode. He confessed that, in the process of coping with his illness, he had a distressing experience of guilt and of losing his religious faith and shared the intention to take his own life by hanging himself.Themes that emerge in the discussion include issues related to the boundaries of psychiatric diagnosis, the spiritual dimension of mental health and the values that underlie clinical decision-making regarding a suicidal individual.Incorporating religious and spiritual perspectives in the clinical assessment of patients is essential to understand individual’s framework of cultural values and social attitudes on disease.
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Costa, Giovanni, Eleonora Tommasi, Leonardo Giovannini, and Nicola Mucci. "Shiftwork Organization." In Textbook of Patient Safety and Clinical Risk Management, 403–12. Cham: Springer International Publishing, 2020. http://dx.doi.org/10.1007/978-3-030-59403-9_29.

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AbstractIn healthcare companies, shiftwork organization is fundamental to ensure continuous 24-h patient care. This chapter gives an overview of health-related problems associated with shift work and the preventative actions that can be taken to protect workers’ health and well-being. Shift work, in particular night work, results in a disruption of biological circadian rhythms with serious social and psychophysical ramifications for the worker. The adverse health effects of shift work can be both in the short-term (sleep, digestive, mental, and menstrual disorders) and in the medium- to long-term (increased gastrointestinal, neuropsychic, metabolic, and cardiovascular diseases). In 2007, the IARC classified shift work as “probable carcinogen” for humans due to the destructive effects on the circadian rhythm. The modification of the sleep/wake cycle also negatively influences worker’s vigilance and performance (“jet-lag syndrome”) leading to a consequently greater risk of accidents and errors. Shift work can be harmful to the safety of both the worker and the patient. Appropriate shift scheduling that respects ergonomic criteria is important to protect worker and patient health and well-being. Medical residents should be conscious of the legislation and rights regarding shift work to ensure they provide appropriate assistance to patients and to preserve their own social and psychophysical well-being.
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"Psychotic disorders not elsewhere classified (including mania and depression with psychotic features)." In Clinical Child Neuropsychiatry, 268–73. Cambridge University Press, 1995. http://dx.doi.org/10.1017/cbo9780511570094.012.

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Stanaway, Fiona F., Naomi Noguchi, Clement Loy, Sharon Reid, and Jonathan C. Craig. "Clinical epidemiology." In Oxford Textbook of Global Public Health, edited by Roger Detels, Quarraisha Abdool Karim, Fran Baum, Liming Li, and Alastair H. Leyland, 149–60. Oxford University Press, 2021. http://dx.doi.org/10.1093/med/9780198816805.003.0035.

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Clinical epidemiology is a science that extends the principles and methods of epidemiology to clinical practice and clinical research. In this chapter, we provide an overview of clinical epidemiological methods and how these approaches can be used to improve global public health. We have focused primarily on using evidence in decision-making in this chapter, rather than study design and conduct elements, such as randomized controlled trials, which are covered in detail elsewhere. Consequently, we have provided a framework for critical appraisal and reporting of relevant study designs (how to use and report), rather than a detailed discussion about how such studies should be designed and conducted (how to do).
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"Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)." In Pediatric ICD-10-CM, 259–69. American Academy of Pediatrics, 2016. http://dx.doi.org/10.1542/9781610020435-ch18.

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"Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)." In Pediatric ICD-10-CM 2018: A Manual for Provider-Based Coding, 275–86. American Academy of Pediatrics, 2017. http://dx.doi.org/10.1542/9781610021074-ch18.

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"Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00–R99)." In Pediatric ICD-10-CM 2022. 7th ed. American Academy of PediatricsItasca, IL, 2021. http://dx.doi.org/10.1542/9781610025539-ch18.

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"Symptoms, Signs, and Abnormal Clinical and Laboratory Findings, Not Elsewhere Classified (R00-R99)." In Pediatric ICD-10-CM: A Manual for Provider Based Coding, 311–23. 6th ed. American Academy of Pediatrics, 2020. http://dx.doi.org/10.1542/9781610024495-ch18.

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"Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)." In Pediatric ICD-10-CM, 249–59. American Academy of Pediatrics, 2015. http://dx.doi.org/10.1542/9781581109016-ch18.

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"Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (R00 - R99)." In Pediatric ICD-10-CM Coding 2019, 4th Ed, 281–92. American Academy of Pediatrics, 2018. http://dx.doi.org/10.1542/9781610022026-ch18.

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Conference papers on the topic "Clinical health not elsewhere classified"

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"Was there a difference in the COVID-19 symptoms among Ghor Elsafi population either before or after receiving the COVID-19 vaccines?" In International Conference on Public Health and Humanitarian Action. International Federation of Medical Students' Associations - Jordan, 2022. http://dx.doi.org/10.56950/pzez3624.

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Introduction: COVID19 vaccination had high positive results on infections worldwide. Even if someone has been infected after the vaccination; it will be less severe symptoms and will have a better prognosis. The aim: To assess the COVID-19 clinical presentation, the vaccination status and the need for hospitalization both before and after vaccination among Ghor ELSafi residents. Materials and methods: A community-based study was conducted in Ghor ElSafi, al-Karak, Jordan. A questionnaire was conducted on the google form. A total of 101 participants were classified into: first group (n = 58) (Participants infected before COVID-19 vaccination) and second group (n = 43) (participants infected at least 2 weeks after COVID-19 vaccination). Demographic data, History of SARS-CO2 infection and vaccination, Different COVID-19 symptoms, hospitalization, ICU admission and oxygen therapy need were assessed for all participants. Results: All participants were COVID-19 vaccinated. The mean age was 38 (±12.3) years with 51.9% was males. About 32.6% had comorbidities. There was no significant differences between both groups regarding the prevalence of either general, gastrointestinal, respiratory, cardiovascular or gynecological symptoms (Figure 1). There were variations in some COVID-19 symptoms; Group (1) participants had a higher rate of anosmia/ageusia, a lower rate of sneezing and dry cough than Group (2). About 12.9% of participants required hospitalization, 7 participants required O2 therapy, and 2 were admitted to the ICU. The mean hospital stay was 7.38 (±6.16) days without statistical significant difference between both groups. Conclusions: most of the COVID symptoms were statistically non-significant between pre-vaccinated and post-vaccination groups, except few symptoms. Participants who got infected before vaccination had a higher rate of anosmia/ageusia, a lower rate of sneezing and dry cough. Keywords: COVID19, Vaccinations, clinical symptoms
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Sosnina, S. F., M. E. Sokolnikov, and P. V. Okatenko. "LEUKOCYTAL INDICES AND OCCUPATIONAL EXTERNAL GAMMA-EXPOSURE." In The 16th «OCCUPATION and HEALTH» Russian National Congress with International Participation (OHRNC-2021). FSBSI “IRIOH”, 2021. http://dx.doi.org/10.31089/978-5-6042929-2-1-2021-1-488-492.

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Abstract. Background: The hematopoietic system is classified as the most radiosensitive body system. Research of occupational radiation-induced hematological shifts continues to be a relevant question of occupational radiation safety. Aim: Analysis of leukocytal indices dynamics depending on the accumulated dose of occupational external gamma-exposure. Methods: The database «Leukemia in the cohort of Mayak Production Association workers hired in 1948-1958» was used as the material. Leukocytal indices were estimated based on 19592 peripheral blood analyses; dynamics of hematological shifts was traced according to accumulation of absorbed doses of occupational external gamma-radiation; comparative analysis of hemogramms with a group of workers without oncohematological pathology was carried out. Nonparametric statistical methods were applied. Results: The period of dose accumulation at the same total dose of occupational external gamma-exposure was much different in the study groups, it was much shorter for individuals who later died of leukemia. Leukocytal indices in groups were most different in the range of accumulated absorbed doses of external gamma exposure equal to 2 – 2.5 Gy and had the largest amplitude of values among the workers diagnosed for leukemia later. Conclusion: The estimation of leukocytal indices may be used as the tool for early detection of adverse hematological shifts in cell lines and may be the indicator of pathologic hemapoiesis in the exposed workers before clinical manifestation of hematological pathology.
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Oliveira, Mauro Orlando Meurer, Jorge Yoshinori Shida, André Mattar, Felipe Andreotta Cavagna, and Luiz Henrique Gebrim. "INITIAL CLINICAL STAGING AND INCIDENCE OF MOLECULAR SUBTYPE IN BREAST CANCER PATIETS TREATED FROM JAN/2011 TO DEC/2019 AT PÉROLA BYINGTON HOSPITAL." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1035.

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Introduction: Clinical staging (CS) has great importance for therapeutic programming and prognostic evaluation in patients diagnosed with breast cancer. Malignant breast tumors can be classified according to their immunohistochemical (IHC) profile. The study of the IHC profile can also assist in public health strategies, since they determine therapeutic planning. Objectives: Compare our database with literature data. Methods: The staging database (TNM, Tumor, Nodes and Metastasis) of the CRSM-SP (Pérola Byington Hospital) of patients with breast cancer treated at this institution from January 2010 to December 2019. Results: It was observed that 5.7% of the patients had in situ tumors. In the invasive form of tumors, 22.7% of the patients were diagnosed in CS I. Stage II was the one with the highest occurrence, corresponding to 36.5%. Advanced cases belonging to stages III and IV respectively represented 28.2% and 3.26%. As for the IHC profile of our 10,665 patients, luminal tumors A represented 24.7%, luminal B 32.7%. Patients with overexpressed HER2 were subdivided into pure HER2 (7.7%) and triple positive (9.8%). Triple negative tumors represented 25.1% of patients. A Brazilian study with SUS (Brazilian Unified Health System) data included 201,079 women: 19.5% were in stage I, 40.4% in stage II, 30.9% in stage III, and 9.3% in stage IV. In comparison with the public health system in England, a population study of 86,852 cases of breast cancer found 37% of diagnoses in stage I, 32% in CS II, 8% in CS III, and 5% in CS IV. The high ratio of patients (17%) in an unknown staging is noteworthy. In the USA, in a population study of 320,124 women, 72.6% were classified as luminal A, 11.2% as luminal B, 4.8% with overexpression of HER2 and 11.3% as triple-negative. Data from a Brazilian publication with 2,461 patients observed luminal A in 28.8% of the cases, luminal B 39.5%, pure HER2 7.9%, triple positive 9.7% and triple-negative were 14%, with the exception of triple-negative, similar to our results. It is possible that the higher ratio of patients with triple negative tumors at CRSM is explained by the higher incidence of non-screened patients, aged under 50, which are about 39%. Conclusions: The finding of 28.4% of in situ tumors in stage I shows the results of an occasional screening. The predominance of patients in stage II (40.4%) shows the predominance of palpable tumors in our population and the importance of making an agile diagnosis, preventing progression to stage III. The predominance of luminal tumors 68.3% and HER 2 (16.7%) were similar to those in the literature. However, the ratio of 25.1% of triple-negative patients contributes to higher mortality in Brazil and requires greater diagnostic and therapeutic agility.
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Veselova, T. V., and D. V. Chentsov. "COMPARISON OF THE STRUCTURE OF MORBIDITY BY THE RESULTS OF PREVENTIVE MEDICAL EXAMINATIONS AND OF PROFESSIONAL MEDICAL EXAMINATIONS." In The 16th «OCCUPATION and HEALTH» Russian National Congress with International Participation (OHRNC-2021). FSBSI “IRIOH”, 2021. http://dx.doi.org/10.31089/978-5-6042929-2-1-2021-1-110-113.

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Abstract. The aim of the study was to compare the structure of morbidity revealed by the results of preventive medical examination with the structure of morbidity revealed by the results professional examination. Group 1 included 146 999 men aged 20-60, who underwent professional examination, group 2 - 424 770 men aged 21-60 who had undergone preventive medical examinations. In both groups, diseases of the circulatory system are in first place in terms of detection (group 1 – 24,37%, 2 – 41,41%). In second place in the course of preventive medical examinations are diseases of the endocrine system, nutritional disorders and metabolic disorders (16,94%), and in case of professional examination - diseases of the eye and its adnexa (15,46%). The third place in the course of professional examination is - diseases of the respiratory system (14,65%), with preventive medical examinations - diseases of the digestive system (9.83%). Since the diseases of the musculoskeletal system are not separately taken into account during the clinical examination, they are classified in the category «Other diseases». However, it should be noted that during the professional examination, this group of diseases is detected in 21% of cases. Taking into account the figures obtained for the detection of diseases of the musculoskeletal system, it seems important to focus the attention of occupational medicine specialists on this in order to develop and introduce measures to improve the health of the musculoskeletal system into corporate programs. These differences are associated with a different volume of research conducted for different types of medical examinations, as well as with the fact that a number of diseases of the circulatory system and the endocrine system are a contraindication for employment in contact with harmful labor factors. A higher level of detection of infectious pathology and neoplasms in case of professional examination requires a more thorough analysis.
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Paramonova, S. V., N. N. Malyutina, and N. S. Sedinina. "PSYCHOVEGETATIVE PREREQUISITES FOR ARTERIAL HYPERTENSION SYNDROME INUNDERGROUND WORKERS." In The 16th «OCCUPATION and HEALTH» Russian National Congress with International Participation (OHRNC-2021). FSBSI “IRIOH”, 2021. http://dx.doi.org/10.31089/978-5-6042929-2-1-2021-1-393-397.

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Abstract: We examined 109 men working at а mining enterprise exposed to occupational and psychosocial factors. The patients were divided into two groups: the main group - 60 men working in underground conditions, the conditions are assigned to classes 3.3 - 3.4; comparison group - 49 men performing ground work, whose conditions are classified as 3.2. In connection with the established diagnosis of "Syndrome of arterial hypertension" in middle-aged people of the main group, it was divided into two subgroups in terms of age - people under 45 years old (n = 20, age 38.45 ± 2.95 years), and people older 45 years old (n = 40, age 50.90 ± 1.46 years.). Purpose: to study the prerequisites for the development of hypertension based on the psychovegetative status and some changes in the biochemical and functional indicators of the CVS, depending on the age-related changes in these indicators. Materials and methods: the patient underwent a study of the psycho-vegetative state with an assessment of the level of neuropsychic stress, personal and situational anxiety, attention function, subjective reflection of psycho-vegetative distress. The state of the cardiovascular system was investigated according to the results of functional and clinical laboratory diagnostics. Results: A decrease in attention, an increase in personal anxiety and an increase in the number of psychovegetative complaints were significantly more often detected in the group of patients with hypertension (OR 7.50; 95% CI 2.39-23.58; OR 11.06 95% - CI - 4.35 - 28.10; CI 22.50; 95% CI - 7.09 - 71.41). Adaptive psychovegetative phenotypes were distinguished in two subgroups. In patients over 45 years old, a negative relationship was established between age, experience and some parameters of psycho-vegetative status, as well as a direct relationship between these parameters and some indicators of homeostasis in the diagnosis of hypertension syndrome in 95% of patients in this subgroup. Conclusions: with an increase in age and experience, there is a transformation of the adaptive psychovegetative phenotype with an inversion of connections with psychovegetative parameters against the background of increased functional disorders of the cardiovascular system. Diagnostics of the transformation of this phenotype makes it possible to assess the risk of developing arterial hypertension and contributes to the prevention of hypertension by forming risk groups.
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Silva, Antonio Márcio Teodoro Cordeiro, Liliane Emilly dos Santos Sousa, Camila de Assunção Martins, Bárbara de Magalhães Souza Gomes, Jacqueline Andréia Bernardes Leão Cordeiro, Fábio Silvestre Ataides, and Cesar Augusto Sam Tiago Vilanova Costa. "EARLY TRACKING THROUGH MAMMOGRAPHY IN BREAST CANCER DETECTION IN WOMEN IN BRAZIL FROM 2015 TO 2019: EPIDEMIOLOGICAL STUDY." In Abstracts from the Brazilian Breast Cancer Symposium - BBCS 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s2113.

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Objectives: To analyze the aspects of mammography in the early screening of breast cancer, in Brazil, from 2015 to 2019. Methodology: Descriptive epidemiological study, with secondary data extracted from the Department of Informatics of the Brazilian Unified Health System (DATASUS), through the Cancer Information System (SISCAN). Information related to mammography examinations was classified by place of care according to the clinical indication (screening or diagnosis), age group (70 years), previous mammography, high risk of breast cancer (BC), examination completion time, and the Breast Imaging Reporting and Data System (BI-RADS®), which classifies radiological findings as 0 (undefined), 1 (negative), 2 (benign), 3 (probably benign), 4 (suspect), 5 (highly suspicious), and 6 (diagnosed with cancer). Results: Between 2015 and 2019, 3,031,607 mammograms were performed in Brazil, of which 2,955,262 occurred by screening and 76,345 by clinical diagnostic indication. Among the screening mammograms, 63.2% were performed on women in the age group recommended by the Brazilian Ministry of Health (MS), from 50 to 69 years old. The previous history of this examination was confirmed by 2,300,995 women, where 17.5% were at high risk for BC. For the examination time, 1,396,105 mammograms took place within 30 days, and 775,971 and 859,531 over 60 days. BI-RADS was higher in category 2 (1,520,469 mammograms), followed by category 1 with 1,071,514 of mammograms, and in the target population recommended by the Brazilian Ministry of Health, the largest number of tests was concentrated in BI-RADS category 2 with 34.2%. Conclusion: Characterization of the main aspects involved in mammography, such as age, high risk, and among others, allows to infer that the early screening of BC when prioritized by public health policies, aiming at the promotion of women’s health, impacts on the early detection and the reduction of the incidence and mortality by BC in women in Brazil.
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Jugl, Sebastian, Aimalohi Okpeku, Brianna Costales, Earl Morris, Golnoosh Alipour-Harris, Juan Hincapie-Castillo, Nichole Stetten, et al. "A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the United States, from 2016 to 2019." In 2020 Virtual Scientific Meeting of the Research Society on Marijuana. Research Society on Marijuana, 2021. http://dx.doi.org/10.26828/cannabis.2021.01.000.25.

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Background: Medical cannabis is available to patients by physician order in two-thirds of the United States (U.S.) as of 2020, but remains classified as an illicit substance by federal law. States that permit medical cannabis ordered by a physician typically require a diagnosed medical condition that is considered qualifying by respective state law. Objectives: To identify and map the most recently (2016-2019) published clinical and scientific literature across approved conditions for medical cannabis, and to evaluate the quality of identified recent systematic reviews. Methods: Literature search was conducted from five databases (PubMed, Embase, Web of Science, Cochrane, and ClinicalTrials.gov), with expansion and update from the National Academies of Sciences, Engineering, and Medicine’s (NASEM) comprehensive evidence review through 2016 of the health effects of cannabis on several conditions. Following consultation with experts and stakeholders, 11 conditions were identified for evidence evaluation: amyotrophic lateral sclerosis (ALS), autism, cancer, chronic pain, Crohn’s disease, epilepsy, glaucoma, HIV/AIDS, multiple sclerosis (MS), Parkinson’s disease, and posttraumatic stress disorder (PTSD). The following exclusion criteria were imposed: preclinical focus, non-English language, abstracts only, editorials/commentary, case studies/series, and non-U.S. study setting. Data extracted from studies included: study design type, outcome, intervention, sample size, study setting, and reported effect size. Studies classified as systematic reviews with or without meta-analysis were graded using the AMSTAR-2 tool by two raters to evaluate the quality of evidence, with additional raters to resolve cases of evidence grade disagreement. Results: A total of 438 studies were included after screening. Five completed randomized controlled trials (RCTs) were identified, and an additional 11 trials were ongoing, and 1 terminated. Cancer, chronic pain, and epilepsy were the most researched topic areas, representing more than two-thirds of all reviewed studies. The quality of evidence assessment for each condition suggests that few high-quality systematic reviews are available for most conditions, with the exceptions of MS, epilepsy, and chronic pain. In those areas, findings on chronic pain are mostly in alignment with the previous literature, suggesting that cannabis or cannabinoids are potentially beneficial in treating chronic neuropathic pain. In epilepsy, findings suggest that cannabidiol is potentially effective in reducing seizures in pediatric patients with drug-resistant Dravet and Lennox-Gastaut syndromes. In MS, recent high-quality systematic reviews did not include new RCTs, and are therefore not substantially expanding the evidence base. In sum, the most recent clinical evidence suggests that for most of the conditions assessed, we identified few studies of substantial rigor and quality to contribute to the evidence base. However, there are some conditions for which significant evidence suggests that select dosage forms and routes of administration likely have favorable risk-benefit ratios (i.e., epilepsy and chronic pain), with the higher quality of evidence for epilepsy driven by FDA-approved formulations for cannabis-based seizure treatments. Conclusion: The body of evidence for medical cannabis requires more rigorous evaluation before consideration as a treatment option for many conditions and evidence necessary to inform policy and treatment guidelines is currently insufficient for many conditions.
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Barros, Thomas, Carolina Magalhães dos Santos, and Aline Marques. "Treatment of chronic wounds with 10% papain gel: a pilot study." In 7th International Congress on Scientific Knowledge. Biológicas & Saúde, 2021. http://dx.doi.org/10.25242/8868113820212416.

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Any interruption in the continuity of the skin, whether to a greater or lesser extent, is considered a wound and can be classified as acute or chronic. In Brazil and several parts of the world, the chronic wound is seen as a barrier to public health because, in addition to raising the cost for the health service, the patient is susceptible to numerous losses in quality of life, which can have social impacts, economic and psychological. For this reason, the investigation of alternative and low-cost technologies for the treatment of wounds is imperative. The study aimed to describe the use of 10% papain gel in the treatment of wounds arising from amputation processes, characterize the sociodemographic profile of individuals and trace the clinical profile of the patients involved in the study. For this, a pilot study was carried out in a Health Unit in the city of Campos dos Goytacazes/RJ, which works in welcoming patients with chronic wounds of different etiologies. The sample consisted of two individuals, of both sexes, with chronic wounds resulting from recent amputation processes in the lower limbs, treated with a 10% papain gel between April 19 and June 21, 2021. In clinical development, is considered the treatment of wounds with 10% papain gel and measurement of wound area using ImageJ software. Statistical analysis of data was performed using SPSS version 23 software. The sociodemographic results obtained showed that 100% of the sample was composed of patients of economically active age (±51.5 years), both living in areas far from the location where they undergo the treatment of the lesions (±28.5 km), requiring of great displacement to change dressings, which can hinder access to the Health Service. As for the characterization of the clinical profile, 100% of the sample had hypertension and diabetes undergoing treatment for both pathologies, with recent surgical amputation (less than 6 months) at the wound site. Regarding wound healing, patient A showed a reduction in wound area (cm2) of 37.54%, and patient B of 40.53%. Treatment with 10% papain gel was presented as a viable and low-cost alternative compared to the usual coverage offered by the public sector, representing an effective savings of 42% when comparing therapies with similar results. It is suggested that further studies be carried out to expand the scope of evaluation of the alternative therapy proposed by this study.
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Abou-Sido, Marah, Marwa Hamed, Suad Hussen, Monica Zolezzi, and Sowndramalingam Sankaralingam. "Are Blood Pressure Devices Available in Qatar Community Pharmacies Validated For Accuracy?" In Qatar University Annual Research Forum & Exhibition. Qatar University Press, 2021. http://dx.doi.org/10.29117/quarfe.2021.0119.

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Research purpose: Hypertension is a leading cause of cardiovascular morbidity and mortality in Qatar. Community pharmacist-managed home blood pressure monitoring (HBPM) services have been shown to provide better control of hypertension. Digital BP devices available and sold in community pharmacies are commonly used for HBPM services. Devices validated for accuracy are important for clinical decision-making. Non-validated devices are more likely to be inaccurate and could potentially lead to poor BP control and health risks. The objectives of our study are 1) to identify the proportion of validated BP devices available in community pharmacies in Qatar and 2) to determine the relationship between the validation status of devices and cuff location and price. Methodology: We visited 28 community pharmacies including the 2 major pharmacy chains in Qatar. The following data were collected about BP devices: brand/model, validation status, cuff location, and price. Findings: A total of 87 distinct models of BP devices from 19 different brands are available in Qatar community pharmacies. The three most commonly available brands are Beurer®, Omron®, and Rossmax®. Most models available are upper arm devices (75%) while the rest are wrist devices (25%). Among all models, only 57.5% are validated. Sixty percent of upper-arm devices and 50% of wrist devices are validated. Importantly, 60% of lower-priced (≤ QAR 250) devices are not validated while 83% of higher-priced (QAR 500-750) devices are validated. Research originality/value: This is a novel study that has investigated the validation status of BP devices available in community pharmacies for the first time. This information will serve both pharmacists and the public alike. In Qatar and elsewhere, there are no regulations on the accuracy of devices sold in community pharmacies. Therefore, regulations on the sale of BP devices should be implemented in the best interest of patient safety.
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Conceição, Karoline de Oliveira Senna, Jonas Sarro, Felipe Cavagna, Jorge Shida, and Luis Henrique Gebrim. "LOCAL RECURRENCE AND 5-YEAR SURVIVAL AFTER CONSERVATIVE SURGERY IN STAGES I AND II IN PATIENTS WITH BREAST CANCER TREATED BY THE BRAZILIAN UNIFIED HEALTH SYSTEM FROM JANUARY 2011 TO DECEMBER 2019 AT PÉROLA BYINGTON HOSPITAL." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1037.

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Introduction: Breast cancer is the most common neoplasm in women in Brazil and in most of the known countries, and for this reason, and early diagnosis and treatment is essential to provide the best possible survival. Conservative breast surgery has been used as a standard procedure for the local treatment of breast cancer in the early stages. As a consequence of the preservation of breast tissue, ipsilateral recurrence in some patients is predictable. An ipsiateral recurrence rate of 10.4% was observed over an average follow-up period of 67.5 months). The survival data of patients diagnosed with breast cancer are important to know our service and evaluate the treatments provided to patients with the objective of improving the patients´ more and more their quality of life and of trying to achieve the best possible treatment. Objective: To identify data related to 5-year survival after conservative surgery in stages I and II in patients with breast cancer treated at Pérola Byington Hospital. Materials and Methods: Data were collected from medical records of patients with breast cancer classified in stages I and II at Pérola Byington Hospital. Results: 11,237 patients were diagnosed with breast cancer at Perola Byington Hospital from January 2011 to December 2019, among which 9,477patients underwent surgery as part of their treatment. Among the patients who underwent surgery, 4,593 (48.5%) had conservative surgery and 4,884 had radical surgery (51.5%). Most conservative surgeries were performed using the quadrantectomy technique in a total of 43.14% (4,088) of all surgeries and about 89% of conservative surgeries. Other techniques used were adenectomy / adenomastectomy with 2.10% of all surgeries, segmental resection 0.33% and 1.30% segmentectomy. The 5-year survival of 11,327 patients diagnosed with breast cancer in general was around 75% and 89% among patients undergoing surgical treatment. Patients in clinical stage I who underwent conservative surgery had a survival rate of less than one year (0.27%), of one to two years (0.54%) of two to three years (0.61%), of three to four years (0.34%), of four to five years (0.61%) and of more than five years (97.6%). The surgeries performed that resulted in free margins for invasive neoplasia were 93.27%, and 2.53% required a reoperation to reach free margins. Conclusions: The data related to the survival of breast cancer patients submitted to conservative surgery collected at Pérola Byington Hospital were similar to the data found in Dutch women demonstrating a survival very close to 97% to 99%. In American women, the 7-year survival rate in initial cases (stage I) was 97.8%. Conservative surgery when combined with radiotherapy had results in relation to 5-year survival which are very close to the ones patients undergoing mastectomy had.
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Reports on the topic "Clinical health not elsewhere classified"

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Treadwell, Jonathan R., James T. Reston, Benjamin Rouse, Joann Fontanarosa, Neha Patel, and Nikhil K. Mull. Automated-Entry Patient-Generated Health Data for Chronic Conditions: The Evidence on Health Outcomes. Agency for Healthcare Research and Quality (AHRQ), March 2021. http://dx.doi.org/10.23970/ahrqepctb38.

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Background. Automated-entry consumer devices that collect and transmit patient-generated health data (PGHD) are being evaluated as potential tools to aid in the management of chronic diseases. The need exists to evaluate the evidence regarding consumer PGHD technologies, particularly for devices that have not gone through Food and Drug Administration evaluation. Purpose. To summarize the research related to automated-entry consumer health technologies that provide PGHD for the prevention or management of 11 chronic diseases. Methods. The project scope was determined through discussions with Key Informants. We searched MEDLINE and EMBASE (via EMBASE.com), In-Process MEDLINE and PubMed unique content (via PubMed.gov), and the Cochrane Database of Systematic Reviews for systematic reviews or controlled trials. We also searched ClinicalTrials.gov for ongoing studies. We assessed risk of bias and extracted data on health outcomes, surrogate outcomes, usability, sustainability, cost-effectiveness outcomes (quantifying the tradeoffs between health effects and cost), process outcomes, and other characteristics related to PGHD technologies. For isolated effects on health outcomes, we classified the results in one of four categories: (1) likely no effect, (2) unclear, (3) possible positive effect, or (4) likely positive effect. When we categorized the data as “unclear” based solely on health outcomes, we then examined and classified surrogate outcomes for that particular clinical condition. Findings. We identified 114 unique studies that met inclusion criteria. The largest number of studies addressed patients with hypertension (51 studies) and obesity (43 studies). Eighty-four trials used a single PGHD device, 23 used 2 PGHD devices, and the other 7 used 3 or more PGHD devices. Pedometers, blood pressure (BP) monitors, and scales were commonly used in the same studies. Overall, we found a “possible positive effect” of PGHD interventions on health outcomes for coronary artery disease, heart failure, and asthma. For obesity, we rated the health outcomes as unclear, and the surrogate outcomes (body mass index/weight) as likely no effect. For hypertension, we rated the health outcomes as unclear, and the surrogate outcomes (systolic BP/diastolic BP) as possible positive effect. For cardiac arrhythmias or conduction abnormalities we rated the health outcomes as unclear and the surrogate outcome (time to arrhythmia detection) as likely positive effect. The findings were “unclear” regarding PGHD interventions for diabetes prevention, sleep apnea, stroke, Parkinson’s disease, and chronic obstructive pulmonary disease. Most studies did not report harms related to PGHD interventions; the relatively few harms reported were minor and transient, with event rates usually comparable to harms in the control groups. Few studies reported cost-effectiveness analyses, and only for PGHD interventions for hypertension, coronary artery disease, and chronic obstructive pulmonary disease; the findings were variable across different chronic conditions and devices. Patient adherence to PGHD interventions was highly variable across studies, but patient acceptance/satisfaction and usability was generally fair to good. However, device engineers independently evaluated consumer wearable and handheld BP monitors and considered the user experience to be poor, while their assessment of smartphone-based electrocardiogram monitors found the user experience to be good. Student volunteers involved in device usability testing of the Weight Watchers Online app found it well-designed and relatively easy to use. Implications. Multiple randomized controlled trials (RCTs) have evaluated some PGHD technologies (e.g., pedometers, scales, BP monitors), particularly for obesity and hypertension, but health outcomes were generally underreported. We found evidence suggesting a possible positive effect of PGHD interventions on health outcomes for four chronic conditions. Lack of reporting of health outcomes and insufficient statistical power to assess these outcomes were the main reasons for “unclear” ratings. The majority of studies on PGHD technologies still focus on non-health-related outcomes. Future RCTs should focus on measurement of health outcomes. Furthermore, future RCTs should be designed to isolate the effect of the PGHD intervention from other components in a multicomponent intervention.
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Kenya: Identifying RTIs remain problematic: Prevention is essential. Population Council, 2000. http://dx.doi.org/10.31899/rh2000.1015.

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Since 1990, the Nakuru Municipal Council (Kenya) has implemented a multifaceted program to reduce the incidence of reproductive tract infections (RTIs), especially those that are sexually transmitted, including HIV/AIDS. Staff in the Council’s five health clinics use syndromic management guidelines, based on clients’ reported symptoms and clinical signs, to identify clients with RTIs. In 1998, the Population Council conducted a study to assess the accuracy of syndromic management and determine the best ways to integrate RTI management into existing antenatal (ANC) and family planning (FP) services. After an assessment of existing RTI services, 18 nurses from the five municipal clinics attended a three-day refresher course in syndromic management. As noted in this brief, more than half of the FP and ANC clients in Nakura had one or more RTIs, and roughly one-third of these infections were sexually transmitted. Using syndromic management algorithms based on reported symptoms, providers correctly classified only 5–16 percent of women who later tested positive with laboratory results. Given the limitations of syndromic management, programs need to stress prevention of sexually transmitted infections.
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