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1

Jardine, A. H., M. V. Griffiths, and E. Midgley. "The acceptance of hearing aids for children with otitis media with effusion." Journal of Laryngology & Otology 113, no. 4 (1999): 314–17. http://dx.doi.org/10.1017/s0022215100143865.

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AbstractConservative treatment for otitis media with effusion (OME) led us to consider the use of hearing aids as a way of managing the associated hearing loss. This study aimed to assess the compliance of patients and acceptance of hearing aids for the management of children with OME.Thirty-nine children who had been given binaural hearing aids to manage OME were assessed at routine follow-up after six months. A clinician who did not prescribe the aid administered a questionnaire to assess compliance, change in symptoms and acceptance of the aids.Thirty-eight parents thought the aids were easy to use and 25 (66 per cent) were completely satisfied with the management. Aided hearing improved by a mean of 17 dB (Range 10–30) over three frequencies, 0.5, 1.0, 2.0 Khz and all parents reported subjective hearing improvement in their children. The stigma of an aid was reported as minimal under the age of seven.Hearing aids provide a non-invasive way of managing the problems associated with OME which is acceptable to certain parents and children. Long-term effects of using aids need to be evaluated before they can be recommended.
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Ferreira, Dennis de Carvalho, Mauro Romero Leal Passos, Norma de Paula Motta Rubini, et al. "Validation study of a scale of life quality evaluation in a group of pediatric patients infected by HIV." Ciência & Saúde Coletiva 16, no. 5 (2011): 2643–52. http://dx.doi.org/10.1590/s1413-81232011000500034.

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With the advent of potent antiretroviral therapy and the increase in life expectancy of pediatric patients infected with HIV, the quest for the promotion of enhanced quality of life should currently be the main focus in care of children with HIV/Aids. The scope of this study was to validate the Scale of Children's Quality of Life in a group of children infected with HIV receiving clinical care in Aids Service Units in Rio de Janeiro, Brazil. This scale consists of 26 questions and was tested on 100 children, with ages varying between 4 and 12, and their respective parents or guardians. Statistical analysis was conducted using canonical correlation and confidence interval analysis and the c² test. The results showed that the cut-off point obtained was 49; the internal consistency with Cronbach's alpha was 0.73 for the children and 0.67 for parents or guardians. The response profile revealed marked satisfaction with aspects such as vacations and birthdays, though less satisfaction with items including hospitalization and playing alone. The conclusion was that the scale revealed satisfactory psychometric measurements, proving to be a reliable, consistent, valid and recommended instrument for measuring the quality of life of children infected with HIV.
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Agrawal, Vedika, Tara Ness, Amanda Small, et al. "940. Impact of Using Arts Programming to Support Treatment in Adolescents Living with HIV in Eswatini." Open Forum Infectious Diseases 7, Supplement_1 (2020): S503. http://dx.doi.org/10.1093/ofid/ofaa439.1126.

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Abstract Background Adolescents and young adults with HIV are a unique population given the distinct psychosocial challenges of their age-group coupled with having a stigmatizing disease. In 2018, approximately 1.6 million adolescents were living with HIV worldwide, with the highest HIV prevalence found in Eswatini. As this group struggles more than any other age-group with medication adherence, novel interventions that are peer-inclusive and empowering should be explored to support their treatment. Methods We piloted a theater camp to determine the impact of fostering creative expression amongst adolescents and young adults enrolled at our HIV clinic in Mbabane, Eswatini. A two-week camp was conducted in collaboration with a non-profit organization of professional teachers, actors, and musicians. We emphasized enrollment of patients struggling with medication adherence, teen mothers, and those on second-line antiretroviral treatment. Twenty individuals (ages 12-23) participated in self-expression activities, story development, and a final play performed for the community. To assess impact, we compared viral loads pre- and post- camp as well as surveyed participants on effect of participation on areas such as personal stigma, sense of community, and confidence. Results Of those who participated, 25% showed a substantial decrease and 10% a substantial increase in viral load after the camp (>0.1 log10 change). Those who completed the survey (n=18) felt the camp helped them with confidence (13/18), teamwork (13/18), and friendships (11/18). Quotes from participants reinforced this growing sense of community, confidence, and decreased personal stigma. One wrote “theater camp helped me know that I can do a lot of things in life to achieve my future goals although I am HIV positive” and another stated “it made me not feel sorry for being an HIV positive person.” Conclusion Our pilot program demonstrates creative arts programming has beneficial psychosocial effects, aids in community building, and potentially enhances the effectiveness of medical treatment. Further programs and studies should continue to investigate creative arts as an avenue for treatment support, self-expression, and community building among vulnerable populations such as adolescents and young adults with HIV. Disclosures All Authors: No reported disclosures
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Thomsen, Hauke, Xinjun Li, Kristina Sundquist, Jan Sundquist, Asta Försti, and Kari Hemminki. "Familial associations for Addison’s disease and between Addison’s disease and other autoimmune diseases." Endocrine Connections 9, no. 11 (2020): 1114–20. http://dx.doi.org/10.1530/ec-20-0328.

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Design Addison’s disease (AD) is a rare autoimmune disease (AID) of the adrenal cortex, present as an isolated AD or part of autoimmune polyendocrine syndromes (APSs) 1 and 2. Although AD patients present with a number of AID co-morbidities, population-based family studies are scarce, and we aimed to carry out an unbiased study on AD and related AIDs. Methods We collected data on patients diagnosed with AIDs in Swedish hospitals and calculated standardized incidence ratios (SIRs) in families for concordant AD and for other AIDs, the latter as discordant relative risks. Results The number of AD patients was 2852, which accounted for 0.4% of all hospitalized AIDs. A total of 62 persons (3.6%) were diagnosed with familial AD. The SIR for siblings was remarkably high, reaching 909 for singleton siblings diagnosed before age 10 years. It was 32 in those diagnosed past age 29 years and the risk for twins was 323. SIR was 9.44 for offspring of affected parents. AD was associated with 11 other AIDs, including thyroid AIDs and type 1 diabetes and some rarer AIDs such as Guillain–Barre syndrome, myasthenia gravis, polymyalgia rheumatica and Sjögren’s syndrome. Conclusions The familial risk for AD was very high implicating genetic etiology, which for juvenile siblings may be ascribed to APS-1. The adult part of sibling risk was probably contributed by recessive polygenic inheritance. AD was associated with many common AIDs; some of these were known co-morbidities in AD patients while some other appeared to more specific for a familial setting.
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Buriti, Ana Karina Lima, Simone Helena dos Santos Oliveira, and Lilian Ferreira Muniz. "Hearing loss in children with HIV/AIDS." CoDAS 25, no. 6 (2013): 513–20. http://dx.doi.org/10.1590/s2317-17822013.05000013.

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PURPOSE: To investigate the occurrence of hearing loss in children with HIV and its association with viral load, opportunistic diseases, and antiretroviral treatment. METHODS: A cross-sectional study was carried out with 23 HIV-positive children under care at two specialized centers in João Pessoa, Paraíba, Brazil. Their parents or legal guardians responded to a questionnaire, containing data on the clinical situation and the hearing health of the children, who were then submitted to audiological assessment. We complied with the guidelines for human research contained in the CNE (National Education Council) Resolution number 196/1996. The findings were analyzed through descriptive statistics. RESULTS: We observed that lamivudine (3TC) was the antiretroviral drug most used in 17 (94.4%) patients, followed by Kaletra (KAL), administered in 14 (77.8%) patients, d4T in 11 (61.1%) patients, and zidovudine (AZT) in 7 (38.9%) participants. Otitis was the most frequent opportunistic disease, with 11 (61.1%) cases. In the audiometric examination, we observed 39 (84.8%) ears with hearing loss and 7 (15.2%) normal ears. After the immitance testing, we found five (10.9%) normal ears, characterized by type A tympanometric curves. The other 41 (89.1%) ears were revealed as altered, with predominance of type B curves in 67.4% of the cases. CONCLUSION: There were hearing alterations in children with HIV/AIDS analyzed in this study. Discreet hearing losses were the most occurring. We verified statistically significant associations with the use of antiretroviral therapy and otitis. Therefore, we point out the importance of auditory monitoring and intervention as soon as possible, thus favoring adequate development in language and decreasing possible difficulties in learning and social inclusion.
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Gao, Y., Z. Z. Lu, R. Shi, X. Y. Sun, and Y. Cai. "AIDS and sex education for young people in China." Reproduction, Fertility and Development 13, no. 8 (2001): 729. http://dx.doi.org/10.1071/rd01082.

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Although China has had a rich sexual culture for thousands of years, Chinese people are usually unwilling to openly discuss issues of sex. Some parents are quite ignorant of the change in their children’s sexual attitude and behaviour. In China today, adolescents are becoming much more sexually liberated. Premarital sex and unplanned pregnancies among teenagers are increasing. Sexually transmitted diseases (STD) including HIV/AIDS are also spreading rapidly. However, young people lack basic information on AIDS/STD and do not know how to protect themselves from these diseases or how to avoid unintended pregnancies. Several major youth peer education programmes in China are mentioned in this paper. Among them, a four-year programme entitled the Australian–Chinese AIDS/STD/Safer Sex Peer Education Programme for Youth, is discussed in some detail. The programme has so far reached over 40000 university and school students. Evaluation results show that the programme is effective in both significantly increasing students’ knowledge about AIDS/STDs and changing their attitude towards AIDS patients. In addition, the programme is highly praised by the students.
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Helleberg, Marie, Gitte Kronborg, Carsten S. Larsen, et al. "Poor CD4 response despite viral suppression is associated with increased non-AIDS-related mortality among HIV patients and their parents." AIDS 27, no. 6 (2013): 1021–26. http://dx.doi.org/10.1097/qad.0b013e32835cba4c.

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8

Hidayanti, Ema. "IMPLEMENTASI BIMBINGAN DAN KONSELING UNTUK MENINGKATKAN SELF ESTEEM PASIEN PENYAKIT TERMINAL DI KELOMPOK DUKUNGAN SEBAYA (KDS) RSUP DR. KARIADI SEMARANG." Jurnal Ilmu Dakwah 38, no. 1 (2019): 31. http://dx.doi.org/10.21580/jid.v38.1.3970.

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<p><em>HIV / AIDS patients experience complex problems both physically, psychologically, socially, and spiritually. Psychosocial problems experienced include depression, anxiety, despair, and worry, and affect the destruction of social life such as isolating themselves and getting stigmatized. These various problems make HIV / AIDS patients feel useless and worthless. In dealing with psychological problems such as low self-esteem, HIV / AIDS patients desperately need social support from both partners, parents, children, friends, counselors and health teams. Unfortunately during this time the expected social support, rarely HIV / AIDS patients were found, including from their own families. To facilitate these needs, hospitals that become a reference center for HIV / AIDS patients form Peer Support Groups (</em><em>P</em><em>S</em><em>G</em><em>). </em><em>PSG </em><em> activities include group guidance and peer counseling for HIV / AIDS patients. These activities provide opportunities for HIV / AIDS patients to increase knowledge about their illness, exchange experiences with each other, even help each other solve problems. The various positive benefits of peer support groups in turn can increase the self-esteem of HIV / AIDS patients</em>.</p><p> </p><p align="center">****</p>Pasien HIV/AIDS mengalami problem yang kompleks baik fisik, psikologis, sosial, dan spiritual. Problem psikososial yang dialami antara lain depresi, cemas, putus asa, dan khawatir, serta berpengaruh pada rusaknya kehidupan sosial seperti mengisolasikan diri dan mendapat stigmatisasi. Berbagai masalah tersebut membuat ODHA merasa tidak berguna dan tidak berharga. Dalam menghadapi problem psikologis seperti rendahnya harga diri, ODHA sangat membutuhkan dukungan sosial baik dari pasangan, orang tua, anak, teman, konselor dan tim kesehatan. Sayangnya selama ini dukungan sosial yang diharapkan tersebut, jarang ODHA didapatkan termasuk dari keluarganya sendiri. Untuk memfasilitasi kebutuhan tersebut, rumah sakit yang menjadi pusat rujukan bagi ODHA membentuk Kelompok Dukungan Sebaya (KDS). Kegiatan KDS diantaranya bimbingan kelompok dan konseling sebaya bagi ODHA. Kegiatan tersebut memberikan peluang bagi ODHA untuk menambah pengetahuan tentang sakitnya, bertukar pengalaman dengan sesamanya, bahkan saling membantu memecahkan masalah. Berbagai manfaat positif KDS tersebut pada gilirannya mampu meningkatkan harga diri ODHA.
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Suwento, Ronny, Dini Widiarni Widodo, Tri Juda Airlangga, et al. "Clinical Trial for Cartilage Conduction Hearing Aid in Indonesia." Audiology Research 11, no. 3 (2021): 410–17. http://dx.doi.org/10.3390/audiolres11030038.

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Hearing improvement represents one of the may valuable outcomes in microtia and aural atresia reconstruction surgery. Most patients with poor development in their hearing function have had a severe microtia. Conventional methods to improve hearing function are bone conduction and bone anchored hearing aids. Cartilage conduction hearing aids (CCHA) represents a new amplification method. This study assessed the outcomes and evaluated the impact and its safety in the patients with microtia and aural atresia whose hearing dysfunction did not improve after surgery for ear reconstruction in our hospital. Hearing functions were evaluated with pure tone audiometry or sound field testing by behavioral audiometry and speech audiometry before and after CCHA fitting. As a result, there was a significant difference between unaided and aided thresholds (p < 0.001). Speech recognition threshold and speech discrimination level also significantly improved with CCHA. The average functional gains of 14 ears were 26.9 ± 2.3 dB. Almost all parents of the patients reported satisfaction with the performance of CCHA, and daily communication in children with hearing loss also became better than usual.
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Li, Xinjun, Hauke Thomsen, Kristina Sundquist, Jan Sundquist, Asta Försti, and Kari Hemminki. "Familial Risks between Pernicious Anemia and Other Autoimmune Diseases in the Population of Sweden." Autoimmune Diseases 2021 (January 12, 2021): 1–5. http://dx.doi.org/10.1155/2021/8815297.

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Background. Pernicious anemia (PA) is an autoimmune disease (AID) which is caused by lack of vitamin B12 (cobalamin) due to its impaired uptake. PA is a multifactorial disease which is associated with a number of other AID comorbidities and which is manifested as part of autoimmune polyglandular syndrome. Due to the shortage of family studies on PA, we planned to address the problem by assessing familial risks for concordant PA between family members and for discordant PA in families of other AID patients. Methods. We collected data on patients diagnosed with AIDs from the Swedish hospitals and family data from a population register. We calculated standardized incidence ratios (SIRs) in families for concordant and discordant risks. Results. The number of PA patients in the offspring generation (for which the familial risk was calculated) was 7701; 278 (3.6%) patients had a family history of PA. The population prevalence of PA was 0.9/1000. The familial risk for PA was 3.88 when any first-degree relative was the proband, equal for men and women. The familial risk was two times higher between siblings than between offspring and parents which may be due to complex genetic background. Associations of PA with 14 discordant AIDs were significant; these included some AIDs that have previously been described as comorbidities in PA patients and several yet unreported associations, including rheumatoid arthritis and other AIDs. Conclusions. The familial risks for PA were high suggesting multifactorial genetic etiology. The results call for further population-level studies to unravel mechanisms of familial PA which may help to understand the etiology of this disease.
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Lima, Núbia Maria Freire Vieira, and Anamarli Nucci. "Clinical attention and assistance profile of patients with amyotrophic lateral sclerosis." Arquivos de Neuro-Psiquiatria 69, no. 2a (2011): 170–75. http://dx.doi.org/10.1590/s0004-282x2011000200005.

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OBJECTIVE: To evaluate the functional status of amyotrophic lateral sclerosis (ALS) patients diagnosed at this institution; to analyze hospital and palliative care; to identify patients' knowledge about home care and supportive resources. METHOD: Twenty-nine patients were evaluated on the ALSFRS-R scale and two semi-structured questionnaires, at the start of the study and every four months thereafter for 1 year. RESULTS: ALSFRS-R score was 30.1±11.5 initially and 24.4±10.5 at 1 year. There was an increase in use of physiotherapeutic care and adaptive aids. The primary caregivers were spouses (55.2%), parents/children/cousins (20.7%), friends (10.3%) and private nurses (3.5%); 10.3% of patients had no caregivers. Basic ALS patient care was provided by the public health system. CONCLUSION: ALS patients' multidisciplinary care was provided by UNICAMP hospital and its outpatient clinics and, in some patients, complemented by a private health plan or personal expenditure. Few ALS patients were aware of the possibility of home nursing. It is necessary to implement national and regional public home nursing in addition to multidisciplinary specialized care of ALS patients.
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Sari, Ni Putu Wulan Purnama, and Anselmus Aristo Parut. "HIV/AIDS-Related Knowledge and Willingness to Participate in Voluntary Counseling and Testing among Health Sciences University Students." Jurnal Ners 13, no. 2 (2019): 162. http://dx.doi.org/10.20473/jn.v13i2.6716.

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Introduction: Health sciences university students (HSUS) are susceptible to HIV infection due to frequent contact with patients whose HIV status is unknown. This study aimed to compare the HIV/AIDS-related knowledge and the willingness to participate in VCT among HSUS, analyzing the differences between groups, and correlation and effect between variables. Methods: This cross-sectional study involved 357 HSUS from the faculty of nursing, pharmacy, psychology and medicine at an accredited university. Samples were selected using simple random sampling. Data analysis used descriptive statistic, Pearson correlation, one-way ANOVA test, and linear regression test (α<0.05).Results: Most respondents were 20-21 years old single female who still live with parents, exposed to HIV/AIDS material twice/more via academic activities; lack of HIV/AIDS-related knowledge (51.5%), highest mean found in medical students (73.1%); willing enough to participate in VCT (83.5%), highest mean found in nursing students (86.4%). No correlation found between variables (p=0.101), and the regression model was not significant (p=0.101). HIV/AIDS-related knowledge contributed only 0.8% influence on the willingness to participate in VCT among HSUS (R2=0.008), other unidentified factors possibly play a more important role.Conclusion: Besides knowledge, other factors like demographic factors, social determinants, close person, health education, fear, and HIV-related stigma may affect the willingness to participate in VCT among HSUS. HSUS's knowledge about HIV/AIDS was low but their willingness to participate in VCT was quite high. HIV/AIDS-related knowledge has a slight contribution in determining HSUS's willingness to participate in VCT. Further analysis of other potential factors is needed to determine stronger predictors.
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Lisovskaya, T. V., S. S. Smirnova, A. M. Gzgyan, et al. "Surrogacy and HIV: features of a clinical case in comorbid cancer." Ural Medical Journal 20, no. 1 (2021): 65–69. http://dx.doi.org/10.52420/2071-5943-2021-20-1-65-69.

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Introduction. A significant increase in the quality and increase in the life expectancy of HIV patients during treatment with antiretroviral drugs necessitates the implementation of the reproductive function in these patients. The participation of a surrogate mother in the treatment of infertility in HIV-infected potential parents, vided by the Russian legislation, requires additional solutions to a number of clinical and organizational problems. The aim was to substantiate a surrogacy program as a method of choice for the treatment of infertility in patients with HIV-positive status and comorbid cancer and also a multidisciplinary approach to organizing it on the example of a specific clinical situation and based on the analysis literature data.Materials. We report a case of using a surrogacy program for a married couple with a positive HIV status in the 4th stage of the disease using the husband's sperm and donor oocytes. The use of donor oocytes in this situation is due to the onset of menopause against the background of a comorbid severe cancer that required multiple courses of chemotherapy.Conclusion. Potential biological parents with a positive HIV status in stage 4 of the disease may have a comorbid oncological pathology, which in itself, as well as its treatment, contributes to a decrease in fertility, and for the future biological mother, it is an obstacle to independently carrying a pregnancy. In this regard, the surrogacy program is the method of choice for the treatment of infertility in this clinical situation. It is advisable for obstetricians-gynecologists (reproductologists) to inform the surrogate mother about the potential risks of infection with the participation of genetic parents with HIV-positive status at various stages of IVF and about preventive measures during gestation in conjunction with the infectious disease specialist of the regional centers for the prevention and control of AIDS.
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Morrow, Allison S., Stephen P. Whiteside, Leslie A. Sim, Juan P. Brito, Zhen Wang, and Mohammad H. Murad. "Developing tools to enhance the use of systematic reviews for clinical care in health systems." BMJ Evidence-Based Medicine 23, no. 6 (2018): 206–9. http://dx.doi.org/10.1136/bmjebm-2018-110995.

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We aimed to develop tools that can facilitate uptake of evidence summarised in systematic reviews by clinical decision makers in health systems. After conducting a systematic review on the management of anxiety in children, we interviewed health system representatives, clinicians and patients to ask about additional information needed for decision-making. Using stakeholders’ feedback and literature searches for contextual and implementation information, we developed two tools (decision aids (DAs)), one for the health system and the second for the clinical encounter. This information mapped to factors of the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) Evidence to Decision Framework. The health system DAs provided information on which patients are candidate for treatment, values and preferences, costs and resources, acceptability, impact on health equity, feasibility, drug dosing, alternative therapies, remission rates and prognosis. Health system stakeholders found the DA useful for clinical decision-making and generalisable to other conditions. The encounter DA was produced as cards containing information on issues that drive treatment decisions (effect on symptoms, effect on function, treatment burden, side effects and cost). Patients and parents prioritised the cards and chose the order in which these issues were discussed with clinician. The encounter DA was found to be helpful by patients, parents and clinicians. We conclude that the uptake of evidence summaries by health systems can be enhanced by developing tools that provide contextual and implementation information about clinical care. A dual approach addressing health system stakeholders as well as clinicians and patients is likely feasible and helpful.
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Kaufmann, Beatrice, Tannys Helfer, Dana Pedemonte, Marika Simon, and Sarah Colvin. "Communication challenges between nurses and migrant paediatric patients." Journal of Research in Nursing 25, no. 3 (2020): 256–74. http://dx.doi.org/10.1177/1744987120909414.

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Background Many people receiving medical treatment in Switzerland speak none of the country’s four languages or English, which is a major communicative barrier for health staff. Appropriate treatment in hospitals depends on the successful communication between hospital staff and patients. Consequently, migrant patients can be particularly challenging for hospital staff. Aims The aim of this project was to examine the following topics: (a) which communicative challenges hospital nurses are confronted with in the care of migrant paediatric patients and how they cope with them, and (b) what requirements nurses (and other stakeholders) have regarding a digital communication aid to improve the care of migrant paediatric patients in the hospital setting. Methods This study used a qualitative approach. The following steps of data collection were undertaken: (a) two literature searches corresponding to the research questions, (b) a focus group interview with paediatric hospital nurses, (c) observation of communication between paediatric nurses/healthcare professionals and children/parents through shadowing, (d) short interviews with paediatric nurses who were being shadowed, and (e) a focus group interview with experts. Data analysis was based on thematic analysis and was supported by MAXQDA software. Results Evaluation of the data showed there are multiple communicative challenges that emerge in the care of migrant paediatric patients. These challenges influence each other and appear at different moments in the hospital stay. Additionally, the results revealed that digital communication aids must be user friendly and easily accessible. Conclusions This study highlights the areas of hospital care in which a digital communication aid could be feasible. However, many of the described communication challenges stem from issues that cannot be solved solely with a digital communication aid. Instead, strategies to tackle these issues must be embedded in the training of nursing staff, in the hospital management strategy and at the political level.
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Kiran, K., Swati Dwivedi, Satyaki Arora, Deepa Singal, Varun Nikhra, and Neeraj Chandra. "Audio-Visual Aid: An Effective Means to improve Parental Awareness toward Habits and Malocclusion Prevention in Children." World Journal of Dentistry 5, no. 2 (2014): 98–101. http://dx.doi.org/10.5005/jp-journals-10015-1267.

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ABSTRACT Introduction Malocclusion is a very prevalent disorder of children. These disorders are frequently the result of deleterious oral habits. These disorders and their etiology are very difficult to explain to the parent, but the advent of audio-visual aids has solved this dilemma for the clinician. They allow the clinician to make the parents understand problems and also to compare with normal individuals. Aim The aim of the present study was to evaluate the awareness of parent toward malocclusion and the efficiency of audio-visual aid in improving parent awareness and compliance toward treatment. Materials and methods A sample size of 100 was estimated which were selected randomly from patients coming to the Department of Pedodontics and Preventive Dentistry, IDS Bareilly. An audio-visual aid was prepared describing the oral habits and their associated malocclusions. A self-prepared questionnaire was presented to the parent before and after the audio-visual aid was shown to them. Their awareness and change in attitude was recorded. Results There was statistically significant (p ≤ 0.001) improvement in the knowledge and attitude toward treatment after audio-visual aids were used. Conclusion Audio-visual aid is effective in improving awareness toward malocclusion caused due to oral habits. How to cite this article Chandra S, Singal D, Arora S, Dwivedi S, Kiran K, Nikhra V, Chandra N. Audio-Visual Aid: An Effective Means to Improve Parental Awareness toward Habits and Malocclusion Prevention in Children. World J Dent 2014;5(2):98-101.
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Su, Brooke M., Jason S. Park, and Dylan K. Chan. "Impact of Primary Language and Insurance on Pediatric Hearing Health Care in a Multidisciplinary Clinic." Otolaryngology–Head and Neck Surgery 157, no. 4 (2017): 722–30. http://dx.doi.org/10.1177/0194599817725695.

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Objective This study aims to describe the effects of primary language and insurance status on care utilization among deaf or hard-of-hearing children under active otolaryngologic and audiologic care. Study Design Cross-sectional analysis. Setting Multidisciplinary hearing loss clinic at a tertiary center. Subjects and Methods Demographics, hearing loss data, and validated survey responses were collected from 206 patients aged 0 to 19 years. Two-sided t tests and χ2 tests were used to obtain descriptive statistics and hypothesis testing. Results Of the sample, 52.4% spoke primarily English at home. Non-English-speaking children and families were less likely to receive psychiatric counseling (12.2% vs 35.2% in the English group, P < .001) and reported more difficulty obtaining educational interventions ( P = .016), and 68.9% had public insurance. Parents of publicly insured children were less likely to know the type or degree of their child’s hearing loss (56.9% vs 75.4%, P = .022), and these children were older on presentation to the clinic (8.5 vs 6.5 years of age, P = .01) compared to privately insured children. Publicly insured children were less likely to receive cochlear implants ( P = .046) and reported increased difficulty obtaining hearing aids ( P = .047). While all patients reported impairment in hearing-related quality of life, publicly insured children aged 2 to 7 years were more likely to perform below minimum thresholds on measures of auditory/oral functioning. Conclusion Even when under active care, deaf or hard-of-hearing children from families who do not speak English at home or with public insurance face more difficulty obtaining educational services, cochlear implants, and hearing aids. These findings represent significant disparities in access to necessary interventions.
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Bélec, Laurent, Ali Si Mohamed, Michaela C. Müller-Trutwin, et al. "Genetically Related Human Immunodeficiency Virus Type 1 in Three Adults of a Family with No Identified Risk Factor for Intrafamilial Transmission." Journal of Virology 72, no. 7 (1998): 5831–39. http://dx.doi.org/10.1128/jvi.72.7.5831-5839.1998.

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ABSTRACT A small number of cases of human immunodeficiency virus (HIV) infection have been reported in individuals with no identified risk factors for transmission. We report on the seroconversion of the 61-year-old mother and the subsequent finding of HIV seropositivity in the 66-year-old father of a 31-year-old AIDS patient. Extensive investigation failed to identify any risk factor for intrafamilial transmission. We conducted a genetic analysis and determined the amino acid signature patterns of the V3, V4, and V5 hypervariable domains and flanking regions in the HIV-1 gp120 env gene of 26 clones derived from proviral DNA in peripheral blood mononuclear cells of the members of the family. env sequences of the viruses isolated from the patients were compared with sequences of HIV-1 subtype B viruses from Europe and local field isolates. Phylogenetic analysis revealed that the sequences of the viruses isolated from the patients were genetically related and formed an intrafamilial cluster of HIV-1 distinct from other subtype B viruses. Interindividual nucleotide variability in the C2-V3 and V4-C4-V5 domains ranged between 1.2 and 5.0% and between 2.2 and 7.5%, respectively, whereas divergence between HIV strains from the patients and control viral strains ranged from 6.6 to 29.3%. The amino acid signature patterns of viral clones from the three patients were closely related. In the C2-V3 region, two minor clones derived from the son’s virus showed less nucleotide divergence (mean, 3.5 and 3.9%) than did the clones derived from the viruses of both parents or the seven other predominant clones derived from the virus from the son (mean, 5.4%). The top of the V3 loop of the last two clones and of all viral clones from the parents exhibited an unusual GPGG sequence. This is the first report of genotypic relatedness of HIV-1 in three adults of the same family in the absence of identified risk factor for transmission between the members of the family. Our findings suggest that atypical transmission of HIV may occur.
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Knishkowy, Barry, Moshe Schein, Alexander Kiderman, Aliza Velber, Richard Edman, and John Yaphe. "Preventive Adolescent Health Care in Family Practice: A Program Summary." Scientific World JOURNAL 6 (2006): 619–27. http://dx.doi.org/10.1100/tsw.2006.116.

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The AMA Guidelines for Adolescent Preventive Services (GAPS) has been the cornerstone of preventive care for teenagers since its publication in 1994. Despite this, there has been little documentation of their implementation in the family medicine literature. This article gives an overview of a family practice–based adolescent preventive health program based on GAPS recommendations, and reports on compliance, feasibility and health issues. A Community-Oriented Primary Care (COPC) program targeted all adolescent patients aged 12—18 years in two Israeli family practices. 321 teenagers were invited to participate. Every 7th and 10th grader was invited for a preventive health visit with the family physician and nurse. The visits included a medical evaluation, screening and counseling regarding health issues recommended by GAPS, and counseling regarding personal health concerns. Parents were also invited to meet with the staff. 184 (57%) of the adolescents invited for health visits attended. The overall visit time was 47 minutes, including 12 minutes for a questionnaire and 35 minutes with providers. Common biomedical problems included overweight, acne and dysmenorrhea. Health risk behaviors and psychosocial problems included cigarette or alcohol use, dieting, infrequent/never seat belt use, and feeling depressed. 78% wanted to discuss at least one personal health issue. 27% were invited for follow-up visits. Only 3% of the parents came for visits. A community-oriented approach facilitates bringing adolescents for preventive health visits. Many previously undetected health issues, particularly psychosocial and behavioral, are revealed during these visits. A concerns checklist aids in addressing personal health concerns.
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Lakhan, Prabha, Deborah Askew, Mark F. Harris, Corey Kirk, and Noel Hayman. "Understanding health talk in an urban Aboriginal and Torres Strait Islander primary healthcare service: a cross-sectional study." Australian Journal of Primary Health 23, no. 4 (2017): 335. http://dx.doi.org/10.1071/py16162.

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Health literacy is an important determinant of health status. This cross-sectional study aimed to describe the prevalence of adequate health literacy among Aboriginal and Torres Strait Islander patients or their carers including parents of sick children attending an urban primary healthcare clinic in Australia, and their experiences of communication with General Practitioners (GPs). A questionnaire, including questions from the Brief Health Literacy Screen (BHLS) and questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS): Communication with Provider, was administered to 427 participants. Descriptive statistics, Pearson’s Chi-Square test and logistic regression analysis were used to describe the prevalence and risk factors associated with health literacy and any associations between the CAHPS questions and health literacy. In total, 72% of participants had adequate health literacy. An age of ≥50 years was independently associated with inadequate health literacy, and completion of secondary or post-secondary schooling was protective. Communication questions that identified areas for improvement included less use of incomprehensible medical words and more frequent use of visual aids. The study provides useful information on health literacy among Aboriginal and Torres Strait Islander patients, or their carers, and their experiences of communication with GPs. Further population-based research is required to investigate the effect of health literacy on health outcomes of Aboriginal and Torres Strait Islander patients.
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Bruce, Iain, Nicola Harman, Paula Williamson, et al. "The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation." Health Technology Assessment 19, no. 68 (2015): 1–374. http://dx.doi.org/10.3310/hta19680.

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BackgroundCleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate.ObjectivesTo identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies.DesignThe management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP.SettingThe survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients’ homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting.ParticipantsClinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association.ResultsThe clinician survey revealed that care was predominantly delivered via a ‘hub-and-spoke’ model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research.ConclusionsThere exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered.FundingThe National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.
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Bagatto, Marlene, Sheila Moodie, Christine Brown, et al. "Prescribing and Verifying Hearing Aids Applying the American Academy of Audiology Pediatric Amplification Guideline: Protocols and Outcomes from the Ontario Infant Hearing Program." Journal of the American Academy of Audiology 27, no. 03 (2016): 188–203. http://dx.doi.org/10.3766/jaaa.15051.

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Background: Guidelines and protocols for pediatric hearing aid fitting are necessary to meet the goals of Early Hearing Detection and Intervention (EHDI) programs. The American Academy of Audiology published an update to their Pediatric Amplification Guideline in 2013. Ontario's Infant Hearing Program (IHP) offers specific protocols that aim to fulfill recommended guidelines. It has recently been updated to align with the American Academy of Audiology Guideline and other evidence. Purpose: A summary of the updates to the Ontario IHP’s Amplification Protocol is described. In addition, data illustrating hearing-related outcomes of the program are offered. Research Design: The updated Ontario protocol is based on evidence, wherever possible. Where research is not yet available, clinical decision support has been described in a systematic way. Outcomes of the Ontario IHP were obtained through a longitudinal clinical observation study. Study Sample: One hundred and fifteen children with hearing loss, who wore hearing aids, were included in the outcome analyses (mean = 28.6 mo; range = 1.3–115.3 mo). Hearing losses ranged from mild to profound, unilateral or bilateral sensorineural (pure-tone average = 52.3 dB HL). They were recruited from four IHP clinics within Ontario. Children with complexities in addition to hearing loss were included. Intervention: The children were fitted with hearing aids following Ontario's Amplification Protocol. Data Collection and Analyses: During routine clinical appointments, IHP Audiologists administered questionnaires to the parents of their pediatric patients using a systematic outcome measurement protocol (University of Western Ontario Pediatric Audiological Monitoring Protocol). Hearing aid fitting details (e.g., speech intelligibility index) were also gathered to describe the quality of the hearing aid fittings in relation to the functional outcomes. Regression analyses were conducted to characterize scores on the questionnaires and the impact of important variables. Children with complexities were analyzed separately from those who were typically developing. Results: Important updates to Ontario's Amplification Protocol offer new details about candidacy considerations as well as technical updates. Outcomes from the IHP reveal protocol elements can be executed clinically and when they are, typically developing children who wear hearing aids are meeting auditory development and performance milestones. Conclusions: Updates to Ontario's Amplification Protocol are necessary to support the evolution of EHDI programs and the evidence which sustains them. With advances in technology and additional research, pediatric hearing aid fitting will continue to progress and support systematic measurement of outcomes for children who wear hearing aids. The application of state-of-the-art hearing aid fitting practices to the pediatric population within EHDI programs supports good outcomes for infants and children with hearing loss.
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Crosby, Lori E., Francis J. Real, Bradley Cruse, et al. "An Immersive Virtual Reality Curriculum for Pediatric Providers on Shared Decision Making for Hydroxyurea." Blood 134, Supplement_1 (2019): 3402. http://dx.doi.org/10.1182/blood-2019-128661.

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Background: Although hydroxyurea (HU) is an effective disease modifying treatment for sickle cell disease (SCD), uptake remains low in pediatric populations in part due to parental concerns such as side-effects and safety. NHLBI Guidelines recommend shared decision making for HU initiation to elicit family preferences and values; however, clinicians lack specific training. A HU shared decision-making (H-SDM) toolkit was developed to facilitate such discussions (NCT03442114). It includes: 1) decision aids to support parents (brochure, booklet, video narratives, and an in-visit issue card [featuring issues parents reported as key to decision-making about HU]); 2) quality improvement tools to monitor shared decision-making performance; and 3) a curriculum to train clinicians in advanced communication skills to engage parents in shared decision-making. This abstract describes the development and preliminary evaluation of the virtual reality (VR) component of the clinician curriculum. Objectives: The goals are to: 1) describe the development of a VR simulation for training clinicians in advanced communication skills, and 2) present preliminary data about its tolerability, acceptability, and impact. Methods: Immersive VR simulations administered via a VR headset were created. The VR environment was designed to replicate a patient room, and graphical character representatives (avatars) of parents and patients were designed based on common demographics of patients with SCD (Figure 1). During simulations, the provider verbally counseled the avatars around HU initiation with avatars' verbal and non-verbal responses matched appropriately. The H-SDM in-visit issue card was incorporated into the virtual environment to reinforce practice with this tool. The VR curriculum was piloted for initial acceptability with parents of a child with SCD and clinicians at a children's hospital. Evaluation: Hematology providers participated in the workshop training that included information on facilitating shared decision-making with subsequent deliberate practice of skills through VR simulations. Each provider completed at least one VR simulation. The view through the VR headset was displayed on to a projector screen so others could view the virtual interaction. Debriefing occurred regarding use of communication skills and utilization of the issue card. To assess tolerability, providers reported side effects related to participation. To assess acceptability, providers completed a modified version of the Spatial Presence Questionnaire and described their experience. Impact was assessed by self-report on a retrospective pre-post survey of confidence in specific communication skills using a 5-point scale (from not confident at all to very confident). Differences in confidence were assessed using Wilcoxon Signed-ranks tests. Results: Nine providers (5 pediatric hematologists and 4 nurse practitioners at 3 children's hospitals) participated. Tolerability: The VR experience was well tolerated with most providers reporting no side effects (Table 1). Acceptability: All providers agreed or strongly agreed that the VR experience captured their senses and that they felt physically present in the VR environment. Providers described the experience as "enjoyable", "immersive", and "fun". One provider noted, "It (the VR simulation) put me in clinic to experience what it felt like to discuss HU and use the tool." Impact: Providers' self-reported confidence significantly improved after VR simulations on 4 of 5 communication skills: confirming understanding, Z =1.98, p = .05, r = .44, eliciting parent concerns/values, Z = 2.22, p = .03, r = .50, using an elicit-provide-elicit approach, Z =1.8, p = .02, r = .50, minimizing medical jargon, Z = 1.8, p = .07, r = .40, and using open-ended questions, Z =1.98, p = .05, r = .44. Median scores changed by one-point for all responses and effects were medium to large (see Figure 2). Discussion: The VR curriculum was rated as immersive, realistic, and well-tolerated. Providers endorsed it as a desirable training method. Self-report of confidence in shared decision making-related communication skills improved following completion of VR simulation. Thus, initial data support that VR may be an effective method for educating providers to engage parents in shared decision making for HU. Disclosures Quinn: Amgen: Other: Research Support; Celgene: Membership on an entity's Board of Directors or advisory committees.
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Zhang, Rong Feng, Peng Yun Wang, Ming Yang, et al. "Application of 3D Printing Technology in Orthopedic Medical Implant -Spinal surgery as an example." International Journal of Bioprinting 5, no. 2 (2019): 3. http://dx.doi.org/10.18063/ijb.v5i2.168.

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Additive manufacturing has been used in complex spinal surgical planning since the 1990s and is now increasingly utilized to produce surgical guides, templates, and more recently customized implants. Surgeons report beneficial impacts using additively manufactured biomodels as pre-operative planning aids as it generally provides a better representation of the patient’s anatomy than on-screen viewing of computed tomography (CT) or magnetic resonance imaging (MRI). Furthermore, it has proven to be very beneficial in surgical training and in explaining complex deformity and surgical plans to patients/ parents. This paper reviews the historical perspective, current use, and future directions in using additive manufacturing in complex spinal surgery cases. This review reflects the authors’ opinion of where the field is moving in light of the current literature. Despite the reported benefits of additive manufacturing for surgical planning in recent years, it remains a high niche market. This review raises the question as to why the use of this technology has not progressed more rapidly despite the reported advantages – decreased operating time, decreased radiation exposure to patients intraoperatively, improved overall surgical outcomes, pre-operative implant selection, as well as being an excellent communication aid for all medical and surgical team members. Increasingly, the greatest benefits of additive manufacturing technology in spinal surgery are customdesigned drill guides, templates for pedicle screw placement, and customized patient-specific implants. In view of these applications, additive manufacturing technology could potentially revolutionize health care in the near future.
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Xu, Juan, Yong Yin, Hao Zhang, et al. "Paediatric asthma control under a community management model in China: a protocol for a prospective multicentre cohort study." BMJ Open 7, no. 8 (2017): e015741. http://dx.doi.org/10.1136/bmjopen-2016-015741.

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IntroductionChildhood asthma is globally one of the most common respiratory disorders and accounts for more school absences and more hospitalizations than any other chronic illness. The worldwide economic burden of this disease exceeds those of HIV/AIDS and tuberculosis combined. Proper intervention and effective management is of paramount importance for the control and prognosis of paediatric asthma. Unfortunately, the rate of uncontrolled and partially controlled paediatric asthma in China is >90%. This study will use a new management model to investigate the status of asthma control and the adherence of patients to a medication protocol.MethodsThis prospective, multicentre, observational study will be conducted at 15 hospitals on children (n=800) diagnosed with asthma. Each patient will be assigned to either the nearest community hospital or Shanghai Children's Medical Center, whichever is closer to the patient's home, according to the decision of parents. Participants were divided into two groups: tertiary care hospital (Shanghai Children's Medical Center) follow-up group and community hospital follow-up group. The primary outcome will be the difference in the proportion of controlled, partially controlled and uncontrolled asthma among the two groups. Secondary outcomes will be the differences in adherence rate, lung function, exacerbations, growth development, total asthma-related unscheduled visits, days absent from school and loss of working days for the patient's caregiver. Data will be analysed on an intention-to-treat and a per-protocol basis.Ethics and disseminationEthics approval was obtained from the Institutional Review Board of Shanghai Children's Medical Center affiliated with Shanghai Jiao Tong University of Medicine. We plan to publish the results of this study in a peer-reviewed journal article.
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Lisnevska, N. O. "Medical secrecy: the rights and responsibilities of participants of the medical process." Infusion & Chemotherapy, no. 3.2 (December 15, 2020): 172–74. http://dx.doi.org/10.32902/2663-0338-2020-3.2-172-174.

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Background. Medical secrecy (MS) is a set of information about the disease, its treatment, the results of examinations, which became known to certain healthcare workers (HCW) during their professional activities. The attending physician and the nurse who performs the drug administration are most aware of the patient’s condition. The information included in the MS is divided into two types: medical and personal information of the patient, which became known during the performance of medical professional duties.
 Objective. To describe selected aspects of the MS problem.
 Materials and methods. Analysis of the legal framework.
 Results and discussion. Medical information belongs to professional confidential information and should not be disclosed. Even the information about the very fact of seeking medical care belongs to professional confidential information. Unlawful intentional disclosure of MS by a person to whom it became known in the course of its professional duties entails criminal liability. This applies not only to HCW, but also to other staff of medical institutions. It is possible to provide information about the treatment and even the patient’s stay in the hospital to third parties, including relatives of any degree of kinship, only with the patient’s own consent. Exceptions include cases of extreme urgency, such as when a patient is taken to hospital unconscious and relatives can provide information on existing allergies and comorbidities. Of course, in such cases, the necessary disclosure limits should be followed. If a relative or other person wishes to visit a patient in the hospital, he or she should be contacted in person and visited only with personal consent. With regard to law enforcement officers, the answer to the question of whether a particular patient is treated in this institution should be given only in the presence of criminal proceedings and after resolving this issue with the chief physician. It should be noted that medical information concerning the deceased is also confidential and cannot be disclosed. It should not be assumed that the deceased can no longer be harmed, so any liability will be absent. Disclosure of such information is also a crime, on the basis of which criminal proceedings may be started. Recently, the medical legislation in Ukraine was changed, and as of today, the fine for disclosing MT is over UAH 50,000. When treating patients with disabilities, all necessary information should be provided to their parents or carers. When treating children aged 14-18, it is impossible not to provide information about treatment to parents, although this may be contrary to the wishes of the child. An important issue is the provision of information to children who are incapacitated by age, but legally capable. If a 5-year-old child asks questions about his or her health, a doctor or other HCW must answer them in a form that is accessible. A similar situation occurs with mentally ill patients: they are deprived of legal capacity, but they have the right to know about their health. You should also be very careful in keeping medical records. For example, information on viral infections (hepatitis, HIV/AIDS) should not be placed on the cover of the medical history, but inside.
 Conclusions. 1. MS information is divided into two types: medical and personal information of the patient. 2. Medical information belongs to professional confidential information and should not be disclosed. 3. It is possible to provide information about the treatment and even the patient’s stay in the hospital to third parties, including relatives, only with the patient’s own consent. 4. In the treatment of patients with disabilities, all necessary information should be provided to the parents or carers.
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Rabrageri, Alberthzon Kris Silo, Risanto Siswosudarmo, and Soetrisno Soetrisno. "FAKTOR RISIKO TRANSMISI VIRUS HIV PADA IBU HAMIL DI PAPUA." Jurnal Kesehatan Reproduksi 4, no. 1 (2017): 23. http://dx.doi.org/10.22146/jkr.35433.

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Background: Human Immunodeficiency Virus (HIV) has been transmitted all over the world and attack people including pregnant women and their fetus. HIV-AIDS has become the main cause of maternal death. The transmission is started from Africa to Indonesia, specifically to Papua Island. In Papua, HIV is a serious threat for pregnant women’s life because of its fast transmission, even faster from other regions in Indonesia. Until present, there has no research about HIV transmission on pregnant women in Papua Island.Objective: To conduct analysis on risk factors related to HIV transmission on pregnant women in Papua Island.Method: Cross sectional continued with retrospective cohort. Data was taken from medical record of all patients delivering in eight state-owned hospitals in Papua and West Papua provinces started from 1 January 2013 to 31 December 2013. Inclusion criteria were all pregnant women who delivered vaginally or by caesarean sections with HIV and non HIV diagnosis and had complete medical record data. Data being taken included mother’s age when delivered the baby, mother’s education, parents’ social economic status, mother’s ethnicity, parents’ domicile, prematurity and infant’s birth weight. The two research groups were HIV (+) and HIV (-) groups. Data were statistically analyzed using Pearson Chi Square for univarian and logistic regression for multivarian.Result and Discussion: In Papua island, prevalence of pregnant women with HIV was 15.3%, and mostly occurred in reproductive age ( 85.1%). The main transmission source was heterosexual (100%). Univarian analysis found that mothers’s age <20 years old when delivered the baby increase 1.12 times compared to > 20 years old but it’s statistically insignificant (p=0.53). Mothers education < 9 years increases the risk of HIV 1.4 times compared to mother’s education > 9 years (p=0.01). The husband’s low socioeconomic status increase the risk of 5.51 times compared with husband’s high socioeconomic status (p<0.01). The wife’s low socioeconomic status increase the risk of 1.22 times, in which statistically insignificant (p=0.14). Native Papuanese pregnant women has significantly 3.05 times higher risk for HIV transmission compared to non Papuanese (p<0.01). Pregnant women’s domicile in villages increase the transmission significantly 2.21 times compared to cities’ domiciles (p<0.00). Premature delivery increased HIV transmission by 1.7 times (p<0.01). Low infant body weight increased the transmission by 1.64 times significantly (p<0.01). Multivarian analysis showed that husband’s low socioeconomic status, Papuanese ethnicity and domicile in villages are the most dominant factors influencing HIV transmission on pregnant women in Papua Island.Conclusion: Varied risk factors on HIV transmission resulted in the occurrence of HIV (+) cases in Papua Island, while the most dominant factors are husband with low socioeconomic status, Papua ethnicity and domicile in villages. Keywords: HIV, risk factors, birthing mothers, Papua Island.
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Aldosari, Mohammed, Ana Oliveira, and Sharon Conroy. "P04 Barriers and facilitators to medicines adherence in children: a systematic review." Archives of Disease in Childhood 105, no. 9 (2020): e7.3-e8. http://dx.doi.org/10.1136/archdischild-2020-nppg.13.

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AimImproving adherence to medicines in children with chronic conditions may lead to significant economic and health benefits.1 To improve adherence, the multifactorial causes of poor adherence should be understood.1 A systematic review for barriers and facilitators to medicines adherence in children was conducted seven years ago.2 We updated this to identify barriers and facilitators to medicines adherence in children reported in the last ten years.MethodA systematic literature search was performed using PubMed, EMBASE, Medline, CINAHL, IPA and Cochrane library databases covering the period November 2008 to March 2019. Inclusion criteria were original research studies identifying barriers and/or facilitators of medicines adherence in children (aged 0–18 years) and included all countries and languages. Exclusion criteria included review articles, editorials, conference papers, reports and studies in adults only. As a reliability measure, 5% of titles and abstracts were assessed independently by a second researcher. Quality assessment was performed on all included studies using the STROBE checklist for observational studies and Cochrane collaboration tools for randomised controlled studies and was checked by a second researcher.ResultsOf 9,360 papers identified by the search, only 172 articles met the inclusion criteria. Most studies were conducted in the US (76), with 11 in the UK, six in Canada and the remaining 79 studies in various countries. Diseases studied included: HIV/AIDS (60), asthma (25), kidney or liver diseases and transplants (18), psychiatric disorders (12), inflammatory bowel disease (10), epilepsy (9) and others (38). Various tools were used to identify barriers and facilitators to medicines adherence. These included 131 studies which used individually designed questionnaires, 32 studies used validated questionnaires and the remaining 9 studies used patients’ medical data. Forgetfulness and fear of side effects were the most common reported barriers to medicines adherence. Others reported barriers to adherence included family conflict, weak patient-provider relationships, stigma and discrimination, drug regimen complexity and lack of support from families. Factors reported to facilitate high rates of adherence included the linking of medicine taking with daily life routines, using reminders to avoid forgetfulness, a higher level of caregivers and parental education and good communication between healthcare professionals, patients and parents.ConclusionThe main findings of this systematic review show that children faced many and varied barriers to medicines adherence with different diseases. Using reminders to avoid forgetfulness and good communication between healthcare professionals, patients and parents were the most common facilitators. To achieve optimal adherence, healthcare providers need to be aware of these barriers and to consider the most appropriate facilitators to encourage patients to take their medicines as prescribed.ReferencesBrown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc 2011;86:304–14.Elliott RA, Watmough DE, Gray NJ, Conroy S, Lakhanpaul M, Pandya H, et al. Talking about medicines (TABS): a multi-method study to understand reasons for medicines non-adherence in children and young people with chronic illness, and to improve their contribution to managing their medicines. Natl Inst Heal Res 2012; 1–423.
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Edwards-Elliott, Ronisha, Robin Johnson, Divya Bhandar, et al. "Utilizing a Peer Patient Advocate to Develop Sickle Cell Transition Educational Materials." Blood 134, Supplement_1 (2019): 5807. http://dx.doi.org/10.1182/blood-2019-128533.

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Background: Peer patient advocates, also called peer advocates or peer supporters have the same chronic illness as the patients that they aid to manage their health care (MacLellan, 2017). Our team developed an interactive group educational program that aimed to prepare and guide adolescents and emerging adults (AEAs) with Sickle Cell Disease (SCD) as they transition from pediatric to adult care and included a peer patient advocate as a co-facilitator of the program. Here we describe a peer advocate led process to develop an educational booklet equipped with visual aids, tables, and pertinent definitions. To our knowledge, this is a novel use of a peer patient advocate as it has not been seen in the literature before. Methods: The first iteration of the booklet was developed by the peer patient advocate based on topics discovered as important to AEAs and parents through qualitative interviews. The intent of the booklet was to be a guide and resource to four AEA's ages 16-21 as they completed the group healthcare meetings The peer advocate drew on personal experiences with SCD to make the educational booklet as relevant as possible while integrating health information from the National Institutes of Health (National Institutes of Health, 2015), American Society of Hematology (American Society of Hematology, n.d.), and Got Transition (Got Transition, n.d.). The second iteration of the program and booklet facilitated by the peer patient advocate integrated lessons learned from the pilot and was used by twelve patients ranging in age from 14-21. Each AEA was called 1-7 days prior to the next group meeting to evaluate the educational material and share their experiences. These structured interviews took between 5-10 minutes to complete was audio-recorded and transcribed into a text file that could be used for feedback analysis. Results: The AEAs overall described the booklet as useful, easy to understand, and beneficial to their learning. It was described as a resources that they found useful to go to for quick information and they enjoyed that it was related to the information presented within the group. The project overall demonstrated that using peer patient advocates as guides to the healthcare team can be very instrumental in developing patient educational materials and programs. Although peer patient advocates are not experts in developing educational material, this project demonstrates that peer patient advocates can develop excellent patient educational materials that are usable and relatable to adolescent patients with sickle cell disease. Conclusions: Having a peer patient advocate as part of the team that creates the education material can increase pertinent, usable, and relatable information for AEAs with sickle cell disease. The team felt the peer advocate's contributions were vital to the booklet content. Including a peer patient advocate to develop patient education development for other chronic diseases may be valuable for AEAs with other chronic health conditions. Disclosures No relevant conflicts of interest to declare.
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Phillips, Stephanie, John Lazarchick, and Shayla Bergmann. "Type 3 Von Willebrand Disease: A Case Report of a Rare Entity." Blood 128, no. 22 (2016): 4988. http://dx.doi.org/10.1182/blood.v128.22.4988.4988.

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Abstract Background: Von Willebrand Factor (VWF) is essential for proper hemostasis. It serves as a carrier protein for factor VIII and also aids in platelet adherence to damaged endothelium. Von Willebrand Disease (VWD) may result from congenital absence of VWF, structural or functional abnormalities or mutations leading to mild decreases in expression of VWF. Type 3 VWD is an autosomal recessive disorder, which accounts for only 1% of patients with VWD and is characterized by a virtual absence of VWF and low levels of Factor VIII. Objective: To describe a case of Type 3 VWD including the presentation, diagnosis and clinical course. Design/Method: Case Report. A 4 month old female presented with a history of 8 hours of persistent bleeding from an injection site following vaccination administration. At that time, the patient's platelet count and PT/PTT were normal. She had a few intermittent episodes of persistent bleeding with minor abrasions and had labs repeated at the age of 4 months which were significant for a prolonged PTT of 59.5 seconds with normal PT and platelet count. Factor VIII level was <1% and VWF activity was <15%. Results: A complete Von Willebrand panel was sent to Mayo Medical Labs and showed a Factor VIII level of 2%, VWF antigen 6%, VWF activity of 8, and an absence of VWF multimers. Confirmatory VWF full gene sequence analysis testing was sent to Blood Center of Wisconsin and showed a heterozygous sequence variant, c.2435delC, in the VWF gene consistent with a diagnosis of VWD Type 3. VWF full gene sequence analysis was also sent on both parents. Mother's results showed that she is a carrier of the same VWF gene sequence variant. Father's results were negative. Given the patient only has a heterozygous sequence variant yet still has expression of VWD, gene duplication testing was sent to Blood Center of Wisconsin to look for possible duplication of this area. Results of this testing showed that the patient had two pathogenic variants, one on each allele: heterozygous c.243delC in exon 18 and a deletion involving exon 6 in the VWF gene. Conclusion: This case represents the clinical presentation and diagnosis of a patient with Type 3 VWD. While VWD is not uncommon, diagnosis of VWD Type 3 is quite rare. VWD Type 3 is inherited in an autosomal recessive fashion. In the case of our patient, only one parent was identified as a carrier of the same gene sequence mutation. Therefore, the second pathogenic variant resulting in VWD Type 3 was found to be a de novo deletion, further adding to the uniqueness of this case. Disclosures No relevant conflicts of interest to declare.
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Wang, W., S. Yang, Z. Yu, M. Wei, L. Zhong, and H. Song. "AB1067 CASE OR FAMILY?FROM 2 CHINESE FCAS3 CHILDREN WITH PLCG2 MUTATION TO THEIR FAMILIES." Annals of the Rheumatic Diseases 79, Suppl 1 (2020): 1822.3–1823. http://dx.doi.org/10.1136/annrheumdis-2020-eular.862.

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Background:Familial cold autoinflammatory syndrome 3 (FCAS3) is an autoinflammatory disease (AID) caused by mutation of the PLCG2 gene, which has not been reported in China. We will report 2 cases of Chinese FCAS3 patients with no claimed family history, but we found the same mutations in a parent during their genetic analysis. After further inquiry of the parent’s medical history, we confirmed that actually, they were two FCAS3 families. Through a literature review, we found that the clinical features of Chinese patients are milder than foreign countries, and their symptoms are concealed and may be ignored, resulting in mistakes in family history collecting.Objectives:To summarize the genetic and clinical features of Chinese FCAS3 patients and to provide diagnostic recommendations for the disease.Methods:Two suspected AID children with recurrent fever and urticaria were enrolled in this study. Clinical data and family history were collected, and genetic analysis was performed by next-generation sequencing (PID panel or WES) and Sanger-based validation. Literature was reviewed from PubMed, CNKI, and Wanfang Database.Results:The two children were both diagnosed to be FCAS3 with PLCG2 mutation. The clinical manifestations of 2 children were recurrent fever, urticaria, and increased ESR and CRP. Case 1 has a paternal, and Case 2 has a maternal heterozygous mutation in the PLCG2 gene, while both had claimed without a family history. Further inquiry showed the two parents used to have a fever with urticaria. By comparing with foreign literature, we found our patients were milder than abroad patients. Large fragment deletions were relatively more common in foreign patients.Conclusion:We reported the case of FCAS3 in China for the first time. Their genotype and phenotype were different from foreign patients. Their symptoms are mild, and heterozygous mutations are more common than foreign patients, which are the main differences. The difference in mutation type may be the reason for different clinical manifestations. Besides, both two families showed a trend of more severe clinical features in the next generation. As the symptoms of the elders were not obvious and may be ignored, it caused trouble for the genetic diagnosis. Therefore, family history should be collected carefully. For rashes and fevers, which are not too severe in overall symptoms, care should be taken about the possibility of AIDs. Genetic testing can help to make a definite diagnosis.Table 1.Descriptive charecteristics of the patients with FMF, n=474VariableCompliant(n=230)Noncompliant (n=244)P valueGender of patient (F)142(61.7)147(60.2)0.73Age, years*35(28-42.5)34(27-44.2)0.88Being Married152(66.1)146(59.8)0.15Disease duration, years*22(14-31)22(15-31)0.71Number of index flare*within last 12-month6.7(1-10)5(3-10)<0.001Family historyof parents54(23.5)39(16.0)0.04Family historyof sibling73(32.9)102(43.4)0.02Comorbid disease presence73(31.7)55(22.5)0.02Treatment<0.001Colchicine230 (94.1)180(78.6)Anakinra&Canakinumab134(5.3)49(21.4)Colchicine response presence127(55.2)126(52.3)0.52Drug using except FMF74(32.2)44(18.0)<0.001Presence of 2 attacks except fever90 (39.1)68(27.9)0.009Chronic peripheral arthritis16(7.0)7(2.9)0.03Amyloidosis18(7.8)9(3.7)0.05Proteinuria23(10.8)8(3.6)0.004Adequate medical care161(70.0)132(54.8)<0.001ISSF severity score*3(2-4)3(2-4)0.02ADDI index*1(0-1)1(0-1)0.05References:[1]Pathak S, Mcdermott M F, Savic S. Autoinflammatory diseases: update on classification diagnosis and management[J]. Journal of Clinical Pathology, 2017, 70(1):1-8.[2]Broderick, L., Hereditary Autoinflammatory Disorders: Recognition and Treatment. Immunol Allergy Clin North Am, 2019. 39(1):13-29.[3]Milner, Joshua D. PLAID: A Syndrome of Complex Patterns of Disease and Unique Phenotypes[J]. Journal of Clinical Immunology, 2015, 35(6):527-530.[4]Picard C, Gaspar H B, Al-Herz W, et al. International Union of Immunological Societies: 2017 Primary Immunodeficiency Diseases Committee Report on Inborn Errors of Immunity[J]. Journal of Clinical Immunology, 2017, 38(Suppl 1):96-128.[5]Ombrello M J, Remmers E F, Sun G, et al. Cold Urticaria, Immunodeficiency, and Autoimmunity Related to PLCG2 Deletions[J]. New England Journal of Medicine, 2012, 366(4):330-8.[6]Zhou Q, Lee GS, Brady J, et al. A Hypermorphic Missense Mutation in PLCG2, Encoding Phospholipase Cγ2, Causes a Dominantly Inherited Autoinflammatory Disease with Immunodeficiency[J]. American Journal of Human Genetics, 2012, 91(4).[7]Neves, J.F., et al., Novel PLCG2 Mutation in a Patient with APLAID and Cutis Laxa. Front Immunol, 2018. 9: 2863.[8]Mcdermott M F, Aksentijevich I, Galon J, et al. Germline mutations in the extracellular domains of the 55 kDa TNF receptor, TNFR1, define a family of dominantly inherited autoinflammatory syndromes[J]. Cell, 1999, 97(1):133-144.Disclosure of Interests:None declared
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Bhandari, Sudhir, Ajit Singh Shaktawat, Bhoopendra Patel, et al. "The sequel to COVID-19: the antithesis to life." Journal of Ideas in Health 3, Special1 (2020): 205–12. http://dx.doi.org/10.47108/jidhealth.vol3.issspecial1.69.

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The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed.
 
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 Lee SM, Kang WS, Cho A-R, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018; 87:123-127. https://dx.doi.org/10.1016%2Fj.comppsych.2018.10.003.
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Dlamini, Sabelo Bonginkosi, Hans-Uwe Dahms, and Ming-Tsang Wu. "Factors associated with prognostic or treatment outcomes in HIV/AIDS patients with and without hypertension in Eswatini." Scientific Reports 11, no. 1 (2021). http://dx.doi.org/10.1038/s41598-021-92185-0.

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AbstractNon-communicable diseases are increasing faster in HIV/AIDS patients than in the general population. We studied the association between hypertension and other possible confounding factors on viral load and CD4-cell counts in hypertensive and non-hypertensive HIV/AIDS patients receiving antiretroviral therapy (ART) at a large hospital in Eswatini over a 4-year period. We performed a retrospective longitudinal review of the medical records of 560 ART patients divided into non-hypertension and hypertension groups (n = 325 and n = 235) from July 27 to September 8, 2018. Generalized Estimated Equation was used to analyze the longitudinal data. Hypertensive patients were more likely to have improved CD4-cell counts than non-hypertensive patients (OR = 1.83, [1.37–2.44]). ART patients with hypertension were more likely to have detectable viral loads, though not significant (OR = 1.37 [0.77–2.43]). In non-hypertensive patients, second line ART was significantly associated with viral load (OR = 8.61 [2.93–25.34]) and adverse side effects (OR = 3.50 [1.06–11.54]), while isoniazid preventive therapy was significantly associated with CD4-cell counts (OR = 1.68 [1.16–2.45]). In hypertensive patients, factors associated with viral load were WHO HIV stage (OR = 2.84 [1.03–7.85]) and adherence (OR = 8.08 [1.33–49.04]). In both groups, CD4-cell counts significantly and steadily increased over time (p-value < 0.001). Results show a significant association between hypertension and CD4 cell counts but not viral load. In ART patients with and without hypertension, the factors associated with prognostic markers were different. More attention may need to be paid to ART patients with well controlled HIV status to monitoring and controlling of hypertension status.
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34

Sliep, Y., M. Poggenpoel, and A. Gmeiner. "The experience of HIV reactive patients in rural Malawi - Part I." Curationis 24, no. 3 (2001). http://dx.doi.org/10.4102/curationis.v24i3.851.

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Malawi has a population of 9 million people with AIDS the leading cause of death in the 20 - 40 age group. The HIV positive prevalence rate, estimated at 23% in urban areas and 8% in rural areas, is one of the highest in the world (AIDSEC, 1994:1). Evaluation of counselling practices showed poor results with counsellors feeling ineffective and inadequate. Patients are mostly tested on medical indication but patients who do not see the benefit of knowing their HIV status increasingly refuse testing. The counselling practise as it is known in the Western world is a foreign concept for patients living in rural Malawi. The high stigma of AIDS complicates support of the patients. The goal of the research study was to describe a model of counselling that would meet the needs of an AIDS patient in rural community in Malawi. A qualitative research design that was explorative, descriptive and contextually specific to rural Malawi was used for the study. In order to describe a counselling model it was important to understand the illness experience of HIV reactive patients. The patients are seen in group context congruent with the African culture and therefore the experience of the primary care giver of AIDS patients is explored as the other major factor in the phenomenon examined. One phase of the research is described in this article namely exploring and describing the experience of the HIV reactive patient in rural Malawi. Results show that patients are in an advanced stage of AIDS when they are diagnosed and complain of weakness and an inability to do work, including an inability to do their daily chores. This causes a feeling of desperateness that is worsened by the perception that support systems are inadequate. Support systems are mostly identified as parents, partners and siblings to assist mainly with the physical care and financial support. Despite the fact that the family is very important to patients there is a reluctance to acknowledge their HIV status. Patients fear being rejected once it is known that they have AIDS - not only because AIDS is a sexually transmitted disease, but also because it is perceived that financial and other support will be withheld if it is known that patients have AIDS and will therefore die and not be able to return the support provided. Patients feel they have no future once a diagnosis of AIDS has been made which results in refusal of testing, as they do not see the benefit of knowing their HIV status. Assessing the coping ability of the patient within the household as part of an overall assessment is one proposed strategy that could be taken. Secondly the patient is encouraged to take a more active role in the counselling process, which could be achieved by narration. The family should be incorporated into the counselling process as early as possible.
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Kalateh Sadati, Ahmad, Vajihe Taheri, and Soroor Hemmati. "Challenges Experienced by HIV/AIDS-Positive Women in Marital Relationships; A qualitative study." Journal of Tolooebehdasht, January 22, 2020. http://dx.doi.org/10.18502/tbj.v18i5.2282.

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Introduction: The prevalence of HIV/AIDS is alarmingly increasing. Considering the experiences of HIV/AIDS-positive patients, experiences of the women who took HIV/AIDS from their husbands –marital relationships- can be different. The purpose of this study was to describe the challenges of these women.
 Methods: This qualitative study was conducted using focus group discussions with 10 women who took HIV/AIDS from their husbands. All interviews were recorded, transcribed verbatim, and analyzed by thematic analysis.
 Results: Data analysis showed that participants experienced a kind of compulsive social isolation. They could not interact with anyone except their parents. They suffered from social stigma because the disease is associated with the illicit sex label. From data analysis, three main themes of fear, marital despondency, and stigma emerged.
 Conclusion: The concerns and challenges of women who took HIV/AIDS from their marital relationships revealed that these women were exposed to the social strains because of having HIV / AIDS and stigma of illegitimate sexual relationships. In this regard, public awareness should be raised about this disadvantaged group of the community. To hit this target, individuals should be provided with the required information through schools as well as broadcasting and social media. Implementation of the counseling visits can create psychological and social support for these traumatized group and their families.
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Thomsen, Hauke, Xinjun Li, Kristina Sundquist, Jan Sundquist, Asta Försti, and Kari Hemminki. "Familial risks between giant cell arteritis and Takayasu arteritis and other autoimmune diseases in the population of Sweden." Scientific Reports 10, no. 1 (2020). http://dx.doi.org/10.1038/s41598-020-77857-7.

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AbstractGiant cell arteritis (GCA, also called temporal arteritis) is a rare and Takayasu arteritis (TA) is an even rarer autoimmune disease (AID), both of which present with inflammatory vasculitis of large and medium size arteries. The risk factors are largely undefined but disease susceptibility has been associated with human leukocyte antigen locus. Population-level familial risk is not known. In the present nation-wide study we describe familial risk for GCA and for GCA and TA with any other AID based on the Swedish hospital diagnoses up to years 2012. Family relationships were obtained from the Multigeneration Register. Familial standardized incidence ratios (SIRs) were calculated for offspring whose parents or siblings were diagnosed with GCA, TA or any other AID. The number of GCA patients in the offspring generation was 4695, compared to 209 TA patients; for both, familial patients accounted for 1% of all patients. The familial risk for GCA was 2.14, 2.40 for women and non-significant for men. GCA was associated with 10 other AIDs and TA was associated with 6 other AIDs; both shared associations with polymyalgia rheumatica and rheumatoid arthritis. The results showed that family history is a risk factor for GCA. Significant familial associations of both GCA and TA with such a number of other AIDs provide evidence for polyautoimmunity among these diseases.
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Larrabee, Catherine. "Inherited Injustice: Stigma and Gender Discrimination as Barriers to AIDS Prevention in India." Elements 11, no. 2 (2015). http://dx.doi.org/10.6017/eurj.v11i2.9068.

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Over the past decade, programs that prevent the vertical transmission of HIV from parents to their children have become widely accessible in India. Despite this ostensible success, most Indian women and their unborn babies do not utilize these programs, and therefore remain vulnerable to vertical transmission. This article explores this troubling phenomenon by highlighting the particular effect of HIV/AIDS-related stigma on women who live in highly patriarchal societies. In these contexts, the effects of stigma become tangible rather than simply emotional. When stigma exists alongside gender inequality, these forces collude and become a structural barrier that keeps women from safely obtaining the treatment to prevent vertical transmission. This probelm is double-pronged as negative attitudes from health care staff create prejudices and prompt patients to keep their health status a secret out of fear of judgement. Attending to isuses of stigma and gender injustice is a necessary step in the mission of holistically adddressing the crisis of HIV/AIDS in India as well as the global community.
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Kuliński, Włodzisław, and Magdalena Żukowska. "CEREBRAL PALSY: CLINICAL AND SOCIAL PROBLEMS." Wiadomości Lekarskie 72, no. 12 (2020). http://dx.doi.org/10.36740/wlek201912101.

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Introduction: Cerebral palsy / MPD/is a motor and postural disorder caused by permanent brain damage that occurred at an early stage of development. Cerebral palsy is the most common cause of disability in children. The aim: To present cerebral palsy as a clinical problem and to outline the importance of physiotherapy in the treatment of cerebral palsy patients. Materials and methods: The study included 67 children with cerebral palsy (mean age was 9 years) treated and followed up for 6 months at the “Górka” Orthopaedic and Rehabilitation Hospital in Busko Zdrój. The clinical presentation was dominated by manifestations of motor and postural abnormalities resulting from upper motor neuron and corticospinal tract damage. A diagnostic survey was used as the research method. The physiotherapy and rehabilitation used in the patients consisted of kinesiotherapy (usually Bobath/NDT) and physical therapy procedures (magnetic stimulation, laser therapy, LED light therapy). The study used a survey questionnaire that collected information about problems with everyday life and functioning of cerebral palsy patients and opinions about their rehabilitation programme. Results: Follow-up data were analysed in patient groups, which were created based on the method of ambulation in children with cerebral palsy. The results emphasise the role of physiotherapy in the rehabilitation of cerebral palsy patients. Systematic motor rehabilitation contributed to an improved physical fitness and better everyday functioning. Parents of children walking with aids reported having problems with access to specialist healthcare, which resulted from the fact that they did not live close enough to an appropriate centre. Parents of non-ambulatory patients reported that they lacked financial means and parents of children who were able to walk unassisted complained of long waiting times for rehabilitation. Conclusions: 1. MPD is a difficult clinical and social problem. 2. Physical improvement procedures is an essential element in the treatment of this group of patients.
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Arshad Altaf, Syed Sharaf Ali Shah, Safdar Pasha, Altaf Ahmed Soomro, Nazia Farrukh, and Rafiq Khanani. "Index testing among HIV-positive patients is feasible and successful in identifying additional HIV infections in Pakistan." Journal of the Pakistan Medical Association, August 7, 2021, 6–10. http://dx.doi.org/10.47391/jpma.0001.

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Objective: To assess the feasibility of index testing approach to test the parents and siblings of human immunodeficiency virus (HIV)-positive children, and identify HIV-positive individuals.
 Methods: The study was conducted at Ratodero, Pakistan. Study participants were enrolled from September 2019 to February 2020. The list of HIV-positive persons was provided by the Provincial Acquired Immunodeficiency Syndrome (AIDS) Control Programme. Families of 706 HIV-positive persons were approached and all of them agreed to participate. The first test was performed by trained outreach workers. All those with a reactive first test were transported to the nearest health facility for further testing and confirmation. Mothers and siblings were tested at home while additional visits were carried out to reach the fathers. 
 Results: A total of 1766 persons were tested through HIV index testing. Biological siblings accounted for 81% of the contacts. We were able to test 413/463 (89.2%) mothers, 232/413 (56.2%) fathers and 1121/1392 (80.5%) siblings. Out of these, 7 mothers (1.7%) and 22 siblings (2.0%) were confirmed to be HIV-positive, while no one was found to be positive among the fathers. The overall HIV prevalence was 1.6% (29/1766). All HIV-positive persons were guided for treatment and care. 
 Conclusion: Results indicate that index-testing approach is feasible in Pakistan to expand HIV testing services through home visits. 
 Key words: Human immunodeficiency virus, HIV, HIV testing, Pakistan, Index testing, HIV outbreak, Prevalence.
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40

Kumar, Arvind, Abha Shukla, and Dinesh Matoli. "Study of Congenital Ocular Anomalies Prevalent in Routine Eye OPD in a Tertiary Care Hospital." Ophthalmology Research: An International Journal, November 28, 2019, 1–7. http://dx.doi.org/10.9734/or/2019/v11i230122.

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Aims: Congenital ocular anomalies require treatment, visual rehabilitation and genetic counselling. Goes undetected in neonates and children due to lack of routine eye checkup. Diagnosed later during eye examination or when come for disability certificate.
 Study Design: Prospective and observational study.
 Place and Duration of Study: We conducted study at tertiary care hospital, over a period of six months (from January 2018 to June 2018).
 Methodology: Patients with congenital ocular anomalies irrespective of their age were identified. Findings were confirmed by detailed ocular examination and investigations when required. Whatever best management like correcting refractive error, surgery, low vision aids or rehabilitation was advised. Those having acquired defects giving similar appearance as in congenital anomalies, cases of ocular trauma, infections, with prior surgical intervention were excluded.
 Results: Over a period of six months 128 eyes were detected with congenital ocular anomalies. The most common anomalies were microphthalmos, microcornea and iris coloboma seen in 85 eyes. Other congenital anomalies were congenital cataract, nystagmus, anophthalmos, aniridia, congenital glaucoma, Ankyloblepharon, coloboma of disc, congenital esotropia, lid coloboma, congenital ptosis, axenfield anomaly, limbal dermoid.
 Conclusion: Patient with congenital ocular anomalies and their parents should be counseled regarding possible current treatment, visual prognosis and genetic counselling regardless of age and time of presentation.
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Batouk, Omar Ali, Mohammed Marzoog Almutairi, Majd Amjed Saemaldahar, and Badr Zuhair Ambon. "Congenital insensitivity to pain with anhidrosis and multiple Charcot joints in a child: A case report." Journal of Musculoskeletal Surgery and Research, July 7, 2021, 1–5. http://dx.doi.org/10.25259/jmsr_42_2021.

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Congenital insensitivity to pain with anhidrosis (CIPA) syndrome is a rare autosomal recessive condition affecting various tracts in the peripheral and autonomic nervous system. CIPA has an incidence of 1/125,000,000. The only known causative gene to date is neurotrophic tyrosine receptor kinase 1 (NTRK1), which is located on chromosome 1q21-q22. The mutation in the NTRK1 gene is associated with consanguineous marriages. Manifestations of this condition are highly variable, with insensitivity to pain being the mainstay. Patients are commonly presented with bruises, joint dislocations, multiple fractures, oral manifestations, and disfigured joints. We present a rare case of a CIPA patient manifested with Charcot’s joints. A 15-year-old male presented with multiple destructed joints in both knees, ankles, and wrists. He uses walking aids and has a loss of response to painful stimuli. The condition started at the age of 7 years. Other manifestations were fever, anhidrosis, mental retardation, and self-mutilating behaviors. The parents have a consanguineous marriage. Nerve and muscle biopsies were obtained and revealed no significant pathological abnormalities. However, imaging showed grossly disorganized joints and the clinical diagnosis of CIPA was confirmed. As illustrated in this case, the occurrence of CIPA syndrome, hereditary sensory and autonomic neuropathy Type IV, remains highly unprecedented and genetic testing is mandatory for the diagnosis. In addition, nerve and muscle biopsy should be obtained, and advanced imaging such as magnetic resonance imaging is needed to evaluate the case fully. There is no definitive therapeutic intervention for this condition, therefore, education and prevention are important to improve the quality of life of a CIPA patient.
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Paul, Nsirimobu Ichendu, and Rosemary Ogochukwu Ugwu. "Dolutegravir (DTG) Based Fixed Dose Combination (FDC) of Tenofovir/Lamivudine/Dolutegravir (TLD) and Viral Load Suppression in Children in Port Harcourt, Nigeria." Journal of Scientific Research and Reports, March 16, 2020, 52–59. http://dx.doi.org/10.9734/jsrr/2020/v26i230224.

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Background: Currently, dolutegravir (DTG) based fixed dose combinations (FDC) of tenofovir/ lamivudine/dolutegravir (TLD) and Abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) is now recommended by the World Health Organisation (WHO) as the preferred first-and second line antiretroviral drug necessitating transition of eligible children to TLD.
 Objective: The objective of this study is to compare the HIV viral suppression rate at baseline and after 6 months of transition to TLD and to determine adverse drug reaction associated with the use of TLD if any.
 Methods: This was a prospective cross-sectional study carried out among stable children who were on treatment and follow up for HIV disease at the Paediatric HIV clinic of the University of Port Harcourt Teaching Hospital (UPTH). All Children who were eligible for transition to TLD, whose care givers/parents gave a verbal consent and who gave consent or accent were recruited for the study. Information obtained included the sociodemographic characteristics, weight and height, ART regimen at initiation of treatment and when it was commenced, the baseline viral load and viral load 6 months after transition and any adverse drug reaction. Obtained data were analysed. Comparison of categorical variables was done using chi square and Fischer’s exact test while A p-value of < 0.05 was set as statistically significant.
 Results: A total 106 children aged 9 to 18 years with a mean age of 13.4±2.3 years were recruited for the study. Sixty (56.6%) were males, while 59 (55.5%) were from the lower socioeconomic class. The mean weight was 44.4±11.1 kg while the mean height was 151.3 ± 15.2 cm. At baseline, 48 (45.3%) were virally suppressed (viral load < 1000 copies/ml), however after 6 months, 97 (91.5%) became virally suppressed, the difference in viral suppression rate was statistically significant (X2 =53.77, p= 0.0001). Twenty-five (23.6%) had undetectable viral load (<20 copies/ml) at baseline while 61(57.5%) had undetectable viral load after transition. All those who were virally suppressed at baseline remained so 6 months after transition. Also, 80.6% (29/36) of those with treatment failure became virally suppressed. Only one child developed severe erythematous skin rashes. There was no statistically significant relationship between viral suppression and age, sex and social class (P >0.05).
 Conclusion: This study has shown that DTG-based FDC is efficacious in the treatment of eligible children and adolescents with HIV/AIDS with significant viral load suppression in all age groups, gender and social class. Adverse drug reaction with the use of DTG-based ART is low. Transition to TLD is therefore advocated in eligible patients.
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43

Kostyshyn, А. В. "PROFESSIONAL ADVANCED EDUCATION - THE BASIS OF QUALITY HIGHER EDUCATION." Art of Medicine, January 6, 2021, 114–19. http://dx.doi.org/10.21802/artm.2020.4.16.114.

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Abstract:
Education is a process on which the future of a nation depends. In addition, a quality educational process is a necessary condition for higher education, without which education will not be competitive. Teachers, educational technologies, methods, tools (visual aids, textbooks, technical devices, etc.), educational management are involved in the process.
 Education provides general cultural and professionally oriented training of a graduate of the degree of junior specialist, determines the amount of special knowledge, skills and abilities sufficient to solve typical tasks of the specialist in the respective position, including the ability to use theoretical knowledge and practical skills, to perform the technological stages of manufacturing orthopedic prostheses, to provide medical care in emergencies, to assess the impact of dangerous factors on the development of occupational diseases.
 Education provides the activities of a nurse, which includes organizational functions, determining the needs of patients, the ability to prepare patients for complex laboratory tests and instrumental methods of examination, special care and care for patients, participation in treatment and prevention, conduct an educational work in accordance with the principles of nursing ethics and deontology, constant improvement of professional level, practice of practical skills in the departments of hospitals, hospices and family medicine clinics.
 Education provides students with the ability to form a worldview, understanding the principles of society, the ability to think abstractly, analyze and synthesize on the basis of logical arguments and verified facts, consider social phenomena in development and specific historical conditions, lead a discussion, use appropriate terminology and thoughts expression in oral and written forms in the native language.
 Students are taught to use knowledge in the field of socio-economic training, communicate in a foreign language, be ready to work in a foreign language environment using information technology, search for processing and analysis of information from various sources, communicate professionally, provide harmonious and constructive relationships in the performance of professional tasks. At IFNMU Medical College, students learn the ability to interpret and use theoretical knowledge and practical skills on diseases questions, methods of organizing the safety of human life, their protection from the possible consequences of accidents and disasters.
 At the same time, education, and hence its quality, is not limited to learning outcomes. It is also the physical, intellectual and spiritual development of the individual, the level of his upbringing.
 That is why well-known scientists do not have a single opinion on the concept of quality education.
 The quality of education depends on many factors: teaching staff, the level of their skills; resource provision of the educational process; management of the educational process; curricula of educational content and educational and methodological support; effective educational technologies; psychological support of the educational process, as well as from the subjects of education, concerted actions with parents, etc.
 Of course, education will be of good quality if all components interact effectively. The article highlights the features of providing quality professional before higher education, its interrelation with efficiency of preparation of experts in higher educational institutions is defined.
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