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Primary care centers are trialing open access scheduling models to expand access. Given evidence linking irregular caregiver work schedules with adverse child developmental outcomes, we hypothesized that children presenting for unscheduled "walk-in" visits would have higher odds of developmental concerns than those presenting for scheduled visits.We conducted a retrospective review of electronic health record data for children aged 6 to 66 months visiting an academic pediatric primary care center between July 1, 2013 and February 1, 2019. Our primary outcome was presence of developmental concerns, defined by results below cutoff on a child's AgesStages Questionnaire, Third Edition (ASQ-3). We examined associations between visit stream (unscheduled vs scheduled; time of day) and ASQ-3 using multivariable logistic regression, adjusting for child demographics, visit type (well-child vs ill), and responses to a standardized social history questionnaire.Of 11,169 eligible total encounters each for a unique child, 8% were unscheduled (n = 848); 19% had developmental concerns in at least one domain (n = 2100). Twenty-eight percent of children presenting for unscheduled visits had developmental concerns compared to 18% of those presenting for scheduled visits (P.0001). Compared to those presenting for scheduled well-child visits, children presenting for unscheduled ill visits had a higher odds of an ASQ-3 score below cutoff (adjusted odds ratio 2.02; 95% confidence interval, 1.54-2.65).As pediatric primary care centers implement open access scheduling models, they should be prepared to identify and respond to developmental concerns at a rate that may be higher than what is typically seen during scheduled visits.

The article analyzes the protests in Cuba in the context of the economic blockade and the health crisis as a consequence of the covid 19 pandemic. The current policy of the United States with President Joe Biden and the distances with the diplomacy of Barack Obama and the events after the more than two hundred measures adopted by Donald Trump, who adopted more than 240 additional measures to deepen the blockade. Additionally, the policy of the United States is detailed historically with Cuba and the milestones of the influence of the Cuban Revolution in Latin America are detailed.

Bruising is a commonly sustained injury in childhood, and thus is often overlooked during examination. However, it is the most common abusive injury, and may indicate severe internal injury, or precede catastrophic injury. Knowing which bruises warrant further investigation is vital to protect the child. A careful history, including developmental stage, past medical and social history followed by a full top to toe examination is required. Evidence highlights that some patterns of bruising warrant further investigation. This includes bruising in young, immobile infants, or bruising to the cheeks, ears, neck, trunk, genitalia or multiple bruises from a single incident, particularly in a distinct pattern or accompanying petechiae. Full assessment includes obtaining high quality clinical photographs of the bruising, exclusion of underlying bleeding disorders, consideration of differential diagnosis, and assessment for occult injury. The latter should include a skeletal survey in those aged less than two years, and computerized tomography of brain and full ophthalmology examination for those aged less than one year. Discussion with senior colleagues, consideration of the safety of the child, and clear communication with the family is vital throughout this process. Acting promptly and appropriately when concerning bruises are found may be the only opportunity to protect this child from further harm.

INTRODUCTION: A transition from face-to-face to virtual consultations occurred in response to the COVID-19 pandemic. Evaluation of outcome data is essential for future healthcare modelling. METHODS: Clinicians at a children's hospital evaluated perceptions of face-to-face video and telephone appointments by questionnaire. Responses were compared with operational outcomes from June 2019 and June 2020. RESULTS: Ninety-three clinicians responded from 28 subspecialties. Virtual consultations increased from 6% (2019) to 67% (2020). No differences were found between appointment types for recording a medical and social history; a significant difference (p

BACKGROUND: Guillain-Barre syndrome (GBS) is considered an acute immune-mediated monophasic illness. Standard therapy includes intravenous immunoglobulin (IVIG) and/or plasmapheresis. Yet, long-standing disability remains a problem. In Indonesia, the availability and cost of these therapies are constraints. AIM: To show the capability of hyperbaric oxygen (HBO2) therapy in GBS patients who did not undergo standard therapy. HBO2 also provides healing in patients who experience delays in therapy. METHODS: Data included identity, demographic, social history, current disease history, disease progression and therapies used. Data were displayed in the form of tables and graphs. RESULTS: Twenty-five GBS patients underwent HBO2 from 2016 to 2019. The majority of patients were males aged 20-30 years, triggered by preceding diarrhea. After approximately three to ten days following HBO2, they felt their first positive changes. They walked with assistance after two to three weeks receiving HBO2 and without assistance after four to 12 weeks receiving HBO2. CONCLUSION: HBO2 administration show clinical improvement in GBS patients. HBO2 is expected to become an adjuctive therapy for GBS patients in Indonesia.

Due to their likelihood for experiencing a number of traumatic events, refugee minors have an increased risk of developing post-traumatic stress disorder (PTSD). However, the prevalence of PTSD in refugee children varies widely between studies, and it remains somewhat unclear what factors increase children's risk of PTSD. This study aimed to assess the prevalence of PTSD in a clinical outpatient sample of refugee minors, and to evaluate the association of different risk factors with a PTSD diagnosis. N = 417 refugee minors were recruited from an outpatient clinical center in Hamburg, Germany. The median age was 15.4 years and 74.6% of the minors were male. As part of the standard diagnostic process, their social history and a potential PTSD diagnosis using the Module K of the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was assessed. The predictive value of age, gender, number of interpersonal traumatic events, un-/accompanied status, presence of family member in the host country, flight duration, residence status, and time since arrival in the host country were investigated using logistic regression analysis. The prevalence of PTSD among the young refugee patients was 61.6%. Significant predictors of a PTSD diagnosis were number of interpersonal traumatic life events, age, residence status, and time since arrival in the host country. The prediction model explained 33.8% of variance of the outcome with the number of interpersonal traumatic events having the largest contribution (20.8%). The high prevalence of PTSD among refugee minors in outpatient care emphasizes the need to establish appropriate care structures and train specialists in the treatment of PTSD.

The history of medical and pharmaceutical education development is part of the social history. The quality of medical personnel training determines the efficiency of the entire health care system and has been a priority area of development throughout the history of the Russian state. The paper reflects the main stages of the medical education system development in the period from the 17th century to the present. The training of medical personnel in Russia began in the second half of the 17th century, when, under the Pharmaceutical Order, a medical school was established in 1654to train doctors for the needs of the army.The need to provide qualified medical personnel remains relevant, both in wartime and in peacetime. The reforms of medical education that have been taking place over the centuries make it possible to diversify educational programs, as well as the to introduce new educational technologies, considering modern requirements and global trends. The study of the historical aspects of domestic medicine determines a more competent approach to the development of the health care system and medical education.

This article offers a framework in history taking for functional gastrointestinal disorders (FGIDs). Clinicians rely on history taking and knowledge of the latest ‘Rome IV criteria’ rather than biomarkers to make a positive diagnosis of FGIDs. Improving one's history-taking skills is imperative, as early diagnosis can improve patient outcomes by avoiding over investigation and/or chronicity. Our suggested structure for history taking adopts the bio-psycho-social model of disease. We describe the assessment of gastrointestinal symptoms with open and closed questions, the importance of ruling out ‘alarm’ signs or symptoms, the use of a multi-system approach to identify coexisting functional disorders and eliciting patients’ nutritional history. We explore the increased psychological comorbidity present in FGIDs and the significance of the social history in identify predisposing, precipitating, perpetuating and protective factors, which will ultimately guide treatment recommendations. We believe history taking should be used to build rapport with patients while, at the same time, validating their problems and reducing stigma. Reattribution of symptoms is then achieved through education of the gut–brain axis and can be used to provide reassurance to patients at the first encounter. Success of treatment depends on engagement and acceptance of such explanations.

A 41-year-old woman with no significant past medical history presented to the hospital with complaints of nausea, vomiting, and generalized weakness over two weeks. The patient did not seek medical attention as she assumed that her symptoms willwould resolve. Following her initial denial of drug abuse and her abnormal urine drug screening, we discussed the findings with the patient. She later admitted to using both amphetamines and marijuana. This led us to take a detailed social history that revealed an unexpected event.

Social history (SH) makes it possible to learn the social environment of children in pediatric practice and enables interventions into social risks such as poverty. While SH has been evolving in use as an advocacy practice in high-income countries, that seems not to be the case in low- and middle-income countries. We explored pediatricians’ and pediatric residents’ opinions and experiences of SH with an aim to promote advocacy-based SH practices in Turkey. A qualitative study conducted involving interviews with pediatrics residents, pediatricians and educators, and a focus group with residents. Interviews and the focus group were transcribed and reviewed for themes using qualitative content analysis. The principal objective of SH was found to be diagnosis rather than advocacy. Although all participants expressed opinions about socioeconomic conditions’ vital influence on child health, most reported limited use of SH. When asked about social needs screening with SH, most participants opposed with various reasons, primarily time concerns and doubts about the necessity for each child. Lack of time was reported as the leading barrier to SH by participants. Other barriers were identified as lack of structured SH education, problems regarding referrals and interdisciplinary work, and the biomedical health approach which defines the physician’s role within the physical health domain. To achieve an advocacy-based SH practice, the biomedical health approach should be questioned. Action is needed to implement a social determinants of health approach and equity focus to health policies and to medical and residency education.

Food hypersensitivity in young children is a quite pressing issue as it encompasses a wide range of clinical symptoms and requires a patient-centred approach in diagnosis, therapy and selecting preventive measures. A progressive increase in different forms of food hypersensitivity is associated with many factors, and, in particularly, with malnutrition and harmful environmental impact. Epigenetic and genetic factors, which potentially can be related to food hypersensitivity and allergy, are being thoroughly studied. In such a complex context, the detection of risk factors for the disease development is of great importance as taking them into account the healthcare professionals can offer proper recommendations on diet, living conditions, and lifestyle. The aim of this research is to perform analysis of factors, which can result in the development of food hypersensitivity in young children in Lviv oblast. The study of the prevalence of food intolerance in children was conducted by using a special questionnaire. 4500 questionnaires were distributed in pre-school and medical settings to question parents. The questionnaire included 34 questions grouped into four sections: general information and health details in parts A, B, and C. The section of general information included questions about the region where the child resided, personal data of a child (age, sex) and presence of serious disease (either past or present). Part A had questions about serious past or present diseases; part B covered information about the child’s family and its social history; part C included questions about the environment and living conditions of a child, as well as dietary habits and their relation to the development of clinical symptoms of the disease. Analysis of 3214 questionnaires providing information from parents on anamnesis and living conditions of young children was carried out. Values of 56 factors were analyzed with further calculation of correlation coefficients regarding the development of food hypersensitivity for each of them. Statistical analysis enabled to distinguish 15 signs among these factors that significantly correlated with the formation of food hypersensitivity in young children. This investigation enabled not only to detect factors that can affect the development of food hypersensitivity in young children, but also to suggest a mathematical model for customized calculation of risk factors to this pathology. Data of mathematical analysis performed can be used for elaborating the integrated complex of measures aimed at preventing the development of food hypersensitivity in young children in Lviv oblast.

Neuropsychiatric manifestations of Huntington's disease (HD) can present years before motor symptoms. Nurses with specialized training provide superior care for HD patients, but HD exposure in nursing education is limited. Here we aimed to describe the historical neuropsychiatric burden in 50 HD patients and discuss implications for psychiatric nurses. Fifty patients with HD were assessed by a board-certified psychiatrist and completed surveys about symptoms, social history, medication use, and quality of life outcomes. Descriptive statistics were used to summarize patient characteristics, and correlation analyses assessed the relationships between neuropsychiatric symptoms and quality of life outcomes. Most patients (72%) reported a history of neuropsychiatric symptoms prior to their HD diagnosis. Prodromal anger/irritability was most common (52%), though few patients received treatment for this. Anxiety was the most common current symptom (78%), yet 40% of patients had never been prescribed an SSRI. Anxiety was associated with poorer patient-reported quality of life outcomes (p < .01). HD patients in this sample experienced frequent, early-onset neuropsychiatric symptoms. In coming years, psychiatric nurses in community settings will be more likely to encounter gene-positive HD patients before they develop motor symptoms. Psychiatric nurses can address identified gaps through enhanced screening and encouraging early intervention in those at risk.

There are many risk factors for bladder cancer. During an initial assessment of a patient with bladder cancer, a careful discussion and history assessment is important. Particular focus should include social history with details regarding occupational background and discussion of any environmental exposure history.

The aim of the review is to present the book by Milena Angelova „The social disease. The tuberculosis in Bulgaria in the first half of the XXth century“

Background Documentation is the cornerstone of good patient care and vital to proper coding and billing. Consistent and standardized documentation improves communication among physicians and can lead to better reimbursement. By understanding which elements in the neurosurgery history and physical examination are omitted the most often and the effects on the coding level, institutional-specific solutions can be implemented. Methods We performed a retrospective study of neurosurgical patients at a single academic institution who undergone a neurosurgery history and physical examination for an initial inpatient admission from July 2015 to July 2016. The data collected included documentation type (typed, dictated, dynamic documentation without a template, neurosurgery history and physical examination template [NHPT]) and ultimate coding level (1, 2, or 3) determined by a review by a professional coder. Results A total of 609 notes were reviewed. Of the 609 notes, 88 (14.4%) were missing an element of documentation. The most common missing element was the physical examination (40 of 88; 45.5%), followed by a combination (27 of 88; 30.7%), review of systems (14 of 88; 15.9%), and medical, family, and/or social history (7 of 88; 8.0%). The dynamic documentation without template notes had the highest percentage of missing elements (49 of 96; 51.0%), followed by the typed notes (7 of 49; 14.3%) and dictated notes (30 of 268; 11.2%) compared with the NHPT notes (2 of 196; 1.0%). Conclusion The most common missing elements for inpatient neurosurgery documentation were the review of systems and physical examination. The documents with the highest percentage of missing elements were those that used dynamic documentation without a template. We recommend implementing a dedicated NHPT to improve capturing these elements for improved clinical documentation. Such changes could also improve the coding level and subsequent reimbursement.

Background and Objectives: Many United States military personnel are not full-time service members. Because of their part-time service, these veterans may not self-report their military service during medical visits. Consequently, past military service can be overlooked when taking a social history. We developed a case to provide preclinical medical students patient interview experience wherein the diagnosis relied on identifying past military service. Our objective was to determine if medical record write-ups included social history details about occupational information after this innovation. Methods: We conducted this case discussion in small groups during year 1 of medical school. We analyzed clinical skills examination write-ups before and after the case discussion to determine if the social history included occupational issues. Results: Initial results showed increased occupational issues as potential diagnoses or contributing factors. Conclusions: This case methodology specifically raised awareness of health issues related to military service and generally increased students’ likelihood of identifying occupational risk factors when conducting the social history. The template for this military case will allow us to develop additional cases focusing on different occupational health issues to complement other organ systems blocks.

Objectives This is the first report of a successful skin grafting between monozygotic twins in the United Kingdom (UK). We discuss the process of assessing the suitability of the patients for the procedure, gaining approval and extraordinary funding from the relevant bodies, developing a new protocol within the trust and the logistics of carrying out the procedure safely. Methods We describe the case of a 61-year-old paraplegic woman with insensate legs who presented with a 5-week old 2% TBSA deep dermal to full-thickness scald burn which was sustained accidentally in the shower. In view of the prolonged healing time and the risk of burn wound infection, skin grafting of the wound was the recommended treatment. However, given the high risk of impaired wound healing in denervated skin of quadriplegic individuals, the patient was warned of potential donor site wound healing problems. This, along with concerns over the donor site area interfering with the use of her mobility aids prompted her homozygotic twin sister to donate the necessary skin. The process was risk assessed and approval was sought from the Trust's Caldicott Guardian, NHS Specialist Commissioners and the Trust's Human Tissue Authority (HTA) Designated Individual (DI). A new protocol for the pathway in line with HTA guidance was developed. Specific patient information documents were written, psychological assessments performed and specific consent for skin donation undertaken. One week prior to and again on the day of the procedure, the donor was serologically screened for communicable diseases. A donor medical and social history assessment was also carried out. Results There was 100% graft take at day 5 post-surgery. The sister's donor site healed well by day 13. At 3 months, there were no signs of hypertrophic scarring. No additional outpatient or dressing clinic appointment were required. Discussion This is the first case of successful skin homografting between monozygotic twins in the United Kingdom. Donation of skin grafts between such patients, however, requires clinical justification, twin zygosity DNA testing, approval from the HTA and NHS commissioners with appropriate protocols and procedures in place to ensure patient safety. Liaising with the local Tissue Bank can facilitate this process. Conclusion Skin grafting between identical twins is a feasible and successful procedure and offers an alternative treatment modality when wound healing in the recipient twin is suboptimal or when severely burnt. This principle should also be considered, in appropriate cases, for composite tissue transfer in situations where complex reconstructions are required.

Psychological stress is a risk factor for primary polydipsia in adolescents without psychiatric comorbidity. Taking a detailed family and social history can help to distinguish primary polydipsia from diabetes insipidus in adolescents with challenging presentations of polydipsia and polyuria.

Sexuality is an important aspect in women's quality of life, however, sexuality studies dedicated to women age 60 and older are scarce. The objective of this study was to determine the prevalence of female sexual dysfunction and its domains in women age 60 and older, and to identify the association between diseases and drug use with sexual dysfunction. A descriptive and cross-cutting study was conducted, in women 60 years and older, in Havana, Cuba. Two surveys participated in 112 women: The Female Sexual Function Index (IFSF) and another who collected a medical and social history. 66.1% of women had some degree of sexual dysfunction, the prevalence increased with age. The domains most affected were desire, excitement, and lubrication. A strong association between Parkinson's disease, depression and osteoarthritis was identified with the onset of sexual dysfunction in the studied population, as well as the use of antidepressants, oral hypoglycemics and diuretics. Sexual dysfunction was present in 100% of octogenary women. All women with Parkinson's disease had sexual dysfunction.

(analítico)La salud mental de los niños, niñas y adolescentes institucionalizados en hogares es un desafío clínico y ético para Chile y América Latina. Con el objetivo de explorar experiencias y desafíos percibidos por profesionales de la atención primaria de salud que atienden esta población, se realizó una investigación cualitativa, utilizando un cuestionario con preguntas abiertas. Los datos se analizaron mediante teoría fundamentada. Los resultados mostraron que la atención era parcializada y discontinua. La información sobre el desarrollo vital, la familia, los contextos de vulneración e institucionalización era insuficiente y fragmentada. Además, existía escasa coordinación entre las instituciones que intervienen simultáneamente con los niños, niñas y adolescentes. Se discuten las implicancias para la formación de equipos de salud mental de la atención primaria de salud y la implementación efectiva del trabajo intersectorial y multinivel. Palabras clave: Salud mental, salud pública, adolescencia vulnerada.

The history of medicine and healthcare of the young Soviet state is a wide and developing research field. The topic is significant, as researchers face the necessity of comprehensive and profound study of the practices of the new Soviet society building. One aspect of this research field is studying health care system. However, the scope of data used to address this problem needs to be expanded. The article analyses clinical records of the surgical department of the First Workers’ Hospital in Kazan. It introduces them into scientific use as a new source for medical history. The specificity of this type of data lies in its dual origins. On the one hand, it is a source containing standard (medical) information, and on the other, a resource possessing unique private (personal) data. The potential of studying this kind of data can be unlocked by using modern approaches. The article describes and characterises the analysed data and raises important interpretative questions. Analysis of place and role of clinical records as a product of professional community of doctors in the new Soviet state is central here. Time and geographical frameworks are defined by events that were important to Soviet authorities. In 1918, Kazan was a strategic object of the Civil War. The city was one of the first large multinational provincial university cities to implement Bolshevik ideas. Thus, the study covers the period from September 1918 to May 27, 1920. The author concludes that clinical records can be used as a source on social history, as well as on history of science. Their data provide illustrative materials, it can answer many questions about transformation of medical professional community in the new Soviet state.

Introduction: Despite the advertised impressive economic growth, stunting in children continues to be an important problem in India demanding further exploration of enigma of height. Role of socio-economic factors, environmental variables and genetic factors have been documented. Till recent past it was also argued that Indians are a different genetic pool and would need separate standards for measuring heights. It is important to understand phenomenon of height and its determinants. Objective: The aim of the study is to identify the intergenerational variation in adult height among tribal men and its determinants; to understand the structural changes in the pattern of food composition and adequacy in the neoliberal era, and illness histories along with changes in the health care service accessibility for understanding determinants of the height. Materials and Method: Two groups of villages were selected with different developmental levels as reflected in their backwardness, road connectivity, employment opportunities and poverty levels from Salumber Block in Rajasthan. The social history of these two groups of villages was collected through key person interviews and available records to understand the changes happening in living condition over a period of time. Average heights of adults and its patterns from the selected six villages were assessed through a sample of 573 adult men. The selection of 573men was done through systematic sampling process household. Adult male (20-60 years) of every 3rd household were the part of study for analysis of the intergenerational variation. Childhood history of 120 adult males (10 from each stratum of 20-40 years and 40-60 years) was collected from every 5th household for detailed analysis of determinants of height. The childhood history was corroborated with the parents/guardian/caretaker or elder person of the family member who observed the growing periods of respondents. Women respondents were excluded from the study due to the corroboration issues. Because before and after 20 years women left their parental house due to marriage. So, in that case researcher was unable to track the person who observed the growing age periods of women. The selection of generations is based on the age group division. Age group 20-40 and 40-60 represent current generation and earlier generation, respectively. Results: The average heights of tribal men from six villages are 162.19 cm (95% CI (161.74-162.64, p-0.001). The Meena community from the group two villages showed significant improvement in current height about 2.17 cm (p-0.002) while group one villages showed decline in average height of current generation about 1.05 cm. The days of food shortage and reported hunger in the growing age/years is inversely associated with average height gain (p-0.001). The frequency of pulses and dairy product consumption significantly associated with average height gain (p-0.03 and 0.001, respectively). Occurrence of disease and recurrence of disease in the growing age is significantly and inversely associated with height gain (p-0.001). The episodes of diarrhoea in the growing age were observed to be a major impediment of the height growth (95%CI, 21.48-24.40, p-0.001). The villages where the employment opportunities are frequently available round the year showed improvement in the average height of current generation. Conclusion: The average height of the current generation is marginally improved. Changes in the pattern of food consumption and adequacy affected the average height of current generation in the new globalization era. Adequate nutrition intake, lower exposure to disease environment, and better access to health care services is positively and significantly correlated with height gain of the individual. Keywords: Intergenerational, Height, Tribal, Nutrition, Hunger, Disease

Haemophilia B (HB) is less well studied than haemophilia A (HA); despite similarities between the two inherited bleeding disorders, important differences remain that require further research.B-Natural is a multi-centre, prospective, observational study of HB, designed to increase understanding of clinical manifestations, treatment, quality-of-life (QoL), inhibitor development, immune tolerance induction (ITI) outcome, renal function and create a biorepository for future investigations.Participants include sibling pairs/groups without a current/history of inhibitors and singletons or siblings with a current/history of inhibitors followed for six months. Demographics, medical, social history and treatment were recorded. A physical examination including joint range of motion (ROM) was performed; QoL was assessed. Samples were collected for F9 gene mutation, HLA typing, non-inhibitory antibodies and renal function testing.Twenty-four centres enrolled 224 individuals from 107 families including 29 with current/history of inhibitors. Of these, 68, 30.4%, had severe (1% FIX level of normal); 114, 50.9%, moderate (1%-5%); and 42, 18.8%, mild (5-40%) disease. At enrolment, 53.1% had 50 + exposure days to exogenous FIX. Comparison of joint scores showed significant (P .05) differences between those with severe (with/without inhibitors), and those with moderate/mild disease. The majority with severe disease, 80.0% with current/history of inhibitors and 64.3% of those without, were treated with prophylaxis.B-Natural provides data supporting an increased understanding of HB and its impact throughout life. The need for optimal disease control to normalize physical and psychosocial outcomes is underscored, and further analyses will contribute to an increased understanding of critical issues in HB.

Background and aims: Uncontrolled diabetes has been associated with poorer clinical outcomes in COVID-19. We aimed to evaluate and assess the impact of COVID-19 pandemic on management of diabetes and challenges faced by people with diabetes in India during and after the lockdown phase. Methods: A cross-sectional study based on an online questionnaire survey was designed. The questions collected socio-demographic details, medical and social history, and impact of the pandemic on medical and social life from 1582 participants. Linear regression was employed to evaluate association of different parameters with the change in glycemic levels. Results: The frequency of clinical visits during the COVID-19 pandemic were reduced in 87.28% of participants. 92.45% of participants were able to monitor their blood glucose levels (BGLs) in which 78.42% (49.35%, 20.91%, and 8.16%) participants experienced an increase in BGL (mild, moderate, and severe respectively). Only 47.41% of participants possessed the digital glucometer at home. 69.07% of participants reported a decrease in physical activity while 46.88% reported an increase in food intake. 80.06% of participants were able to buy all medicines and 29.80% were gone for virtual consultations while 87.81% reported that they didn’t have access to healthcare services. Overall, 89.47% participants experienced disruption in therapy. A highly significant correlation (r = 0.89, p = 0.0145) was found between increasing age and reporting of higher BGLs. Conclusion: This study provides a firsthand evidence of major disruption in diabetes care activities during and after the lockdown phase in India and increased risk of poorer clinical outcomes, if infected by SARS-CoV-2., Highlights • COVID-19 lockdowns disrupted healthcare services for Non-communicable diseases. • 87.82% of participants reduced their clinical visits with the doctor. • A highly significant correlation exists between increasing age and severe disruption in BGLs. • Diabetes management is severely disrupted during the COVID-19 pandemic in India.

BackgroundA child’s home and family environment plays a vital role in neuro-cognitive and emotional development. Assessment of a child’s home environment and social circumstances is an crucial part of holistic Paediatric assessment.AimsOur aim is to achieve full compliance with comprehensive documentation of biopsychosocial history, for all children medically admitted to the children’s inpatient unit in University Hospital Limerick.MethodsWe performed a retrospective chart review to audit documentation within our department. This was followed by teaching interventions and a survey on knowledge, attitudes and behaviour of paediatric non-consultant hospital doctors (NCHDs) towards the social history. We performed two subsequent re-audits to assess response to our interventions, and provided educational sessions to seek improvement in quality of care.ResultsResults showed a significant improvement in quality of documentation following interventions, demonstrated by a net increase of 53% in levels of documentation of some social history on first re-audit. Though this was not maintained at an optimum level throughout the course of the year with compliance reduced from 95% to 82.5% on second re-audit, there was nonetheless a sustained improvement from our baseline. Our qualitative survey suggested further initiatives and educational tools that may be helpful in supporting the ongoing optimisation of the quality of documentation of social history in our paediatric department.ConclusionWe hope this quality improvement initiative will ultimately lead to sustained improvements in the quality of patient-centred care, and early identification and intervention for children at risk in our community.

In the context of renewed interest in the 1918-1919 flu pandemic as a result of the development of COVID-19, this paper presents a reflection from the point of view of the social history of medicine on the transformation that the erroneously named “Spanish flu” brought to the working environment of health professionals in Spain, combining what happened in Madridand in the country as a whole. Using as our sources monographs and the principal professional scientific journals of physicians, pharmacists and veterinarians, together with a selection from the general press and documentation from both houses of Parliament, we show how the dailyactivity of doctors was marked by the escalation of their clinical work as well as a considerable deployment of laboratory research in order to establish the aetiology of the flu and to prepare specific therapeutic and prophylactic measures. We show the difficulties this work encountered,and the interest of pharmacists and veterinarians in reproducing this new aspect of science and competing with doctors to achieve greater involvement in the bacteriological fight against infectious diseases. The paper also points out how, faced by the difficulty of controlling the pandemic, a section of the medical profession turned to the socioeconomic inequalities (poor working and living conditions, overcrowding, shortage and cost of food, medicine and basic necessities) in the working population and shortcomings in health care to explain its extreme seriousness, and proposed scientific medical and general measures to correct the situation inthe future. En el marco del renovado protagonismo alcanzado por la pandemia de gripe de 1918-1919 como consecuencia del desarrollo de la COVID-19, se ofrece una reflexión desde la historia social de la medicina de la transformación que la mal llamada gripe española operó en el ámbito laboral de los profesionales sanitarios en España, conjugando lo sucedido en la ciudad de Madrid y en el conjunto del país. Utilizando como fuentes monografías y las principalesrevistas científico-profesionales de médicos, farmacéuticos y veterinarios, combinadas con una selección de prensa general y documentación de ambas Cámaras Parlamentarias, se muestra cómo la actividad diaria de los médicos estuvo marcada por la intensificación de su labor clínica y un gran despliegue de actividad investigadora en el laboratorio con el fin de fijar la etiología de la gripe y poner a punto medios terapéuticos y profilácticos específicos. Se muestran las dificultades encontradas en dicha tarea y el interés de farmacéuticos y veterinarios por reproducir esta nueva faceta científica y competir con los médicos para lograr una mejor instalación social en la lucha contra las enfermedades infecciosas desde la Bacteriología. El trabajo pone de relieve igualmente cómo, ante las dificultades para controlar la pandemia, una parte del colectivo médico volvió la mirada hacia las desigualdades socioeconómicas (malas condiciones de vivienda y de trabajo, el hacinamiento, la escasez y carestía de alimentos, medicamentos y productos de primera necesidad) de la población trabajadora y las carenciassanitarias para explicar su gran gravedad, y propuso medidas científico-sanitarias y generales para corregir la situación en el futuro.

Introduction: Craniosynostosis (CS) can be detected as a premature fusion of one or more sutures of skull bones, activating an abnormal cranial conformation, with variable consequences, from cranial hypertension to psychological disorders. Objective: To statistically analyze the occurrence of surgical treatment for craniosynostosis in the months of July 2017 to June 2019 at SUS. Materials and Methods: This is a descriptive, cross-sectional and retrospective study based on data from the Ministry of Health – SUS hospital information system (SIH / SUS). Results and Discussion: 19,175 cases of surgical procedure for cranial surgery were used during this period. According to the month, most surgeries took place between the final months of the year until the first months of October 2018 and March 2019 with 6124 cases (31.9% of the total). Conclusion: It is important to develop continuing education strategies not only for health professionals, but also for family members as genetic counseling. Thus, an informative manual on facial expressions has been proposed for patients and family members, in addition to studies on patients with a social history.

The purpose of this study is to provide a deeper analysis characterizing the current health status of Tulane University School of Medicine’s student-run free clinic patients. Only one prior study by Rebholz et al. (South Med J 106(3):217–223, https://doi.org/10.1097/SMJ.0b013e318287fe9a , 2013) has explored the demographics in this population. Ultimately, this study will allow for easy interpretation of the demographics of the student clinic system as a whole and for the individual clinics participating in this study. This information will allow clinics to better customize care for their respective populations and ultimately improve health outcomes. Patient demographic data was collected from five preceptor-based clinics from December 2016 to May 2019 and submitted via a REDCap survey. Survey fields included patient age, sex, gender, race, ethnicity, insurance status, chief complaints, past medical history, social history, and medications. Gross data was analyzed in Excel and subsequently stratified by clinic for inter-clinic comparison. A total of 772 patient responses were collected from five different student-run clinics; 56% were male and 44% were female. The three most common reasons for a clinic visit were complaint-free wellness visits (26%), musculoskeletal complaints (16%), and respiratory complaints (11%). The three most common comorbidities included smoking and/or tobacco abuse (28%), psychiatric conditions (19%), and illicit drug abuse (15%). Future applications derived from this study may include redistribution of resources for patient education, social services, medical inventory, and preventative health services based on patient clinical needs.

Prevention of medicolegal case by proving Patient’s contributory Negligence beforehand, by keeping betel nuts in mouth while sleeping, as bad habit documented in social history of patient, is better option, than fighting these allegations in the consumer courts, to prove our innocence as health care provider, filed mostly under Consumer Protection Act. We are presenting an interesting case reported in our Emergency, brought in critical state, rescued by logical approach in diagnosing, and recovered after bronchoscopic removal judiciously.

The COVID-19 pandemic is an unprecedented global crisis, affecting millions globally and in Canada. While efforts to limit the spread of the infection and ‘flatten the curve’ may buffer children and youth from acute illness, these public health measures may worsen existing inequities for those living on the margins of society. In this commentary, we highlight current and potential long-term impacts of COVID-19 on children and youth centring on the UN Convention of the Rights of the Child (UNCRC), with special attention to the accumulated toxic stress for those in difficult social circumstances. By taking responsive action, providers can promote optimal child and youth health and well-being, now and in the future, through adopting social history screening, flexible care models, a child/youth-centred approach to “essential” services, and continual advocacy for the rights of children and youth.

In this first report, I overview research on storytelling of the histories of GIS. I suggest that these efforts reveal important pathways for thinking the current moment and conditioning technoscience futures. I argue that these stories around technology illustrate various disciplinary crucibles around technical practices and knowledge work. To report on progress in GIScience is also to narrate the moments of change in the discipline, whether marked as quantitative, qualitative, radical, critical, black, feminist, Marxist, indigenous, environmental, postcolonial, queer, or minor, among others. I suggest ‘minor GISciences’ to encourage attentiveness to the historical conditions and social implications of geographic technologies.

A 38-year-old Caucasian man presented with central chest heaviness at rest. There was a history of mild abdominal discomfort but no infective prodrome. There was no antecedent exertional or nocturnal chest pain. The patient had a 26-pack-year history of tobacco smoking and no known comorbidities. Recent social history was unremarkable. Examination and vital signs were normal. An ECG taken with mild residual chest discomfort is shown in figure 1A. High-sensitivity troponin I was 74 ng/L, peaking at 1405 ng/L. Echocardiography demonstrated a structurally normal heart with normal biventricular function. Medical therapy for an acute coronary syndrome was commenced and invasive coronary angiography was performed (figure 1B,C). Figure 1 Index presentation. (A) ECG and (B) coronary angiography: right anterior oblique–caudal view. (C) Coronary angiography: anterior–posterior cranial view. Insets show the proximal …

Multiple idiopathic external cervical root resorption is a rare condition with numerous predisposing factors that have not yet been clearly elucidated. In addition, its diagnosis and treatment pose challenges for clinicians, and thus, the extraction of the involved teeth is commonly performed. Here, we report a 29-year-old pregnant woman with no contributory medical or family/social history who experienced cervical root resorption that progressed aggressively and involved all permanent teeth. This case is unique owing to the involvement of all teeth. Reports of multiple idiopathic external cervical root resorption are rare in the literature, and the pathogenesis of the condition is poorly understood. This report aims to add an additional case to the existing literature, analyse the underlying mechanisms and provide clinicians with some guidance in diagnosing cervical root resorption.

Objectives Head and neck cancer (HNC) diagnosis through the 2‐week wait, urgent suspicion of cancer (USOC) pathway has failed to increase early cancer detection rates in the UK. A head and neck cancer risk calculator (HaNC‐RC) has previously been designed to aid referral of high‐risk patients to USOC clinics (predictive power: 77%). Our aim was to refine the HaNC‐RC to increase its prediction potential. Design Following sample size calculation, prospective data collection and statistical analysis of referral criteria and outcomes. Setting Large tertiary care cancer centre in Scotland. Participants 3531 new patients seen in routine, urgent and USOC head and neck (HaN) clinics. Main outcome measures Data collected were as follows: demographics, social history, presenting symptoms and signs and HNC diagnosis. Univariate and multivariate regression analysis were performed to identify significant predictors of HNC. Internal validation was performed using 1000 sample bootstrapping to estimate model diagnostics included the area under the receiver operator curve (AUC), sensitivity and specificity. Results The updated version of the risk calculator (HaNC‐RC v.2) includes age, gender, unintentional weight loss, smoking, alcohol, positive and negative symptoms and signs of HNC. It has achieved an AUC of 88.6% with two recommended triage referral cut‐offs to USOC (cut‐off: 7.1%; sensitivity: 85%, specificity: 78.3%) or urgent clinics (cut‐off: 2.2%; sensitivity: 97.1%; specificity of 52.9%). This could redistribute cancer detection through USOC clinics from the current 60.9%–85.2%, without affecting total numbers seen in each clinical setting. Conclusions The use of the HaNC‐RC v.2 has a significant potential in both identifying patients at high risk of HNC early thought USOC clinics but also improving health service delivery practices by reducing the number of inappropriately urgent referrals.

Emergency physicians (EPs) often regard care for older adults as complex, while they lack sufficient geriatric skills. This study evaluates the effect of a geriatric education program on EPs’ geriatric knowledge, attitude and medical practice when treating older adults. A mixed-methods study was performed on EPs from two Dutch hospitals. Effects were measured by pre–post tests of EPs’ (n = 21) knowledge of geriatric syndromes and attitudes toward older adults, and by a retrospective pre–post analysis of 100 records of patients aged 70 years or more. Six EPs were purposively sampled and interviewed after completion of the education program. The program significantly improved EPs’ geriatric knowledge. EPs indicated that the program improved their ability and attentiveness to recognize frailty and geriatric syndromes. The program also significantly improved EPs’ attention for the older patient’s social history and circumstances (P = 0.04) but did not have a significant effect on medical decision making. EPs valued especially the case-based teaching and indicated that the interactive setting helped them to better understand and retain knowledge. Combined quantitative and qualitative data suggest that EPs benefit from geriatric emergency teaching. Future enhancement and evaluation of the geriatric education program is needed to confirm benefits to clinical practice and patient outcomes.

In order to study the medical and social characteristics of families, an analysis of the biological and social history of mothers and fathers of children born with a body weight less than 1500 was carried out. To identify the psychological characteristics, mothers were tested.It has been established that the social characteristics of the families of children born with a body weight of less than 1500 g was favorable – most families were two-parent, had satisfactory living conditions, mothers and fathers of these children were working and had education not lower than secondary special. The majority of fathers (80%) considered themselves healthy, the state of health of mothers was characterized by a high frequency of somatic pathology, only 27% of women were healthy. The majority of fathers and mothers noted the impact of occupational hazards, while the mothers’ adverse factors were mainly associated with intellectual activity, and the fathers – with physical labor. Half of mothers and 70% of fathers belonged to the age group of 30 years and older. Despite the favorable characteristics of reproductive behavior at the stage of pregravid preparation and in the first trimester of pregnancy, mothers who gave birth to children weighing less than 1500 g were characterized by an unfavorable obstetric gynecological history and a high incidence of gynecological pathology. Psychological features of mothers consisted in a high frequency of accentuation of hyperthymic character traits, a desire to emphasize determination and masculinity, anxiety, impulsivity, which may indicate a compensatory reaction to a stressful situation – the birth of a premature baby. This is also indicated by the high frequency of psychosomatic (45.9%) and authoritarian (29.5%) types of attitude to the problems of the child. In this regard, only 62.2% of mothers established optimal emotional contact with the child by the end of the neonatal period. The revealed psychological characteristics of mothers require early psychological and psychotherapeutic correction to successfully overcome the stress of giving birth to a premature baby and consolidate all the efforts of a woman for habilitation.

Cannabis is the most commonly consumed recreational drug in the world. As more states legalize cannabis use in some form, the incidence of cannabinoid hyperemesis syndrome (CHS) is expected to rise. CHS is a constellation of symptoms including severe cyclical nausea and vomiting and epigastric or periumbilical abdominal pain as a result of long-term cannabis use. Recognizing the diagnosis and educating patients on the benefits of cessation is essential, as these patients often undergo extensive and repeated evaluations in the clinic, emergency department, and inpatient setting that could be avoided with extensive history taking and early recognition of the syndrome. In this study, we compared costs incurred by patients in various settings to determine if there is a difference between patients with and without CHS. Although there were not statistically significant cost differences between groups for all cost categories, it is clear that patients with CHS consume considerably more health care dollars than patients who deny cannabis use, and obtaining a detailed social history is imperative to prevent unnecessary workups and increased financial burden on the health care industry.

INTRODUCTION We conducted a retrospective analysis of cases of sudden unexpected infant death (SUID) referred to the SIDS-ALTE Center of the Liguria Region (Italy) from 2010 to 2018. In all cases, the death scene was inspected, and a multidisciplinary post-mortem evaluation was conducted. Our aim was to analyze the epidemiological data and etiological distribution. EVIDENCE ACQUISITION We examined 15 cases initially classified as sudden infant death. EVIDENCE SYNTHESIS In all cases, the death was initially unexplained. Seven cases involved males and eight involved females. Their mean age was 67.47 days; the youngest victim was 2 days old, while the oldest was 8.5 months (253 days). In 7 cases, the post-mortem analysis showed an infection of lung. In 4 cases, the prone position of the infant during sleep was identified as a risk factor. Only in one case the cause of death remains unexplained, and it was classified as sudden infant death syndrome II according to San Diego Classification. CONCLUSIONS In the forensic approach to cases of SUID, it is always important to conduct a thorough multidisciplinary investigation. In order to avoid procedural errors that might compromise the post-mortem investigation, it is necessary to consider the medical and social history of both mother and child, in addition to the circumstances of the death. Moreover, a complete pediatric post-mortem examination and multidisciplinary discussion are required in order to identify potentially important causative or contributory factors.

Objective Electronic Health Records (EHRs) increasingly include designated fields to capture social determinants of health (SDOH). We developed measures to characterize their use, and use of other SDOH data types, to optimize SDOH data integration. Materials and Methods We developed 3 measures that accommodate different EHR data types on an encounter or patient-year basis. We implemented these measures—documented during encounter (DDE) captures documentation occurring during the encounter; documented by discharge (DBD) includes DDE plus documentation occurring any time prior to admission; and reviewed during encounter (RDE) captures whether anyone reviewed documented data—for the newly available structured SDOH fields and 4 other comparator SDOH data types (problem list, inpatient nursing question, social history free text, and social work notes) on a hospital encounter basis (with patient-year metrics in the Supplementary Appendix). Our sample included all patients (n = 27 127) with at least one hospitalization at UCSF Health (a large, urban, tertiary medical center) over a 1-year period. Results We observed substantial variation in the use of different SDOH EHR data types. Notably, social history question fields (newly added at study period start) were rarely used (DDE: 0.03% of encounters, DBD: 0.26%, RDE: 0.03%). Free-text patient social history fields had higher use (DDE: 12.1%, DBD: 49.0%, RDE: 14.4%). Discussion Our measures of real-world SDOH data use can guide current efforts to capture and leverage these data. For our institution, measures revealed substantial variation across data types, suggesting the need to engage in efforts such as EHR-user education and targeted workflow integration. Conclusion Measures revealed opportunities to optimize SDOH data documentation and review.

Hypotonic hyponatremia secondary to acute water intoxication is most commonly associated with primary polydipsia in the setting of psychiatric illness. However, in certain circumstances, otherwise healthy individuals can be compelled to consume large enough volumes of water to overwhelm the kidney’s dilutional capacity of urine and cause a potentially life-threatening rapid decline in serum sodium. We present such a case of a 20-year-old basic military trainee with acute symptomatic hypotonic hyponatremia after drinking five to six liters of water prior to urine drug testing. The clinical manifestations of this disorder are non-specific and can be seen with many different pathologic processes, presenting a diagnostic challenge to the emergency clinician. This challenge can be further complicated by unclear or unobtainable history depending on clinical presentation. The authors will discuss key diagnostic and treatment elements of this potentially life-threatening disease to encourage clinicians to utilize social history when evaluating cases of acute water intoxication and resultant symptomatic hypotonic hyponatremia.

This article examines the evolution of the understanding of child mental health based on documents that guide nursing practise in Brazil. Eleven relevant documents were submitted to normative analysis, which revealed four themes: Developmental approach of the child mental health; Brazilian policies and social history of children; Spaces for prevention, promotion, and care in children's mental health; and The (in)visibility of nurses' work in the context of mental health. These are linked through ideological and social constructions that have although transformed through the years yet remained the same in their core. Based on our results, we propose adopting a decolonial perspective to compose nursing knowledge to improve child mental health in Brazil.