General Medical Practice Research Articles

Persistent Orofacial Pain Attendances at General Medical Practitioners

Patients with persistent orofacial pain (POFP) can go through complex care pathways to receive a diagnosis and management, which can negatively affect their pain. This study aimed to describe 44-y trends in attendances at Welsh medical practices for POFP and establish the number of attendances per patient and referrals associated with orofacial pain and factors that may predict whether a patient is referred. A retrospective observational study was completed using the nationwide Secure Anonymised Information Linkage Databank of visits to general medical practices in Wales (UK). Data were extracted using diagnostic codes (“Read codes”). Orofacial and migraine Read codes were extracted between 1974 and 2017. Data were analyzed using descriptive statistics and univariate and multivariable logistic regression. Over the 44-y period, there were 468,827 POFP and migraine diagnostic codes, accounting for 468,137 patient attendances, or 301,832 patients. The overall attendance rate was 4.22 attendances per 1,000 patient-years (95% confidence interval [CI], 4.21–4.23). The attendance rate increased over the study period. Almost one-third of patients (n = 92,192, 30.54%) attended more than once over the study period, and 15.83% attended more than once within a 12-mo period. There were 20,103 referral codes that were associated with 8,183 patients, with over half these patients being referred more than once. Odds of receiving a referral were highest in females (odds ratio [OR], 1.23; 95% CI, 1.17–1.29), in those living in rural locations (OR, 1.17; 95% CI, 1.12–1.22), and in the least deprived quintile (OR, 1.39; 95% CI, 1.29–1.48). Odds also increased with increasing age (OR, 1.03; 95% CI, 1.03–1.03). The increasing attendance may be explained by the increasing incidence of POFP within the population. These patients can attend on a repeated basis, and very few are referred, but when they are, this may occur multiple times; therefore, current care pathways could be improved.

Pharmacotherapy of Anxiety Syndrome in Psychosomatic Pathology: Drug Selection Criteria

The article examines modern approaches to the problem of psychoemotional disorders and, in particular, anxiety syndrome in psychosomatic pathology. Special attention is paid to the somatic «masks» of the anxiety syndrome in the most common clinical forms of psychosomatics, as well as the role of chronic stress in the pathogenesis of the specified syndrome and in the occurrence of neurotransmitter imbalance, which is the basis of the development of anxiety disorders. The advantages and disadvantages of the main groups of drugs used to treat anxiety in patients with various nosological forms of psychosomatic pathology are analyzed. In this regard, special attention is paid to the possibilities of combined phytotherapeutic agents. The advantages of the combination within one dosage form of plant components with proven synergistic anxiolytic action are emphasized. This combination is the original domestic phytotherapeutic agent, which for the first time contains a combination of Vitania extract, L-theanine and Passiflora extract. The peculiarities of the mechanisms of action of each of the components of the specified combination and the justification of the expediency of their combination from the point of view of the impact on the main pathogenetic mechanisms of the development of the anxiety syndrome are considered. Special attention is paid to the issue of safety during therapy with the specified agent as one of the leading criteria for choosing a tool for the treatment of psycho-emotional disorders in psychosomatic pathology. Reasoned expediency of using the considered phytotherapeutic combination in the treatment of various clinical forms of anxiety disorders in general medical practice.

132 STRUCTURED REFLECTION ON POTENTIAL IMPACTS FROM HEALTH INEQUALITIES AND UNCONSCIOUS BIAS ON CLINICAL DECISION MAKING AT A MOVEMENT DISORDER CLINIC

Abstract Background Healthcare inequalities can result in avoidable, unfair and systemic differences in health between different groups of people. Clinicians have unconscious biases that can impact on their decision making. The General Medical Council's Good Medical Practice: Maintaining Trust Domain 4, states that doctors must “treat...patients fairly without discrimination”. The Reflective Practitioner should use a variety of tools to support structured reflection. The movement disorder service in question provides care for a mix of urban and rural communities with a wide range in deprivation indices. Methods A single doctor's referral patterns and prescribing decisions for parkinsonian syndromes was retrospectively analysed for 99 consecutive attendees at a mixed face-to-face and telehealth clinic service over six weeks. Harvard Implicit Association Tests were completed to assess for unconscious biases. Patient characteristic data are available for: age, sex, religion, skin colour, sexual orientation, primary language, deprivation index, Trust of residence, weight, hearing loss, visual loss, Rockwood Clinical Frailty Scale, Hoehn and Yahr staging and educational attainment. Clinical decision making data are available for: referral patterns to physiotherapists, occupational therapists, speech and language therapists, continence services, psychiatry services, bone mineral density measurement, specialist nursing service, brain imaging and prescribing decisions made. Results The sample had 60 males, 38 females and 1 male-to-female active transition. Deprivation indices ranged from the 64th to 889th least deprived postcodes (of 890). Only one non-white attendee. Two non-heterosexual attendees. Primary language for all was English. Mean age 76.72years. Mean Hoehn and Yahr stage 2.49. 25.25% are living with dementia. 55 attendances were face-to-face. Prescribing changes were more likely to occur through telehealth clinics. Women were more likely to be referred to physiotherapy and psychiatry. Patient religion may have impacted prescribing decisions. Conclusion Open and honest reflection can improve patient care by identifying health inequalities and through using a metacognitive approach to clinical decision making.

Reciprocal Links between Cyberaddiction and Depression in Adolescents: A Cross-Sectional General Population Study in Casablanca

Cyberaddiction, a relatively new phenomenon, is a recent field of research in mental health, particularly among adolescents. Recent research indicates that depression and cyberaddiction are two closely related phenomena. This work aims to determine its characteristics of the cyberaddiction and highlight a probable link between cyberaddiction and depression. This is a cross-sectional descriptive and analytical study conducted on a population of adolescents between the ages of 13 and 19. The study was preceded by a pre-test. Adolescents were recruited in public places and in a medical general practice in Casablanca. An anonymous voluntary self- administered questionnaire was administered to them. We noted socio-demographic characteristics, internet use, internet addiction with IAT, video game addiction with GAS, depression with BDI-2, and drug use. Our study included 102 adolescents. 85.3% consider their parents to be available and 81.4% have good communication with their parents. 97.1% use the Smartphone and 93.1% use Social Networks. As for cyberaddiction, 36.3% have a problematic use or moderate addiction and 3.9% have a severe addiction to the Internet. Sevrel variables significantly related to cyber addiction were fond. In the end, internet can lead vulnerable people to real addictive behaviors. This vulnerability is particularly exacerbated during adolescence. There is a link between cyberaddiction and depression. We need to be able to identify and treat these two pathologies in order to ensure better mental health for adolescents.

The History of Pupillography and Possibility of Its Using in Modern Ophthalmology

Nowadays medicine has great opportunities for a detailed study of organs and systems, quick and accurate diagnosis of norm or pathology. Many diagnostic procedures are universal and are used by doctors of different specialties. Pupillography is a method of studying pupillary reactions, which is based on registering changes in its magnitude by photographing or filming. This study has found wide application in many areas of medicine, such as ophthalmology, neurology, narcology, general medical practice, for the diagnosis of different pathological conditions.Currently, in all areas of medicine, preference is given to objective diagnostic methods. In our country, much attention is paid to the development and introduction into medical practice of new technologies and minimally invasive research methods which purpose is timely accurate diagnosis and effective treatment of various diseases. The visual analyzer transmits visual information to the center of the parasympathetic division of the autonomic nervous system, which is responsible for the work of the sphincter of the pupil and to the center of the sympathetic division, which is responsible for the work of the dilatator. In the pathology of the visual organ, there is a violation of the correctness of information transmission, which can be used for basic research not only in ophthalmology but also in other specialties. Science and technology provides opportunities for ultra-thin, specific diagnostics and monitoring of various physiological and pathological states of organs and systems, the results of which are taken into account in many analyzing programs of the latest devices. Therefore, the importance of studying pupillary reactions is of great interest for many areas of medicine, and more specific studies can improve the accuracy of the diagnosis. This article describes the history of the development of pupillometric and pupillographic methods of research from the middle of the XVIII century and till modern devices. The importance of the study of pupillary reflexes for assessing the state of the visual analyzer and the possibility of using chromatic pupillometry is discussed, the main indicators of the pupillomotor system and their norms are given. Pupillometry provides the ability to accurately quantify changes in pupil size for clinical and research purposes.

Implementation of a virtual, on-demand, molecular tumor board at a large, multi-clinic, community oncology practice.

96 Background: Despite the availability of molecularly-targeted agents for the treatment of many cancer types, gaps remain in integrating comprehensive precision oncology decision support tools and services into routine clinical practice. Molecular Tumor Boards (MTBs) have been shown to improve accurate incorporation of precision oncology and oncologic clinical trial enrolment into clinical practice. However, the traditional MTB model is a didactic meeting occurring at regular pre-scheduled cadences which may not align with treatment decisions or schedules of community-based general medical oncologists and advanced practice providers (APPs) without protected time away from clinic. Herein, we report on the utilization of an on-demand virtual MTB (vMTB) implemented at Tennessee Oncology (TO) powered by the Personalized Medicine (PM) team at the Sarah Cannon Research Institute (SCRI). Methods: “MolecularHelp” (MH) decision support services were implemented in September 2021 for oncology providers at TO – a network of over 100 oncologists and 86 APPs practicing across 34 clinics in Tennessee. The MH services request was a structured order that could be placed directly within the electronic health record (EHR) or through patient-protected email within the practice. MH orders initiated a virtual, on-demand interpretation of comprehensive genomic profiling (CGP) reports by a centralized vMTB run by SCRI's PM team and supported by Genospace, SCRI's precision medicine software platform. The PM team – comprised of pharmacologists, cell biologists, human geneticists, and molecular biologists – analyze CGP results and provide expert advice on both standard-of-care (SOC) and clinical research therapeutic options. Both SOC and clinical research targeted therapy options were relayed back to the treating physician and embedded within the EHR. Herein, we report key metrics including MH order frequency, average turnaround time, and subsequent clinical trial enrolment between September 2021 and March 2022. Results: CGP reports from 120 unique patients were reviewed by the vMTB during the collection period. MH orders were initiated by 30 TO providers from 14 different clinic locations across Middle and East Tennessee. The average turnaround time from referral to vMTB interpretation was less than 10 hours. Of the 120 patients reviewed, actionable mutations were identified by the MTB in 103 patients, of whom 27 subsequently enrolled onto clinical trials (15 phase 1 and 12 phase 2/3). Conclusions: An on-demand vMTB is feasible within an engaged community oncology practice with investments in bioinformatics, decision support software tools, and a team of precision oncology experts supported by a robust clinical trial menu. On-demand vMTBs can be widely adopted to enhance clinical trial enrolment. Future directions include studying the impact of vMTBs on patient outcomes over time.

Characteristics of a case-series of COVID-19 reinfection and its trend from 2020 to June 2022 in a general medicine office in Toledo, Spain

Background: Longitudinal data on SARS-CoV-2 re-infection are scarce. Objectives: 1) Characterize COVID-19 reinfection cases clinically and epidemiologically; 2) Determine whether the risk of SARS-CoV-2 reinfection has altered over time in the context of the development of beta, delta, and omicron variants.Methods: From March 1, 2020 to July 1, 2022, an observational, longitudinal, and prospective investigation of Covid-19 re-infections was done in a general medical practice in Toledo, Spain.Results: There were 43 cases in total, including 45 reinfections (2 cases presented 2 reinfections). The average period between first infection and reinfection was 346 days (range: 95-813 days). The average age was 41 years (range: 17-70 years). 5% were over the age of 65. 56% were female. 14% belonged to an ethnic minority. 82% of reinfections occurred among individuals who had been vaccinated (19%, 28%, and 35% in those who had received one dose, two doses, and a booster, respectively). They were symptomatic in 96% of the cases. All cases of reinfection were minor, with nonspecific symptoms (discomfort, asthenia, myalgia, fever, arthralgia) predominating (39%). Chronic illnesses were present in 60% of reinfection cases, with the Genitourinary (19%), Endocrine (17%), and Respiratory (16%) systems predominately. Reinfections have been steadily growing since 2020, with 67% occurring in 2022.Conclusion: We discovered evidence of a continual increase in the incidence of reinfections in Toledo, Spain, primarily beginning in January 2022, which is temporally congruent with the introduction of the omicron variety, indicating its improved ability to infect previously infected persons.

Death, Grief and the Victorian GP: A Case Study of Edward Wrench of Baslow, Derbyshire, 1862 - 1898

ABSTRACT While historians such as Anne Digby and Irvine Loudon have explored and examined the processes of general medical practice in the nineteenth century, we still know relatively about individual doctors' emotional responses to death, grief and dying. The diaries of Edward Wrench, a Derbyshire GP, act as a lens through which to examine his responses when faced with the deaths of his own children, family members, close friends and his patients many of whom he came to know well through living and working in a relatively isolated rural community. In the early days of his practice Wrench had a strong Christian faith but this waned over time as new scientific findings made him more sceptical and unable to balance his faith against these new discoveries. This article will by using his diaries focus on his emotional and professional attitudes to death across the entire spectrum of his practice and family life.

Encounters and management of oral conditions at general medical practices in Australia

BackgroundPoor oral health has been widely recognised as an ongoing public health issue. Patients with oral conditions may visit either a general practitioner (GP) or a dental practitioner for management. The aims of this study are to report (i) the GP management rate of oral health conditions by patient and GP demographics, (ii) what specific oral conditions were managed, and (iii) how GPs managed oral conditions.MethodsData from the Bettering the Evaluation and Care of Health study (2006 to 2016 inclusive) were analysed. Descriptive statistics with 95% confidence intervals around point estimates were used to summarise data. Multivariate logistic regression was performed to determine the independent effect of patient and GP characteristics.ResultsA total of 972,100 GP encounters were included in the dataset, with oral condition-related encounters managed at a rate of 1.19 oral conditions per 100 GP encounters. Patients who were aged 54 years or younger, resided in a socioeconomically disadvantaged area, came from a non-English speaking background or Indigenous background were more likely to have oral conditions managed by GPs. The most commonly reported oral conditions were dental and oral mucosa-related. Over 60% of oral conditions were managed by GPs through prescribed medications.ConclusionsThis study provided an overview of management of oral conditions by GPs in Australia. Patients from certain vulnerable demographic groups were more likely to attend a GP for management of oral conditions. Common oral conditions and management approaches were identified. The findings of this study contribute to public health and health policy discussions around optimising primary care provision in oral health.

Effectiveness of a complex intervention of group-based nutrition and physical activity to prevent frailty in pre-frail older adults (SUPER): a randomised controlled trial

The increasing prevalence of frailty with age is becoming a public health priority in countries with ageing populations. Pre-frailty presents a window of opportunity to prevent the development of frailty in community-dwelling older adults. This study aimed to examine the effectiveness of a complex intervention that combined a nutrition-based intervention and a physical activity intervention, along with the effectiveness of each intervention individually, to reduce physical frailty in pre-frail older adults over 2 years. In this single-blind, 2 x 2 factorial, randomised, controlled trial, we recruited pre-frail community-dwelling older adults in Aotearoa New Zealand via mail through general medical practices. To be eligible, participants had to be pre-frail according to self-reported FRAIL scores of 1 or 2, aged 75 years or older (or 60 years or older for Māori and Pacific Peoples), not terminally ill or with advanced dementia as judged by a general practitioner, able to stand, medically safe to participate in low-intensity exercise, and able to use kitchen utensils safely. Participants were randomly allocated to receive an 8-week Senior Chef programme (SC group), a 10-week Steady As You Go programme (SAYGO group), a 10-week combined SC and SAYGO intervention (combined group), or a 10-week social programme (control group), using computer-generated block randomisation administered through an electronic data capture system by local study coordinators. Assessors were masked to group allocation for all assessments. SC is a group-based nutrition education and cooking class programme (3 h weekly), SAYGO is a group-based strength and balance exercise programme (1 h weekly), and the social control programme was a seated, group socialising activity (once a week). Masked assessors ascertained Fried frailty scores at baseline, end of intervention, and at 6, 12, and 24 months after the programme. The primary outcome was change in Fried frailty score at 2 years. Intention-to-treat analyses were completed for all randomised participants, and all participants who had a high (≥75%) adherence were analysed per protocol. This study is registered at ANZCTR, ACTRN12614000827639. Between May 12, 2016 and April 9, 2018, we assessed 2678 older adults for eligibility, of whom 468 (17%) consented and completed baseline assessment, with a mean age of 80·3 years (SD 5·1) and a mean Fried score of 1·9 (1·2); 59% were women. We randomly allocated these participants into the four groups: 117 in the SC group, 118 in the SAYGO group, 118 in the combined group, and 115 in the control group; 318 participants attended the 24-month follow-up: 89 in the SC group, 78 in the SAYGO group, 73 in the combined group, and 78 in the control group. At the 24-month follow-up, there were no differences in mean Fried scores between the intervention groups and the control group. No adverse events were reported. The study did not find that the combined SC and SAYGO programme was effective in reducing frailty in pre-frail older adults. Although some short-term benefits were observed in each individual programme, there was no clear evidence of long-term impact. Further research is needed to evaluate combinations of group-based programmes for community-dwelling older adults to optimise their physical function. Health Research Council New Zealand and Ageing Well Challenge (Ministry of Business Innovation and Employment).

Diagnosis and Therapy of Psychosomatic Disorders in Reproductive Cycle of Women in General Medical Practice (Review)

The incidence of different psychiatric disorders (affective, anxious, dysmorphic, psychotic) during menstruation, pregnancy and the postpartum period reaches 80 %. Mental disorders are risk factors for the delayed onset and shortening of menstruations, manifestation of the premenstrual syndrome (PMS), inadequate emotional reactions during menstruations, disruptions in the menstrual cycle, decreased regularity and satisfaction of sexual activity, fertility, pregnancy failure, reduction of the lactation period, early onset of menopause with long duration and clinical severity of premenopause, etc. An individual approach to treatment should take into account risk factors (heredity, comorbid disorders, sex, age, etc.) of adverse events (AD), the balance of efficacy and safety of drugs

TINJAUAN HUKUM KESEHATAN PEMASANGAN VENEER DI INDONESIA

<span class="fontstyle0">Aesthetic dental care can be done in various ways, nowadays the most popular dental treatment is by applying veneers to the teeth. Even so, many people still do not understand that veneer treatment is the authority of dentists. This study aims to determine the regulation of veneer installation in positive law in Indonesia and the application of the law to violations of authority in veneer installation in Indonesia. The result of the research is that although it does not specifically regulate the veneer method, based on the Dentist Competency Standards, Law Number 29 of 2004 concerning Medical Practice has become a positive legal arrangement in<br />Indonesia which becomes the legal umbrella for all forms of general medical practice and dentistry. The application of the law against violations of authority in veneer installation should be able to include elements of a more complex crime in several positive legal regulations in Indonesia. This is intended so that the public can learn about the powers of medical treatment that can only be carried out by medical personnel or doctors or dentists.</span> <br /><br />

MetaCogs: Mitigating Executive Dysfunction via Agent-based Modeling for Metacognitive Strategy Development

Executive functions (EF) are a collection of cognitive domains governing task initiation, motor planning, attention, and goal-oriented action. Difficulties with EF have marked impacts on adaptive living skills, learning outcomes, and quality of life for people with cognitive and psychosocial disabilities, as well as the broader population. While there is considerable research interest in EF training intervention for disabled populations, very few studies explore metacognitive intervention for people with cognitive disabilities. Metacognition comprises conscious beliefs and strategies around task management and goal setting. Metacognitive awareness has been shown to mediate the effects of executive function on self-regulated learning. Metacognitive interventions have also shown promise in general education, military training, and medical practice. We present a virtual reality experience deploying agent-based modeling to support explicit metacognitive strategy instruction for undergraduate students of all neurotypes. Our results support that explicit instructional material explaining executive function and metacognition in relation to problem-solving experiences influenced participant self-concept and awareness of personal traits and cognitive processes.

Кадровое обеспечение первичной медико-санитарной помощи в Российской Федерации

The Russian system of public health protection and primary health care as its component require reforming. Excessively narrow specialization of outpatient care loses the identity of the primary health care doctor as a «guardian of health». The state bears the financial burden associated with large investments in specialized medical care, which is much more expensive. It is required to reform district assistance in organizational and personnel support. Unfortunately, 30 years of reforming primary health care on the principle of general medical practice have not brought Russia closer to the formation of a new organizational and institutionally sustainable model of primary health care. P u r p o s e o f t h e s t u d y . Based on the analysis of the reported data on the availability of medical personnel in primary health care in the Russian Federation and its subjects and the content of the analysis of author’s studies, proposals were developed for reforming primary health care and general medical practices. M a t e r i a l s a n d m e t h o d s : content analysis, statistical, sociological, analytical, direct observation. The article used the results of the research work of the authors of the article, followed by content analysis and the development of proposals for reforming primary health care, district service and general education, in particular. R e s u l t s . The article provides an analysis of the provision of doctors, therapist and general practitioners in the Russian Federation in dynamics (2016–2020), a ranking of indicators of the provision of general practitioner in the constituent entities of the Russian Federation is carried out. The analysis showed that over the 5 years, the provision of district physicians increased slightly: general practitioner (from 0,63 to 0,72‰î), district therapist (from 2,98 to 3,21), in total, the provision of these specialists increased from 3,61 to 3,93‰ and their share (2020) amounted to 8,6% of the total number of doctors in the Russian Federation, which determines the need to prioritize the reform of primary health care in the context of the development of general medical practice. Based on content analysis and our own research on the state of primary health care and the development of primary health care in the Russian Federation, proposals were developed for reforming primary health care and promising models of primary health care in the city were scientifically substantiated. F i n d i n g s . The introduction of promising general medical practice models in the urban environment implies a complete transition of the medical organization providing medical care on an outpatient basis to general medical practice, while reducing the staff positions of medical specialists. It is necessary to expand the job responsibilities of the general practitioner’s nurse with a ratio of general practitioner to general practitioner’s nurse of 1:2. It is necessary to develop regulatory, legal and managerial decisions regarding the priorities of primary health care and the development of general medical practice in its structure

Vertical integration of GP practices with acute hospitals in England and Wales: rapid evaluation

Background Vertical integration refers to merging organisations that operate at different stages along the patient pathway. An organisation running an acute hospital and also operating primary care medical practices (i.e. general medical practitioner practices, also known as ‘general practices’) is an example of vertical integration. Evidence is limited concerning the advantages and disadvantages of different arrangements for implementing vertical integration, their rationale and their impact. Objectives Our aim was to (1) understand the rationale for, and early impact of, vertical integration in the NHS in England and Wales and (2) develop a theory of change for vertical integration. Design We carried out a rapid qualitative cross-comparative case study evaluation at three sites in England (n = 2) and Wales (n = 1), which comprised three work packages: (1) a rapid review of literature, telephone scoping interviews and a stakeholder workshop; (2) interviews with stakeholders across case study sites, alongside observations of strategic meetings and analysis of key documents from the sites; and (3) development of a theory of change for each site and for vertical integration overall. Results We interviewed 52 stakeholders across the three case study sites; however, gaining access to and arranging and completing non-participant observations proved difficult. The single most important driver of vertical integration proved to be the maintenance of primary care local to where patients live. Vertical integration of general practices with organisations running acute hospitals has been adopted in some locations in England and Wales to address the staffing, workload and financial difficulties faced by some general practices. The opportunities created by vertical integration’s successful continuation of primary care, namely to develop patient services in primary care settings and better integrate them with secondary care, were exploited to differing degrees across the three sites. There were notable differences between the sites in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial. Limitations Across all three case study sites, the study team was unable to complete the desired number of non-participant observations. The pace of data collection during early interviews and documentary analysis varied. Owing to the circumstances of the COVID-19 pandemic during project write-up, the team was unable to undertake site-specific workshops during data analysis and an overall workshop with policy experts. Conclusions The main impact of vertical integration was to sustain primary medical care delivery to local populations in the face of difficulties with recruiting and retaining staff, and in the context of rising demand for care. This was reported to enable continued patient access to local primary care and associated improvements in the management of patient demand. Future work The patient experience of vertical integration, effectiveness of vertical integration in terms of impact on secondary care service utilisation (e.g. accident and emergency attendances, emergency admissions and length of stay) and patient access (e.g. general practitioner and practice nurse appointments) to primary care requires further evaluation. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 17. See the NIHR Journals Library website for further project information.

НОВЫЙ НЕИНВАЗИВНЫЙ СПОСОБ ОЦЕНКИ АЛИМЕНТАРНОЙ ОБЕСПЕЧЕННОСТИ СЕЛЕНОМ IN VIVO

Selenium (Se) is essential trace element in human nutrition. The aim of this study was to assess selenium nutritional status by analyzing Se frequency distribution in the long-term biological indicator tissue of hair (H∙Se) and in the short-term biological indicator tissue of whole blood (WB∙Se). Hair selenium was analyzed in 1073 apparently healthy adult Croats (339 ♂ and 734 ♀) and the whole blood selenium was analyzed in a random subsample of 91 ♂ and 143 ♀. Samples were analyzed by the ICP-MS at the Center for Biotic Medicine, Moscow, Russia. There were no significant gender dependent difference in the selenium adequate linear reference range which was (µg∙g1) for H∙Se 0.078–0.701 and for WB∙Se 0.120–0.200, respectively. Hair selenium concentrations below 0.078 and 0.120 for WB∙Se indicate selenium deficiency. The estimated upper adequate selenium limits for H∙Se and WB∙Se are set at 0.701 and 0.200 µg∙g1, respectively. The linear segment of the generated H∙Se logistic distribution sigmoid curve is considered to represent adequate Se intake range. This adequate selenium intake segment can be itself partitioned by a 60:30:10 percentage ratio into Sparsely adequate (♀ 0.078–0.405, ♂ 0.1740.474), Adequate (Optimal) (♀ 0.4050.573, ♂ 0.474–0.608), and Ample adequate segment (♀ 0.5730.623, ♂ 0.608–0.709). These reference dose data are essential for continuous monitoring of the selenium nutritional status and selenium supplementation medication The noninvasive selenium status assessment is especially important when dealing with a vulnerable segments of human population like pregnant and lactating women, and their infants. The Median Derivatives Bioassay provides a new public health asset for general medical practice.

Anxiety and depressive disorders in general practice

The problem of anxiety and depressive disorders (ADD) is one of the most urgent in modern general medical practice. ADD are widespread both in the general population and in the hospital network, especially in outpatient general practice. The article presents the main clinical manifestations of anxiety and depression, emphasizes their polysystemic somatic manifestations and concurrence with cardiovascular diseases. The pathophysiology of the clinical manifestations of anxiety and depression is discussed. A detailed analysis of their diagnosis and main treatment methods is given.

Families’ Access to Early Intervention and Supports for Children With Developmental Disabilities

Early intervention (EI) provision is critical for families who have children with developmental disabilities (DD), but existing evidence suggests accessing EI is not always straightforward. The purpose of this study was to provide a comprehensive description of access to various EI supports (e.g., professionals, services, interventions) for families of young children with suspected or diagnosed DD across the United Kingdom and to investigate perceived ease of access to support, unmet need for support, and barriers and facilitators of access to support. Overall, 673 parental caregivers of children aged 0 to 6 years with suspected or diagnosed DD (e.g., developmental delay, intellectual disability, autism) completed our survey anonymously. Across education, health, and social care, services accessed the most were pediatrics ( N = 569, 84.5%), speech and language ( N = 567, 84.2%), and general medical practice ( N = 530, 78.8%). However, only 18.9% ( N = 127) accessed packaged interventions. More than three-quarters ( N = 508, 75.5%) reported an unmet need for early support, indicating a mismatch between the availability and capacity of services and demand for support. Parents also reported common barriers (e.g., obstructive services and unhelpful professionals) and facilitators (e.g., supportive and competent professionals, enabling parent factors) of access. Implications for policy, practice, and research are discussed.

International Research Collaboration During the Pandemic: Team Formation, Challenges, Strategies and Achievements of the African Translational Research Group

This paper discusses multidisciplinary international research collaboration team formation during the COVID-19 pandemic, challenges faced, strategies adopted, achievements and dynamics in the implementation of research on Coronavirus disease-2019 (COVID-19), by the African Translational Research Group (ATReG). The paper also discusses the lessons learnt and future opportunities for global collaborative research. In-depth virtual interviews were conducted with consenting members of ATReG. Questions were designed to provide rich, deep, and insightful opinions, lived experiences and perspectives of ATReG group members on group formation, challenges, strategies and achievements. Interview data was transcribed and analysed thematically, and the results were presented with important quotations presented. The ATReG consisted of English ( n = 13) and French ( n = 1) speaking sub-Saharan African (SSA) researchers who specialise in public health, epidemiology, optometry, information technology, supply chain management, psychiatry, community health, general medical practice, nutrition and biostatistics. Most members of the group reported an informal but well-coordinated structure of the group. Formed during the pandemic, all group meetings were held online, and many members are yet to meet each other in person. The group collected data from Africans and published 10 peer reviewed journal articles on COVID-19 within two years. It presented in international conferences, engaged with the media and the public and was awarded a national competitive funding in Nigeria all of which which contributed to career progression and academic promotion of some members. There have been challenges in sustaining the research collaboration and maintaining productivity. Challenges include difficulties meeting deadlines and obtaining funding for research activities. However, these challenges have been addressed through a collaborative problem-solving approach. The study found the need for operational and methodological flexibility, centralised coordination, and established funding sources as being essential for long term sustainability and performance of the group. The ATReG’s objective of providing useful data on COVID-19 and generating useful knowledge about COVID-19 in SSA has been achieved. In such a multi-disciplinary international collaborative team relaiant on the online medium to operate, the experiences and challenges can be a model for learning for researchers intending to form international multidisciplinary collaborative groups. Nonetheless, there are still many important areas of research which ATReG will continue to pursue.

Recognizing IPED Use in Clinical Practice

Recognizing IPED Use in Clinical Practice Abstract. The non-medical use of image- and performance-enhancing drugs (IPEDs) is widespread in the fitness and bodybuilding scene. The reasons for IPED use are often hedonistic in nature and they are used in so-called "cycles" over several weeks. The most common side effects are: testicular atrophy, acne, hypersexuality, hypertension, gynecomastia, lipid metabolism disorders, mood swings, hair loss, and policythemia. Common consequences following IPED use are: decreased libido, oligo- or azoospermia, and erectile dysfunction. To reduce undesirable side effects and consequences, IPED users often take medications for self-treatment; occasionally IPED users also mention such medications and ask for them in the general medical practice.