World Health Organization International Classification Research Articles

International Survey & Analysis of Laws and Regulations Addressing Internet Addiction and/or Problematic Usage of the Internet

Public health is facing new types of global challenges coming from the risks all classes of population get exposed to via their growing use of Internet based media and contents. As the individualized treatment of such health and social problems is both difficult and very costly, preventive and legislative measures have been taken in a vast number of countries. Excessive internet use has not yet been recognised as a disorder by the World Health Organization (WHO), nor in the American Psychiatric Association’s list of Diagnostic and Statistical Manual of Mental Disorders (DSM-5); however, the related diagnosis of online gaming disorder (6C50) and online gaming disorder (6C51) have been included in the forthcoming 11^th revision of WHO International Classification of Diseases (ICD-11). This paper is focussing on top-down laws voted in a Parliament, or enacted public regulations and some industry wide regulations, which, in different countries, tackle one or several facets of Internet addiction or problematic uses of the Internet (PUI). This international survey is carried out on a basis of laws and regulations in each country, with Internet addiction or PUI as a direct or indirect scope. This has resulted early 2020 in the identification and summarization of a catalogue of 66 laws or regulations from 50 countries, each described in template form in a supplementary document. The identified laws and regulations are analysed with respect to specific consequences of the Internet addictions, as well as by categories of stakeholders addressed in these measures. The laws and regulations are also classified in terms of the underlying principles and solution approaches, showing large cultural differences.

Self-Reported Communication Attitudes of Children With Childhood Apraxia of Speech: An Exploratory Study.

Much of the research literature on childhood apraxia of speech (CAS) has focused on understanding, diagnosing, and treating the impairment, rather than examining its functional effect on children's daily lives. This study focuses on the Personal Factors component of the World Health Organization International Classification of Functioning, Disability and Health-Children and Youth Version Framework. Specifically, the purpose was to examine the self-reported communication attitudes of children with CAS. Two validated communication attitude questionnaires were administered to 12 children with CAS enrolled in an intensive speech-focused intervention (age range: 4-10 years old). Children's scores were compared to the questionnaires' typically developing norms. Descriptive analyses explored relationships between communication attitude and CAS severity, caregiver perceptions of communicative participation, frustration ratings during therapy, and change in communication attitude over a brief time. Older (ages 6-10 years) but not younger (ages 4-5;11 [years;months]) children with CAS were more likely to have negative attitudes about their speech. No clear relationships were observed between communication attitudes and caregiver perceptions of communicative participation; small positive relationships were observed between communication attitude and frustration during therapy. For the younger children, there was also a relationship with CAS severity. For most children, no change in communication attitude was observed over a brief period, though one child appeared to develop more negative and one appeared to develop more positive attitudes. These initial findings suggest that older children with CAS may be at greater risk for negative communication attitudes than their peers without CAS. The findings also highlight the need to include more child self-report measures in research. Further implications for CAS assessment and intervention are discussed. https://doi.org/10.23641/asha.21834432.

WHO fact sheet on infertility (definition of infertility), published in Global Reproductive Health (2021)

To the Editor, I have read the article entitled “WHO fact sheet on infertility” published in Global Reproductive Health (2021), this was initially published by the World Health Organization (WHO) International Classification of Diseases, 11th Revision (ICD-11) Geneva: WHO 2018. This article has given a concise definition of infertility as “Infertility is a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular unprotected sexual intercourse.” This has been a helpful guide in the diagnosis, classification, treatment, and epidemiological survey of infertility all over the world. I will like to thank WHO for this definition and make some contribution based on my experience. The definition focused on the individual rather than the union between the couple or the 2 individual that is trying to reproduce or have a child. A couple can be infertile due to pathology in one of the 2 members or due to lack of compensation from other members of the union thus labeled infertile. However, each member may have a chance of having a pregnancy if he or she had unprotected intercourse with another individual for the specified time frame and such relationship will not be clinically presented as infertile. The definition of infertility would have been more encompassing if it is based on couple or union rather than considering individual entities. The individual involved should be labeled as “suspected infertile” as there is the possibility of pregnancy if he or she has unprotected intercourse over the time frame of a year with another individual. A critical look at this suggestion can change the orientation, psychology, management, and every other factor related to infertility.

From individualised treatment goals to personalised rehabilitation in osteoarthritis: a longitudinal prospective mapping study using the WHO international classification for functioning, disability and health

Background/Objective(s)/Introduction In clinical practice, treatment goals are often set up without exploring what patients really want. We, therefore, collected individualised treatment goals of patients with osteoarthritis (OA), categorised and mapped them to the World Health Organisation International Classification for Functioning, Disability and Health (ICF). Patients/Materials and Methods A longitudinal prospective cohort study was conducted (2019–2021). We used descriptive statistics and Chi2/Fisher’s Exact Tests, where appropriate, as well as Kruskal-Wallis-Tests for the mean score ranks of the patients’ goals. Results In total, 305 goals reported by 132 participants were analysed (267 women vs. 38 men). The top 3 ICF categories were sensation of pain (ICF:b280), mobility of joint (ICF:b710) and muscle power functions (ICF:b730). Overall, 51% of all individually reported functional goals were achieved after 3 months. Men were more likely to achieve their goals than women (p = 0.009). The majority of the “very important” goals (51%) and “very difficult” goals (57%) was not improved. Goals’ mean score ranks significantly differed between baseline and follow-up. Conclusion(s) As the human lifespan as well as the number of people affected by OA worldwide increase, there is a growing need to identify and evaluate rehabilitation outcomes that are relevant to people with OA. Key Messages Treat-to-target agreements between patients and health care providers present a step towards more personalised precision medicine, which will eventually lead to better reported functional and health outcomes. In patients with osteoarthritis, the Goal Attainment Scale instrument can be used to measure health outcomes at different time points and its content may be linked to ICF providing a unified language and conceptual scientific basis.

World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Core Set Development for Interstitial Lung Disease.

Background: The World Health Organization (WHO) introduced the International Classification of Functioning, Disability, and Health (ICF) as a scientific method of disability data collection comprised of >1,200 categories describing the spectrum of impairment types (functional, symptoms-based and anatomical) under the bio-psycho-social model with consideration of environmental and personal factors (pf). ICF Core Sets and ICF Checklists are streamlined disease-specific resources for clinical use, service provision, and for use in health economics and health policy. ICF can disclose strengths and weaknesses across multiple patient-reported outcome measures (PROMs) and help consolidate best-fitting question-items from multiple PROMs. Interstitial lung diseases (ILDs), are generally progressive, with restrictive physiology sometimes occurring in the context of multi-organ autoimmunity/inflammatory conditions such as connective tissue diseases (CTDs). In spite of significant associated morbidity and potential disability, ILD has yet to be linked to the ICF. Methods: Each instrument and their question-items within the consensus-recommended core sets for clinical trials in ILD were deconstructed to single concept units, and then linked per updated ICF linkage rules. Inter-linker agreement was established. Three additional subsequently validated measures were also included. Results: One-hundred-eleven ICF categories were identified for ten PROMs and three traditional objective measures that were amenable to ICF linkage. The proportion of agreement ranged from 0.79 (95% CI: 0.62, 0.91) to 0.93 (0.76, 0.99) with the overall proportion of inter-linker agreement being very high 0.86 (0.82, 0.89) for the initial instruments, with 94–100% for the three additional PROMs. Thirty-four new ‘Personal Factors’ emerged to capture disease-specific qualities not elsewhere described in ICF, e.g. ‘pf_embarrassed by cough’ or ‘pf_panic/afraid when can’t get a breath’. Conclusion: This first known effort in ICF linkage of ILD has provided important revelations on the current utility of the ICF in lung disease. Results have indicated areas for meaningful assessment of ICF descriptors for lung impairment. The mapping across PROMs provides insight into possibilities of developing more streamline and precise instrumentation. Finally, familiarity with the ICF in ILD may enable clinicians to experience a smoother transition with the imminent harmonization of ICD and ICF, ICD-11.

Urban green spaces and suicide mortality in Belgium (2001–2011): A census-based longitudinal study

BackgroundExposure to green spaces is associated with improved mental health and may reduce risk of suicide. Here, we investigate the association between long-term exposure to residential surrounding greenness and suicide mortality. MethodsWe used data from the 2001 Belgian census linked to mortality register data (2001–2011). We included all registered individuals aged 18 years or older at baseline (2001) residing in the five largest urban areas in Belgium (n = 3,549,514). Suicide mortality was defined using the tenth revision of the World Health Organisation International Classification of Diseases (ICD-10) codes X60-X84, Y10–Y34, and Y870. Surrounding greenness was measured using the Normalized Difference Vegetation Index (NDVI) within a 300 m and 1,000 m buffer around the residential address at baseline. To assess the association between residential surrounding greenness and suicide mortality, we applied Cox proportional hazards models with age as the underlying time scale. Models were adjusted for age, sex, living arrangement, migrant background, educational attainment, neighbourhood socio-economic position. We additionally explored potential mediation by residential outdoor nitrogen dioxide (NO2) concentrations. Finally, we assessed potential effect modification by various socio-demographic characteristics of the population (sex, age, educational attainment, migrant background, and neighbourhood socio-economic position). Associations are expressed as hazard ratios and their 95% confidence intervals (CI) for an interquartile range (IQR) increase in residential surrounding greenness. ResultsWe observed a 7% (95%CI 0.89–0.97) and 6% (95%CI 0.90–0.98) risk reduction of suicide mortality for an IQR increase in residential surrounding greenness for buffers of 300 m and 1,000 m, respectively. Furthermore, this association was independent of exposure to NO2. After stratification, the inverse association was only apparent among women, and residents of Belgian origin, and that it was stronger among residents aged 36 or older, those with high level of education, and residents of most deprived neighbourhoods. ConclusionOur results suggest that urban green spaces may protect against suicide mortality, but this beneficial effect may not be equally distributed across all strata of the population.

Neurological and Functional Outcomes after Pediatric Stroke

Pediatric stroke results in life-long morbidity for many patients, but the outcomes can vary depending on factors such as age of injury, or mechanism, size, and location of stroke. In this review, we summarize the current understanding of outcomes in different neurological domains (eg, motor, cognitive, language) for children with stroke of different mechanisms (ie, arterial ischemic stroke, cerebral sinus venous thrombosis, and hemorrhagic stroke), but with a focus on World Health Organization International Classification for Functioning, Disability, and Health (ICF-CY) framework for measuring health and disability for children and youth. We describe outcomes for the population as a whole and certain factors that may further refine prognostication.

Mapping the use of patient reported outcomes at a health organisation to inform integration into hospital data systems.

ObjectivesIncorporating patient reported outcomes into health data linkage research ensures that the patient’s perspective is considered. We aimed to understand the use of patient reported outcomes across an entire healthcare organisation, to inform routine collection and integration of patient reported outcomes into hospital data systems for clinical practice and research.
 ApproachWe applied a mapping process consisting of 1) an audit of patient reported outcomes used in research projects and data registries, and 2) a survey of clinicians’ use of patient reported outcomes in their clinical practice from January 2015 to March 2021. Patient reported outcomes were then classified as ‘specific’ to a particular disease and/or conditions, or as a ‘generic’ measure that was applicable to a broader population. Patient reported outcomes were also mapped to the health domains they measured, using the World Health Organisation International Classification Framework. Data were described using frequency and proportion.
 ResultsPatient reported outcomes were used by 22% of research projects (n=144/666), 68% of clinical registries (n=13/19), and 76% of clinical specialties in their clinical care (n=16/21). Of the projects, registries and specialties that used patient reported outcomes, disease specific outcomes were most commonly used: 83% for research projects n=130/144), 69% for clinical registries (n=9/13), and 75% for clinical specialties (n=12/16). Greater than 80% of research projects, clinical registries and clinical specialties measured health domains relating to both body impairments and participation in daily life activities. The most commonly used generic patient reported outcome for research, data registries and clinical practice was the European Quality of Life Five Dimension Five Level (EQ-5D-5L) (research projects n=31/144, 22%; data registries n=2/13, 15%; clinical specialties n=3/16, 19%).
 ConclusionIn our setting, the EQ-5D-5L had broad applicability across a range of clinical specialties, collection systems and research studies, making it suitable for routine integration into health data systems with potential for linkage with other population data. Sufficient flexibility is required for the collection of population and disease specific measures.

Attitudes toward the use of low-tech AAC in acute settings: a systematized review

The purpose of this systematized review was to investigate how attitudes toward low-tech AAC might be impacting its use in acute care settings. A comprehensive and systematic search of databases identified 23 articles for inclusion. Thematic analysis using the World Health Organization International Classification of Functioning, Disability and Health (ICF) framework facilitated a narrative synthesis of findings. Results suggest that in acute care settings (a) adult patients, families, nursing staff, medical team, and allied health professionals all have opportunities to use but do not regularly engage with AAC; (b) individuals reject low-tech AAC devices for a variety of reasons, including that they are not useful, necessary, suitable, or appropriate in settings such as intensive care units; (c) negative attitudes toward AAC are linked to a lack of initial training and ongoing support, perceived impersonal content, limited functionality, and a lack of consistent availability; and (d) positive attitudes toward low-tech AAC are more prevalent when training and support are offered, low-tech AAC effectiveness is demonstrated, and organizational, financial, and procedural commitments are provided. Limitations of the research are highlighted and future research opportunities are identified.

Generalized infections of putative oral origin in Helsinki University Hospital in 2012 to 2017.

Bacteria entering the bloodstream through oral mucosa cause bacteremia, which can lead to septic or distant infections. The underlying factors and need for dental treatment in patients referred for oral examination because of septic infection were investigated. It was expected that general diseases and poor socioeconomic status of patients would increase the risk of bacteremia. This descriptive retrospective study included patients (N = 128) referred from medical clinics of the Helsinki University Hospital (HUH), during 2012 to 2017, to the Department of Oral and Maxillofacial Diseases due to bacteremia suspected to be of oral origin. Data were extracted from medical and dental records according to the World Health Organization International Classification of Diseases (ICD-10) for systemic or remote infections. Different groups were formed using modified Skapinakis classification for socioeconomic status (SES), from I (high) to V (low). Underlying medical conditions were retrieved according to McCabe classification: healthy, nonfatal, ultimately fatal, and rapidly fatal diseases. The data were analyzed using the statistical software package SPSS (IBM). Patients were referred most often from the Departments of Infectious Diseases and Internal Medicine. Because of infection, 12 patients needed aortic or mitral valve operations. Many of the patients were intravenous drug users. However, the majority of patients presented McCabe class I, indicating no systemic disease. The main SES was intermediate III. Tooth extraction was the principal mode of treatment. No demographic background variables were identified to explain increase of the risk for bacteremia except that most patients were men with untreated dental problems. Contrary to the authors' expectation, poor SES and underlying diseases did not seem to link to the outcome. However, untreated dental infections present an evident risk for life-threatening septic complications also in generally healthy individuals.

Appraisal of Long COVID: Lessons to be Learned from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Objective(s)Little is known regarding after-effects of Long-COVID-19 (LC), while ME/CFS has been extensively researched. We performed a rigorous scoping review to inform a better definition of symptomatology of LC and cross-cutting similarities with ME/CFS. Our objective was to review the National Institutes of Health (NIH) ME/CFS Common Data Elements (CDEs), identify Patient Reported Outcome Measures (PROMs) and link items to the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) codes to inform efforts to define LC.Data SourcesNIH ME/CFS CDEs (Jan. 2020), Google Scholar, PubMed - search terms: Long COVID and ME/CFS.Study SelectionA review of 119 NIH ME/CFS CDEs applied the following inclusion criteria: 1) PROM based; 2) assess symptomatology; 3) specific to adults 18 years and over; 4) no visual or pictographic scales.Data ExtractionOf the 119 NIH ME/CFS CDEs, 38 met review criteria; items were entered into an Excel spreadsheet. Five researchers independently coded items using ICF linking rules and resolved discrepancies using a consensus-based process.Data SynthesisSix articles specifically compared LC and ME/CFS for symptom overlap. Similarities between ME/CFS and Long COVID symptoms include: fatigue, post exertional malaise (PEM), cognitive symptoms, sleep dysfunction, pain, noise and light hypersensitivity, orthostatic intolerance, cardiac, gastrointestinal and immune pathologies. The 944 items from 38 PROM CDEs were coded based on common ME/CFS and LC symptoms. The percent of items linked to one or more ICF categories (1288 codes) was as follows: Body Function (b codes) 73%: Fatigability, N=252 (20%); Cognitive functions, N=234 (18%); Sleep functions, N=139, 11%; and Pain, N=119, (9%). Activity and Participation (d codes), N=332, (26%). Environment (e codes), N=11, 0.9%.ConclusionsThe ICF provides a common language to assess ME/CFS and LC cross-cutting symptoms and their impact on body function, activity and participation. This review of ME/CFS CDE's can help identify common symptoms, such as PEM, and encourage appropriate symptom management to prevent cycles of overexertion and relapse for those with LC.Author(s) DisclosuresThe authors have no conflicts of interest to declare.

Prevalence and determinants of care needs among older people in Ghana.

Given the longevity noticed among older people in Ghana, and the potential occurrence of functional disability in later years of life, it has become essential to understand their care needs. This study examined the care needs in daily tasks and associated factors in Ghana, following the World Health Organisation International Classification of Functioning, Disability and Health framework. A cross-sectional survey was conducted among a sample of 400 older people from Komfo Anokye Teaching Hospital in Southern Ghana. Care need was assessed by one question; "Do you regularly need help with daily tasks because of long-term illness, disability, or frailty?" Multivariate logistic regression was used to test the association between care need and independent variables based on the WHO-ICF conceptual framework. Majority of the sample (81%), particularly women (54%) reported needing care in daily tasks. Per the WHO-ICF conceptual framework, functional disability-activity variable, (OR = 1.07 95%CI: 1.05-1.09, p<0.001), and absence of government support-an environmental factor, (OR = 3.96 95%CI: 1.90-8.25, p<0.001) were associated with care need. The high prevalence of care needs among older people may offer an indication that majority of older people in Ghana could benefit from long-term care services. Functional disability and the absence of government support are the major issues that need to be prioritised in addressing the increased demand for care related to performing daily tasks among older people in Ghana.

Academy of Geriatric Physical Therapy Research Agenda: Rationale for the Development and the Intent for Use.

The rationale for the development and the intent for use of a research agenda for the Academy of Geriatric Physical Therapy is described. The reasons for the research agenda for geriatric physical therapy are (1) to have a broad representation of the research conducted by physical therapist(s) working with older adults, (2) to provide guidance and assistance to emerging investigators to aid the trajectory of a research career, and (3) as a document to engage potential funding agencies, foundations, and individuals in support of physical therapist-conducted research. The design was based on the Research Agenda for Physical Therapy (APTA document), formatted to be consistent with the World Health Organization International Classification of Functioning, Disability and Health, priority ratings for the research statements, and specific examples of research questions for each category of the Research Agenda. The Academy of Geriatric Physical Therapy Research Agenda generated to be a living document, with revisions to research questions and priority ratings expected in the future to enable the agenda to adapt to changes in science, practice, workforce, education, and health policy.

Facilitators and barriers to developing romantic and sexual relationships: lived experiences of people with complex communication needs

The aims of this study were to investigate the lived experiences of people with complex communication needs in developing romantic and sexual relationships, and identify and explore barriers and facilitators they encountered in pursuing these relationships. For the study, nine participants were interviewed. All were at least 21-years-old, used augmentative and alternative communication, and had physical and communication disabilities since childhood. A methodology employing critical hermeneutics, a form of interpretive phenomenology, and Feminist Standpoint Theory was utilized. The World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) model (2013) was used to develop questions for the semi-structured interviews. Interview data were analyzed using reflexive thematic analysis, with the ICF model and the concept of ableism used to identify four main themes: (a) Attitudes of others (ableism), (b) Communication Within Intimate Moments, (c) Assistance of Support Workers, and (d) Additional Education Related to Sexuality and Disability. Most of the barriers participants encountered related to ableist attitudes they experienced from others. Facilitators included creative communication strategies for intimate moments and using dating websites. The participants’ experiences bring attention to the need for changes in policies, practice, and research to further support people with complex communication needs in their quest to develop intimate relationships.

Care in COVID: A qualitative analysis of the impact of COVID-19 on the health and care of children and young people with severe physical neurodisability and their families.

AimTo evaluate clinicians' perspectives on the impact of ‘lockdown’ during the COVID‐19 pandemic for children and young people with severe physical neurodisability and their families.MethodFramework analysis of comments from families during a recent service review was used to code the themes discussed according to the World Health Organization International Classification of Functioning, Disability and Health (ICF) and interpreted into emergent themes to summarize the impact of lockdown (Stage 1). They were presented to a clinician focus group for discussion (consultants and physiotherapists working in a specialist motor disorders service, [Stage 2]).ResultsThree overarching themes ‘Uncertainty and Anxiety’, ‘Exacerbation of Existing Inequalities’ and ‘Care Provision: Reaction, Adaptation, and Innovation’ summed up the impact of the COVID‐19 pandemic on health and well‐being in children and young people with neurodisability and their families. All themes were influenced by time.InterpretationThis study reflects clinician's perceptions of family experiences of the pandemic and lockdown. Significant impact is apparent in the entire U.K. population, but the complexity of care needs for children with physical neurodisability exacerbates this. Lobbying for government policy is vital to ensure that all children, and in particular those with significant health and social care needs, are protected and continue to access services. During the restoration and recovery phase of the pandemic, there is a need for service reconfiguration that utilizes what we have learned and is adaptive to individual family circumstances.

A Registry-Based Geodemographic Assessment of Non-Hodgkin Lymphoma Subtypes in North Carolina

Background: Non-Hodgkin lymphoma (NHL) is the most common hematologic malignancy in the United States. NHL comprises a heterogeneous group of over 40 histological subtypes, each of which has distinct genetic, morphologic and clinical features. While NHL epidemiology as a single entity has been well-characterized using population-based cancer registry data, the epidemiology of NHL subtypes is not well understood and even less data are available for rarer subtypes. We aimed to determine geodemographic correlates for NHL subtypes in North Carolina to provide rarely reported epidemiologic characterization of each distinct malignancy.Methods: Demographic data were obtained on all NHL subtypes reported in persons >18 years of age from 2009-2019 from the North Carolina Central Cancer Registry (NCCCR). NHL subtypes were determined based on World Health Organization International Classification of Diseases for Oncology,Third Edition (ICD-O-3) Morphology codes provided by NCCCR. Crude incidence and mortality rates were estimated per 100,000 persons for the 10-year period using 2019 population data from the U.S Census Bureau. Urban and rural residence designations were based on zip code using rural-urban commuting codes developed by the Rural Health Research Center. County tier designations were used as markers of economic prosperity, with 3 being most prosperous, and provided by the North Carolina Department of Commerce. Data are being mapped using ESRI ArcMap 10.8.1.Results: A total of 25,627 incident cases of NHL and 9,930 associated deaths were reported between 2009 and 2019 in North Carolina. Therefore, the standard NHL incidence and mortality rates are 24.1 and 9.3 per 100,000 persons. For incident NHL cases, median age at diagnosis was 68 years (range 19-103), 55% were male and 45% female. Most (83%) identified as white, 14% as black, and 3% as other. Median age at death was 70 years (range 19-106). Twenty-eight NHL subtypes were identified with the four most common NHL subtypes being Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma (CLL/SLL), Diffuse Large B Cell Lymphoma (DLBCL), Follicular Lymphoma (FL), and Marginal Zone Lymphoma with 6.54, 6.42, 3.55, and 2.0 cases (per 100,000 persons), respectively. Least common subtypes included Intravascular Large B Cell Lymphoma, Primary Effusion Lymphoma, Primary Cutaneous Gamma Delta T-cell Lymphoma (PCGD-TCL) and Subcutaneous Panniculitis-Like T-cell Lymphoma, all with 0.01 cases per 100,000 persons (or 15, 14, 9 and 6 cases respectively). The distribution of NHL subtypes varied according to demographics with several notable findings. DLBCL had the highest crude mortality rate of 2.98 deaths/100,000 persons, followed by CLL (2.12 deaths/100,000 persons), FL (0.98 deaths/100,000 persons) and Lymphoma NOS (0.51 deaths/100,00 persons). Mediastinal Large B-cell Lymphoma (MLBCL) was diagnosed in the youngest individuals with median age of 36 (range 20-74), whereas PCGD-TCL occurred in the oldest with median age of 74 (range 31-99). Primary Effusion Lymphoma had the highest male predominance (93%) and MLBCL had the highest female predominance (73%). Mantle Cell Lymphoma had the highest predominance of persons who identify as white (90%), Anaplastic Large Cell Lymphoma (ALK+/-) with those who identify as black (66%), and Primary Effusion Lymphoma with those who identify as other (14%). Predominance of rurality and county tier designations varied by NHL subtype.Conclusions: A registry-based assessment of NHL subtypes illustrates the heterogeneous nature of this group of malignancies and highlights significant variation in the geodemographic features of each subtype. Evaluating geodemographic correlates deepens our understanding of NHL subtypes and can inform populations at risk for each unique NHL subtype. [Display omitted] DisclosuresDittus: BeiGene: Other: Advisory Board; Seattle Genetics: Research Funding; AstraZeneca: Research Funding; Genentech: Research Funding.

The Use of Advanced Integrative Therapy with C-PTSD and Intergenerational Trauma Transmission

Complex posttraumatic stress disorder (C-PTSD) and adverse childhood experiences (ACEs) pose health problems in the United States, and intergenerational relational trauma plays a role in the continuation and transmission of these issues. Advanced Integrative Therapy (AIT), a novel treatment, was used to treat a case of C-PTSD. The client’s chief concern was a flare-up of anxiety, relational distress, and fibromyalgia that occurred when they (chosen pronoun) accepted custody of their nephew. Over a span of nine 90-minute sessions, the clinician assessed progress using the PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013) to measure PTSD symptoms; the International Trauma Questionnaire (ITQ; Cloitre et al., 2018), which measures C-PTSD symptoms according to the criteria of the World Health Organization (WHO) International Classification of Diseases, 11th revision (ICD-11); the Child-Parent Relationship Scale (CPRS; Pianta, 1992), which measures connection and conflict in the caregiver-child relationship; and the Subjective Units of Distress (SUD) scale (Wolpe, 1969), which rates the client’s current level of distress or discomfort. The clinician also used the self-report questionnaire Helpful Aspects of Therapy (HAT; Llewelyn et al., 1988) and the Change Interview (CI) method (Elliott et al., 2001) to measure client experience and perspective. After treatment with AIT, the client no longer met criteria for C-PTSD and showed dramatic improvement in intergenerational relationship satisfaction. In addition, there was a rapid reduction of hard to eradicate C-PTSD symptoms as well as reduction in the quantity and intensity of fibromyalgia induced pain. Use of AIT with caregivers could interrupt the transmission of intergenerational trauma thereby reducing or preventing ACEs by increasing emotional regulation and resilience.

Quantifying Neck Fibrosis and Its Functional Implications: Development of the Neck Fibrosis Scale.

Despite increasing recognition of the importance of functional outcomes for patients with head and neck cancer, post-treatment neck fibrosis remains poorly understood. We sought to develop and validate a patient reported outcome measure for head and neck cancer patients with neck fibrosis. Prospective multiphase cross-sectional study. To guide instrument development, we employed the World Health Organization International Classification of Functioning, Disability and Health as our conceptual framework. Items were generated using a composite strategy consisting of patient focus groups, literature review, and expert opinion from a multidisciplinary group. Candidate items were reduced through the item impact method. Preliminary psychometric properties of the finalized instrument were evaluated through measures of internal consistency, test-retest reliability, and construct validity. Four in person focus groups were held with 13 head and neck cancer patients. The process of item generation led to 221 relevant citations and 68 unique items. An additional 17 items were identified from review of existing neck disability questionnaires and expert opinion. A draft instrument with 25 candidate items was generated and reduced to its final 15-item scale using item impact method. Early psychometric testing revealed excellent internal consistency (Cronbach's alpha=0.95) and test-retest reliability [ICC=0.95]. Internal consistency at the item level was good (>0.7) for 11/15 individual items. Four separate constructs were evaluated. Three of the four constructs matched our a priori hypotheses. The Neck Fibrosis Scale demonstrates preliminary reliability and validity for discriminate use. Further research is needed to confirm dimensionality and assess responsiveness. NA Laryngoscope, 132:1015-1021, 2022.

Neonatal deaths among infants born to women living with HIV in the UK and Ireland.

To estimate the incidence of neonatal mortality among infants born to women living with HIV in the UK and Ireland in 1998-2017, describe causes of neonatal death (NND) and examine risk factors. Population-based surveillance of pregnancies in diagnosed women living with HIV and their infants in the UK and Ireland. Estimated incidence of NND was reported for 1998-2017 and causes coded using the World Health Organization International Classification of Perinatal Mortality. Risk factor analyses used multivariable logistic regression, including delivery year, maternal origin, maternal age, delivery CD4+ cell count and viral load (VL), antiretroviral therapy (ART) at conception, preterm delivery (PTD), injecting drug use and infant sex. There were 20 012 live-born infants delivered to 12 684 mothers in 19 601 pregnancies. The overall neonatal mortality rate was 4.10 per 1000 livebirths (95% confidence interval, 3.2-5.0), which was higher than that of the general population. Prematurity was the leading cause of death followed by congenital abnormality. Most NND occurred on the first day of life. ART at conception was associated with significantly reduced NND risk. In a restricted 2007-2017 analysis including VL, PTD and detectable maternal VL were associated with significantly increased NND risk. The vertical transmission rate in the UK, at 3 per 1000, is now lower than the neonatal mortality rate among infants born to women living with HIV. More research is needed to investigate the complex relationship between ART, preterm delivery and neonatal death in order to improve all perinatal outcomes.

Factors influencing perceived function in the upper limb prosthesis user population.

Patient-reported outcomes (PROs) can be used to evaluate perceived capacity of an individual in executing tasks in a natural environment with their prosthetic device. According to the World Health Organization International Classification of Health, Functioning, and Disability (ICF) models, there may be specific factors of a person, factors of assistive prosthetic technology, or factors related to the health condition or body function that affect their functioning and disability. However, an understanding of factors affecting an upper limb prosthesis user's perception of their ability to execute tasks in a natural environment is not well established. To use the ICF model to identify which health condition-related, body function, environmental, and personal factors influence activity as measured by perceived function in the upper limb prosthesis user population. Quantitative clinical descriptive study. Clinical offices within outpatient private practice (removed for blinding). A sample of 101 participants with upper limb amputation who use a prosthetic device and were undergoing a prosthesis fitting process. Not applicable. PROs on pain with/without a prosthesis, satisfaction, and perceived function derived from the Comprehensive Arm Prosthesis and Rehabilitation Outcomes Questionnaire. Model coefficients indicate that with a unit increase in satisfaction (p< .001) and pain (p= .031) scores (with higher pain scores signifying less pain), the mean of perceived function increases by 0.66 and 0.47 units, respectively. Conversely, for individuals with elbow disarticulation, transhumeral, shoulder disarticulation, and interscapulothoracic amputations, the mean of perceived function decreases by 22.02 units (p= .006). Based on our sample, perceived function is significantly associated with satisfaction, pain, and amputation level. These findings could potentially help to inform initial clinical approach and targeted outcomes for patients based on these factors.