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Assessing medically unexplained symptoms: evaluation of a shortened version of the SOMS for use in primary care
AIDS was first recognized in the United States in the summer of 1981, when the U.S. Centers for Disease Control and Prevention (CDC) reported the unexplained occurrence of Pneumocystis jiroveci (formerly P. carinii) pneumonia in five previously healthy homosexual men in Los Angeles and of Kaposi's sarcoma (KS) with or without P. jiroveci pneumonia in 26 previously healthy homosexual men in New York and Los Angeles. Within months, the disease became recognized in male and female injection drug users (IDUs) and soon thereafter in recipients of blood transfusions and in hemophiliacs.
The CGAP measure of relative macroeconomic performance is attractive for a number of
reasons. First, it is based on changes in real GDP, a fundamental variable that should be
highly correlated with changes in underlying welfare. Second, our measure should not be
unduly sensitive to the stage of an economy’s business cycle going into the crisis. An
economy that was overheating prior to 2008 would tend to have a positive unexplained
component at that point in time, but it is only the unexplained component during the crisis
itself that is considered in our analysis.
Health in its broadest sense includes physical and mental health. Even though many health
workers agree with this broad conception of health, in reality the focus is mainly on physical
health. There are many reasons for this. Probably the most important reason is that health
workers do not understand much about mental health and are therefore less comfortable dealing
with mental health problems. However, in recent years there has been growing awareness about
various types of mental illnesses. Many health workers have become more interested in dealing
with these problems.
They observed that the use of well defined symptoms
as diagnostic tool, even in resource limited settings,
may improve the chances of diagnosing childhood
pulmonary tuberculosis. Fourie et al observed some
clinical criteria thought to be most relevant as
predictors of tuberculosis in children . These criteria
include history of contact with a case of tuberculosis,
positive skin test, persistent cough, low weight for
age, and unexplained/ prolonged fever.
FACTITIAL CAUSES Factitial diarrhea accounts for up to 15% of unexplained diarrheas referred to tertiary care centers. Either as a form of Munchausen syndrome (deception or self-injury for secondary gain) or eating disorders, some patients covertly selfadminister laxatives alone or in combination with other medications (e.g., diuretics) or surreptitiously add water or urine to stool sent for analysis. Such patients are typically women, often with histories of psychiatric illness and disproportionately from careers in health care.
A complete medical history is perhaps the single most important part of the evaluation of the patient with unexplained jaundice. Important considerations include the use of or exposure to any chemical or medication, either physicianprescribed, over-the-counter, complementary or alternative medicines such as herbal and vitamin preparations, or other drugs such as anabolic steroids. The patient should be carefully questioned about possible parenteral exposures, including transfusions, IV and intranasal drug use, tattoos, and sexual activity. ...
Although the Gulf War lasted but a few days, many combat troops have suffered
lingering health problems that they attribute to their wartime service. Their
health problems and illnesses have features in common with illnesses suffered
by veterans of earlier wars, including the difficulty that their physicians have
had in making a diagnosis. As yet, these illnesses remain unexplained by medical
science, which has prompted some people to wonder if troops in the Persian
Gulf theater were exposed to an agent or combination of agents that caused