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Most existing studies were rated as being of low or very low methodological quality, because of risk of bias due to study design issues, and a high degree of heterogeneity across studies. Rationale for the recommendations Balance of benefts and harms the Guidelines Development Group recognized that poor uptake of viral hepatitis testing and linkage to care is a major barrier to access to care and treatment. To expand access to testing and treatment, programmes need to not only make use of multiple testing approaches at the facility and community levels, but also adopt interventions to promote optimal linkage to prevention and treatment. The Guidelines Development Group made a strong recommendation for the general adoption and implementation of a series of relatively simple, low-cost but effective strategies (promotion of testing by lay health workers, clinician reminders and coordinated care between hepatitis and mental health specialists) to enhance uptake of hepatitis testing and linkage to care, based on generally low-quality evidence from the systematic review. Feasibility, acceptability, and resource use Education and support for peer and lay health-care workers. Evidence supports such peer-led interventions as being feasible and acceptable to both those individuals screened and lay health workers themselves (403). The low-cost nature of this intervention could facilitate its use in resource-limited settings. The lay health workers in the seven studies received training in order to help tailor the educational intervention; this training component was relatively simple and of low cost. Clinician reminders are consistent with the broader shift towards standardizing clinical practice, including provider-initiated screening and systems-based approaches to improving clinical outcomes. Implementation is relatively easy and similar systems have demonstrated effectiveness in multiple disease modalities, such as breast (404) and colorectal cancer screening (405). Chapter 17 on service delivery provides a range of examples of integrated care in different settings promoting linkage to hepatitis care. While the interventions addressing multidisciplinary or integrated care in the evidence review were diverse, a likely key contributor to improved outcomes was co-location and coordination of services. However, effective linkage to hepatitis care and treatment following a positive diagnosis would be expected to improve programme effectiveness, support earlier treatment initiation and reduce loss to follow up before treatment initiation, thus resulting in potential cost savings along the continuum of care. Proactive linkage approaches are a critical component of comprehensive hepatitis testing services. Countries should ensure that they have specifc policies and strategies to improve and prioritize linkages between hepatitis testing and prevention, treatment and care services. Interventions that impact on multiple steps along the care continuum will generally be more resource effcient. The success of linkage should be measured by enrolment in care and not by intermediary process indicators such as the number of referrals issued, and areas identifed for improvement.
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Most commonly, cockroach allergens are inhaled in dust or allergens that have collected in pillows, bedding or other dust-trapping fabrics. Tests have found that one in fve homes with no history of cockroach infestation had a signifcant level of cockroach allergens in dust and fabrics. Proteins found in saliva, urine and feces American Lung Association State of Lung Disease in Diverse Communities 2010 19 from cats, dogs and other pets can also cause allergic reactions in some people. Research also indicates that male cats produce less Fel d I allergen than female cats, although the reason is not clear. They remain suspended in the air for a long time; much longer than allergens from cockroaches or dust mites. Because of their microscopic size and jagged shape, pet allergens easily stick to furniture, bedding, fabrics and many items carried into and out of the home. Animal dander is easily spread through the home and out to public places like schools and hospitals. The symptoms range in severity and include itchy, watery eyes, sneezing, and wheezing. Pollen indoors largely comes from outdoor pollen entering through windows, doors and vents. Pollen in a building may settle in dust or on fabrics and be stirred up by activities that disturb dust, such as vacuuming. Despite the potential for exposure to pollen, indoor environments are considered protective for individuals with allergies to pollen. Sources include cosmetics, building materials, furnishings, and home and offce products, such as paints, paint strippers, cleaning supplies, pesticides, copiers, printers, and craft supplies,42 as well as car exhaust from attached garages. Lead paint chips, dust and lead in soil pose particular danger to children and unborn babies. It can affect physical and mental development and cause acute illness in both children and adults. In older buildings (often found in poor urban areas), lead primarily comes from old, lead-based paint that is still on the walls, though lead can also come from cosmetics, hobby materials and other products. Occupational exposures to lead can pose health risks for adults, such as increased blood pressure or impaired neurological or renal function. Recent studies have found that lead dust can be tracked in to carpeting in homes and automobile interiors from these workplace exposures, putting children at risk. Due to its durability and heat resistance, asbestos was once widely used in shingles, freproofng, heating systems, and foor and ceiling tiles. When asbestos-containing material is damaged or disintegrates, microscopic fbers are dispersed into the air.
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In section 6 of the principal Act, after clause (b), the following clause of section 6. In section 14 of the principal Act, for clause (f), the following clause of section 14. For section 16 of the principal Act, the following section shall be of new substituted, namely: section for section 16. The Board shall have the following functions, namely: (i) to advise the Central Government on policy matters Functions of relating to use of pre-natal diagnostic techniques, sex selection the Board. After section 16 of the principal Act, the following section shall be Insertion of new inserted, namely: section 16A. After section 17 of the principal Act, the following section shall Insertion of new be inserted, namely : section 17A. The Appropriate Authority shall have the powers in respect of the following matters, namely : Powers of Appropriate (a) summoning of any person who is in possession of any Authorities. In section 18 of the principal Act, for sub-section (1), the Amendment of following sub-section shall be substituted, namely : section 18. For section 22 of the principal Act, the following section shall be Substitution of substituted, namely: new section for section 22. In section 23 of the principal Act, for sub-sections (2) and (3), the of section 23. For section 24 of the principal Act, the following section shall be Substitution of substituted, namely: new section for section 24. In section 30 of the principal Act, for sub-section (1), the Amendment of following sub-section shall be substituted, namely: section 30. After section 31 of the principal Act, the following section shall Insertion of be inserted, namely: new section 31 A. Government may, by order published in the Official Gazette, make such provisions not inconsistent with the provisions of the said Act as appear to it to be necessary or expedient for removing the difficulty: Provided that no order shall be made under this section after the expiry of a period of three years from the date of commencement of the Pre-natal Diagnostic Techniques (Regulation and Prevention of Misuse) Amendment Act, 2002. Sale of ultrasound machines/imaging machines: (1) No organization including a commercial organization or a person, including manufacturer, importer, dealer or supplier of ultrasound machines/imaging machines or any other equipment, capable of detecting sex of foetus, shall sell distribute, supply, rent, allow or authorize the use of any such machine or equipment in any manner, whether on payment or otherwise, to any Genetic Counselling Centre, Genetic Laboratory, Genetic Clinic, Ultrasound Clinic, Imaging Centre or any other body or person unless such Centre, Laboratory, Clinic, body or person is registered under the Act.
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Recommendation: X-ray for Acute Cervicothoracic Pain with Red Flags or Subacute or Chronic Cervicothoracic Pain X-ray is recommended for acute cervicothoracic pain with red flags for fracture or serious systemic illness,(336) subacute cervicothoracic pain that is not improving, or chronic cervicothoracic pain. Also indicated for subacute or chronic cervicothoracic pain particularly when not improving as an option to rule out other possible conditions. Recommendation: X-ray for Spondylolisthesis Flexion and extension views are recommended for evaluating symptomatic spondylolisthesis in which there is consideration for surgery or other invasive treatment or occasionally in the setting of minimal trauma. An experienced reader with an established protocol is recommended to avoid variation in interpretation. Recommendation: X-ray for Acute, Non-specific Cervicothoracic Pain Routine x-ray is not recommended for acute, non-specific cervicothoracic pain. X-rays are believed to be unnecessary for the routine management of cervicothoracic pain outside of the setting of red flags. In the absence of red flags and if the patient is able to rotate the neck 45 both left and right then radiographs are not indicated. In the event there is cervical pain without any improvement over 4 to 6 weeks, x-rays may be recommended to rule out other possible problems. A prospective study examined inter-rater reliability in interpretation of flexion extension x-rays of the cervical spine. Three orthopedic surgeons, one neurosurgeon, and 3 radiologists blindly read the same 75 flexion extension x-rays for instability. The same x-rays were re-read in a different order from 28 to 183 days later using a computer assistant program. It was concluded that there was a need for standardization and quantitative definitions of spinal instability and spinal fusion. Quality Evidence There is 1 moderate quality and 1 other study incorporated into this analysis. Significant trauma with no improvement in significantly painful or debilitating symptoms; 3. Multiple neurological abnormalities that span more than one neurological root level;(340, 344 347) Previous neck surgery with increasing neurologic symptoms; 5.