The suspiciousness of a paranoid patient could reach extremes.

To present the lessons learned after an interview with a similar patient.

Case report.

Fifty-two year old woman suffering from paranoid schizophrenia (F20.0). Symptoms almost identical to her previous (two) hospitalizations: delusions of thought reading and of being surveilled by electronic equipment in her house/neighborhood. This time, though, she was additionally convinced of being the object of medical experiments and of being electronically surveilled even within the ward. Treatment: risperidone 12mg/day, lorazepam 3.75mg/day, biperiden 2mg/day. Three weeks after admission, the author noted a slight tremor in her hands (most certainly of extrapyramidal origin). I asked her to place both hands in front of her, fingers wide open, to assess it better. The patient followed with the fingers attached, though. Consequently, I approached my hands to hers -to show how it should be done correctly-, touching them lightly. Then, a spark was generated between our hands. Evidently, it was an electrostatic discharge (I was wearing a wool sweater that day; static electricity could easily accumulate on wool). She became outraged: “what kind of experiments are you doing to me?”, “what electronic devices are you using?”, “this is the proof of what I have been constantly saying”.

The symptoms of psychotic relapses could evolve over time. A clinician should refrain from any strictly unnecessary physical contact with an exceedingly paranoid patient, particularly when the latter claims that is the object of “medical experiments”. The elaborative “ability” of such patients could be, simply, astounding.

No significant relationships.

This project is funded by ERA-NET of the European Union.

Pharmaceutical treatment and psychotherapy constitute the most common treatment methods for depression and anxiety. Physical training has been shown to have comparable effect to cognitive behavioral therapy in treatment of mild to moderate depression and anxiety. Physically active individuals also show lower risks to develop depression and relapse in depression.

The objectives are to evaluate how physical activity can affect depressive and anxiety symptoms, by examining biomarkers in the blood and from the gut and also by measuring cognitive functions. Hopefully, this can lead to new treatment strategies for patients with depression and anxiety.

102 patients are randomized to two groups and undergo 12 weeks intervention as add-on to standard outpatient psychiatric treatment. The first group will participate in physical training three times per week and the other group will receive relaxation therapy on a weekly basis. Daily activity intensity will be measured before and at the last week of intervention with an accelerometer. Blood and faeces sample collection, symptom grading by clinician together with self-rating scales and cognitive screening will be performed at baseline, week 12 and one year of follow-up. The cognitive screenings are performed digitally in cooperation with Mindmore.

The RCT is currently recruiting patients at the Department of Psychiatry of Örebro University Hospital.

The project aims to be holistic in its approach, combining the defining clinical psychiatric symptoms in patients who have both depression and anxiety with the finding and evaluation of new biomarkers from blood and gut to improve cognitive functions.

No significant relationships.

The usage of mobile phones has seen exponential growth worldwide.1,2 While college students use mobile applications for educational purposes, the reports of adverse health problems are emerging.3,4

Investigate the impact of mobile usage patterns on the life of medical students and its association with psychiatric effects concerning ringxiety and nomophobia.

Data was collected from the 300 medical students of Ashwini Rural Medical College of India through a survey for this cross-sectional study. Chi-square (χ2) was used for statistics that revealed association, mobile phone usage patterns, including time spent before sleep, in classrooms or clinics, and frequency of update checks.

A significant association was found between time spent on mobile before sleep and duration of sleep, and mobile usage in classrooms or clinics and psychological effects (p<0.0001). Significant association observed between mobile use in classes or clinics and the frequency of update checks, and the frequency of update checks and psychological effects (p<0.0001). About 78% of participants distracted in self-study due to mobile. Updates checked every 10 minutes by 14.7%, every hourly by 43%, and during breaks by 42.3%. Mobile low network caused anxiety (13.3%) and irritability (67.3%). About 41.7% of students couldn’t abstain from mobile use for a day. Every student used the mobile phone averagely for 24 minutes before they went to sleep.

Our study results highlight the prevalence of ringxiety and nomophobia in medical school students. With the surging dependency on mobile phones and technology, we need to cautiously monitor its adverse effects on psychology and psychiatric conditions.

Intramuscular injections (IMI) remain a frequent practice in mental health. The available guidelines for IMI in mental health only focus on the technical side of the practices. Moreover, no recent update has been performed to improve practice of IMI in mental health

To assess a formalized consensus agreement regarding the best practice concerning IMI in mental health and to develop practice guidelines.

A two-round Delphi method was used. The scientific committee consisted in one psychiatrist, one orthopaedic surgeon, one infection control practitioner, one hospital pharmacist, one mental health nurse, one nurse exploring care relationship and one nurse educator. From literature review, each expert proposed specific recommendations. The panel experts were asked to rate the appropriateness and the applicability in current practice of each recommendation on a 9-point Likert scale. Panel members were recruited in five mental health institutions. The first round questionnaire was emailed to each respondent on February 2020 and the second one on June. Propositions were considered appropriate and applicable in current practice if the median was >=7. Agreement among experts were judged by the statistical measure of the Interpercentile Range

From the first round, 46 recommendations were retained by 49 nurses. 27 propositions were retained after this second round by 32 nurses. The scientific committee added 12 other recommendations because of their importance in the literature and clinical practice.

This study provides consensus-based recommendations on IMI in mental health. Nursing staff need to be educated about the new guidelines from both the theoretical and clinical perspectives

No significant relationships.

The frail elderly with multimorbidity and polytherapy may need both residential and home services. The psychogeriatric patient can make both of these contexts very demanding and painful, so that the care burden increases.Psycho-behavioral events lead to an unexpected and particularly complex workload, requiring specific and integrated skills in the fields of health, social assistance and education.

Evaluate whether the integrated team, operating in the health district, is able to intecept multimorbidity in the presence of psychogeriatric disorders. A possible index of the ability to take charge of psychogeriatric multimorbidity is to measure admission rates to acute psychiatric services or to nursing homes.

Metodi. This is an observational study on a cohort of thirty elderly patients over-65, consecutively assessed in the health district with multimorbidity and psycho-behavioral, followed for six months.

One third of psychogeriatric patients with multimorbidity, despite being intercepted by health services of community, are admitted to acute psychiatric services for brief observation or hospitalization. Psychogeriatric patients have high clinical instability, reducing ability to make adequate choices, lower levels of consistent actions.

Organizational models, in response to the growing multimorbidity, and the allocation of resources cannot be oriented to the single pathology but to groups of patients in the perspective of long term care. The case-mix is an index of the complexity of the cases treated; when we refer to the psychogeriatric population, this index is high, due to emergence of social and medical problems in both residential and home services.

In Spain, we are forced to familiarize ourselves with Arab-Muslim culture to properly treat our patients. The diagnosis becomes complicatedbecause western health professionals are not usually familiar with thisform of symptom presentation.

The objective of this work is to study the influence of Arab culture and Muslim religion on the psychopathological symptoms presented duringa psychotic episode.

We present two cases of psychosis in two brothers of Maghreb originwho were treated for the first psychotic episode in the acute psychiatricunit in a Spanish regional hospital. Then, we carried out a litle researchfrom the literatura.

The common psychopathological symptoms presented by two brothersof 26 and 27 years were: symptoms of thought, control and influence of the self. Delusional ideas of self-referential harm and persecution. Auditory and cenesthetic hallucinations. In the literature we find that patients with Islamic backgrounds whosuffer hallucinations can attribute these experiences to different beliefssuch as geniuses (jinn), black magic and the evil eye. One of the siblings was diagnosed with a psychotic episode withoutspecification, while the other brother got the schizophrenia label. Webelieve that this may be related to the fact that mental healthprofessionals generally tend to label fantastic stories as mind-blowingor delusional in nature.

1. Religious beliefs and fantastic tales of Muslim culture can be considered psychotic symptoms if healthcare professionals are notfamiliar with this culture. 2. Teamwork between mental health professionals, translators and religious counselors can improve care for Muslim patients.

Personal traits influence persons’ perception of the social environment. Therefore analyzing stories with the non-specific plot can enable to distinguish particular characteristics.

The aim is to determine the features of verbal self-presentation of people with high and low scores on the Machiavellian scale.

1. For the selection of particular participants, who have high and low scores, the questionnaire «Dark triad» of Egorova was used. 2. For collection stories of respondents, a series of interviews was carried out with extra stimulus. There were 20 conversations. Age was from 19 to 29 (m = 23; sd = 7,1).

The opportunity to predict personal traits in general stories was proved. There is a confrontation between the person and the world in the speech of the Machiavellians. Their stories usually have a strong hero, other characters are ignored by the main person. Machiavellians want a safe and calm place that allows them to be themselves. We assume that this is a consequence of the fact that they have to dissemble in society. This statement requires further verification Non-Machiavellians are concerned by the opinion of society, that affects their life and behavior. They act for the well-being of the world while their own feelings are being ignored. There is a feeling of guilty in non-Machiavellians’ tales which is connected with failures around them.

The study was piloted interviewing method (with stimulus material) for the study of indirect verbal self-presentation. Differences were found between the people’s self-presentation with an accentuation of Machiavellianism and non-Machiavellianism.

Mild cognitive impairment (MCI) becomes increasingly common. It has been demonstrated high risk of progression to dementia. There are no approved medications for treatment of MCI while cognitive intervention might improve cognitive deficits. However, there have been insufficient evidence supporting the effect of the cognitive intervention.

To evaluate the effects of a cognitive rehabilitation training in patients with Mild cognitive impairment

A randomized controlled single-blind trial was conducted. Participants aged ≥ 60 years diagnosed with MCI were recruited and randomly assigned to intervention group (n=32) or waiting list control group (n=32). The intervention was 3-day weekly sessions of multi-component cognitive rehabilitation training for 3 months. Outcomes were assessed by the Cambridge Neuropsychological Test Automated Battery (CANTAB) to measure the effects of intervention at baseline, 3-month and 6-month follow up within the intervention group and compare between intervention group and control group.

The intervention showed significant improvements on the visual episodic memory (p<0.05) and on the executive function (p<0.05) at 3-month follow up. There was a trend towards improvement of cognition between the intervention group and control group, but this effect was not significant. At 6-month follow up, the OTS significantly changed from 3-month follow up, which reflect the maintaining effects of the cognitive training.

The cognitive rehabilitation training has demonstrated improvement of the visual episodic memory and the executive function for the elderly with MCI.

Nowadays, ‘Acute and transient psychotic disorders’ in ICD-10 and ‘Brief psychotic disorders’ in DSM-5 are both classifications of the same clinical entity. Over the years, several concepts have been formulated to define the same syndrome.

To explore the historical evolution of brief psychotic disorders and relate them to current nosologies.

Literature review, using the most relevant papers, with the keywords “brief psychosis”, “bouffée délirante”, “cycloid psychosis”, “psychogenic psychosis”, “atypical psychosis” and “holodysphrenia”.

Initially, in 1896, Kahlbaum coined the term ‘dysphrenia’, a group of severe form of psychosis that remitted without showing the typical sequence of disease states and without leaving a lasting alteration. Later, Kraepelin included this kind of disorder in manic depressive illness, which he first named as ‘periodic delirium’ and then as ‘delirious mania’. Magnan, in the pre-Kraepelinian era, created the term ‘bouffée délirante’, a sudden onset of delusional ideas with rapid evolution and intense symptomatology with complete remission usually followed after a short time. Later on, Henry Ey grabbed this entity and renewed it, contrasting it to the defined concept of schizophrenia. Other psychiatric schools have proposed numerous designations: ‘cycloid psychosis’ by Kleist from the German school, ‘psychogenic psychosis’ by Wimmer of the Scandinavian school and ‘holodysphrenias’ by Barahona-Fernandes from the Portuguese school. Cultural variants are also observed, as ‘amok’ seen in Malaysia or ‘shinbyung’ in Korea.

The intensity and polymorphism of brief psychosis present a clinical challenge. The historical evolution may be helpful on recognizing this entity in current clinical practice.

Unipolar depression is daily encountered in psychiatry.

To describe the socio-demographic and clinical characteristics of patients with unipolar depression.

This is a cross-sectional, descriptive study carried out at the psychiatric department of the University Hospital of Mahdia. We have included patients with unipolar depression. The data were collected from patients’ medical files using a pre-established 37-item questionnaire.

We have collected 53 patients. The mean age was 44 years. The majority of patients were female (56.6%) and unemployed (70%). 47.2% of patients were married. 72% of patients had a low socio-economic level. They were smokers in 45.3% of cases. Alcohol consumption was found in 24.5% of cases. A family history of mood disorder and suicide or attempted suicide were present in 7% and 13.2% of the cases respectively. 7% of the patients had a history of a postpartum thymic episode. The mean number of depressive episodes was 2.5. Personal history of suicide attempts was found in 40% of cases. The mean age of the first thymic episode was 35 years. At the psychiatric examination, psychomotor retardation was present in 64% of cases, anxiety distress in 58.5% of cases, psychotic, melancholic and atypical characteristics in 30%, 13.2% and 5.7% of cases respectively. 81% of patients were treated with anxiolytic drugs in combination with an antidepressant. Antipsychotic treatment was combined in 45% of cases and electro-convulsive therapy in 9.4% of cases.

Our patients presented predictive criteria of bipolarity. Therefore, vigilance is necessary in their medical management.

In emergency departments, workers regularly report unfavorable working conditions. It’s a stressful workplace with excessive workloads, high demands on patient care including exposure to violence, time pressures and overcrowding.

-Identify the prevalence of violence, psychological distress and job stress in the emergency department. -Investigate risk factors of aggression among emergency department staff.

This study is a descriptive-cross sectional analysis study conducted on emergency department staff. Data were collected through a questionnaire including sociodemographic information, circumstances of the aggression, the Karasek questionnaire, and the GHQ-12 (General Health Questionnaire).

Our study included 62 health workers. Half of the population were physicians. The prevalence of assault was estimated at 59.6%. Psychological distress was noted in 64.5% of cases. Occupational stress was estimated at 75.8%. The most common type of assault was verbal aggression (86.4%). The aggressor was most often an accompanying person. The occurrence of violence was not associated with the worker’s psychological distress or job stress. On the other hand, we noted an association between aggression and variable work schedule.

Violence against healthcare workers in the emergency department is an important phenomenon. Preventive actions should be taken to improve health professional wellbeing at work.

No significant relationships.

The general confinement in Tunisia in the covid-19 pandemic is a new event for the Tunisian society with economic, social and psychological repercussions.

To evaluate the behavior of Tunisians during the general confinement of 2020.

descriptive and analytical study through a questionnaire sent online under the model of “google forms”.

Our sample is composed of 500 people, mostly women, with an average age of about 40 years, an average to good economic level, and a secondary and higher education level. In the Tunisian family, the most discussed topic during the lockdown is the covid-19 and its evolution in the world and the country. The most avoided subject is the behavior of neighbors. The Tunisian’s main sources of information on covid-19 are television and social networks. The behavior most adopted to avoid contamination is hand washing. Only 2/3 of the group applied the measures announced by the government. A quarter of our sample spent more than 5 hours in front of the computer screen or smartphone. During confinement the most important behaviors are smoking, eating, doing nothing and playing cards. Only 10% of our sample have plans for next year.

For our sample, covid-19 has greatly transformed the behavior in daily life which has become dominated by anxiety and fear of contamination.

Epidemiological data suggest that in youth the prevalence of co-occurring borderline personality disorder (BPD) is particularly high in people with gambling disorder (GD).

The objective of this study was to investigate clinical presentations of GD in youth patients with BPD.

Clinical psychopathological interview, SCID-II, The Gambling Symptom Assessment Scale (G-SAS), Hamilton Depression Rating Scale (HDRS), Zung Anxiety Rating Scale (ZARS). Sample: N=65 male and female, age: 18-25 with GD and BPD.

GD clinical presentation in BPD patients in youth have age and individual specific signs, like polymorphism and high conjugacy with comorbid mental disorders (including, but not limited to MDD, OCD, anxiety disorders, body dysmorphic disorder and etc.) Types of GD in BPD varied due to these comorbid syndrome: 1. Subjects with GD, BPD and MDD in youth demonstrated severity progression in anticipatory tension emotional distress (mental pain, shame, guilt) and lower level in pleasure on winning the bet (G-SAS:SD/Mean 35± 3). 2. Group with OCR and Anxiety Disorders showed different profile: urges to gamble and emotional distress dominated here (G-SAS SD/Mean 32.5± 1). 3. Individuals with no clear co-occurring clinical syndromes revealed combination low level control thoughts of gambling with much excitement and pleasure on winning the bet (G-SAS:SD/Mean 41.2± 2).

Our research provides further insight on GD structure in youth BPD patients with comorbid psychiatric syndromes

No significant relationships.

Clozapine is the most effective antipsychotic for treatment resistant schizophrenia but adverse reactions to clozapine include neutropenia. Patients with COVID-19 infection frequently experience lymphopenia, but not neutropenia.The impact of clozapine treatment in the presence of COVID-19 is unknown

Show 2 cases of neutropenia in patients treated with long-term clozapine during COVID-19 infection.

Subjects: 48 admitted patients to a long-stay psychiatric unit. COVID-19 infection confirmed by positive nasopharyngeal swab for viral ribonucleic acid of SARS-CoV-2. Hematological controls between March and April 2020.

16 patients (33%) treated with clozapine.18 patients (37’5%) had COVID-19 infection, of which 5 (10’4%) were treated with clozapine; 2 presented neutropenia. 1- 56-year-old woman diagnosed with schizophrenia on clozapine since 2009. Begins to have a dry cough and fever with positive COVID-19 swab (day 0). Slight leukopenia without neutropenia was observed on day 1. On day 7, neutropenia was observed with an absolute neutrophil count (ANC) of 1100. We decided to suspend clozapine and to initiate daily hematological controls. The ANC on day 8 was 970. Over the next few days the ANC will progressively improve until neutropenia resolved (day 22). 2- 55-year-old woman who required a transfer to a general hospital because of respiratory complications from COVID-19. She presented significant leukopenia (1’01x 10^3/uL) and neutropenia (ANC 100). Clozapine was not withdrawn. She was treated with granulocyte colony-stimulating factor.

An urgent full blood count will be required to exclude neutropenia with appropriate action. Further research will be needed to clarify the possible relationship between COVID-19, clozapine and neutropenia.

No significant relationships.

It is known that the intensity of inflammation weakens with age, and therefore it is of interest to study the clinical features of schizophreniс process in relation to the level of inflammatory markers.

To determine the level of inflammatory markers (the activity of leukocyte elastase (LE) and α1-proteinase inhibitor (α1-PI), autoantibodies (aAB) to neurotrophin S100b and myelin basic protein) in plasma in different years old groups of patients with schizophrenia.

Two groups of patients with schizophrenia were examined: the 1st group - 19 women aged 60 to 78 years; the 2nd group - 24 women aged 19 to 42 years.

An increase in activity both of LE and α1-PI was found in young patients. This characterizes a balanced inflammatory response. Elderly patients showed a similar increase in the activity of α1-PI, however, LE activity did not exceed the control values. Insufficient LE activity probably characterizes a decrease in the functional activity of neutrophils. The negative correlation was revealed between the activity of LE and TotPsy (PANSS) in the group of elderly patients (r=-0.62, p<05) and positive correlation between aAB to S100b and TotNeg in both groups (r=0.56 and r=0.49, p<05 respectively). There is relationship between age, the activity of psychopathological symptoms and the rate of development of schizophrenia: the rapid course and variety of disorders at a young age, against the poverty of symptoms and a slow rate in the elderly.

There is relationship between the features of inflammatory reactions and clinical picture in elderly and young patients with schizophrenia.

Research following the Covid-19 pandemics has shown that psychological reactions to the pandemic and its constraints can vary significantly depending on personality. One of the traits that has not been studied yet, but can play a harmful role in the COVID-19 psychological impact is perfectionism. This trait, characterized by setting excessively high standards of performance and striving for flawlessness, has increased in recent years and is considered a transdiagnostic process involved in several (mental) health problems (Curran & Hill 2019).

To analyze the role of Perfectionism in the levels of fear of COVID19 and of perception of infection risk by COVID-19.

234 adults (75.6% women; mean age=29.53±12.51) completed an on-line survey with the Portuguese validated versions of Covid-19 Perceived Risk Scale (C19PRS; Pereira et al. 2020), Fear of COVID-19 Scale (FC19S; Cabaços et al. 2020) and Big Three Perfectionism Scale (BTPS; Garrido et al. 2020). SPSS was used to perform correlation and regression analysis.

Perceived Risk and Fear of COVID-19 were significantly correlated with perfectionism (.243, .228, respectively) (both, p<.01). Perfectionism explains 5.5% (Adjusted R2) of the FC19S variance (Beta=.243, p<.001) and 4.8% of the C19PRS variance (Beta=.228, p=.01).

This study provides preliminary, but completely innovative evidence that perfectionism contribute to the psychological impact of Covid-19 pandemics. In the near future we will test the hypothesis that the nature of unpredictability and the limitations imposed by the global crisis may be exacerbating the already high levels of psychological distress that affect negative perfectionists.

In the mental health area, the most problematic issues are the involuntary placement of the mentally ill in closed institutions, both under civil and criminal proceedings, and their involuntary treatment. Despite the international efforts of harmonizing measures, the nature and practice of the services still vary from country to country.

To analyse involuntary placement of persons with mental disorders in closed institutions under civil and criminal proceedings, which include both psychiatric hospitals and care institutions.

Review and analysis of regulations and practice of involuntary placement of a person with a mental disorder in a closed institution in the context of Estonian, Finnish, Russian, and English law, health care and social system.

Estonian, Finnish, Russian, and English law distinguish between criminal and civil proceedings regarding involuntary placement of a mentally ill person in a closed institution. However, specifics of the proceedings are different among the countries, e.g. judicial involvement, and deadlines. Also, the provision of forensic mental health services differ among these countries, e.g. in Estonia offenders and non-offenders are kept separately, whilst in England and Russia patients are not distinguished so strictly.

The distinction between involuntary placement of the mentally ill in criminal and civil proceedings is distinguished primarily for the reason that in one case the risk arising from the person is directly realized by committing an unlawful act and in the other case the risk arising from the person is directed at themselves or is not qualified as an unlawful act.

Postpartum depression (PPD) is the commonest postpartum psychiatric condition, with prevalence rates around 20%1. PPD is associated with a range of adverse outcomes for both the mother and infant2. Therefore, identifying modifiable risk factors for perinatal depression is an important public health issue3.

To explore the role of dysfunctional attitudes towards motherhood in postpartum depressive symptoms and disorder.

247 women were evaluated in the third (12.08±4.25 weeks) and sixth months (31.52± 7.16 weeks) postpartum with the Attitudes Towards Motherhood Scale4, the Postpartum Depression Screening Scale5 and the Diagnostic Interview for Psychological Distress-Postpartum6. Correlation analysis was performed followed by linear/logistic regression analysis when the coefficients proved significant (p<.05), using SPSS.

Dysfunctional beliefs towards motherhood concerning judgement by others and maternal responsibility positively correlated with depressive symptoms at the third (.528; .406) and the sixth months (.506; .492) postpartum. Those dysfunctional beliefs were predictors of depressive symptoms at the third (ß=.440; ß=.151) and sixth months (ß=.322; ß.241) explaining 29.4% and 30.2% of its variance, respectively. Having dysfunctional beliefs at the third month significantly increase the likelihood of being diagnosed with Major Depression (DSM5) both in the third (Wald=9.992, OR=1.169; Wald=16.729, OR=1.231) and sixth months (Wald=5.638, OR=1.203; Wald=7.638, OR=1.301) (all p<.01).

Cognitive distortions should be included in the assessment of risk factors for PPD. Early identification of women presenting motherhood-specific cognitive biases may be crucial for implementing preventive interventions favoring a more positive and healthier motherhood experience.

No significant relationships.

Substance use disorders (SUDs) are estimated to affect around 30 million people worldwide, and are characterized by repeated use of a substance that leads to clinically significant impairment or suffering, making it a serious health problem, with high associated costs.

Understand and evaluate the impact of cannabis use on adherence to treatment in young patients with psychosis.

Narrative literature review by performing a search on MedLine for English-written articles. The query used was “(Cannabis) AND (Schizophrenia OR Psychosis) AND (Adherence)”.

About 70 to 80% of young people with SUDs have at least one concomitant psychiatric disorder and cannabis is involved in approximately 50% of psychosis or schizophrenia of those cases, so there is a growing concern about the deleterious medical and psychiatric consequences of the increase and early initiation of consumption of this substance. It is estimated that about 26% of patients with psychotic conditions do not adhere to the treatment plan established by the psychiatrist; however, especially during the inaugural phases of psychotic disorders, rates of non-adherence to therapy are high (above 50%), and are said to be higher in younger patients.

The risk of relapse after a first psychotic episode is high. As the use of cannabis is a potentially preventable risk factor, interventions aimed at improving therapeutic adherence in psychotic conditions must specifically target the use of this substance, since reducing its consumption can lead to a more favorable course of the disease and at less expensive costs in addressing these pathologies.

No significant relationships.