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Jennifer L. Sabol MD, FACS

• Assistant Professor of Surgery, Jefferson Medical College, Philadelphia,
• Pennsylvania
• Director, The Breast Care Center, Lankenau Hospital, Wynnewood,
• Pennsylvania

Access to bulk-billed services Under Medicare medications gabapentin buy rocaltrol 0.25mcg free shipping, health providers can choose to bulk-bill their services medicine wheel images buy rocaltrol 0.25mcg overnight delivery. Bulk-billing rates have also increased for other kinds of non-hospital Medicare services medications information purchase 0.25 mcg rocaltrol overnight delivery, particularly non-hospital specialist attendances (32% in 2007fi08 to 41% in 2016fi17) medications known to cause pill-induced esophagitis purchase rocaltrol uk, diagnostic imaging (68% to 84%) medications not to be taken with grapefruit rocaltrol 0.25mcg lowest price, and pathology (95% to 99%) (Department of Health 2017a) treatment quotes and sayings generic 0.25 mcg rocaltrol with amex. Of these people, 26% (around 528,000 people) reported that they could not do so at least once when needed. Telehealth Telehealth is the delivery of health services through information and communication technologies such as videoconferencing. Along with opportunities stemming from the revolution in digital health technologies, advances in telehealth can provide a cost-efective way to support people with chronic conditions to more efectively self-manage their health (Box 7. Australians can use online and telephone advice at any time via Healthdirect Australia. From 2017, healthdirect began supporting health organisations in New South Wales, Vic to ria and Western Australia to integrate the use of video calls with their everyday delivery of services (Healthdirect Australia 2017). This present with the patient during their program expanded in November 2017 to video consultation with a specialist to include consultations with allied mental give clinical support. The uptake of Medicare-subsidised video conferencing has increased steadily since the introduction of Medicare rebates and incentives in 2011 (fgures 7. This represents a rate of 47 telehealth services and 21 patient-end support services per 10,000 population. Although Medicare services data provide some insight in to variation in use of primary health care across Australia, they do not include information about why patients visit health professionals, their diagnosis, treatment, test results or referrals for further care. Without these data, it is difcult to assess the appropriateness, cost-efectiveness, safety, quality and accessibility of primary health care. It is also difcult to attribute improvements in health outcomes to the primary health care system, as responsibility for health outcomes is across the health care sec to r and there is often a lag time between intervention and improved health outcome. Developments are now underway to improve the completeness and use of primary health care data. This will help to measure and moni to r primary health care performance at a local, regional and national level to enable research, inform policy, and identify regionally specifc issues and best-case practices to better understand health and health care in the community ongoing reviews and consolidation of national reporting frameworks (see Chapter 1. Data linkage can improve the understanding of patient outcomes and pathways through the health system developments in ensuring the anonymity and secure transfer of data. Some medicines are only available via prescription from a health professional, while others can be bought over-the-counter at places such as pharmacies and supermarkets. Providing consumers with access to afordable medicines is a key part of the Australian health care system. The Australian Government helps people to pay for many medicines dispensed in nearly 300 million prescriptions each year under two subsidy schemes (Box 7. Today, around 5,300 brands of medicines, used to treat a wide range of health conditions, are listed on the Schedule of Pharmaceutical Benefts. Some medicines are priced below the co-payment amount, so the consumer pays the to tal cost and the government does not contribute. Generally available medicines and those available under special arrangements All subsidised medicines are listed on the Schedule of Pharmaceutical Benefts under Section 85 (s85) of the National Health Act 1953. Most of these medicines (referred to as s85 medicines) are listed on the General Schedule and are generally available to consumers. They are dispensed mainly through community pharmacies, although some are available through eligible hospitals to day patients and patients on discharge. The special arrangements for many of these medicines mean that they are prescribed under specifc conditions, supplied through hospitals, require specialised medical supervision, and are high in cost. It currently provides subsidised access to 13 expensive life-saving medicines for 9 rare and life-threatening conditions. Medicines that do not require a prescription can be bought over-the-counter in a pharmacy or in other retail outlets (for example, supermarkets). Aside from government and individual consumers, hospitals are a major source of spending on medicines. Although the volume of medicines dispensed for cardiovascular disease remains higher than for other groups of medicines, the number of statins dispensed has been relatively stable over recent years. Other commonly dispensed medicines Medicines to treat nervous system conditions were the second largest group dispensed. Three types of antibiotics were among the 10 most commonly dispensed medicines (Figure 7. They are used to treat a variety of infection sites, such as skin, respira to ry tract and urinary tract infections, as well as infected wounds. These are the doses for a particular medicine that are assumed to be the average per day for an adult. The most commonly dispensed antibiotics were amoxicillin, cephalexin, and amoxicillin with clavulanic acid. Unnecessary prescribing of antibiotics leads to a higher risk of adverse side efects and, importantly, increased anti-microbial resistance in the population. The population fgures are taken from the Australian Bureau of Statistics Estimated Resident Population (the ofcial estimate of the Australian population) as at 31 December 2016. The often high cost of these medicines means that even a moderate growth in the number of prescriptions dispensed can substantially afect spending. Approximately 230,000 Australians are infected with the hepatitis C virus, which causes liver infammation; however, before 2016, less than 2% of people with hepatitis C were treated and cured annually. Compared with the medicines previously available for people with hepatitis C, these are easier to take, have fewer side efects and are more efective, with the capacity to eventually cure people of the disease. An important one is the Price Disclosure Policy, which requires pharmaceutical companies to provide data to the government on the sale prices for their medicine brands in the market. These include naturally occurring substances that can be used to maintain or res to re health, such as vitamins and minerals, herbal medicines, homeopathic preparations and probiotics. This information would greatly help in assessing how many prescriptions are prescribed, and how much money is spent on each disease group. It may also shed some light on whether some medicines are being over-prescribed for certain conditions. Furthermore, there is at present an incomplete picture of medicines dispensed in hospitals. Nationally collated data on medicines dispensed to hospital admitted patients would provide a clearer picture of the overall use of medicines in Australia. The 30 principal referral hospitals (mostly located in metropolitan areas) had an average of 659 beds each, while 69% of hospitals had fewer than 50 beds. Both hospital sec to rs provide services for admitted and non-admitted patients (outpatient clinics and emergency department care). Admitted patient services Admitted patient services, or hospitalisations (see Glossary), are provided when a patient is formally admitted to a hospital. Hospitalisations can either be on the same day or involve a stay in hospital of 1 or more nights. Non-admitted patient services Non-admitted patient care includes care provided in emergency departments and outpatient clinics. For some emergency department services, the patient is later admitted to hospital; that admitted patient activity is not included here. This was an average of more than 21,000 each day across Australia and represented a 2. Although well-developed hospitalisation data are available, there are variations in how hospital services are defned and counted between jurisdictions. Data are based on each hospitalisation or service, rather than on individuals, and current national data cannot easily be used to analyse care patterns for patients hospitalised several times. Similarly, it is difcult to analyse patterns of care across admitted and non-admitted patient settings (including non-hospital settings such as primary health care). Data linkage can improve the understanding of patient outcomes and pathways through the health system. Private hospital data are collected, analysed and disseminated through diferent reporting pathways. As a result, private hospital data may not be consistent across the various collections, or with data for public hospitals. Information about activity and performance for more than 1,000 Australian public and private hospitals is on the My Hospitals website. The information presented in this snapshot relates to hospitalisations for: public patients, who are admitted at no charge (publicly funded) patients whose stay was either completely or partially funded by private health insurance patients funded by other sources (see Glossary for defnitions of public, private health insurance and other patients).

Syndromes

• Examination of vaginal discharge under the microscope
• Chemotherapy
• Use medicines such as ibuprofen or acetaminophen to ease pain.
• Developing fetuses
• Breathing problems, including no breathing, shortness of breath, or rapid breathing
• Methylprednisolone
• Alcohol
• Rubella
• Tearing eyes
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney

Different lithotripsy techniques medications causing dry mouth order genuine rocaltrol on line, including ultrasonic symptoms yellow eyes buy discount rocaltrol online, pneumatic and laser lithotripsy symptoms pneumonia discount rocaltrol online american express, have all been shown to be safe and effective symptoms high blood sugar discount rocaltrol line. Because of the smaller size of the probes medications not to take with blood pressure meds proven rocaltrol 0.25mcg, laser energy is easier to use in smaller instruments and is more useful for paediatric cases (53 medicine 75 yellow generic 0.25 mcg rocaltrol amex,71,73,77-83). However, an important problem was the inability to obtain retrograde access to the ureter in approximately half of the cases (87,88). Suitable candidates include patients who have a his to ry of previous failed endoscopic procedures, complex renal ana to my (ec to pic or retrorenal colon), concomitant ureteropelvic junction obstruction or caliceal diverticula, megaureter, or large impacted s to nes. However, there is very limited experience with these techniques and they are not routine therapeutic modalities (90,91). The use of appropriate-size instruments will decrease the number of complications in surgical 1 A treatment. Urinary excretion of calcium following an oral calcium loading test in healthy children. Urinary oxalate and glycolate excretion patterns in the first year of life: a longitudinal study. Results of a prospective trial to compare normal urine supersaturation in children and adults. A study of the etiology of idiopathic calcium urolithiasis in children: hypocitruria is the most important risk fac to r. Cystine calculi in children: the results of a metabolic evaluation and response to medical therapy. Ureteropelvic junction obstruction and coexisting renal calculi in children: role of metabolic abnormalities. Paediatric urolithiasis: 15 years of local experience with minimally invasive endourological management of paediatric calculi. Relationship between kidney size, renal injury, and renal impairment induced by shock wave lithotripsy. Extracorporeal shock wave lithotripsy as first line treatment alternative for urinary tract s to nes in children: a large scale retrospective analysis. Does size and site matter for renal s to nes up to 30-mm in size in children treated by extracorporeal lithotripsyfi Outcome of small residual s to ne fragments following shock wave lithotripsy in children. Monotherapy extracorporeal shock wave lithotripsy for the treatment of staghorn calculi in children. Extracorporeal shock wave lithotripsy for distal ureteral calculi: what a powerful machine can achieve. Modified Clavien classification in percutaneous nephrolitho to my: Assessment of complications in children. Feasibility of to tally tubeless percutaneous nephrolitho to my under the age of 14 years: a randomized clinical trial. Hydrodilation of the ureteral orifice in children renders ureteroscopic access possible without any further active dilation. Treatment of distal ureteral s to nes in children: similarities to the american urological association guidelines in adults. Some remain asymp to matic, therefore, the true incidence is difficult to determine (2). Ureteroceles usually cause obstruction of the upper pole, but the degree of obstruction and functional impairment is variable according to the type of ureterocele and upper pole dysplasia. In the ortho to pic form, there is often no or only mild obstruction, and frequently the function of the moiety is normal or slightly impaired, and the corresponding ureter may be dilated. Vesicoureteral reflux can be observed in 50% on the ipsilateral side and 20% on the contralateral side. It can be voluminous, dissociating the trigone and slipping in to the urethra, and may prolapse through the urethral meatus (caeco-ureterocele). In girls, the ureteral orifice may be located (13): in the urethra, from the bladder neck to the meatus (35%) in the vaginal vestibule (34%) in the vagina (25%) in the uterus and Fallopian tube (6%). In boys, the ureteral orifice may be located (13): in the posterior urethra (47%) in the prostatic utricle (10%) in the seminal vesicles (33%) in the vas deferens or ejacula to ry ducts (10%). In cases with a small upper pole or a slightly obstructive ureterocele, prenatal diagnosis is difficult. In a newborn boy, it might cause acute urinary retention, simulating urethral valves. In cases of prenatal diagnosis at birth, ultrasonography confirms the ureteral dilatation that ends at the upper pole of a renal duplication. In some cases, clinical symp to ms can lead to diagnosis: In neonates: dribbling of urine, pyuria, and acute pyelonephritis. In some cases, the large ec to pic ureter presses against the bladder and can look like a pseudo-ureterocele (22,23). Filling the bladder with methylene blue and checking for clear urine output from the vagina can give clear evidence of extrasphincteric ureteral ec to pia. This test is also helpful in confirming a vesicovaginal fistula (in this case blue fluid is drained from the vagina). In a clinically asymp to matic child with a ureterocele and a non or hypofunctional upper pole, without significant obstruction of the lower pole and without bladder outlet obstruction, prophylactic antibiotic treatment is given until follow-up procedures are instigated. If decompression is effective and there is no reflux (~25% of cases and more often in intravesical ureterocele), the patient is followed-up conservatively. After an endoscopic incision, most of the children with an extravesical ureterocele (50-80%) need a secondary procedure, compared with only 18% of those with an intravesical ureterocele (32). Surgery may vary from upper pole nephrec to my to complete unilateral bladder reconstruction (10,26,33-40). Obstruction is considered to be the presence of non-refluxing dilatation of non-ureterocele-bearing moieties (especially of the lower pole) or of an obstructive drainage pattern on diuretic renography. Ureteral reconstruction (ureteral reimplantation/ ureteroureteros to my/ureteropyelos to my and upper-pole ureterec to my) is a therapeutic option in cases in which the upper pole has function worth preserving. Both procedures can be performed through an open or laparoscopic approach (42-44). In patients with bilateral single ec to pic ureters (a very rare condition), an individual approach depending on the sex and renal and bladder function is necessary. Treatment Choice of treatment will depend on symp to ms, function and 3 B reflux as well on surgical and parenteral choices: observation, endoscopic decompression, ureteral reimplantation, partial nephroureterec to my, complete primary reconstruction. In half, to two-thirds of children with an extravesical ureterocele a secondary procedure is needed (compared to 20-25% of those with an intravesical ureterocele). The role of 99mtechnetium dimercap to -succinic acid renal scans in the evaluation of occult ec to pic ureters in girls with paradoxical incontinence. Ec to pic ureteroceles in infants with prenatal hydronephrosis: use of renal cortical scintigraphy. Pseudoureterocele: potential for misdiagnosis of an ec to pic ureter as a ureterocele. A meta-analysis of surgical practice patterns in the endoscopic management of ureteroceles. Long-term outcome of transurethral puncture of ec to pic ureteroceles: initial success and late problems. Effectiveness of primary endoscopic incision in treatment of ec to pic ureterocele associated with duplex system. Recent advances in the management of ureteroceles in infants and children: why less may be more. Laparoscopic ipsilateral ureteroureteros to my in the management of ureteral ec to pia in infants and children. Bilateral single ureteral ec to pia: difficulty attaining continence using standard bladder neck repair. We refer to the consensus document as a general guideline, while this chapter will focus on what is relevant for the practising paediatric urologist. As the urologist is likely to be involved in both surgical and nonsurgical neonatal work, this chapter will discuss the neonatal emergency and the diagnostic and therapeutic role of the paediatric urologist. An exception is the risk of gonadal cancer, for which the level of evidence is higher. Micropenis should be distinguished from buried and webbed penis, which is usually of normal size. Stimulated hormone levels may also give an idea of the growth potential of the penis. In the presence of androgen insensitivity, good outcome of sexual function is questioned and gender conversion can be considered (8-10). An extended stimulation can help to define phallic growth potential and to induce testicular descent in some cases of associated cryp to rchidism. Instead, gender assignment decisions should be based upon: age at presentation; fertility potential; size of the penis; presence of a functional vagina; endocrine function; malignancy potential; antenatal tes to sterone exposure; general appearance; psychosocial well-being and a stable gender identity. Information gathered by the various examinations described below should help the team to come to a final diagnosis. A cot to n bud placed at the suprapubic base of the implant of the stretched phallus allows for a good measurement of phallic length. Laparoscopy is necessary to obtain a final diagnosis on the presence of impalpable gonads and on the presence of Mullerian structures. The rationale for early surgery includes: beneficial effects of oestrogen on infant tissue; avoiding complications from ana to mical anomalies; minimising family distress; mitigating the risks of stigmatisation and gender-identity confusion (18). Although some techniques that conserve erectile tissue have been described, the long-term outcome is unknown (21). Many techniques for urogenital sinus repair have been described, but their outcome has not been evaluated prospectively (22,23). Every technique (self dilatation, skin or bowel substitution) has its specific advantages and disadvantages (24). The goals of genital surgery are to maximise ana to my to allow sexual function and romantic partnering. The reconstruction of minor labiae from an enlarged cli to ral hood is an example of aesthetic refinement. Gender assignment is imminent and should be based on multidisciplinary consensus taking in to account the latest knowledge. Timing of surgery will be dependent on the severity of the condition and on the assigned sex. The effect of cli to ral surgery on sexual outcome in individuals who have intersex conditions with ambiguous genitalia: a crosssectional study. Feminizing geni to plasty: a synopsis of issues relating to genital surgery in intersex individuals. These processes are continued as thin membranous sheets, direct upward and forward which may be attached to the urethra throughout its entire circumference. This obstruction was attached to the entire circumference of the urethra, with a small opening in the centre (9). The transverse membrane described has been attributed to incomplete dissolution from the urogenital portion of the cloacal membrane (10). This may be due to the valve itself and the high pressure in the bladder, or due to obstruction of the ureterovesical junction by the hypertrophied bladder. During prenatal ultrasonography screening, bilateral hydroureteronephrosis and a distended bladder are suspicious signs of a urethral valve. Other types of pop-off mechanism include bladder diverticula and urinary extravasation, with or without urinary ascites (14). Creatinine, blood urea nitrogen and electrolytes should be moni to red closely during the first few days. A sodium level below 100 mmol/L, a chloride value of < 90mmol/L and an osmolarity below 200 mOsm/L found in three foetal urine samples gained on three different days are associated with a better prognosis (18). The placing of a vesicoamniotic shunt has a complication rate of 21-59%, dislocation of the shunt occurs in up to 44%, mortality lies between 33% and 43%, and renal insufficiency is above 50% (18-20). One recently published studied demonstrated a significant lower urethral stricture rate using the cold knife compared to diathermy (21). If initially a suprapubic tube has been inserted, this can be left in place for 6-12 weeks. Otherwise, a cutaneous vesicos to my provides an improvement or stabilisation of upper urinary tracts in over 90% of cases (22). Although there has been concern that a vesicos to my could decrease bladder compliance or capacity, so far there are no valid data to support these expectations (23,24). Diversion may be suitable if there are recurrent infections of the upper tract, no improvement in renal function and/or an increase in upper tract dilatation, despite adequate bladder drainage. Reconstructive surgery should be delayed until the upper urinary tract has improved as much as can be expected. During the first months of live, antibiotic prophylaxis may be given especially in those with high grade reflux (29) and in those with a phimosis, circumcision can be discussed in order to reduce the risk of urinary tract infections (30). High-grade reflux is associated with a poor functioning kidney and is considered a poor prognostic fac to r (1,31). However, early removal of the renal unit seems to be unnecessary, as long as it causes no problems. It may be necessary to augment the bladder and in this case the ureter may be used (32). Life-long moni to ring of these patients is manda to ry, as bladder dysfunction is not uncommon and the delay in day and night-time continence is a major problem (12,3). Poor bladder sensation and compliance, detrusor instability and polyuria (especially at night) and their combination are responsible for bladder dysfunction. Nuclear renography with split renal function assess kidney function and serum creatinine nadir above 80 fimol/L is correlated with a poor prognosis.

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Although newer antipsychotic medications may be less likely to cause some medication-induced movement disorders symptoms sinus infection order rocaltrol 0.25 mcg with amex, those disorders still occur symptoms 8 days post 5 day transfer purchase rocaltrol in united states online. Neuroleptic medications include so-called conventional medicine show order rocaltrol 0.25mcg overnight delivery, "typical treatment 001 cheap 0.25mcg rocaltrol free shipping," or first-generation antipsychotic agents treatment example purchase 0.25mcg rocaltrol. Diagnostic Features Patients have generally been exposed to a dopamine antagonist within 72 hours prior to symp to m development medications identification cheap 0.25mcg rocaltrol with mastercard. Generalized rigidity, described as "lead pipe" in its most severe form and usually unresponsive to antiparkinsonian agents, is a cardinal feature of the disorder and may be associated with other neurological symp to ms. Creatine kinase elevation of at least four times the upper limit of normal is commonly seen. Changes in mental status, characterized by delirium or altered consciousness ranging from stupor to coma, are often an early sign. Although several labora to ry abnormalities are associated with neuroleptic malignant syndrome, no single abnormality is specific to the diagnosis. Alteration in mental status and other neurological signs typically precede systemic signs. Some cases develop within 24 hours after drug initiation, most within the first week, and virtually all cases within 30 days. Once the syndrome is diagnosed and oral antipsychotic drugs are discontinued, neuroleptic malignant syndrome is self-limited in most cases. The mean recovery time after drug discontinuation is 7-10 days, with most individuals recovering within 1 week and nearly all within 30 days. Total resolution of symp to ms can be obtained in most cases of neuroleptic malignant syndrome; however, fatality rates of 10%-20% have been reported when the disorder is not recognized. Risk and Prognostic Fac to rs Neuroleptic malignant syndrome is a potential risk in any individual after antipsychotic drug administration. It is not specific to any neuropsychiatric diagnosis and may occur in individuals without a diagnosable mental disorder who receive dopamine antagonists. Clinical, systemic, and metabolic fac to rs associated with a heightened risk of neuroleptic malignant syndrome include agitation, exhaustion, dehydration, and iron deficiency. A prior episode associated with antipsychotics has been described in 15%-20% of index cases, suggesting underlying vulnerability in some patients; however, genetic findings based on neurotransmitter recep to r polymorphisms have not been replicated consistently. Nearly all dopamine antagonists have been associated with neuroleptic malignant sjmdrome, although high-potency antipsychotics pose a greater risk compared with low potency agents and newer atypical antipsychotics. Some investiga to rs consider neuroleptic malignant syndrome to be a drug induced form of malignant cata to nia. In some patients, movements of this type may appear after discontinuation, or after change or reduction in dosage, of neuroleptic medications, in which case the condition is called neuroleptic withdrawal-emergent dyskinesia. This tremor is very similar to the tremor seen with anxiety, caffeine, and other stimulants. Examples include 1) presentations resembling neuroleptic malignant syndrome that are associated with medications other than neuroleptics and 2) other medication-induced tardive conditions. Symp to ms generally begin within 2-4 days and typically include specific sensory, somatic, and cognitive-emotional manifestations. To qualify as antidepressant discontinuation syndrome, the symp to ms should not have been present before the antidepressant dosage was reduced and are not better explained by another mental disorder. D iagnostic Features Discontinuation symp to ms may occur following treatment with tricyclic antidepressants. The incidence of this syndrome depends on the dosage and half-life of the medication being taken, as well as the rate at which the medication is tapered. Unlike withdrawal syndromes associated with opioids, alcohol, and other substances of abuse, antidepressant discontinuation syndrome has no pathognomonic symp to ms. The antidepressant use prior to discontinuation must not have incurred hypo mania or euphoria. The antidepressant discontinuation syndrome is based solely on pharmacological fac to rs and is not related to the reinforcing effects of an antidepressant. D ifferen tial Diagnosis the differential diagnosis of antidepressant discontinuation syndrome includes anxiety and depressive disorders, substance use disorders, and to lerance to medications. Discontinuation symp to ms often resemble symp to ms of a persistent anxiety disorder or a return of somatic symp to ms of depression for which the medication was initially given. Tolerance and discontinuation symp to ms can occur as a normal physiological response to s to pping medication after a substantial duration of exposure. A condition or problem in this chapter may be coded if it is a reason for the current visit or helps to explain the need for a test, procedure, or treatment. In the extreme, these close relationships can be associated with maltreatment or neglect, which has significant medical and psychological consequences for the affected individual. This category should be used when the main focus of clinical attention is to address the quality of the parent-child relationship or when the quality of the parent-child relationship is affecting the course, prognosis, or treatment of a mental or other medical disorder. Clinicians should take in to account the developmental needs of the child and the cultural context. Siblings in this context include full, half-, step-, foster, and adopted siblings. The child could be one who is under state cus to dy and placed in kin care or foster care. Problems related to a child living in a group home or orphanage are also included. Typically, the relationship distress is associated with impaired functioning in behavioral, cognitive, or affective domains. Affective problems would include chronic sadness, apathy, and/or anger about the other partner. Further guidance in distinguishing grief from a major depressive episode is provided in the criteria for major depressive episode. Because of the legal implications of abuse and neglect, care should be used in assessing these conditions and assigning these codes. Having a past his to ry of abuse or neglect can influence diagnosis and treatment response in a number of mental disorders, and may also be noted along with the diagnosis. A separate code is also provided for designating a past his to ry of abuse or neglect. Such injury is considered abuse regardless of whether the caregiver intended to hurt the child. Physical discipline, such as spanking or paddling, is not considered abuse as long as it is reasonable and causes no bodily injury to the child. Nonaccidental acts of physical force include shoving, slapping, hair pulling, pinching, restraining, shaking, throwing, biting, kicking, hitting with the fist or an object, burning, poisoning, applying force to the throat, cutting off the air supply, holding the head under water, and using a weapon. Sexual violence may involve the use of physical force or psychological coercion to compel the partner to engage in a sexual act against his or her will, whether or not the act is completed. Also included in this category are sexual acts with an intimate partner who is unable to consent. This category should be used when such psychological abuse has occurred during the past year. Acts for the purpose of physically protecting oneself or the other person are excluded. Psychological reactions to deployment are not included in this category; such reactions would be better captured as an adjustment disorder or another mental disorder.

Diseases

• Pena Shokeir syndrome
• Foreign accent syndrome
• Nasopalpebral lipoma coloboma syndrome
• POEMS syndrome
• Anodontia
• Hypothermia
• Lumbar malsegmentation short stature
• Hageman factor deficiency