Etiology Sample Clauses

Etiology. Osteoarthritis is no longer regarded simply as a “wear and tear “ disease but as a disease with a complex etiology. Systemic factors determine an individual’s susceptibility to the impact of local biomechanical factors in developing osteoarthritis (Figure 2). Well-known systemic factors are age, female sex and genetic predisposition(29). Of the local biomechanical factors, physically demand- ing occupations (30), a history of joint trauma and meniscectomy (31) are factors most commonly associated with osteoarthritis. Obesity is also an important risk factor for osteoarthritis not only due to its local biomechanical properties associated with knee osteoarthritis (32) but also due to its metabolic attributes, such as the production of adipokines, that have been suggested to contrib- ute to the susceptibility of hand osteoarthritis (33). In recent years, there has been a rapid development in the field of osteoarthritis genetics and several chromosomal regions and gene variants have been identified to be important in osteo- arthritis susceptibility. A hereditary basis for hand osteoarthritis has been documented already in the 1940s by Xxxxxxx and was later confirmed and extended for radiological generalised osteo- arthritis by Xxxxxxxx et al (4, 34). Since then, heritabilities ranging from 10 to 70% were reported respectively for osteoarthritis in the knees, hands, hips and spine (6, 10, 11). It is unclear whether the varying heritabilities for the different joint groups imply that the genetic contribution to OA is joint-related or whether it is the result of heterogeneous phenotype definitions and study designs, or different prevalences of acquired risk factors. A number of genes encoding extra-cellular matrix components (such as collagen type II) cause Mendelian skeletal diseases and severe early onset osteoarthritis as one of the phenotypic components of the disease. However, these genes did not contribute by genetic variation of milder effects to primary OA arising at later ages. More recently a number of gene variants have been identified that do contribute to primary OA. These findings on the frizzled-related protein 3 gene (FRZB) (35, 36), the asporin (ASPN) gene and the calmodulin 1 (CAML1) gene indicate that genetic susceptibility to primary OA points at a role of signal transduc- tion (37) and (local) inflammatory responses (38, 39) rather than the quality of the extra-cellular matrix. Osteoarthritis: an introduction to the disease 13 Figure 2. Patho...
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  • PSYCHOLOGICAL SERVICES Psychotherapy is not easily described in general statements. It varies depending on the personalities of the psychologist and patient, and the particular problems you hope to address. There are many different methods I may use to deal with those problems. Psychotherapy is not like a medical doctor visit. Instead, it calls for a very active effort on your part. In order for the therapy to be most successful, you will have to work on things we talk about both during our sessions and at home. Psychotherapy can have benefits and risks. Because therapy often involves discussing unpleasant aspects of your life, you may experience uncomfortable feelings like sadness, guilt, anger, frustration, loneliness, and helplessness. When treating insomnia specifically, therapy might cause you to experience increased sleepiness and fatigue, especially in the early phases of treatment. On the other hand, psychotherapy has also been shown to have benefits for people who go through it. Therapy often leads to better relationships, solutions to specific problems, significant reductions in feelings of distress, improved sleep, and less fatigue. But there are no guarantees as to what you will experience. Our first session will involve an evaluation of your needs. By the end of the evaluation, I will be able to offer you some first impressions of what our work will include and a treatment plan to follow, if you decide to continue with me for therapy. You should evaluate this information along with your own opinions about whether you feel comfortable working with me. At the end of the evaluation, I will notify you if I believe that I am not the right therapist for you and if so, I will give you referrals to other practitioners who I believe are better suited to help you. Therapy involves a large commitment of time, money, and energy, so you should be very careful about the therapist you select. If you have questions about my procedures, we should discuss them whenever they arise. If your doubts persist, I will be happy to help you set up a meeting with another mental health professional for a second opinion. Please note that the psychological services I provide are not for emergency situations. For emergencies, call 911 or go to the nearest emergency room. FEES My fee is $395 for an initial evaluation lasting 90 minutes, and $250 for each subsequent psychotherapy session (either in-person or over the telephone) lasting 45 minutes. I charge this same $250 per 45-minutes rate for other professional services you may need, though I will prorate the cost if I work for periods of less than 45 minutes in increments of 15 minutes, rounded to the nearest 15-minute increment (e.g., 22 minutes of service will be charged for 15 minutes whereas 23 minutes of service will be charged for 30 minutes). Other professional services include telephone conversations or email responses lasting longer than 15 minutes, and the time spent performing any other service you may request of me. If you become involved in legal proceedings that require my participation, you will be expected to pay for any professional time I spend on your legal matter, even if the request comes from another party, at the same $250 per 45-minutes rate. I do not charge for time spent writing reports and progress notes as per the standard routine of my care of you. I also do not charge for any time I may spend collaborating with your other providers. From time to time, I may institute fee increases and these will be discussed and agreed upon ahead of time with a new Treatment Contract. If it has been more than one year since our last appointment, then you will re-initiate services at my current standard fee which may be higher than the fee you were previously paying. In addition, if it has been more than one year since our last appointment, you will be scheduled for another initial evaluation (90 minutes) and charged accordingly, with subsequent 45-minute psychotherapy sessions thereafter. INSURANCE REIMBURSEMENT You are responsible for paying your full session fee. I am not in-network with any insurance companies. If you decide to submit claims to your insurance company for reimbursement for any out-of-network benefits you might have, you may do so. However, be aware that the services provided will still be charged to you, not your insurance company, and you are responsible for the full payment. I have no role in deciding what your insurance covers. You are responsible for checking your insurance coverage, deductibles, payment rates, pre-authorization procedures, etc. Missed appointments, late cancellations (i.e., cancellations within 24 hours of service), and telephone session are not typically covered by insurance companies and therefore you will likely be responsible for the full session fee in these instances. If your insurance company doesn’t reimburse you, I am not responsible for refunding you any payment you expected to be reimbursed or otherwise. I will provide you a superbill after each session with the following information that you will need to submit to your insurance company for reimbursement for any out-of-network benefits you might have:

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