bluuebunny/crossref_metadata_2025 huggingface dataset:
Child development and disability
Authors: Rosch Richard , Heys Michelle , Kuper Hannah
Published: April 2019

Worldwide, many children do not meet their developmental potential. This is particularly the case in LMICs and especially affects children living with disability. Thus, improving developmental attainment and reducing the impact of disability has now become an integral part of many of the sustainable development goals. This chapter introduces several tools currently available to measure both childhood development, and the effects of disability. Using examples from current research in global health this chapter introduces both known effective intervention strategies that improve developmental outcomes, and highlights challenges and future priorities for further research. These points are further illustrated using epilepsy as a case study, highlighting how the interaction of biomedical, psychosocial, and socioeconomic factors impacts on childhood development.
Translating research into policy
Authors: Mason Elizabeth , Maliqi Blerta
Published: April 2019

This chapter on converting research to policy allows the reader to bridge the gap between acquisition of research data to policy implementation. Healthcare policy goes through four key stages: (1) Policy development: the synthesis of evidence to identify policy content; (2) Policy adoption—contextualisation, endorsement, and authorisation of a policy by a local stakeholder; (3) Policy implementation—making sure the policy leads to a change in practice, through training workforces and ensuring adequate infrastructure and supplies; (4) Monitoring and evaluation—ensuring that policies achieve their intended results, and if not, using the new evidence to inform new policy iterations. Policies for maternal, newborn, child, and adolescent health are dynamic and need to be updated on a regular basis as new evidence of what works is made available. Implementation of the policies is equally, if not more important, as their adoption. Monitoring of the policy implementation is key to accountability for results.
Current challenges and debates for women’s, children’s, and adolescents’ health
Authors: Osrin David
Published: April 2019

Tremendous progress has been made in maternal and child survival over the last thirty years. This progress needs to be extended to those left behind, economically, geographically, and socially, and to stillbirths, newborn survival, and adolescent health. The agenda has expanded beyond survival, to growth, development, and wellbeing. The contemporary challenge, exemplified in the UN Sustainable Development Goals, is to bring together women’s and children’s health programming over the life course and between sectors. This is a century in which we acknowledge complexity, in which individual and population health is affected by a system that encompasses the environment, politics and economics, food production, conflict, mobility, and gender. We need to fix health systems so that care of good quality is available to all; we have to join the components together over the life course, and we have to achieve communication between health and other sectors.
Ethical issues in neurology
Authors: Heimans Jan J.
Published: April 2019

Neurologic diseases may lead to brain dysfunction and consequently to impairment of consciousness, cognitive decline, and emotional disturbances. These conditions may give rise to a wide array of ethical issues. Cerebral dysfunction can be temporary but many conditions are chronic and/or progressive, and the impact of such long-lasting brain dysfunction on decision-making processes is substantial. In this chapter, disturbances of consciousness and the decision-making process, with focus on communication during the various stages of coma, persistent vegetative state, and permanent vegetative state, are discussed. Special attention is paid to the role of proxies, who often have to act as surrogate decision-makers. Further, some aspects of brain death and organ donation are reviewed and the role of the neurologist as a specialist with respect to brain functioning, but also as an advocate acting in the interest of the patient and the patients’ relatives is depicted. Subsequently, consequences of impaired decision-making capacity in dementia and other diseases leading to diminished cognitive functioning are discussed and a short reflection is dedicated to driving ability. Ultimately, ethical issues in connection with decisions on withdrawing and withholding life-sustaining treatment including end-of-life decisions are discussed, both in neurologic diseases with diminished cognitive functioning but also in neurologic disorders, like motor neuron disease, where cognitive functions are preserved.
Knowledge and science are not enough
Authors: Grisold Wolfgang
Published: April 2019

Knowledge and science are the basis of neurology, while competence, skills, and possession of a virtue synthetically referred to as ‘phronesis’ are also expected in clinical practice. There is an increasing awareness of the importance of ‘soft facts’, which are well-formulated in the CanMEDs and belong to the neurologist’s spectrum of abilities. This spectrum embraces several aspects of the ability to work and communicate within a team and a community. Physician advocacy for patients is implicit in many of the agendas of a practising neurologist, but is often related to individual- and patient-based (micro) aspects. Meso and macro aspects are often neglected. This disregard can be due to a lack of awareness but also to a lack of attention. Management and communication skills, compassion, sympathy, empathy, and ‘passion’ are often mentioned, and are implicitly part of successful advocacy.
Advocacy for brain tumours
Authors: Soffietti Riccardo , Marosi Christine , Rudà Roberta , Grisold Wolfgang
Published: April 2019

Brain tumours include different entities in terms of pathology, clinical characteristics, and therapeutic options; however, all represent an important cause of morbidity and mortality. The symptom burden of brain tumour patients is extremely high, and the different phases of the disease (at diagnosis, after surgery, during the adjuvant treatments, when progressive disease) pose specific problems to be managed. Rehabilitation, both at physical and cognitive levels, is increasingly required following the improvement of overall survival. The neurological complications of systemic cancer can negatively impact the quality of life of patients while cured from their primary tumour. Many aspects in neuro-oncology require advocacy. Among them, the cooperation between physicians, nurses, and caregivers, and an appropriate education of medical professionals on how to best manage brain tumour patients are the most critical. Moreover, we must work to guarantee the access for all patients to the best diagnostic and therapeutic tools by lobbying the Public National and European Institutions.
Advocacy in dementia
Authors: Stokin Gorazd B.
Published: April 2019

Advocacy in dementia can be defined best as the act or process by an individual or a group influencing or otherwise supporting within social, health, economic, and political systems and organizations better dementia care at large. Dementia advocacy encompasses many activities including among others public speaking and media campaigns, sharing knowledge and experiences, providing resources including funding, establishing groups and organizations, developing and presenting guidelines, criteria, programmes, strategies, and policies and consulting regional, national, and international decision-makers to promote, support, and otherwise further dementia care. Recently, the World Health Organization recognized dementia as a global epidemic with the majority of people afflicted by dementia originating from low- to middle-income countries where access to dementia care is limited or absent. Indeed, there is an urgent need to develop cost-effective strategies to deliver sufficient and efficient dementia care as well as to optimize needed resources including finances. This need can only be fulfilled with diligent advocacy, which initially played a crucial role in defining the modern notion of dementia and more recently propelled dementia to the centre stage of healthcare priorities across the globe.
Advocacy for epilepsy: From the shadows to centre stage: Stand up for epilepsy
Authors: Beal Jules C. , Moshé Solomon L.
Published: April 2019

Epilepsy is a disease that hijacks the lives of millions of people around the world, affecting people of any age, ethnicity, or socioeconomic status. It is an unpredictable, often debilitating disorder that imposes a serious health burden worldwide. Ongoing advocacy efforts have made great strides towards fighting stigma, improving epilepsy education for medical professionals and the public, and closing the treatment gap for those with epilepsy. Going forward, it is vital that we continue to advocate for government agencies to make epilepsy a priority. Medical professionals need to be educated on how to manage epilepsy, and appropriate diagnostic tools and treatments must be made widely available. We must work to improve public education and establish clear therapeutic and research guidelines. Through collaboration between advocacy groups, governments, and individuals we can bring epilepsy out of the shadows and work towards a world in which no one’s life is limited by epilepsy.
China
Authors: Wang Huali , Xie Hengge
Published: April 2019

With an ageing population, dementia care has become a great challenge in China. This chapter reviews the current major resources in dementia care in China. Memory clinics are the primary setting for diagnosis and management. Caregiver support groups and social media provide mainstream support to caregivers. This chapter also highlights the role of the community in dementia care. Community services are essential to health education, dementia screening, and home care support. In addition, the chapter discusses the role of collaborative research networks and point out that both research on services and dementia prevention are important. The chapter concludes by calling for action to address the priorities of dementia care.
India
Authors: Chaturvedi Santosh K , Ganjekar Sundarnag
Published: April 2019

A number of traditional and socio-cultural factors are involved in the care of the elderly in general, as well as those with dementia, in India. Dementia care has attracted attention recently and is making rapid progress. There is no clarity on whether dementia care should be provided by psychiatrists, neurologists, or general physicians. Nursing care and home care are far from being well developed. Special clinics are few, and specialized centres for dementia care even fewer. Community care is still a distant dream. Family and social support, on the other hand, stands as a natural resource. Society and policymakers are now providing due attention to improving the care of the elderly with dementia, as well as their caregivers.
South Korea
Authors: Shin Cheolmin , Han Changsu
Published: April 2019

In 2008, the first Dementia Management Plan was launched to focus on prevention and early diagnosis, the development of infrastructures and management, and raising awareness. In 2012, the Dementia Management Act was enacted. In addition, in 2008, Korea launched the Long-Term Care Insurance (LTCI) scheme, a social insurance scheme for elderly care and whose beneficiaries also include patients with mild dementia but who still need care. The third Plan launched in 2016 for the next 5 years (i.e. 2016–2020) focuses on investing in dementia research, setting up a robust dementia delivery system, and standardizing a dementia care pathway. The Korean healthcare system for dementia patients has universal health insurance coverage through the national health insurance. The national dementia policy in South Korea was announced as ‘Dementia Comprehensive Management Measures’ in September 2008, of which one of the primary measures is to provide early diagnosis of dementia through the establishment of dementia counselling centres in public health-improving centres.
Belgium
Authors: Salmon Eric
Published: April 2019

Although, in Belgium, there is no national Alzheimer’s plan, several national initiatives are in place for promoting care for patients with dementia and supporting their caregivers. There are strict rules for reimbursement of the cost of dementia drug treatment, which also includes neuropsychological evaluation in the early stages of dementia. Memory clinics provide cognitive rehabilitation to adapt daily activities to help preserve the independence of patients with dementia and also to help support caregivers facing daily difficulties in their caregiving role. Belgium also has legislation in place relating to euthanasia and relating to impaired mental capacity and advance directives. The main challenges in dementia care in Belgium lie in care planning, ensuring the involvement of patients and their chosen caregivers, and the comprehensive assessment of prevention programmes.
Spain
Authors: Franco-Martin Manuel A , Mateos Raimundo
Published: April 2019

In Spain, dementia care varies widely in different regions of the country. Since each region is also autonomous to develop their own health and social service planning, it is difficult to achieve a general model of dementia care in Spain. Moreover, there is no National Dementia Plan to improve inter-professional and inter-regional coordination, thus resulting in a lack of harmonization and implementation of comprehensive treatment plans. Nevertheless, some common features in the country may be identified, including the general methodology for dementia diagnosis and treatment which consists of symptom detection, initial assessment, diagnosis, pharmacological and non-pharmacological treatment, follow-up, and palliative care, several of which are applied similarly in the different regions. The chapter also describes some specific different features such as public foundations for dementia, the National Reference Centre for Alzheimer’s disease, and specialized dementia units. The chapter concludes with an overview of the opportunities and challenges in dementia care in Spain.
Canada
Authors: Gauthier Serge
Published: April 2019

Canada has a long tradition of epidemiologic, basic, and clinical research in dementia, with a special interest in the vascular component of late-onset dementia. A National Dementia Strategy for Canada will set standards of care across the country, both for diagnosis and treatment, and will have to be adaptive to new diagnostic technologies and new treatments. Prevention for the lower-risk ageing population through education and healthy lifestyles is a clear path to go, whereas preventive treatments for higher-risk populations is a challenge that we are clearly dedicated to solve within the next decade.
Brazil
Authors: Canineu Paulo R , Pereira Marta LGF , Stella Florindo , Forlenza Orestes V
Published: April 2019

In Brazil, since 2002, through the National Health System, patients with mild/moderate Alzheimer’s disease have access to cholinesterase inhibitors free of charge. Yet, the country has no comprehensive nationwide dementia programme, and new public health policies are needed to organize health services so to improve the quality of dementia care. There are many important initiatives at local or regional levels, supported by academic, public health, governmental, and private organizations. Although fragmented, these initiatives have yielded a wide range of services in relevant areas of dementia care, particularly early diagnosis, treatment, and rehabilitation, as well as educational programmes. General knowledge about dementia, as well as treatment protocols and available support programmes, is highly variable across the country, particularly in primary care settings. The main challenges in dementia care in Brazil are to increase awareness of the disease and develop professional skills, to promote a multidisciplinary approach to treatment and support in all stages of the disease, and to design a national plan aimed at reducing the risk for dementia.
Uruguay
Authors: Fernández Robert Pérez , Ferrando Rodolfo
Published: April 2019

Uruguay has the oldest population in Latin America, with a prevalence rate of dementia similar to that in developed countries. With regard to dementia care, the key strengths of the National Health System include: equity in accessibility to diagnosis, specialized medical consultations, diagnosis made according to international standards; and the availability of anti-dementia drugs and pharmacological treatments. Its main weaknesses are delayed diagnosis, fragmented care, the use of only a curative model of care, a lack of interdisciplinary team approach, and a lack of non-pharmacological treatments, as well as a lack of communication of diagnoses to patients. In its current format, the health system does not fully guarantee the human rights of people with dementia and their families. Recent actions have been taken by the national association of relatives (AUDAS) and academic groups to address this situation through the presentation of a National Dementia Plan.
Working as partners with the community
Authors: Lankester Ted
Published: April 2019

This chapter explains how to make first contacts with the community. It describes partnership as the basis of all programme stages and explores factors that obstruct partnership. It covers the importance of the facilitator’s role, and discusses various aspects of being a facilitator. It gives a step-by-step approach towards partnering with a community, choosing a project to work on, setting up community meetings. The chapter highlights strategies to avoid pitfalls, and gives examples of working models. It discusses the value of village health committees (VHCs), women’s groups, children’s clubs, and clusters. Finally, it discusses the importance of involving the community as early on as possible, and provides some tips on how to engage community members.
Community health as part of the health system
Authors: Lankester Ted
Published: April 2019

This chapter elaborates on co-operating with others in community health, particularly working with government, aid, and funding organizations. It explores what government is and whether government or the NGO carries out health care more effectively. It discusses how the government and civil society organizations (NGOs and others) can work together for everyone’s benefit. It provides practical guidelines for those working with or for governments, and suggests resources that are available from government health services. It troubleshoots problems faced by agencies, and goes into detail about collaboration between voluntary agencies, the private sector, doctors, traditional health practitioners (THPs), and hospitals. It includes guidelines for working with THPs in the community setting.
Legal aspects of fitness for work
Authors: Howard Gillian S.
Published: April 2019

This chapter looks at the statutory, contractual, and case law aspects of sickness absence and assessing fitness for work. It covers the role an occupational health practitioner/occupational health adviser plays in disability discrimination cases, assessing whether the disability fits the statutory definition and what reasonable adjustments could be recommended. It also covers the role of the occupational health practitioner/adviser in assessing the short-term, persistent, irregular attender and the chronic or long-term sick case. This chapter also covers the role of the occupational health practitioner in cases of malingering. Precedents, model letters, forms, and policies are also included in this chapter, which are relevant for the employer as well as the occupational health practitioner and occupational health adviser.
Ethics in occupational health
Authors: Boorman Steve , Kloss Diana
Published: April 2019

Ethics describes the differentiation between right and wrong and is an essential part of good medical practice. Occupational medicine may involve potentially complex interactions between multiple stakeholders with potential for conflicting interests. A good knowledge of ethics is essential to effective occupational medicine practice. The authors have much experience in this field and are both longstanding members of the Faculty of Occupational Medicine Ethics Committee. This updated chapter coincides with ongoing work to update the Faculty of Occupational Medicine Ethics Guidance, due for release in 2018. Ethical practice has not changed significantly; the updated chapter reflects changes to legislation and updated advice following issues referred to the Faculty of Occupational Medicine in recent years.
The older worker
Authors: Nimmo Steven
Published: April 2019

Throughout the developed world, birth rates are falling and people are living longer, so populations are getting older. This is causing a substantial change in population demographics and an increase in the ratio of people traditionally regarded as ‘retirement age’ to those regarded as ‘working age’. People are also living longer in retirement, further increasing the cost to society of supporting them. To maintain funding for pensions and other social benefits, the pattern of working life and the social and political structures that underpin it have to change to match the changing needs of society. In particular, people in the developed world must expect to work for longer, a change that has implications both for employees and employers. Occupational health professionals have an important role to play so that older workers can be ‘healthy, happy, and here’ in the workplace for longer.
Rehabilitation and return to work
Authors: Wong Danny
Published: April 2019

Rehabilitation and return to work is not a straightforward clinical problem of assessment, diagnosis, and treatment. The chapter explores the concept of worklessness and its impact on life expectancy, what barriers there are in returning to work, why work is good for health, and the relationship between work and health. Common work-related health problems are explored along with disability benefits and most prominent health problems in this area. The chapter details the current UK government system of assessing fitness via the Employment and Support Allowance assessment programme. Models of disability are discussed, focusing on the biopsychosocial model and psychosocial flag system. Workplace management including current UK initiatives of the ‘fit note’ and ‘Fit for Work Scheme’ are further explored. Common workplace adjustments that may assist in a return to work are explored.
Mental health and psychiatric disorders
Authors: Heron Richard J.L. , Greenberg Neil
Published: April 2019

Mental health disorders significantly impact well-being and productivity in the working age population. They affect around 17% of the population and their economic cost has been estimated at £70 billion or 4.5% of gross domestic product in the UK. Mental health conditions are a leading cause of sickness absence with 70 million working days lost per year. Over half of disabled people who are out of work have a mental health and/or musculoskeletal disorder as their main health condition. This chapter considers how work and mental health interrelate, how employers can ensure that their workforce mental health needs are managed, opportunities for productivity maximized, and psychiatric morbidity minimized.
Musculoskeletal conditions, part 2: spinal disorders
Authors: Balain Birender , Hobson John
Published: April 2019

Non-specific low back pain (LBP) is one of the commonest conditions afflicting adults of working age. It represents a leading cause of disability and a major cause of sickness absence. Neck pain and its associated disability are scarcely less common. Collectively, back and neck pain pose a major challenge to employers. Occupational health professionals should be competent when assessing workers with these conditions and be aware of evidence-based advances in the management and rehabilitation of mechanical LBP. Adoption of consensus guidelines has led to better coping and faster recovery. This chapter reviews these initiatives and the problem of assessing fitness for work in those with spinal pain. Emphasis is given to simple, non-specific spinal pain as this is the commonest presentation. Only rarely does the clinician make a more specific diagnosis, but occasionally serious pathology underlies symptoms and different responses are needed. Therefore, this chapter also considers more specific spinal problems and interventions.
Renal and urological disease
Authors: Ide Christopher W. , Brown Edwina A.
Published: April 2019

Diabetes and age-related changes are now the commonest cause of end-stage renal disease (ESRD) in the UK. Polycystic kidney disease is the commonest inherited disorder leading to renal failure. Chronic renal failure implies permanent renal damage, which is likely to be progressive and will eventually require renal replacement therapy. Treatment of ESRD using haemodialysis and peritoneal dialysis can significantly improve physical and metabolic well-being and function but the proportion of those who continue to work with ESRD remains very low despite advances in treatment. Kidney transplantation enables many patients to return to normal lives including work. Reintegration of patients into the workforce following transplantation or dialysis offers an exciting and rewarding challenge to the wider health team.
Manual of Infection Prevention and Control
Authors: Damani Nizam
Published: April 2019

The Manual of Infection Prevention and Control provides practical guidance on all aspects of healthcare-associated infections (HAIs). It outlines the basic concepts of infection prevention and control (IPC), modes of transmission, surveillance, control of outbreaks, epidemiology, and biostatistics. The book provides up-to-date advice on the triage and isolation of patients and on new and emerging infectious diseases, and with the use of illustrations, it provides a step-by-step approach on how to perform hand hygiene and how to don and take off personal protective equipment correctly. In addition, this section also outlines how to minimize cross-infection by healthcare building design and prevent the transmission of various infectious diseases from infected patients after death. The disinfection and sterilization section reviews how to risk assess, disinfect and/or sterilize medical items and equipment, antimicrobial activities, and the use of various chemical disinfectants and antiseptics, and how to decontaminate endoscopes. The section on the prevention of HAIs reviews and updates IPC guidance on the prevention of the most common HAIs, i.e. surgical site infections, infections associated with intravascular and urinary catheters, and hospital- and ventilator-acquired pneumonias. In view of the global emergence of antimicrobial resistance to the various pathogens, the book examines and provides practical advice on how to implement an antibiotic stewardship programme and prevent cross-infection against various multi-drug resistant pathogens. Amongst other pathogens, the book also reviews IPC precautions against various haemorrhagic and bloodborne viral infections. The section on support services discusses the protection of healthcare workers, kitchen, environmental cleaning, catering, laundry services, and clinical waste disposal services.
Basic concepts and prevention strategies
Authors: Damani Nizam
Published: April 2019

This chapter provides a brief description of various microorganisms, and discusses host susceptibility and immune defense mechanisms. It explains how microbes are spread and explains the various modes of transmission of microorganisms in healthcare facilities. It reviews various strategies to prevent and control healthcare-associated infections and discusses the five key elements of the WHO multimodal infection prevention and control (IPC) implementation strategies to prevent, control, and sustain IPC practices in healthcare facilities. The chapter also discusses how to carry out risk assessments in IPC and guide an IPC team on how to set priorities. A brief description is also provided on the root cause analysis.
Disinfection and sterilization
Authors: Damani Nizam
Published: April 2019

The chapter on decontamination examines various methods of heat sterilization and chemical disinfection. It outlines how to carry out a risk assessment of contaminated items and equipment based on the Spaulding classification and provides practical guidance on how to decontaminate various items in healthcare facilities. It also discusses how to transport items, clean, disinfect, and sterilize various items and equipment in healthcare facility. It outlines various heat sterilization procedures and gives practical advice on how to maintain various types of sterilizer or autoclave and how to safely store sterile items. Detail is also provided on how to use chemical disinfectants in healthcare facilities and summarizes the use and antimicrobial activity of various disinfectants and antiseptics. This chapter also includes advice on decontamination of endoscopes and maintenance of automatic endoscope reprocessors. It also provides practical advice and summarizes the key points on how to investigate and follow up cases after a failure of decontamination process.
Practical aspects of prevention and control
Authors: Damani Nizam
Published: April 2019

The chapter examines various types of isolation precautions and provides practical advice on infection prevention and control (IPC) measures to be taken on isolation of patients of new and emerging infectious diseases. In an alphabetical order, it lists IPC precautions, modes of transmission of infections, incubation periods, periods of infectivity, and the duration of isolation for various infectious diseases and multidrug- resistant microorganisms (MDROs). The well-illustrated chapters explain how to properly don and take off various types of personal protective equipment. It reviews the most up-to-date information on the various aspects of hand hygiene, including hand washing and proper use of alcohol-based hand rub products. Practical advice is also given on injection safety, how to prevent transmission of infection after death and prevention of infection by healthcare building design which also includes ventilation of operating theatres.
Prevention of healthcare associated infections
Authors: Damani Nizam
Published: April 2019

This chapter provides the most up-to-date advice on infection prevention and control (IPC) of the four most common healthcare-associated infections (HAIs). These are: surgical site infections; infection associated with peripheral IV line/cannula and central line-associated bloodstream infections (CLABSIs); catheter-associated urinary tract infections (CAUTI); and hospital-acquired and ventilator-acquired pneumonias (VAP). The chapter examines and summarizes various key elements and discusses implementation of HAI care bundles and high impact interventions which are necessary to reduce these infections.
The aims of the IDEAL schedule
Authors: Semrau Maya , Burns Alistair , Lobo Antonio , Rikkert Marcel Olde , Robert Philippe , Schepens Mirjam , Stoppe Gabriela , Sartorius Norman
Published: April 2019

This chapter provides an overview of the purposes of the International Schedule for the Integrated Assessment and Staging of Care for Dementia (IDEAL schedule) and its user manual. The IDEAL user manual provides information that is needed when learning how to use the IDEAL schedule. The schedule is a global clinical staging schedule for dementia, which allows an assessment of a person across seven dimensions (activities of daily living, physical health, cognitive functioning, behavioural and psychological symptoms, social support, informal care, and formal professional care), and provides ability-to-function information as well as suggestions concerning care elements corresponding to the level of impairments of function. Attached to the IDEAL schedule is a ‘Menu of care options’ with recommendations for interventions for different stages of severity of dementia, as measured by the IDEAL schedule.
Case descriptions for use when training users of the IDEAL schedule
Authors: Semrau Maya , Burns Alistair , Lobo Antonio , Rikkert Marcel Olde , Robert Philippe , Schepens Mirjam , Stoppe Gabriela , Sartorius Norman
Published: April 2019

This chapter provides four case histories that can be used in the training of future users of the International Schedule for the Integrated Assessment and Staging of Care for Dementia (IDEAL schedule) and its accompanying ‘Menu of care options’. The case histories describe patients with different types and severity levels of dementia and have been written in a manner that makes them understandable in different settings or countries, as well as having been shown to be useful in the training of users of the schedule in different countries. Ratings for the case histories are provided according to the seven dimensions of the IDEAL schedule, with the consequent links to the ‘Menu of care options’. The chapter also includes suggestions about the development of local case histories typical for the setting in which the schedule will be used when training users in that setting.
Genetic explanations 1: the thrifty genotype and its variants
Authors: Bhopal Raj S.
Published: April 2019

The thrifty genotype proposes that populations susceptible to CVD and DM2 have been subjected to intermittent, serious food shortages and have evolved to cope, e.g. through insulin resistance. This means their glucose is not readily entering the muscle to be used there but is preferentially used by the brain and liver. Glucose is converted to fat in the liver and stored for times of food scarcity. This thrifty state is not, however, beneficial in modern times where food is plentiful. This hypothesis remains a common explanation, including for South Asians’ susceptibility to DM2. The hypothesis has lost support, mostly because of lack of confirmatory empirical data, but has sparked-off new ideas, e.g. the mitochondrial efficiency hypothesis as an adaptation to climatic change, and the predation release hypothesis which sees diminishing need for leanness and agility as triggering higher obesity prevalence. These newer ideas need more research.
Socio-economic development and the demographic and epidemiological transitions: effects on psychosocial circumstances and lifestyles
Authors: Bhopal Raj S.
Published: April 2019

Diabetes mellitus, CHD, and ischaemic, but not haemorrhagic stroke, are closely linked to rising affluence and the accompanying changes in life expectancy and in lifestyles. These changes take place in the context of the demographic and epidemiological transitions. These phenomena could explain the rise in diabetes, CHD, and stroke in populations including South Asians but not why the rates of these diseases exceed those in populations who are already at an even more advanced stage in these transitions. Changes in psychosocial status, including the stresses of migration, social change, and work patterns and lifestyle accompanying these transitions have been especially rapid in the South Asian diaspora. The recent high-heat cooking hypothesis, which proposes South Asians’ cooking styles produce atherogenic substances including advanced glycation products and trans-fatty acids, illustrates how affluence and behaviours might influence disease. Together, these general explanations set the stage to examine specific risk factors.
The burns management pathway II: receiving and initially managing a patient with burns
Authors: Shokrollahi Kayvan , Yao Susie
Published: April 2019

The burns multidisciplinary team includes surgeons, specialist nurses, anaesthetic and critical care specialists, operating theatre staff, physiotherapists, occupational therapist, play specialists, clinical psychologists and dieticians, with input from other specialties (eg. microbiology). Burns units receive referrals from primary and secondary care, usually by telephone. Referral proformas help to document these calls and any information provided about patients, their burns and associated injuries, the treatments provided and their planned transfer. The clinician accepting the patient for transfer must ensure that there is an available ward or ICU bed, as required, prior to arranging transfer. Care should be taken to minimize the risk of a patient deteriorating during transfer. Fluid resuscitation and patient warming should continue during a prompt transfer by an ambulance team with the appropriate equipment and expertise, along with a medical escort if required. Upon arrival, the patient should be formally and systematically assessed (including an ATLS primary and secondary survey and anaesthetic assessment if indicated) and any remaining investigations undertaken. The burn wounds should be cleaned, photographed, swabbed and dressed, and any resuscitation fluids recalculated and prescribed. Appropriate medications and adjuncts should be prescribed including tetanus, deep vein thrombosis and stress ulceration prophylaxis, analgesia, usual medications, and nutritional supplements along with enteral or parenteral feeds. An admission proforma helps junior medical staff to ensure that all required information is collected and all components of the standard management plan are instituted.
Predicting mortality and end of life care
Authors: Marsden Nick , Hemington-Gorse Sarah
Published: April 2019

Despite advances in burn management over recent decades, burn mortality is still the primary outcome measure in burn care. Numerous scoring systems have been developed over the years, which use a number of different prognostic indicators to calculate the estimated likelihood of mortality. This chapter summarizes the different prognostic scoring systems for mortality and highlights the important end of life care in burn patients with a predicted non-survivable injury.
Anaesthesia: intraoperative management of patients with acute burn injury
Authors: Woodson Lee C.
Published: April 2019

Choice of anaesthetic technique for major burn surgery is determined by the patient’s anatomical and physiologic status and the surgical plan. Burns involving the face and neck can make tracheal intubation by direct laryngoscopy difficult or impossible and require an alternative technique. Cutaneous burns may impair application of monitors such as pulse oximetry and ECG. Vascular access and available blood products should be adequate to resuscitate from massive hemorrhage and treat coagulopathy. Difficult peripheral venous access may require central venous cannulation and arterial cannulation may be required for hemodynamic monitoring. An important goal for intraoperative fluid management is to minimize the amount of crystalloid administered. Fluid replacement of shed blood is complex and requires attention to multiple physiological variables. Burn patients are intolerant of hypothermia and vigorous means are necessary to maintain core temperature. Pain associated with burn surgery is intense and a multimodal plan for its control should be initiated intraoperatively.
Paediatric burns
Authors: Lee Jong
Published: April 2019

The burden of burn injury, however trivial it may seem, is devastating physically, psychologically and also financially. Health economists find it difficult to quantify the costs of acute care and almost impossible to define the cost of the needed adjustment after recovery. Burns patients often require long-term therapy and out patient hospital care, and frequently, re-admission for reconstructive surgery. Calculating the cost of burn care is important for reimbursement, resource allocation and achieving efficiency by prudent cost analysis. Realistic cost estimates of burn care require robust data collection and a reliable informatics infrastructure.
Sunburn and artificial tanning
Authors: Marsden Nick , Hemington-Gorse Sarah
Published: April 2019

The dangers of sun burn and artificial tanning are increasingly covered by the media, but mostly in relation to the risk of skin cancer. UV radiation both from sun bathing and artificial tanning is an increasing public health concern as a result of acute burn injuries sustained through ignorance or negligence. This chapter highlights the acute harmful effects UV radiation and artificial tanning has on the skin, and summarizes the management in terms of medical and public awareness.
Diagnostic value of fluorescein-labeled chitinase staining in formalin-fixed and paraffin-embedded tissues of fungal disease
Authors: Shao Jin , Song Yinggai , Zhou Yabin , Wan Zhe , Li Ruoyu , Yu Jin
Published: April 2019

Common histopathologic techniques are used to diagnose fungal infections, but the diagnostic identification of mycoses in tissue specimens is often difficult, particularly when fungi rarely occur in a specimen. The aim of this study was to evaluate the application of fluorescein-labeled chitinase staining to formalin-fixed and paraffin-embedded (FFPE) tissues. We studied 79 archival FFPE tissues from patients diagnosed with fungal disease, including 38 cases of sporotrichosis and 41 cases of other fungal infections. The tissue sections were subjected to periodic acid-Schiff (PAS) staining, Gomori's methenamine silver (GMS) staining, and fluorescein-labeled chitinase staining to detect fungal elements. Culture- and/or hematoxylin-eosin-positive samples were used to estimate the diagnostic sensitivity of each staining method, with the results showing that PAS, GMS, and fluorescein-labeled chitinase staining had sensitivities of 50.6, 70.9, and 68.4%, respectively. The three staining results were the same for all fungal infections except for sporotrichosis and chromoblastomycosis. Fluorescein-labeled chitinase staining exhibited high sensitivity in cases of sporotrichosis and poor performance in detecting muriform cells of chromoblastomycosis. On the whole, the sensitivity of fluorescein-labeled chitinase staining was greater than that of PAS and similar to that of GMS staining. Therefore, the results of our study suggest that fluorescein-labeled chitinase staining is a potentially useful diagnostic tool in the diagnosis of fungal infections.
The telomeric Cdc13–Stn1–Ten1 complex regulates RNA polymerase II transcription
Authors: Calvo Olga , Grandin Nathalie , Jordán-Pla Antonio , Miñambres Esperanza , González-Polo Noelia , Pérez-Ortín José E , Charbonneau Michel
Published: April 2019

Specialized telomeric proteins have an essential role in maintaining genome stability through chromosome end protection and telomere length regulation. In the yeast Saccharomyces cerevisiae, the evolutionary conserved CST complex, composed of the Cdc13, Stn1 and Ten1 proteins, largely contributes to these functions. Here, we report genetic interactions between TEN1 and several genes coding for transcription regulators. Molecular assays confirmed this novel function of Ten1 and further established that it regulates the occupancies of RNA polymerase II and the Spt5 elongation factor within transcribed genes. Since Ten1, but also Cdc13 and Stn1, were found to physically associate with Spt5, we propose that Spt5 represents the target of CST in transcription regulation. Moreover, CST physically associates with Hmo1, previously shown to mediate the architecture of S-phase transcribed genes. The fact that, genome-wide, the promoters of genes down-regulated in the ten1-31 mutant are prefentially bound by Hmo1, leads us to propose a potential role for CST in synchronizing transcription with replication fork progression following head-on collisions.
Effect of belimumab on proteinuria and anti-phospholipase A2 receptor autoantibody in primary membranous nephropathy
Authors: Barrett Christine , Willcocks Lisa C , Jones Rachel B , Tarzi Ruth M , Henderson Robert B , Cai Gengqian , Gisbert Sophie I , Belson Alexandra S , Savage Caroline O
Published: April 2019

Background

Immunosuppressant drugs reduce proteinuria and anti-phospholipase A2 receptor autoantibodies (PLA2R-Ab) in primary membranous nephropathy (PMN) with varying success and associated toxicities. This study aimed to evaluate the effect of belimumab on proteinuria and PLA2R-Ab in participants with PMN.

Methods

In this prospective, open-label, experimental medicine study, 14 participants with PMN and persistent nephrotic-range proteinuria received up to 2 years belimumab monotherapy (10 mg/kg, every 4 weeks). Changes in proteinuria (urinary protein:creatinine ratio), PLA2R-Ab, albumin, cholesterol, B-cell subsets and pharmacokinetics were analysed during treatment and up to 6 months after treatment.

Results

Eleven participants completed to the primary endpoint (Week 28) and nine participants completed the study. In the intention-to-treat population population, baseline proteinuria of 724 mg/mmol [95% confidence interval (CI) 579–906] decreased to 498 mg/mmol (95% CI 383–649) and 130 mg/mmol (95% CI 54–312) at Weeks 28 and 104, respectively, with changes statistically significant from Week 36 (n = 11, P = 0.047). PLA2R-Ab decreased from 174 RU/mL (95% CI 79–384) at baseline to 46 RU/mL (95% CI 16–132) and 4 RU/mL (95% CI 2–6) at Weeks 28 and 104, respectively, becoming statistically significant by Week 12 (n = 13, P = 0.02). Nine participants achieved partial (n = 8) or complete (n = 1) remission. Participants with abnormal albumin and/or cholesterol at baseline gained normal/near normal levels by the last follow-up. Adverse events were consistent with those expected in this population.

Conclusions

Belimumab treatment in participants with PMN can reduce PLA2R-Ab and subsequently proteinuria, important preludes to remission induction.
The Pecking Order of Segmentation and Liquidity-Injection Policies in a Model of Contagious Crises
Authors: Guembel Alexander , Sussman Oren
Published: April 2019

We study a two-country setting in which leveraged investors generate fire-sale externalities, leading to financial crises and contagion. Governments can affect the incidence of financial crisis and the degree of contagion by injecting public liquidity and, additionally, by segmenting the countries’ liquidity markets. We show that segmentation allows a country to avoid contagion and fend off mild financial crises caused by a small shock to its liquidity demand, at the cost of exposing it to more severe financial crises caused by a large shock. We derive a “pecking order” result, whereby segmentation is a second-best measure that coordinated governments should use only when tax capacity constrains them from injecting liquidity. Even when segmentation is welfare-enhancing, it should be applied to public liquidity alone, never restricting the free flow of private liquidity across countries. Uncoordinated governments tend to use segmentation excessively.