bluuebunny/crossref_metadata_2025 huggingface dataset:
The bereaved patient
Authors: Mynors-Wallis Dr Laurence , Moore Dr Michael , Maguire Mr Jon , Hollingbery Mr Timothy
Published: November 2023

Bereavement is a common and distressing experience. For the vast majority of patients, common humanity suggests sympathy, empathy and understanding are required. There may be a temptation to do more: prescribe medication, or refer on to specialized help. However, this is only required in a minority of cases. Most people manage to make the emotional and social adjustments required following bereavement without the need for mental health interventions.
The premotor cortex: from attention to intention
Authors: Boussaoud Driss
Published: November 2023

The capacity of the brain to process information about the external world and to plan and execute appropriate behavior has increased considerably throughout evolution, and has reached its highest level in mammals, especially the human and non-human primates. Our highly sophisticated sensory organs provide us with rich information about the external world, and our central nervous system has the capacity to extract relevant messages and process them in relation to context, previous experience, state of motivation, and other affective signals. Ultimately, the brain selects and executes one action from a diverse repertoire of actions which allow us to manipulate objects with tremendous skill.
Linking perception and action: an ideomotor approach
Authors: Knoblich Gunther , Prinz Wolfgang
Published: November 2023

Theories addressing the links between perception and action normally take one of two clearly distinct perspectives. In sensorimotor approaches the focus is on the question of how certain patterns of stimulation evoke certain actions. Accordingly, actions are conceptualized as responses, i.e. as mere consequences of the preceding stimulation. A strict version of this view was defended in traditional behaviorism (Thorndike 1911, 1913; Hull 1930). Some recent versions of the sensorimotor account adopt the terminology of cognitive psychology and allow for additional factors, such as the influence of internal knowledge structures in encoding. However, essentially actions are still treated as being largely determined by perception.
The mirror neuron system and action recognition
Authors: Rizzolatti Giacomo , Fadiga Luciano
Published: November 2023

Understanding actions made by others is a fundamental cognitive function on which social life and the survival of individuals depend. Despite its crucial role in social behavior, action understanding, unlike other cognitive capacities such as object or space perception, has never been a central topic in neuroscience. Only recently, with the discovery of mirror neurons (Gallese et al. 1996; Rizzolatti et al. 1996a), have action understanding and phenomena closely related to this function, such as imitation, become the object of intense investigation (reviewed by Rizzolatti et al. 2001).
Bimanual coordination and its disorders
Authors: Wiesendanger Mario , Serrien Deborah J
Published: November 2023

In human evolution, hand functions played a significant role in the emergence of toolmaking and tool use, as well as in expressing gestures. Tool use in everyday life, together with gestures and music performance, typically engage both hands in well-coordinated asymmetric synergies. A division of labor between hands is also an evolutionary trend, with the left engaging preferentially in posturing grasps, providing an egocentric reference frame for the right which manipulates the grasped object (MacNeilage 1987).
Speech motor control and its disorders
Authors: Kent Ray D
Published: November 2023

This chapter begins with a brief review of the properties of the speech musculature and its neural control. It then proceeds to a discussion of disorders of speech motor control in children and adults. The two primary types of these disorders are dysarthria and apraxia of speech. The motor control of speech is accomplished through widely distributed motor neuron pools in the aerodigestive tract, which consists of the respiratory, laryngeal, and upper airway muscle systems.
From the grasping reflex to the environmental dependency syndrome
Authors: Pillon Bernard , Dubois Bruno
Published: November 2023

The frontal lobes have been implicated at different levels of motor organization, from the more automatic activities such as walking (Tyrrell 1994) to more elaborate activities such as planning of sequential motor programmes (Luria 1966). In this chapter, we shall consider motor organization from the point of view of environmental adherence, thus emphasizing the role of the frontal lobes in the control of behavioural responses to sensory stimuli. For that purpose, we will analyse behavioural disorders such as forced grasping (Adie and Critchley 1927), prehension and utilization behaviours (Lhermitte 1983), forced collectionism (Volle et al. 2002), imitation behaviour (Lhermitte et al. 1986), and environmental dependency (Lhermitte 1986). The anatomophysiological basis of the concept of environmental autonomy will be discussed.
Special Chemistry
Authors: Southwood T R E
Published: November 2023

The solar system was born some 4550 million years ago when a star exploded at the end of its life. This supernova scattered matter and energy into a cloud of interstellar dust and gas and as a result most of the material came together to form yet another star, our sun. Various other chunks of material collided and coalesced and began to form the planets. The gravitational pull of the nascent earth would have attracted other pieces of debris. Many of these were large—and one was so large that its impact tilted the earth on its axis and knocked off chunks that came together to form the moon. These impacts would have generated great heat, probably enough to melt the earth. Another, and continuing, source of heat, is that generated when radioactive elements, like uranium, decay. Which source of heat was most important is uncertain, but together they were sufficient to allow the heavy materials, principally iron, to flow to the earth’s centre, where they exist as a molten core. This core is now nearly three and a half times more dense than the outer layer, the crust, and just over twice as dense as the mid-dle layer, the mantle. Both the crust and mantle are solid. Compared with the size of the earth the crust is very thin; it has been likened to a layer of paper stuck on the outside of a football.
A Quick Start
Authors: Southwood T R E
Published: November 2023

Three types of evidence indicate when life commenced and when certain types of organisms evolved. The first is based on fossils, the remains of organisms held in rocks where the actual parts of the organism have usually been replaced by a mineral. Less frequently the fossil records a track made by an animal—a worm’s burrow or the footprints of a trilobite or a dinosaur. Sometimes the form of the whole organism is retained in the fossil, but more often only bits and pieces are preserved, and when these are first discovered they are often thought to represent different organisms and are given different names! The hardest parts, such as tree trunks, bones, and claws, retain their shape longest, and so are more likely to be recorded in the mud as it is compressed. Organisms that lack hard tissues and the soft parts of other organisms will quickly decay; it is only in exceptional circum-stances, such as a massive mud slide, that fossilization is so quick that their form is captured.
Cells with Nuclei
Authors: Southwood T R E
Published: November 2023

The development of the nucleus, the feature characteristic of eukaryotic organisms, represents one of the greatest steps in evolution, other than the emergence of life itself. The nucleus can be described as the control centre of the cell. It is bounded by a double membrane and contains nearly all the DNA of the cell, the material that provides the hereditary information. In bacteria (prokaryotes) the usually circular double strand of DNA is attached at one point to the cell membrane; when bacteria reproduce, this strand replicates and so each daughter cell is identical to the parent. In eukaryotes the DNA exists as several pieces held on a number of chromosomes. When the cell divides these form dense structures which, appropriately stained, can be seen under the microscope. In asexual multiplication (cloning) the DNA within each individual chromosome divides to give two identical ‘sister’ chromatids; these then separate and move to opposite ends of the cell which divides forming two new cells each with the same number of chromosomes as the ‘parent’ and with identical DNA—a process known as mitosis (fig.3.1(a)).
The Evolution of the Able Ape
Authors: Southwood T R E
Published: November 2023

That able ape, mankind (Homo sapiens), belongs to the primate group of mammals. This probably evolved in the Cretaceous from insectivorous mammals, not far distant from today’s shrews. They have a number of char-acteristics: a conspicuous one is the retention of the primitive five digits, with the thumb and big toe becoming more mobile and independent of the other digits; and as the nails are flat, rather than modified into claws, the tips of the fingers and toes can evolve a good sense of touch. In contrast the sense of smell is reduced, the snout being shortened. In keeping with their generally wide diets (omnivores), they have retained almost all the teeth found in primitive mammals. There has been a progressive expansion and elaboration of the brain. Comparisons made by Paul Harvey of Oxford University and Tim Clutton-Brock of Cambridge University have shown that, in proportion to their body size, fruit-eating species have larger brains than foliage eaters; fruits are more difficult to find than foliage, they are more scattered in space and time in the forest. As they put it, the brain, in parts, serves as a three-dimensional map of the environment. Here again we see the complex evolutionary interactions between animals and features of the vegetation, apparently simple factors leading eventually to large evolutionary steps. An early example, already discussed (p. 73), is that of clogging water channels by plants leading to the evolution of limbs, an adap-tation that proved suitable for the invasion of land.
Everyday hassles, conflict, and crime
Authors: Graham Philip
Published: November 2023

In this chapter I shall discuss first, just how true is the commonly held belief that when children reach their teens they become more disobedient and difficult in the family. I shall then look at the likelihood of they becoming involved in criminal activity in the neighbourhood. The evidence shows, as we shall see later in this chapter, that most teenaged young people do not show aggressive behaviour in their families nor do most become involved in crime. The majority are generally obedient at home, though they may well become involved in minor hassles with other family members, especially their parents. They are also largely law-abiding outside the home. The MORI 2002 Youth Survey found that three in four young people aged 11–18 years said they had not committed an offence in the last 12 months. However, a sizeable minority do start to show antisocial behaviour for the first time once they reach their teens. In addition, a much smaller minority, who have been seriously problematic since early childhood, continue to cause great trouble in their teens. A different approach is required to prevent and deal with each of these two groups. For the first, attention needs to be focused on the ways in which they are treated as young children when their problems first develop. Once they reach the teen years their problems are difficult and expensive, though not impossible to resolve. I shall suggest that the size of the larger problematic group, whose antisocial behaviour is limited to the teen years and early twenties could be reduced if the competence of those in this age group was better acknowledged and they were more strongly empowered.
Range size
Authors: Gaston Kevin J
Published: November 2023

Whatever the factors responsible, the overall degree of constraint on the geographic ranges of species is extremely variable. In consequence, the areas of these ranges differ enormously; Brown et al. (1996) suggest interspecific variation of 12 orders of magnitude, which would be similar to the variation observed amongst species in local densities (Damuth 1987).
Crossed-product Algebras
Authors: Reiner I
Published: November 2023

In this chapter we collect a number of important results on Brauer groups, crossed-product algebras, and cyclic algebras. We have included proofs in order to make the subject matter more accessible to the reader who is encountering these topics for the first time. As will be seen below, we work directly with the simple algebras themselves, taking advantage of our earlier results from 7 and§ 14. This enables us to avoid introducing the machinery of cohomology groups.
Hereditary Orders
Authors: Reiner I
Published: November 2023

We shall first present the results of Harada [1-5] and Brumer [I] concerning hereditary orders in separable algebras. The approach used is that of Jacobinski [ 4]. As we shall see, we can give an explicit description of the structure of hereditary orders. We can also determine the relationship between a hereditary order and the maximal orders which contain it. The local theory in §39 will be applied in §40 to obtain the global theory of hereditary orders. In §41 we consider integral group rings, and prove several theorems which fit in well with the subject matter of this book.
Expressions and assignments
Authors: Metcalf Michael , Reid John , Cohen Malcolm
Published: November 2023

We have seen in the previous chapter how we are able to build the ‘words’ of Fortran — the constants, keywords, and names — from the basic elements of the character set. In this chapter we shall discover how these entities may be further combined into ‘phrases’ or expressions, and how these, in turn, may be combined into ‘sentences’ or statements.
Operations on external files
Authors: Metcalf Michael , Reid John , Cohen Malcolm
Published: November 2023

So far we have discussed the topic of external files in a rather superficial way. In the examples of the various I/O statements in the previous chapter, an implicit assumption has always been made that the specified file was actually available, and that records could be written to it and read from it. For sequential files, the file control statements described in the next section further assume that it can be positioned. In fact, these assumptions are not necessarily valid. In order to define explicitly and to test the status of external files, three file status statements are provided: open, close, and inquire. Before beginning their description, however, two new definitions are required.
Other features
Authors: Metcalf Michael , Reid John , Cohen Malcolm
Published: November 2023

This chapter describes features that are redundant within Fortran 95 and whose use we deprecate. They might become obsolescent in a future revision, but this is a decision that can be made only within the standardization process. We note again that this decision to group certain features into a final chapter and to deprecate their use is ours alone, and does not have the actual or implied approval of either WG5 or J3.
Gastrointestinal dysfunction in myotonic dystrophy
Authors: Engelen Baziel G M van , Brunner Han G
Published: November 2023

Involvement of smooth muscle is more prominent in myotonic dystrophy than in any other neuromuscular disease (Harper and Rudel 1993). Symptoms related to smooth muscle dysfunction are not only surprisingly common, they can be the initial clinical feature and, in some cases, can dominate the clinical picture, being more troublesome than skeletal muscle weakness (Harper 2001). By comparison with the gastrointestinal tract, abnormalities of smooth muscle function in other systems such as urinary bladder, ureter, uterus and ciliary body of the eye are present less frequently and are not discussed in this chapter, although they may be important for individual patients and, particularly in the case of the gall-bladder, in the context of surgery. Gastrointestinal abnormalities may directly (pseudo-obstruction, megacolon) or indirectly (aspiration) be the cause of death. Nevertheless, gastrointestinal symptoms are much underestimated and often unrecognized (Hilton-Jones 1997).
Endocrine changes in myotonic dystrophy
Authors: Johansson Asa , Olsson Tommy
Published: November 2023

Loss of potency and testicular atrophy were among the earliest clinical features of myotonic dystrophy to be described. Curschmann (1912) was the first to suggest that myotonic dystrophy was a generalized disorder. He described both cataracts and testicular atrophy in myotonic dystrophy and suggested that generalized endocrine disturbances were part of the clinical expression of myotonic dystrophy. Despite this, a minimal amount of research has been concerned with endocrinology in myotonic dystrophy. Most of the scientific endocrine work published has been concerned with insulin, insulin resistance and testosterone. In more recent years, however, endocrine research in myotonic dystrophy has gained interest. Reports have been published on new areas such as the metabolic syndrome, cytokines and leptin, and there has been renewed research interest in steroid hormones. Many endocrine studies in myotonic dystrophy patients show a gender discrepancy, with males most often being more severely affected than females. The reasons for the endocrine disturbances and the gender difference are not dear and may involve several different mechanisms including the severity of the genetic defect, which in turn may affect the response to hormones, and tissue-specific metabolism and production. So far, the clinical significance of the extensive endocrine disturbances encountered is not always obvious and, accordingly, treatment strategies are not easily decided on.
Sharing information, knowledge, and experience to build a team to help manage myotonic dystrophy
Authors: Wilcox Douglas E , Bowler Margaret
Published: November 2023

This chapter is the result of collaboration between the Scottish Muscle Network (SMN) and the Myotonic Dystrophy Support Group (MDSG). Both groups were concerned that not all patients with myotonic dystrophy had access to current best practice in terms of their medical management. In The Expert Patient: A New Approach to Chronic Disease Management for the 21st Century, Donaldson (2001) presents a vision of expert patients who share expertise and participate in user-led self-management training programmes. As a result of greater control and involvement in their medical management, expert patients will be able to minimize the effects of the disease on their daily living. This is a bold vision but much of the underlying theory is based on patients with single-system disabilities such as arthritis, stroke and heart disease (Lorig et al. 1999). However, people with myotonic dystrophy can be disabled by an array of debilitating multisystem complications.
Therapeutic trials and future advances
Authors: Richard T Moxley , Pandya Shree , Thornton Charles A , Griggs Robert C
Published: November 2023

Recent discoveries of the gene defects responsible for myotonic dystrophy type I (DM1) (Brook et al. 1992; Fu et al. 1992; Mahadevan et al 1992) and myotonic dystrophy type 2/proximal myotonic myopathy (DM2/PROMM) (Liquori et al. 2001; Day et al. 2003) have created new opportunities to pursue therapeutic trials. They have also presented the need to redefine the natural history of the myotonic dystrophies. Specific diagnostic tests using DNA analysis are now available to identify both asymptomatic and symptomatic individuals
Psychogeriatric services: current trends in the USA
Authors: Borson Soo , Colenda Christopher , Lessig Mary C
Published: November 2023

Psychogeriatrics in the USA was founded twenty-five years ago on the pioneering contributions of old age psychiatrists in the UK. The development of the field, assessed two decades later in a cross-national study (Reifler and Cohen, 1998), was ranked by US practitioners as second only to the UK in dissemination of training programmes, emergence of national leadership, and achievement of formal certification.
Psychogeriatric services: trends in the UK
Authors: Wattis John
Published: November 2023

Old age psychiatry in the United Kingdom is a well-established specialty. The very first survey of old age psychiatry services in the UK, in 1980, found 106 consultants working in the field (Wattis et al.,1981). Further surveys saw this number rising substantially (Wattis, 1988; Wattis et al., 1999).
Psychogeriatric services: trends in Europe
Authors: Ritchie Karen , Norton Joanna , Kurz Alexander , Hartmann Julia , Parnowski Tadeusz , Eriksson Catalina Tudose,Sture
Published: November 2023

Despite being the continent with the highest proportion of older people, European countries have not widely embraced the development of comprehensive psychogeriatric services of the type described by Edmond Chiu in Chapter 2. A 1997 survey found that the Netherlands and Switzerland were the only continental European countries that had a full range of long term, hospital-based and community-based psychogeriatric services in many parts of the country (Reifler and Cohen, 1998).
Specialized service components
Authors: Conn David K
Published: November 2023

The purpose of this chapter is to describe a number of specialized psychogeriatric services including the day hospital, memory clinic, consultation-liaison service, respite service and services for younger individuals suffering from dementia. These services are ideally components of a larger comprehensive psychogeriatric programme, which would also include inpatient and community outreach services (Sadavoy and Conn, 1994). In addition some special issues relevant to academic psychogeriatric services will be addressed. Good quality of care for older people with mental health problems should be comprehensive, accessible, responsive, individualized, transdisciplinary, accountable and systematic as described in the Consensus Statement issued by the World Health Organization and World Psychiatric Association (Graham et al., 1998).
Introduction To Problem-Solving Treatment
Authors: Mynors-Wallis Dr Laurence
Published: November 2023

Problem-solving treatment is a brief, psychological treatment that has been adapted and developed for particular use in primary care. As the name suggests, the treatment takes a problem-solving approach to the management of psychological disorders. The theoretical assumption underpinning problem-solving is that psychological symptoms of depression and anxiety are often caused by practical problems people face in their everyday lives. Patients themselves readily recognize this link between their problems and the development of their illness. Problem-solving treatment, therefore, is often viewed by patients as a sensible and appropriate intervention.
Other Techniques To Assist The Problem-Solving Process
Authors: Mynors-Wallis Dr Laurence
Published: November 2023

Although problem-solving treatment is a treatment in its own right, there are other simple skills that the therapist might wish to integrate into a course of problem-solving. Activity scheduling is the most commonly used of these interventions and will be incorporated into most problem-solving treatments. Specific help with sleep and anxiety can also occasionally be used as part of a course of problem-solving treatment. Care should be taken, however, that the techniques are used alongside problem-solving and do not replace the problem-solving process. If more specialist and specific treatments are needed, it may be that problem-solving is not the appropriate treatment. Communication skills are also discussed in this chapter. Knowledge and use of these skills will enhance problem-solving treatment.
Additional Guidelines For Effective Problem-Solving Treatment
Authors: Mynors-Wallis Dr Laurence
Published: November 2023

Although the principles of problem-solving treatment are relatively simple, the delivery of treatment is a skilled task. Experience has shown a number of factors to be important in successful delivery of treatment, and these are examined in this chapter.
Adverse events, equally important as efficacy as an outcome parameter?*
Authors: Stenver D I
Published: November 2023

This chapter reflects on the diverting attitudes throughout history towards efficacy and safety parameters. For several decades drug development was focused on providing effective mediactions indicated for life-threatening diseases. The randomized clinical trial was designed with the purpose of demonstrating efficacy and provides only scarce information on safety. This is exemplified by migraine prophylaxis trials. In recent years documentation has emerged that adverse drug reactions represent a major cause of mortality and morbidity. Therefore, the various stakeholders pay increasing attention to safety. A need for developing scientific methods appropriate for a high-quality evaluation of safety signals is recognized.
Migraine prophylaxis:a pharmacoepidemiological study of practices used by general practitioners and neurologists in France
Authors: Lanteri-Minet M , Alchaar H , Besson G , Bille-Turc F , Brudon F , Donnet A , Valance, J , Gastaut J L
Published: November 2023

One aspect of a comprehensive migraine treatment plan is long-term preventive therapy. In France, the Framig I study has demonstrated that only 7% of all migraine subjects use a preventive therapy. In order to understand such an undertreatment, we conducted a pharmacoepidemiological survey to describe the pattern of utilization of migraine prophylactic drugs by French physicians. A telephone survey using a computer assisted telephone interview ( CATI) system was carried out in September 1998 and French physicians completed a phone-mail-phone questionnaire which inquired about migraine prophylactic treatment.
Prophylactic drugs I: discussion summary
Authors: Silberstein S D
Published: November 2023

Key issues in the methodology of prophylactic headache trials were discussed by Peer Tfelt-Hansen. The chosen drug needs to be proven effective in comparison with placebo, even in comparative trials. The minimal effective dose should be determined. Adverse events (AEs) should be quantitated. Onset should be comparable to standard treatment. The benefit/tolerability ratio needs to be estimated. Noise and variability are important issues. Migraine attack frequency fluctuates. Variability can be reduced with a longer period of evaluation. Regression to the mean often accounts for spurious results. Non-responders could be decreased by limiting the number of attacks/month. Dropouts are due to causes other than AEs and lack of efficacy; causes include psychosocial and medical events including pregnancy, death of a near relative, moving, or loss of a job.
Topiramate in a selective group of therapy refractory headache patients
Authors: Agosti R M , Eugster S
Published: November 2023

Topiramate (Topamax®) was developed and introduced as a broad spectrum antiepileptic drug. It is shown to be effective in migraine prophylaxis in several open-label and controlled trials including three double-blind placebo-controlled studies. The mechanism of action in migraine is not known8 but several of the mechanisms discussed for epilepsy could be effective in migraine including inhibition of voltage-gated sodium and calcium channels, limitation of glutamate mediated neurotransmission at the AMPA-kainate receptor subtype, and enhancement of GABAA receptor-mediated chloride flux.
Efficacy of antidepressants in headache prophylaxis
Authors: Bendtsen L
Published: November 2023

Antidepressants have been used for headache prophylaxis for more than four decades. As early as in 1964, Lance and Curran reported that the tricyclic antidepressant amitriptyline was effective in tension-type headache independent of the antidepressant effect and a positive effect in migraine was reported in 1973. Antidepressants are widely used for the prophylactic treatment of primary headaches. After beta-blockers, amitriptyline is the most used drug for migraine prophylaxis in the US for both neurologists and primary care physicians. Amitriptyline is the first drug of choice for the prophylaxis of tension-type headache. The newer antidepressants, in particular the selective serotonin reuptake inhibitors (SSRis), are also used in headache, because of their favourable side effect profile.5 With such an extensive use one would expect a substantial number of studies supporting the effectiveness of antidepressants in headache. But is this the case? The aim of the present paper is to review the scientific evidence for an effect of antidepressants in the prophylactic treatment of primary headaches.
Botulinum toxin type A in the treatment of refractory headache
Authors: Tepper S J , Bigal M E , Sheftell, F D , Rapoport A M
Published: November 2023

Botulinum toxin type A is being evaluated worldwide as a potential treatment for episodic migraine, chronic migraine, and cluster headaches. According to the revised version of the International Headache Society (2003 ), chronic migraine (CM) is considered a complication of migraine. Patients with CM usually have a past history of episodic migraine, reporting a process of transformation characterized by headaches that become more frequent over months to years, with the associated symptoms becoming less severe. Patients then develop a pattern of daily or near daily headache that resembles chronic tension type headache, with a few attacks of full-blown migraine superimposed. They often have daily headaches.
Botulinum toxin A in the prophylaxis of migraine-a double-blind, placebo-controlled, randomized study comparing frontal and cervical injection
Authors: Schwaag S , Frese A Rahmannf A , Husstedt 1.-W , lmer-Haase, J Vo , Evers S
Published: November 2023

Botulinum toxin A has been suggested to be effective in the prophylactic treatment of headache. However, conflicting results have been reported to date. For the prophylactic treatment of migraine, one placebo-controlled and well-designed study has been published showing an efficacy of botulinum toxin A in those patients receiving a small dose (25 U) but not a larger dose (75 U) of Botox® in the pericranial muscles. Another placebo-controlled study, not fully published yet, showed a significant decrease of migraine intensity, but not of migraine frequency and duration, by botulinum toxin A 12 weeks after injection.4 In addition, some open retrospective studies have been published all showing a positive effect of botulinum toxin A on migraine intensity and frequency using different injections sites and different doses of botulinum toxin A.
New possibilities for antimigraine therapy via 5-HT receptors?
Authors: Hill R G , Cumberbatch, M J , Williamson D J
Published: November 2023

The study of 5-HT (serotonin) dependent mechanisms has been pivotal in migraine therapy research for many years. Indeed, the second seminar in this series devoted the whole meeting to 5-HT mechanisms and more recently a seminar was dedicated to perhaps the most successful product of this field of research, the trip tans.2 The question we are now asking is whether there is significantly untapped potential left in 5-HT receptor mechanisms that will lead to better antimigraine drugs, in particular for use in preventive pharmacotherapy. We have learned a great deal about the mechanism of action of the triptans since they were introduced (see ref. 3). In particular, the realization that their key mechanism involves agonism at two distinct receptors (5-HTrn and 5-HTrn) raises the question of whether selective agonists stimulating just one of these receptors might have therapeutic advantages.
Dihydroergotamine interaction with 5-HT2 receptors and its relevance to migraine
Authors: Schaerlinger B , Hickel P , Etienne, N , Roteaux L Ma
Published: November 2023

Serotonin (5-hydroxytryptamine, 5-HT) receptors have been implicated in the regulation of several psychiatric and neurological disorders related to serotonergic neurotransmission, and specific receptor subtypes have recently been associated with either the pathogenesis or the treatment of migraine headache. A role for 5-HT in migraine has been supported by changes in circulating levels of 5-HT and its metabolites observed during the phases of a migraine attack, along with the ability of 5-HT-releasing agents to induce migraine-like symptoms. The ergot alkaloids semi-synthetic derivative DHE interacts with multiple receptors, at variable receptor affinity, intrinsic activity, and organ-specific access.
Nitric oxide and its signalling pathways: a rich source of potential targets for migraine therapy
Authors: Strijbos P J L M , Parsons A A
Published: November 2023

Nitric oxide (NO) is a simple chemical molecule, yet it participates in highly com plex and varied biological activities. It has been implicated as a key messenger molecule in diverse processes including neurotransmission in the central and peripheral nervous systems, vasodilation and host defence signalling during infection, tissue trauma, and neurological disorders. In the context of headache, NO may be involved at a multitude of levels. For example, NO mediates vasodilation of dural blood vessels, NO and its synthesizing enzymes are expressed in migraine relevant tissues such as the dura, spinal trigeminal nucleus, and other somatosensory nuclei in the brain, and NO regulates the release of a host of vasoactive molecules including CGRP, serotonin, and substance P.
Keeping Going with a Self-Management Programme
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

Even if you have a self-management programme that you know is really helpful, keeping going with it can be surprisingly difficult, particularly when the first enthusiasm has died away. If you have been getting on-going medical support and that support comes to and end, it can be even more difficult to keep going. This is a common problem.
Improving Your Sleep
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

Most of us delight in ‘a good night’s sleep’. Unfortunately, sleep problems are common in many long-term illnesses and can add to fatigue and general misery. You may find it difficult to get to sleep, or you may wake often during the night. Sometimes, even if you have slept, you may still wake up feeling tired. These problems can increase fatigue and add to the general misery of illness, so it is worth looking at all the ways in which you could improve the situation.
Setting Goals For Yourself
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

Setting a goal for yourself and then achieving it can be a very satisfying experience. It is something we all do to a greater or lesser extent, and it can be a good way of improving your quality of life within a long-term illness. You are probably doing some of this already, but there may be things that you would like to accomplish, but have set aside because your illness seems to make them difficult. Difficult, however, does not mean impossible. Done in a different way or at a slower pace, some of your goals might be attainable. You may feel that your life would be more satisfying if you could do more physically or mentally, or if you could do more with other people. All this could be part of your self-management plan. You will already have your own way of thinking about what you want to achieve, but may find the following structured approach useful. It looks at both picking out a goal and working out what would need doing to achieve it.
Managing Your Self-Esteem
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

Self-esteem means your personal feeling of self-worth. This is likely to be of great importance to your quality of life. You may have previously had good self-esteem, or you may perhaps have always had problems with this. Whichever is the case, a long-term illness can undermine your sense of self-worth in a variety of ways. It can change your whole idea of who you are and what makes you a valuable and valued person. You may have lost your good looks or physical prowess, the beautiful, active, healthy body you once had, and feel a loss of value because of that. Your illness may have caused a disfigurement. You may feel less effective as a parent, partner or carer. If you have had to give up your job, you may feel that you have lost your position as an achieving person. You may have lost some of your independence and now have to accept help from other people (and perhaps feel that you ought to be grateful, even though you hate having to ask for help).
Thinking About the Future
Authors: Campling Frankie , Sharpe Michael
Published: November 2023

What about your future? Do you think about it? Some people with a long-term illness would rather not think about what might happen, but others prefer to make detailed plans for each eventuality. As in most things, a balance is probably best—somewhere between reasonable planning and excessive worry. Practical, constructive thought about how you could cope with future challenges could be very helpful, and may help you to be less fearful of what might happen. It could be sensible to discuss with your family doctor or consultant what the prognosis is in your particular condition. They may only be able to give you an informed, expert guess, but that might ease some of your fears.
Introduction
Authors: Bannon Michael , Carter Yvonne
Published: November 2023

In the UK, general practitioners (GPs) and other members of the Primary Health Care Team (PHCT) undertake an enhanced role in the provision of healthcare for children. In the first instance, they see a number of children who present with an acute illness that requires a professional opinion. In addition, they are now responsible for the majority of child health promotional and surveillance activities including developmental checks and immunization. They increasingly undertake a shared role with secondary care for children who have chronic illness such as asthma. GPs, because of their unique and sustained relationships with families, provide continuing support for needy and vulnerable children, including families, where there are concerns regarding child protection and/or domestic violence. The last 3 years in the UK have seen great changes in our thinking about children and, in particular, how we respond to children in need of child protection. Following publication of the Laming Inquiry (2003) there have been a considerable number of publications focusing on the need to prioritize services for children.
Respiratory problems
Authors: Hull Jeremy
Published: November 2023

Respiratory infections and wheezing illnesses in children are very common. Most are easy to recognize and simple to treat. A small proportion are more serious, and can be life-threatening in the acute phase, such as a child with severe croup, or can indicate an underlying problem, such as cystic fibrosis (CF). In this short chapter, I have considered an approach to common respiratory symptoms: wheeze, breathlessness, cough, and stridor, as well as to the more specific problems of the primary care management of a child CF and an infant with apnoea.
Neonatal issues in primary care
Authors: Nicholl Richard
Published: November 2023

In this chapter I shall attempt to address the common and current issues likely to confront primary care physicians in relation to the term baby and also review some current issues in the management of the preterm newborn baby. It is not my purpose to give a complete review of normal newborn development and pathophysiology. For a guide to common conditions in the first year of life I would refer the reader to Valman (2002) and for a comprehensive atlas of conditions affecting the term and preterm newborn, to Thomas and Harvey (1997).
Allergy in childhood
Authors: Clark Andrew
Published: November 2023

Allergy in the developed world is common and increasing in prevalence, severity, and complexity resulting in an increased burden on the child, their family, and healthcare providers. Diagnosis is usually straightforward and assessment and treatment is aimed at controlling ongoing symptoms and allergen avoidance. To provide effective advice takes considerable time and an understanding of the natural history of allergy.
Ear, nose, and throat problems in childhood
Authors: Hadfield[ Pandora
Published: November 2023

Middle ear infection is common in children. In the United Kingdom 30% of children under the age of 3 years visit their general practitioner with acute otitis media (AOM) each year. Of these 97% receive antibiotics. One in 10 children will have an episode of AOM by 3 months of age.
Failure to thrive: recognition and management in primary care
Authors: Khan Fauzia , Rudolf Mary
Published: November 2023

When my daughter stopped putting on weight … she was weighed every week and it was over eighteen months of them coming and weighing her every week … and them saying ‘oh, she will grow out of it’. After eighteen months she went two weeks without eating, nothing at all, and I packed her bags up one day, took her down to the clinic, and said take her in hospital because I am not doing it anymore.
Paediatric haematology
Authors: Allard Shubha , Reid Cecil
Published: November 2023

Apart from the platelet count, most other haematological parameters are age related and the appropriate normal range for age will be provided by the laboratory. Physiological changes in the haemoglobin and haematocrit are considered below but it is important to note that after the macrocytosis seen at birth, the mean cell volume (MCV) falls rapidly. Most children are microcytic by adult criteria from 3 months of age with adult values only attained at puberty.
Child protection
Authors: Bastable Ruth , Vickers David
Published: November 2023

This chapter aims to give you an understanding of the issues around the protection of children. It is not about all the signs and symptoms, nor about the details of the legal framework, rather it tries to help you think about the issues you may face in primary care.
The transition to parenthood: the role of the health visitor
Authors: Barlow Jane , Underdown Angela
Published: November 2023

Traditionally the safe arrival of a newborn infant is perceived as one of the happiest and most natural events in the human life cycle. However, while much energy is put into the physical preparations for a new baby, the evidence suggests that there is much less prepa- ration for the inevitable emotional transitions facing partners who become parents.
Accidental injuries in childhood
Authors: Kendrick Denise
Published: November 2023

The use of the term ‘accident’ is often criticized because it implies randomness and unpredictability suggesting that these events are inevitable and not preventable. However, epidemiological studies have shown that many accidents are in some sense predictable, as children, families, and environments that have a high risk of accidents can be identified. In addition, reviews of coroner’s records following accidental deaths have found the majority of deaths were preventable (Bannon et al. 1992). Although ‘unintentional injury’ is now the preferred term, as this is not commonly used among those working in primary care in the UK, the term ‘accidental injury’ has been used in this chapter.
Eating disorders
Authors: Dawson Dee
Published: November 2023

Epidemiological studies suggest that 0.5–1% of all school children may suffer from anorexia nervosa, only 5–10% would be male. Twenty years ago, anorexia was predominantly a Western disease but recently we have been seeing more Afro-Caribbean and Asian girls and boys living in Western countries developing the illness.
Attention-deficit/hyperactivity disorder
Authors: Hill Peter , Williams Jonathan
Published: November 2023

From a primary care perspective, first contact with a child with attention-deficit/ hyperactivity disorder (ADHD) will probably come in one of four ways, here ranked roughly in terms of what is most likely: The child’s parent will bring him (it usually is him), asking for confirmation of their suspicions that he has it and asking for a referral. This may follow their reading of an article in a magazine or a discussion with a teacher. Printouts from the internet may be offered or brandished.
Encopresis and enuresis: their management in primary care
Authors: Oberklaid Frank , Efron Daryl
Published: November 2023

Encopresis is a devastating condition in children. It is often associated with other problems, including recurrent abdominal pain, enuresis, and an inevitable effect on self-esteem and daily functioning. Children often exhibit social withdrawal and may have behavioural and emotional problems as a consequence of the soiling. Furthermore, the issues associated with soiling—the unpredictability, the smell, the social isolation, and the additional workload in cleaning up the child and washing soiled garments—are often reflected in significantly increased family stress and tension in the relationship between the child and his/her parents.
Common psychosocial disorders in children and adolescents: diagnosis and treatment
Authors: Foreman David
Published: November 2023

This chapter reviews the diagnosis and treatment of common psychosocial disorders, other than behaviour disorders or abuse, in primary care. After explaining the limits of the concept of ‘psychosocial disorders’ an assessment programme is set out, addressing the specific needs of the primary care practitioner, in terms of disturbance, disorder, disability, and handicap.
Multicultural paediatrics
Authors: Gatrad Abdul Rashid , Sheikh Aziz
Published: November 2023

They come to the clinic not only with the burden of their illness but also with the cultural fabric of their livesBrown and Segal (1996)The 2001 census revealed that 4.6 million of the UK population class themselves as belonging to a minority ethnic group (Table 35.1). This census, for the first time, also included a question on religious affiliation, revealing that approximately three million people belong to a minority religious group (Figure 35.1). Ethnicity and religion are two key factors that shape cultural identity. Understanding the potential impact of these cultural markers on access to and provision of healthcare is important if we are to make progress in reducing the major health inequalities experienced by black and minority groups in Britain (Acheson Report 1998). Crucial to redressing these inequities is the need to improve the health outcomes of children—for health in the very earliest stages of life represents a key determinant of health status in future life (Barker 1994). In this chapter, we focus on providing the understanding needed to work with minority families and suggest practical approaches that may improve access and quality of primary health- care services for black and minority ethnic children. Although focusing on Britain, many of the issues discussed are in principal likely to be of considerable relevance to many other western European countries.
Ethical and legal issues in paediatric primary care
Authors: Foreman David
Published: November 2023

Ethical and legal issues determine how practitioners should behave at every step in the processes of assessment, diagnosis, and treatment. A model for routine ethical practice in primary care is proposed, based on three sets of assumptions: (1) that ethical practice is consistent with the four principles of beneficence, non-maleficence, justice, and respect for autonomy; (2) ethical concerns lead to legal processes, whose task is to ensure ethical practice; and (3) that we are working in the interests of our patients. Current relevant literature was organized in terms of this model, and recommendations for practice derived from it.