bluuebunny/crossref_metadata_2025 huggingface dataset:
Neuroprogression in children and adolescents with bipolar disorder
Authors: Romo-Nava Francisco , Farrow Jenni E. , Patino Luis Rodrigo , Nery Fabiano G. , Adler Caleb M. , DelBello Melissa P.
Published: April 2019

The concept of neuroprogression in children and adolescents with bipolar disorder is still under construction and remains controversial. It encompasses the notion of a temporal progression of illness with regard to its neurobiology, phenomenology, treatment response, and associated functional impairment. In this chapter, we review current evidence surrounding this concept. There is a definite clinical progression from an asymptomatic risk status, the appearance of the prodromal affective symptoms, and, finally, to the onset of illness. Some, but not all, neuroimaging, neuropsychological, and pharmacological studies support the notion of functional and structural brain differences between high-risk individuals and control subjects. Furthermore, current evidence of neuroprogression after illness onset is frail. Most relevant studies are cross-sectional, with few longitudinal exceptions. We will discuss neuroprogression, its use in the context of clinical staging, and other controversial areas regarding this concept in youth with bipolar disorder.
Substance abuse and neuroprogression
Authors: Sordi Anne Orgler , Schuch-Goi Silvia Bassani , von Diemen Lisia
Published: April 2019

There is a growing body of evidence suggesting that neuroprogression occurs in addiction in the same way as in other psychiatric disorders. Biological markers of neuroprogression will be reviewed in the light of the staging model of addiction proposed by Volkow and Koob (intoxication, withdrawal and negative affect, and preoccupation and anticipation) and of allostatic load theory. Chronic exposure to drugs leads to allostatic load or overload through these stages. Neuroadaptation in this process disrupts brain morphology and function. Evidence regarding neuroprogression in drug addiction will focus on neuroimaging findings as well as neurotrophins, inflammatory markers, oxidative stress, and accelerated ageing.
The pernicious procession of somatoprogression
Authors: Gregory Jonathan M. , Goldstein Benjamin I. , McIntyre Roger S.
Published: April 2019

Psychiatric disorders predispose individuals to physical illness and premature mortality. ‘Somatoprogression’ refers to the accumulation of medical comorbidities that occurs parallel to the chronological deterioration of the mental illness (known as neuroprogression). Psychiatric illness engenders increased medical burden via lifestyle factors, adverse pharmacological effects, differential healthcare access, and illness-related perturbations in psychobiological systems. Because medical comorbidities simultaneously exacerbate the course of mental disorders, the relationship between psychiatric and somatic illness is bidirectional. Moreover, the multitude of shared risk factors points to common pathoaetiological processes, which emerge as both medical and psychiatric phenomena. The allostatic load model provides a framework to understand the interrelationship of the processes underlying neuroprogression and somatoprogression. In bipolar disorder, somatoprogression manifests as increased risk of endocrine/metabolic, inflammatory, and cardiovascular disease, subserved by chronic inflammation, oxidative stress, and reduced neurotrophic support. Importantly, converging evidence suggests a synergy of affective progression and somatoprogression in the development of cognitive impairment.
The scope of the review
Authors: Emond Alan
Published: April 2019

Child health programmes should be based on sound evidence of effectiveness. This chapter summarizes the reasons why an updated review of the evidence is needed in a new edition of Health for all Children, defines the scope of the fifth edition, and explains how the quality and strength of the evidence supporting practice and commissioning have been assessed. The framework for making the evidence-based recommendations for practitioners, managers, and commissioners provided at the end of each chapter is explained. An overview is provided of the book, divided into sections and chapters, with links to online evidence and training resources. The chapter concludes with some overall recommendations applicable to the child health programmes in different countries in the UK.
Integrating immunizations into the programme
Authors: Bedford Helen , Elliman David
Published: April 2019

Immunization is a highly successful public health intervention providing protection against serious infectious diseases. UK vaccine uptake rates are generally high, although pockets of lower uptake and social inequalities remain which compromise herd protection. The child health programme provides health professionals opportunities to introduce immunization to parents, offer ongoing information and advice, and remind them when vaccines are due. Improving and maintaining high vaccine rates depends on multicomponent strategies. In view of their relationship with families, health visitors are the key professionals to work with them to ensure that children are immunized fully and in a timely fashion, although in practice they now do not usually deliver vaccines.
Secondary prevention: principles and good practice/screening tests
Authors: Elliman David
Published: April 2019

Screening can be a very important means to reduce the morbidity and mortality of conditions that cannot currently be prevented. However, it also has the capacity to do harm by incorrectly labelling people as having a condition, when in reality they do not, thus causing anxiety and sometimes resulting in unnecessary interventions. The UK National Screening Committee recommends national policy on screening on the basis of the evidence of the overall effects of a potential programme and its cost-effectiveness. Once a programme is introduced, it should be carefully monitored to ensure that it lives up to expectations, coverage is appropriately high, the expected outcomes are delivered, and that it does not increase inequality. More detail can be found on the UK National Screening Committee website.
Identification of hearing impairment
Authors: Elliman David
Published: April 2019

Universal newborn hearing screening has meant that babies with significant congenital hearing impairment can be identified soon after birth and management instituted to ameliorate resultant problems, that is, minimize disability and handicap and optimize life chances. Evidence for the value of school entry screening is lacking and there is some evidence it is neither effective nor cost-effective. Further research is needed on this. Otitis media with effusion can cause significant long-lasting effects and may need surgical intervention or the provision of hearing aids. Parents and professionals should be aware of the symptoms that are indicative of possible hearing loss. Parents’ concerns should always be taken seriously.
Developmental reviews and the identification of impairments/disorders
Authors: Wilson Philip , Law James
Published: April 2019

There is a considerable international variation in preventative child health programmes suggesting variability in the available evidence. More socially disadvantaged families may be more likely to have children with developmental difficulties but are less likely to make use of such services. Family perceptions of child development and difficulties are likely to be culturally sensitive and professionals need to pay attention to this. Many developmental problems are on continua which border typical development but also overlap and interact with one another. There is evidence for the effectiveness of some interventions but these are rarely tied into population-level health surveillance programmes.
Supporting children with developmental disorders and disabilities
Authors: Emond Alan , Law James
Published: April 2019

At least 10% of children have a development disorder which could be disabling. Many children with developmental conditions can be identified in pregnancy or shortly after birth, or will be referred from a child health programme with atypical or delayed development. Early identification of developmental disorders helps children to achieve their potential and facilitates support to their families. Assessment by a multidisciplinary child development team should lead to the provision of family-friendly services coordinated by a lead professional. Children require packages of care, provided through Education, Health, and Care plans/child plans to optimize learning. To meet families’ needs for information, family support, and respite, coordinated packages need to be commissioned from health and social care, education, and the voluntary sector.
Personal child health record
Authors: Bedford Helen
Published: April 2019

Forms of parent-held records have been in existence for well over 100 years, but it is only relatively recently that they have been introduced on a systematic basis in the UK. As part of the review of Health for all children in 2003, the Personal Child Health Record was reviewed in England and a national standard core record introduced, reflecting the content of the child health programme with flexibility to allow for local details. It is intended as a record of growth and development and health events, but not as a repository of detailed health promotion material. This principle also applies in Scotland, Wales, and Northern Ireland with some variation. Parents value it, but apart from health visitors it is not well used by healthcare professionals. A digital version is in development.
School readiness and transition into school
Authors: Emond Alan , Coad Jane
Published: April 2019

School readiness is a complex construct which includes physical health and well-being, social competence, emotional maturity, language and cognitive development, and communication skills. This chapter reviews the evidence for interventions which help children, and their families, be ready to start school, and highlights good practice in schools being ready and welcoming for new children. The issues of transition into school are discussed, and evidence presented on how children with medical needs can be helped to integrate and participate. Health assessments at school entry are reviewed, and the complicated area of medication in schools is summarized.
Agencies and actors in women’s, children’s, and adolescents’ health
Authors: Rowson Mike
Published: April 2019

This chapter charts the shift from a world dominated by a small number of global health actors—principally the World Health Organization, UNICEF and UNFPA—to a new world where there are many new actors in women’s and children’s health. This process has been accompanied by a large increase in aid for global health since the 1990s. The chapter charts the size and roles of these actors. It argues that all of them need to adapt to the new challenges of women’s and children’s health, and that governments of developing countries will play more of a role in the response to those challenges. A reformed WHO could shape government action in this area positively.
Research methods and evidence-based medicine
Authors: Colbourn Tim
Published: April 2019

This chapter provides an overview of research methods used to build the evidence base for global maternal and child health. It covers primary data collection, secondary data analysis, systematic reviews, and meta-analysis, and provides tips on how to interpret the scientific literature. This chapter should be read in conjunction with Chapters 1–3, Chapter 5 on economic evaluation, and Chapter 4 on converting research into policy to put the use of research evidence into context. The three key points from this chapter are: (1) you need to clearly define a research question before deciding what study type is best suited to answer it; (2) designing a research study involves detailed attention to practical details, including how groups are going to be defined; and (3) scientific studies are sometimes published with incorrect conclusions. Critically appraise each study, and define appropriate conclusions that are based on the data and methodology.
Developmental origins of health and disease
Authors: Fall Caroline , Kumaran Kalyanaraman
Published: April 2019

Sub-optimal nutrition during foetal and infant development is associated with an increased risk of non-communicable diseases (NCDs) in adult life. Animal experiments show that this results from permanent effects on the structure and function of tissues and hormone systems (‘metabolic programming’), probably mediated by epigenetic changes. NCD risk is increased further by adiposity and/or unhealthy lifestyles in childhood or adulthood. Apart from nutrition, other early life environmental influences can programme later disease, including foetal ‘over-nutrition’ (maternal diabetes or obesity) and exposure to maternal smoking, environmental pollutants, and pregnancy complications. The concept that improving the nutrition and health of mothers pre-conceptionally and during pregnancy could prevent common NCDs has huge public health implications. However, unlike the robust demonstration of programming in experimental animals, the evidence in humans rests mainly on observational research. Intervention studies are ongoing to strengthen the evidence and to identify ways to improve early development and prevent NCDs.
Sexual and reproductive health
Authors: Pillay Lavanya , Smit Jenni , Beksinska Mags , Morroni Chelsea
Published: April 2019

Ensuring sexual and reproductive health and rights (SRHR) and empowerment of girls and women are essential to improving individual-level and population-level outcomes globally, and to achieving the Sustainable Development Goals (SDGs). Target SDGs for SRHR include access to a range of (SRH) services, reproductive rights, and ending discrimination and violence against women and girls. SRH services should be provided in a holistic and integrated package to ensure increased access to modern contraceptives, maternity care, prevention, and appropriate treatment of infertility, comprehensive sexuality education and the prevention, diagnosis, and treatment of sexually transmitted infections, reproductive tract infections, and HIV. Addressing these is particularly crucial for ending the HIV/AIDS epidemic, where women are at greater risk of infection compared to men due to a greater physical vulnerability, which is further compounded by gender inequality, poverty, and violence.
Preterm births
Authors: Moxon Sarah , Sadoo Samantha , Lissauer Tom
Published: April 2019

This chapter highlights the increasing burden and significance of preterm births. Direct complications of preterm birth are now the leading cause of mortality in neonates and children under five. There is also a higher risk of neurodevelopmental impairment in survivors. Preterm birth related mortality and morbidity can be reduced through clinical interventions targeted across the continuum of care, from optimising preconception and pregnancy care, to postnatal care of a premature baby. Prevention of prematurity is complex, with some interventions available but with limited impact. With universal coverage of interventions for small and sick newborns, an estimated 84% of deaths could be prevented, but this requires more investment in skilled personnel and robust technology. When scaling up inpatient care for small and sick newborns, improved measurement of outcomes, follow-up to prevent/manage impairment, and family support are all vital.
Child nutrition
Authors: Cardoso Marly , Wells Jonathan
Published: April 2019

The ‘first 1000 days of life’, covering conception to age two, is recognised as a critical period for the growth and development of young children. Evidence suggests that good nutrition in early life can help adults become taller, stronger, healthier, and more intelligent and, thus, more economically productive, with many benefits for the next generation as well. The concept of a ‘window of opportunity’ is essential for designing intervention strategies. However, how to promote healthy growth in the first 2–3 years, without provoking excess weight gain and adiposity, is a major challenge to public health policymakers. This chapter addresses the global burden of childhood under and over-nutrition, highlighting the main public health interventions for improving child nutrition.
Non-communicable diseases in childhood
Authors: Mvula Jessica , Chimowa Takondwa , Molyneux Elizabeth , O’Hare Bernadette
Published: April 2019

The focus is on the most common non-communicable diseases (NCDs) in low and middle-income countries, including asthma, cancer, diabetes, rheumatic fever, and sickle cell disease. It reviews the burden of disease, the global targets, and the challenges in prevention, screening, diagnosis, and management, largely due to limited resources and their low priority relative to other conditions. The chapter proposes a life-course approach to the prevention of adult NCDs due to tobacco use, alcohol abuse, unhealthy diet, and lack of physical activity, as lifestyle habits are often established in childhood and adolescence. The importance of government policies to prioritise prevention of NCDs by limiting the sale of harmful products using tax policies and the use of the revenue generated to promote healthy lifestyle and to strengthen health systems is emphasised.
Patient involvement in European cancer societies: The example of ECCO—the European CanCer Organization
Authors: Hemelryck Françoise Van
Published: April 2019

This chapter, ‘Patient involvement in European cancer societies’, describes how an oncology healthcare professional organization, the European CanCer Organisation (ECCO), engages with patient groups. It outlines the structure established by ECCO, the Patient Advisory Committee (PAC), and how it helps ECCO realize its vision. It gives examples of the inclusion of the patient perspective in scientific congress programmes, policy papers, and events. Patient advocacy has a long history in the field of oncology. Healthcare organizations give increased emphasis to the patient experience to provide care that is of most value to patients but also an essential component of sustainable healthcare.
Advocacy for neurology: Local, regional, and national
Authors: Pauranik Apoorva
Published: April 2019

The spectrum of advocacy for neurology is very wide. This chapter aims to describe and analyse advocacy on the geographical or spatial axis—that is, advocacy at the local level (micro), regional level (meso), and national level (macro). These distinctions may appear arbitrary with hazy boundaries and many overlaps. Yet they serve a tangible purpose for the sake of our understanding. The first two main sections dwell upon (i) education and awareness at different levels and (ii) engagement with various institutions of government. The later three briefer sections cover (iii) role of patient support groups; (iv) roping in of charities, non-government organizations (NGOs), and celebrities; and finally (v) advocacy within our own professional associations. This chapter will cite examples of a wide variety of advocacy actions plans for neurology, so that more action plans can be conceived and executed at various levels. Another chapter of this book deals with advocacy at the international level (Chapter 14, ‘Advocacy in the international arena’). This chapter concludes with an emphasis on role of humanities as an aid in advocacy efforts, the need for a balance between vertical and horizontal approaches to healthcare, and the importance of research into efficacy of advocacy.
Working with others, the lesson of the European Brain Council
Authors: Olesen Jes , Destrebecq Frédéric
Published: April 2019

In neurological advocacy it has often been forgotten that we share interests with related specialties and basic science, as well as with patient organizations and industry. We are all working with the same organ, the brain, and its extensions in the spinal cord and the peripheral nervous system. When it comes to influencing at the highest level the European Union or the National Institutes of Health, it is important that all players work together to promote brain research and brain health. That was the aim of the European Brain Council, which successfully united everybody in Europe and managed to greatly improve the attention to brain research and brain diseases at the European level. While cancer and heart diseases have always worked closely together as major players, this was the first time that concerted action on behalf of the brain and its disorders took place and it was highly successful.
Project management techniques for advocates
Authors: Struhal Walter , Grisold Thomas
Published: April 2019

This chapter focuses on the operational side of advocacy. The question we are pursuing is, ‘What is needed to get an advocacy project done?’. Physicians and nurses are used to working in environments that are marked by stable (infra)structures, well-known goals, and specific requirements and incentives. Most often, advocates will find the opposite when they work on projects. Since there are no or only weak functioning projects in place, advocates may face several challenges throughout a project. There could be no structure, no specified goals, and no incentives. Pursuing the goal to provide operational support to anyone who is doing advocacy, we summarize major challenges and provide concrete tools and strategies to master these challenges and get projects done successfully.
Continuation or ending and ‘debriefing’
Authors: Grisold Wolfgang , Grisold Thomas
Published: April 2019

Projects end according to plan if the goals are achieved, or the content of a project becomes part of routine procedure. In specific circumstances, advocacy projects can be set up for continuous policy/procedure development purposes. Irregular endings can occur at any time for several reasons and do not necessarily indicate failure. Persons working in advocacy projects are usually engaged and enthusiastic persons, driven by altruistic causes, a goal, or a conviction for purpose. By ending a project, it is important to debrief participants, share achievements, and harvest knowledge. Contrasting with the enthusiasm in developing and installing advocacy projects, the process of ending is less well described, although this may be a valuable source to learn for new projects. This chapter deals with ending, closing, harvesting, analysing and debriefing, and emphasizes that ending and closing is important in advocacy projects.
Results, outlook, and goals of this book
Authors: Grisold Wolfgang , Struhal Walter , Grisold Thomas
Published: April 2019

The main goals of this book are to provide a systematic view on advocacy and provide insight that advocacy is a useful and powerful tool. Advocacy, as used in the context of medicine and in particular neurology, is not new, but has always been practised by physicians and neurologists and can be considered an implicit permanent activity, even duty of the profession. The book defines advocacy and provides, views from different perspectives, tools on how advocacy projects could be practised. The experience from several subspecialties explain their own strategies and ways to advocate for patients and aspects of care in neurology. The book summarizes outlook, and ending, closing, and debriefing, as an important part of projects. Our best teachers are our patients, who either need our interventions and help, or on the other hand increasingly take advocacy issues into their own hands, with or without our guidance and leadership, which is within the changing relations of patients and physicians, as well as the increasing autonomy of patients and shared responsibilities. This chapter is a resume and reflects on overall goals that we hope to achieve.
Thailand
Authors: Tangwongchai Sookjaroen , Tunvirachaisakul Chavit , Supasitthumrong Thitiporn , Phabphal Kanitpong , Udomratn Pichet
Published: April 2019

Thailand has unique advantages and challenges in caring for people with dementia. Thailand is in the process of launching its National Dementia Strategy, based on the previously developed care and support policies for the elderly. Currently, care for people with dementia is provided through integrated community care by family and health volunteers, and care costs are covered by the Universal Coverage Scheme. The main challenges are to raise public awareness of dementia, to improve healthcare capacity, and to prepare for a long-term care system. There needs to be focus on innovative medical management and prevention strategies to tackle dementia in Thailand. In the future, Thailand expects to see an improvement in public education about dementia, an increase in specialist training involving multidisciplinary teams, the emergence of sustainable long-term community-based care, and the expansion of an accessible care system with adequate standards for the Thai population.
New Zealand
Authors: Casey Jane , Cheung Gary
Published: April 2019

New Zealand has an ethnically diverse ageing population. There has been no epidemiological study examining the prevalence and incidence of dementia in this country. Despite the lack of official figures, there are three key national strategies to guide clinical services to improve the quality of life of people with dementia and their families. Primary care-based cognitive impairment pathways have been implemented, and there has been uptake in psycho-social interventions such as cognitive stimulation therapy and the Walking in Another Shoes programme. The principles of person-centred, accessible, and integrated underpin the care initiatives in this space. The national Dementia Cooperative has been established as a network of health professionals working in dementia care and dementia knowledge exchange. Work in dementia prevention research and promoting dementia-friendly communities could prepare New Zealand to face some of the future challenges of dementia at the population level.
Croatia
Authors: Mimica Ninoslav , Jukic ́ Marija Kus ̌an
Published: April 2019

For many years, dementia care in Croatia was provided traditionally by the family, without no organized support, and many people with dementia were undiagnosed. Treatment for people with dementia presenting with serious behavioural and psychiatric symptoms was provided on psycho-geriatric wards in psychiatric hospitals. Alzheimer Croatia, founded in 1999, provides information, support, and education to caregivers, as well as to health professionals including psychiatrists, and neurologists, and also raises public awareness of Alzheimer’s disease. The continuing voluntary work of Alzheimer Croatia has helped to encourage the development of other types of services for people with dementia in Croatia.
England
Authors: Burns Alistair
Published: April 2019

The National Dementia Strategy (published in 2009) set the scene for a sea change in dementia care in England. Work was commenced in a number of areas, including a service to recognize the work of general practitioners in identifying and diagnosing dementia in primary care, an initiative to reward hospitals for the correct assessment of people with suspected dementia admitted as emergencies to general hospitals, reducing the level of prescriptions of antipsychotic medication, raising awareness of dementia in care homes, and ameliorating the effects of stigma. In 2012, there was the first Prime Minister’s Challenge on Dementia, which had three major areas of focus. First, based on the fact that dementia is the most feared illness in people over the age of 50, a programme to reduce stigma was developed; this challenged the notion that dementia was considered part of normal ageing. Second was to increase the diagnosis rate, but also to eliminate variation across the country. Third was in terms of dementia research and the aspiration to improve the amount of resources going into research. More recently, a five-point plan of looking at the care and support of people with dementia has been developed, emphasizing the importance of care across the care pathway—Preventing Well, Diagnosing Well, Supporting Well, Living Well, and Dying Well.
France
Authors: Robert Philippe , David Renaud , Manera Valeria
Published: April 2019

In 2011, France began the launch of its National Alzheimer Plans to fund research on Alzheimer’s disease (AD) and related disorders, which resulted in a significant increase in French scientific research output, particularly after implementation of the Third National Alzheimer Plan (2008–2012). The 2014–2019 Neurodegenerative Disease Plan and the new Action and Prevention of Loss of Autonomy National Plan aim at extending the positive research outcomes in AD to other neurodegenerative pathologies. Interestingly, these plans also assign an important role to Information and Communication Technologies in the assessment and training of people with AD, frailty, and related disorders. This may contribute to shaping the new Silver Economy by creating new challenges and opportunities.
Norway
Authors: Engedal Knut
Published: April 2019

Norway has 5 million inhabitants, of whom 200,000 are aged above 80 years. The country is a welfare state, with a tax system covering most health services for its citizens. It is estimated that 78,000 people in Norway suffer from dementia, of whom 60% live at home and the remainder in residential care. In 2007, the first National Dementia Plan was launched (2007–2015), and the second in 2016 (2016–2020). The main goals of the two Plans are to develop services across the country to improve the care and quality of life for all people with dementia and their family caregivers, as well as increase the knowledge of dementia among healthcare professionals. In addition, the Plans also aim to improve awareness of dementia in society as a whole and to develop and implement measures to help create a more dementia-friendly society.
Sweden
Authors: Jelic Vesna , Sandman Per-Olof , Wahlund Lars-Olof
Published: April 2019

Care for the elderly and people with dementia is an important part of a general welfare system in Nordic countries, particularly in Sweden. A specific characteristic of the welfare system is that it is in the main publicly funded, and care services are also under government supervision. Another feature of the Nordic model of care for the elderly is that it has a long tradition of in-home support services for older people. This chapter gives an overview of relevant demographics and milestones in the development of a National Dementia Strategy and current National Guidelines on the care and nursing of people with dementia, as well as results of their recent evaluation. The chapter concludes with a discussion of some future challenges in dementia care.
Wales
Authors: Woods Bob
Published: April 2019

This chapter documents the developments in Wales relating to a National Dementia Vision and Strategy. A new Strategy is to appear by December 2016. While activity and progress are evident in many areas, much remains to be done. Wales benefits from having an Older People’s Commissioner, a statutory voice for older people, including those living with dementia, and from its rich cultural, linguistic, and artistic heritage, with active third-sector organizations. Like many countries, Wales has had well-publicized scandals in relation to quality of care in hospitals and care homes, which have provided learning and impetus for development. Compared with other parts of the United Kingdom, dementia diagnosis rates in Wales appear low and are now the subject of government targets. The new Strategy will need to fully engage with people living with dementia in order to address these challenges, while building on the growing social movement of dementia-friendly communities.
Argentina
Authors: Palau Fátima González , Zamparella Tatiana Castro
Published: April 2019

In 2000, the United Nations placed Argentina among the countries with the oldest populations in Latin America. Ageing of the Argentinian population has progressed steadily over the decades, alongside a rise in the prevalence of dementia. In 2011, findings from the first Central Registry of Cognitive Pathologies were published, which showed that among all dementia types, Alzheimer’s disease, in any of its forms, was diagnosed in 70.5% of subjects. Regarding treatment, findings from the study also showed the considerable importance given to the specific treatment of behavioural and psychological symptoms of dementia. Non-pharmacological treatment is usually based on interventions directed to patients and families. In Argentina and worldwide, non-cognitive symptoms are the real core symptoms of dementia. However, difficulty in accessing care and treatment facilities due to long travel distances makes it challenging to implement traditional psycho-social interventions. In this context, computer-based cognitive interventions and telemedicine could offer a promising solution.
Colombia
Authors: Buraye Jacqueline Arabia , Martínez María Cristina Quijano
Published: April 2019

Dementia is among those diseases with an increased incidence in older people, which, according to population projections, will have an increasing impact in the coming years. Currently, it is estimated that worldwide, 7% of people aged above 65 years, and 20–30% of those aged above 80 years, present with cognitive impairment. Colombia is not spared this reality. This chapter reviews the prevalence of the disease, the current situation in the country, and the challenges, as well as proposed management alternatives for families, caregivers, and the community and clinical trial research in families at genetic risk of developing hereditary early-onset Alzheimer’s disease.
Peru
Authors: Carcelén Víctor , Berrocal Waldo Cárdenas
Published: April 2019

The Peruvian health system is highly influenced by the ageing of the population. Public health spending as a percentage of the gross domestic product is below the average for Latin America; pocket spending is excessive, particularly for the purchase of drugs and payment for diagnostic services. Infrastructure and human resources are inadequate and unequally distributed across the country, with significant disparities between regions. Although Peru has a universal insurance scheme, its coverage remains low. In addition, a high degree of institutional fragmentation persists, which highlights the inequalities and inefficiencies that prevail in the country. Each component of the health system operates independently, serving different populations, with its own rules, networks of suppliers, and therapeutic methods. Cognitive impairment and dementia are closely linked with old age, and their rising prevalence and increasing social impact are particularly marked in developing countries. The prevalence of dementia in adults aged over 65 years in Peru is 6.85%, with Alzheimer’s disease as the commonest type.
Setting up a childhood immunization programme
Authors: Lankester Ted
Published: April 2019

This chapter discusses why childhood immunization is important and how it saves lives. It describes the global strategies currently in place, including EPI and GAVI, as well as other developments. It gives details of commonly used vaccinations and immunization schedules. It describes practical steps in setting up an immunization programme: equipment needed, how to maintain the cold chain, assessing needs for immunization in the programme area, and discussing plans with the government. It talks about setting targets, training the team, and preparing the community for immunizations. It also provides information on how to carry out immunization in field and clinic settings, keeping records, and evaluating the programme.
Setting up a community tuberculosis (TB) programme
Authors: Lankester Ted
Published: April 2019

This chapter describes the recent status, impact, and control of tuberculosis (TB) worldwide through the End TB strategy. It gives examples of how government and civil society programmes can work together, with the roles and tasks of each clearly defined. It gives examples of the many barriers to treatment. The chapter describes current methods of case finding and case holding, existing and new diagnostics, and the treatment of adults and children. It explains the categories for recording cases and of treatment outcomes. It outlines the community and clinic background to managing cases of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB, and of co-infection with HIV. It describes the ongoing value of the DOTS strategy (Directly Observed Treatment-short course) and the limited value of the current BCG vaccine. The chapter emphasizes ways to reduce infection such as strict control on tobacco and reducing household smoke.
Setting up environmental health improvements
Authors: Lankester Ted
Published: April 2019

This chapter describes the key environmental needs regarding water supply, sanitation, and minimizing pollution. It describes WASH (WAter, Sanitation, and Hygiene). It explains the need for clean water sources, storage, and use, emphasizing what can be done at household and community level, e.g. rainwater harvesting. It outlines higher-level causes that need to be tackled where collaboration with other providers and supplies is possible. The chapter then describes different methods of waste disposal, including the need for constructing and using latrines appropriate to the area, built and owned by the community. The chapter then describes what actions need to be taken against other forms of pollution both in urban and rural areas. There is a strong emphasis on community action and leadership, and the importance of training an effective community action group
Setting up community mental health (CMH) programmes
Authors: Eaton Julian
Published: April 2019

This chapter explains why mental health is important for well-being and community development and briefly gives the history of mental health services in low- and middle-income countries. It suggests the best ways of engaging with the needs of those with no access to services and how to improve the current situation. The chapter lists the essential elements of a community mental health programme, discusses medical, psychological, and social aspects of mental ill health, and how to raise community awareness and empowerment to use services. It describes how to establish a mental health programme, including analysing the situation, planning the stages, implementing the programme, and monitoring and evaluation (M&E).
Use of information and communication technologies (ICT) in community health programmes
Authors: Agarwal Smisha , Zan Trinity
Published: April 2019

This chapter looks at the background and growth of information and communication technology (ICT) and its use in community health. It gives many examples of the rapidly growing number and variety of ‘mHealth’ programmes that use mobile phones and other wireless devices to deliver health information and services. It explores the effectiveness of these programmes and provides information about developing and running such programmes. It helps the reader assess their context and gives tools to help decide if an mHealth programme is suitable for the community, and whether programme and community have the capacity to use it effectively. It describes the practical steps needed to implement the programme, including building technology partnerships, content development, and careful pretesting of the programme before implementing it more widely.
Community palliative and home-based care
Authors: Leng Mhoira
Published: April 2019

This chapter discusses palliative, or home-based, care, an often-neglected area of community health. It explains the nature of palliative care, when it is needed, and who requires it. It describes palliative care from a global perspective and as a component of Universal Health Coverage. It discusses the barriers and gaps to delivering palliative care and suggests how palliative care is possible with limited resources. It explains models of palliative care and how others have set up community care initiatives. It covers the concept of how good communication is a crucial key in palliative care, and then outlines how to assess the need for palliative care and medication, identify patients, approach families, and care for physical, psychological, emotional, and spiritual end-of-life needs. It ends with how to support the palliative care team.
The Equality Act 2010
Authors: Landon Mark , Williams Tony
Published: April 2019

Occupational health practitioners have an important part to play in various areas of equality law, and a critical role with regard to disability. This chapter considers the key legal and practical issues when occupational health practitioners are asked to advise on matters such as the likelihood that a person is disabled, adjustments that are likely to assist someone with a disability to secure work, stay in work, or return to work after a period of absence, and the issues that arise when an occupational health practitioner is asked to assess the impact of an employee’s health on his/her performance and that of others.
Health promotion in the workplace
Authors: Boorman Steve
Published: April 2019

This chapter considers the definition of health promotion and its potential in public and occupational health practice. Workplace health promotion provides an opportunity to deliver health messages and reach groups such as ‘blue-collar men’ that may be less accessible to health information delivered through other routes. Practical examples are used to illustrate health promotion techniques. Communication techniques are discussed, with exemplars of successful campaigns. Examples are given of the range of evaluation measurements used to demonstrate impact. It also highlights debate regarding the strength of evidence related to the impact of workplace health promotion. In the UK, the evidence base is less well developed than overseas publications.
Transport
Authors: Carter Tim , Chang Rae-Wen , Colvin Andrew , Hermanns Robbert
Published: April 2019

Many tasks in the transport industries pose risks to public safety. Health problems and disabilities in workers may contribute to these. Fitness standards are usually set by statutory bodies. They aim to protect passengers and the general public. Driving a road vehicle or train or piloting an aircraft is, in essence, a workstation task where sensory inputs are analysed and form the basis for responses to signals, other users, and ambient conditions. Thus standards place emphasis on the capability and reliability of sensory, cognitive, and motor performance. Different capabilities may be required, for instance when working in an air traffic or other control centre. Some jobs also require additional capabilities, such as manual handling in delivery driving or the ability to manage passenger evacuation in the event of an emergency. Statutory or company standards need to take account of such requirements.
Seafaring, offshore energy, and diving
Authors: Carter Tim , Bell Sally , Doig Mike , Hermanns Robbert , Bryson Phil
Published: April 2019

Seafaring, work in the offshore energy sector, and commercial diving share a number of common features that are relevant to the assessment of fitness to work. Physically and mentally demanding tasks, many of which are considered safety critical, are performed, often in an unforgiving environment. Workplaces are commonly remote from onshore health and emergency services, necessitating the provision of emergency medical and incident (including fire) response on site. Employees must be trained and physically and mentally capable of performing these rare but demanding roles. The risks from a serious injury or illness are raised by the lack of full medical care facilities.
Musculoskeletal conditions, part 1: rheumatological disorders
Authors: Nasir Syed , Walker-Bone Karen
Published: April 2019

Upper limb disorders are common and therefore contribute importantly to fitness for work. Other rheumatological conditions, including inflammatory arthritis, fibromyalgia syndrome, and systemic lupus erythematosus, are less common but may cause significant work disability for those affected. This chapter summarizes the key features of the history, examination, and investigations to guide the reader in diagnosis of these conditions and reviews current rheumatological management. A summary of what is known about the work impacts of these conditions is provided together with guidance as to how to assess and mange workers with these conditions in their workplace and develop a management plan to enable their work participation. In general, the management of most of these conditions has improved so that people diagnosed with these conditions will now have a much greater chance of maintaining their function, enabling them to stay at work in the future. However, assessment should be individualized and biopsychosocial.
Neurological disorders
Authors: Poole Jon , Hardie Richard
Published: April 2019

This chapter deals mainly with common acute and chronic neurological problems, particularly as they affect employees and job applicants. The complications of occupational exposure to neurotoxins and putative neurotoxins are also covered in so far as they relate to the fitness of an exposed employee to continue working. In addition to a few well-known and common conditions, many uncommon but distinct neurological disorders may present at work or affect work capacity. Fitness for work in these disorders will be determined by the person’s functional abilities, any co-morbid illness, the efficacy or side effects of the treatment, and psychological and social factors, rather than by the precise diagnosis. This will also need to be put into the context of the job in question, as the basic requirements for a manual labouring job may be completely different from something more intellectually demanding. Indeed, even an apparently precise diagnostic label such as multiple sclerosis can encompass a complete spectrum of disability, from someone who is entirely asymptomatic to another who is totally incapacitated. Furthermore, reports by general practitioners, neurologists, or neurosurgeons may describe the symptoms, signs, and investigations in detail, but without analysing functional abilities. These colleagues may also fail to appreciate the workplace hazards, the responsibilities of the employer, or what scope exists for adaptations to the job or workplace.
Diabetes mellitus and other endocrine disorders
Authors: Hashtroudi Ali , Patel Mayank
Published: April 2019

Diabetes mellitus is a metabolic disease characterized by hyperglycaemia. More people of working age now live with diabetes. If glucose levels are well controlled through diet, lifestyle, and treatment adherence, the risk of hyperglycaemia affecting employment is reduced. Well-controlled diabetes can also reduce the risk of associated complications, which can affect the ability to work. Those with diabetes may require adjustments at work to facilitate their employment and help them control their diabetes better. They may also require precautionary measures such as monitoring glucose levels while undertaking safety-critical roles to reduce the risk of debilitating hypoglycaemia and minimize the risk of harm to them and others. Many people live with other endocrine diseases, which usually do not affect the ability to work but may need specific considerations in the workplace.
Respiratory disorders
Authors: Asanati Kaveh , Cullinan Paul
Published: April 2019

Respiratory diseases commonly cause sickness absence, unemployment, medical attendance, illness, and handicap. Collectively, in the UK, these disorders cause 19 million days/year of certified sickness absence in men and 9 million days/year in women (with substantial additional lost time from short-term self-certified illness) and, among adults of working age, a general practitioner consultation rate of 48.5 per 100/year with more than 240,000 hospital admissions/year. Prescriptions for bronchodilator inhalers run at some 24 million/year, and mortality from respiratory disease causes an estimated loss of 164,000 working years by the age of 64 and an estimated annual production loss of £1.6 billion.