bluuebunny/crossref_metadata_2025 huggingface dataset:
The God Prescription
Authors: Webster Lynn R.
Published: November 2017

“The God Prescription” profiles Walt Alexander, a devout Christian who developed severe chronic pain after suffering accidental nerve damage during surgery. Walt’s faith in God and his support system within his family and his faith community helped him endure his pain and look for the good that could come out of it. Conversely, his pain experience also deepened his submission to God’s will and enhanced his compassion for other people who are in need. Walt’s experience illustrates a truth that scientific research has established: belief tends to affect a person’s pain experience in a positive way. Chapter key idea: Believing in something or Someone bigger than yourself invites healing into your life.
Everyday Saints and Unsung Heroes
Authors: Webster Lynn R.
Published: November 2017

“Everyday Saints and Unsung Heroes” focuses on Ann Peterson, the wife of a man whose intestinal damage and back injury combined to give him three decades of pain and deteriorating well-being. Ann cared for him diligently and lovingly through surgeries and treatments. Sometimes she struggled with knowing how much was too much to do for him. Her experience reveals the sacrifices that the best family caregivers make every day, along with the confusion and questions they sometimes face. Peterson’s caregiving role for her husband finally came to an end when he tragically took his own life. Chapter key idea: A caregiver accompanies another in the journey of pain and recovery.
The Chilling Effect
Authors: Webster Lynn R.
Published: November 2017

“The Chilling Effect” takes a look at the issues surrounding opioids in our society today. An overzealous Drug Enforcement Administration is sometimes prosecuting the wrong physicians, thus creating a chilling effect in the medical community with regard to opioid prescription and making it harder for people in pain to get the help they need. Certainly there are serious risks that come with using opioids to treat pain. But the solution is not to use legislation and legal prosecution to hamper medical professionals who are doing their best for their patients. That approach is responsible for doing further harm to a population that is already hurting. The solution, instead, is to increase education about opioids while allowing physicians to use opioids according to the best knowledge and guidelines available at the time. Chapter key idea: Doctors have second thoughts about prescribing opioids when they know authorities are looking over their shoulders.
A Human Right
Authors: Webster Lynn R.
Published: November 2017

“A Human Right” argues that quality pain treatment should be viewed not as a privilege but as a right. Many types of pain can be treated much more effectively, if not cured entirely, if we have the will to make it happen. But for this, we need a cultural transformation that involves (1) ramping up research efforts to discover better therapies for pain, (2) improving and extending insurance coverage so that people in pain can get the care that’s available, and (3) treating all people in pain with dignity and respect. The chapter concludes with a call for readers to become personally involved as advocates for a better approach to pain treatment. Chapter key idea: People in pain deserve respect and access to treatments that make their lives better.
Psychological aspects of CF care
Authors: Duff Alistair JA , Oxley Helen
Published: November 2017

Living with CF can be psychologically stressful for both patients and their families. Whilst all are vulnerable to a range of psychological and social difficulties, many demonstrate strength and resilience in the face of adversity. The nature and treatment of CF impacts on people’s ability to respond to ordinary tasks and extraordinary life events. Care that is mutation class-specific offers much promise but for the foreseeable future, increased longevity corresponds with an increased burden of care, and treatments.
Psychological assessment and treatment is part of the service specifications for major CF centres. Several functions are necessary, such as participation in clinic consultations and annual reviews. Other contributions to the psychological care are important, including provision of specialist advice to the CF team, determined by the clinical needs of patients and teams. This chapter sets out the key psychological challenges of contemporary CF care.
Pioneering work on HIV/AIDS in Uganda
Authors: Mugyenyi Peter
Published: November 2017

Chapter 4 describes how the author and his colleagues set about trying to tackle HIV/AIDS in Uganda through health education and prevention campaigns, collaborative research, and, ultimately, treatment. It covers how, through the work of the Joint Clinical Research Centre and active support from the country’s President, Uganda took the lead in many aspects of research and development, and how it became clear that the biggest challenges were securing access to treatments and confronting attitudes that the use of antiretroviral therapy (ART) in Africa was simply unfeasible. It also describes how ART became available and successful services were established throughout the country, how Uganda served as a model for many other countries in Africa, and explains the continuing need for investment and development to maintain and build on these successes.
Mobilizing the community against maternal death—the Malawi community champion model
Authors: Mhango Chisale
Published: November 2017

Chapter 5 discusses the challenge of reducing maternal mortality in Malawi, one of the least resourced countries in Africa, through a mixture of clinical measures, service organization, and mobilizing the community. It describes how African Union (AU) and WHO policies were important in shaping plans and how international partners helped support and resource Malawi’s plans, as well as how the community and community leaders have been central to the success in Malawi. It covers how traditional leaders–chiefs–have played a very big role in giving maternal health greater priority and in changing behaviours amongst men as well as women, along with their willingness to confront resistance to change, whether it came from the churches or from individuals. It also covers the use of non-medical personnel, for example, in providing injectable contraceptives to women or in banning traditional birth attendants from delivering babies.
Introduction to Part 4: Making the best use of all the talents
Authors: Omaswa Francis , Crisp Nigel
Published: November 2017

Chapter 11 discusses the greatest shortage in Africa—skilled health workers. It provides the background in terms of numbers, distribution, and migration of health workers, and goes on to describe some of the imaginative solutions that health leaders in Africa and elsewhere have developed to tackle these shortages. It sets the scene for the following chapters in which African health leaders describe how they have dealt with these issues, whilst developing services and professional education in tandem. It concludes with a short chapter on Indigenous Knowledge Systems.
Tecnicos de cirurgia—assistant medical officers trained for surgery in Mozambique
Authors: Mocumbi Pascoal
Published: November 2017

Chapter 12 describes how, faced with a severe shortage of trained workers, the author initiated the training of tecnicos de cirurgia—assistant medical officers trained for surgery—to tackle the pressing needs of pregnant women and war casualties. This account shows that by careful recruitment, training, and consistent supervision it is possible to develop and train non-medical workers to deliver services that are only undertaken by doctors in Europe, the US, and most of the rest of the world. It covers how, almost 30 years later, the programme is still in place and serving the majority of the rural populations of Mozambique, and how the country continues to face enormous health needs but has become, in the last few years, one of the ‘frontier economies’ of sub-Saharan Africa, growing fast economically and beginning to be able to offer its young population the promise of greater opportunities and better services. It also discusses how, at the same time, other countries in Africa and beyond, faced with their own crises in how to provide healthcare for their populations, are interested in learning the lessons from Mozambique’s experiences.
All the skills of the health team
Authors: Fall Hannah
Published: November 2017

Chapter 13 describes how the author led the development of eye services in the Gambia by concentrating on creating a team of people of different skills who together could—and did—bring enormous improvements to the community. It shows how the service and team were built, and prevention of disease as well as treatment. It covers how the author developed a plan and a model that engaged every member of her wider team and involved patients and community members, and shows the impact this important work has had on the West Africa region and the world, as well as improving eye health in the Gambia itself. It also describes how to run a specialist service in a resource-poor country and how to work across country boundaries within a region.
The future: younger and future leaders
Authors: Crisp Nigel , Bagala John Paul , Bombi Clarisse , Edjang Susana , Ndwapi Ndwapi , Ohiri Kelechi , Twum-Danso Nana
Published: November 2017

Chapter 23 discusses the views and opinions of six younger, and future, leaders who live and study in their own countries, or who have global roles, on four topics. These topics are the key features of health and health care in sub-Saharan Africa today, the encouraging signs of improvement and the trends that need to be supported, the worrying signs and concerns about the future, and vision and hopes for the future, all as regarding the need for Africans to take control of their own destinies. It shows an emphasis on innovation and technology, and on creating plural systems with more investment and action from non-governmental players. It also discusses their shared perception of the importance of leadership.
Combination chemotherapy
Authors: McCann Shaun R.
Published: November 2017

One of the major advances in haematology during the past six decades has been the development of combination chemotherapy. However, some would dispute the claim that combination chemotherapy has been a major therapeutic advance, arguing that survival for most common cancers has not improved since the advent of chemotherapy. It is certainly true that the survival of children with acute lymphoblastic leukaemia has improved and that the drug imatinib mesylate and its derivatives have changed the outcome for most patients with chronic myeloid leukaemia. Likewise, combination chemotherapy has greatly modified the prognosis for patients with Hodgkin lymphoma and some types of non-Hodgkin lymphoma. However, it must be said that the application of combination chemotherapy to common non-haematological cancers has not met with similar success. In this chapter, the practicalities of the treatment of blood disorders are discussed, with specific reference to the use of this therapy by the medical profession.
Conceptual background to healthy growth and development
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

This chapter reviews the concepts of developmental plasticity and mismatch, critical periods for exposures, and the emergent science of epigenetics to explain how relatively subtle changes in parental behaviour can affect the outcomes of pregnancy, and why there are echoes of such influences across the whole of life. Contrary to earlier belief that embryonic and fetal development is set by a genetic programme, it is now clear that the fetus responds to cues in the in utero environment and can alter its development and metabolism accordingly. The ‘decisions’ that the developing fetus makes are embedded in its biology and are based on information it receives from its mother and, through her, about the wider environment, in terms of nutrition and physical activity but also about stress and other aspects of lifestyle.
Magnesium in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Magnesium in important for a wide variety of physiological processes; prominent among them is the control of muscle contractions, cardiac function, and carbohydrate metabolism. In pregnancy, low magnesium status is associated with hypertension, pre-eclampsia, gestational diabetes, leg cramping, and preterm labour. Magnesium has been used extensively in obstetrics to reduce uterine contractility in threatened preterm labour. Although current evidence does not support a requirement for magnesium supplementation for most pregnant women, those who are overweight, have risk factors for hypertensive or metabolic disorders or malabsorption syndromes, or who are carrying multiple fetuses, should pay particular attention to their diets and should be monitored for signs of magnesium deficiency. Consuming a magnesium-rich diet throughout pregnancy is recommended.
Potassium in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Potassium is an important electrolyte involved in transmission of electrical signals for muscle contraction, nerve impulse transmission, and cardiac function. The fetus accumulates potassium throughout gestation, but little is known about maternal potassium balance during pregnancy. Conditions associated with pregnancy, such as severe vomiting or morning sickness, can cause potassium loss. Caffeine increases the renal excretion of potassium, and cases of hypokalaemia in pregnancy have been observed in women with heavy caffeine/cola consumption, resulting in extreme muscle fatigue. To date there is insufficient evidence to suggest that the potassium requirement is increased during pregnancy, although a small increase in intake is needed for lactation. Reduction of cardiovascular risk factors and bone loss may be assisted by increasing potassium intake and/or by dietary sodium reduction.
Exercise and physical activity in pregnancy
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Exercise has many beneficial effects for pregnant women and their offspring, reducing insulin resistance and blood pressure and supporting angiogenesis, while also helping to maintain a healthy weight and body composition. Exercise/physical activity also been reported to reduce the risks of large for gestational age/small for gestational age babies and of preterm birth. Moderate exercise of 30 minutes or more on most days is recommended. Reasonable goals of aerobic conditioning in pregnancy should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness level or train for athletic competition. However, extreme exercise in late gestation is cautioned against, as it is associated with lower birth weights and the possibility of long-term adverse consequences on the offspring.
Traditional and herbal remedies in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

The use of herbal and traditional Chinese medicine during pregnancy has become very common worldwide. It is important to be aware of their effects and precautions, and that the evidence base to support claims for efficacy is very weak. Standards of quality and potency for many of the available products do not exist. Commonly used remedies include ginger root, cranberry, St John’s wort, raspberry leaf, castor oil, and blue cohosh. With the exception of ginger, there is currently not enough data to support the use of any other herbal supplements during pregnancy. For some, such as blue cohosh, there is clear evidence of harm and they should be avoided.
Attitudes
Authors: Schmidt Dieter , Shorvon Simon
Published: November 2017

It could be argued that the greatest advance in the field of epilepsy in the modern era has nothing to do with medicine, is not electroencephalography or magnetic resonance imaging or molecular biology, or the development of new drugs, but is in fact the change in societal attitudes towards those with epilepsy. Epilepsy is not only, or even most importantly, just a medical condition, but it is also something that happens to people, and it can destroy lives and livelihoods. There has been a welcome sea change in our opinions in recent years in the way people with epilepsy are treated and are regarded. All is not perfect by any means, and stigma is still present, but it surely is much less than it was in the early periods of the modern history of epilepsy, at least in Western cultures. This chapter charts the course of changing societal attitudes since 1860, through the dire years of theories of degeneration, eugenics, positivist criminology, and racial hygiene. There has been a transformation of epilepsy from the moral to the medical domain, from ‘badness’ to ‘sickness’, and this has certainly contributed to decreasing stigmatisation and deprecation. Much needs still to be done, and prejudice can flare up quickly; but nevertheless the public attitudes to epilepsy are far better now than in even the recent past.
Resecting Epilepsy
Authors: Schmidt Dieter , Shorvon Simon
Published: November 2017

The evolution of surgery for epilepsy in the late nineteenth century was partly the consequence of new ideas about the localisation of function in the brain and advances in the understanding of the physiological nature of epilepsy. This was an exciting time of discovery, and really fundamental and novel principles were enunciated which have stood the test of time. New techniques of investigation, including electroencephalography or magnetic resonance imaging, have since led to more accurate ‘targeting’, allowing the elucidation of the anatomical underpinning of epilepsy to be based, not only on semiology as in the earlier years, but also on more objective structural and functional measures. However, the fact remains that most surgery is based on the concept that resecting ‘bad’ tissue, and thus removing the ‘focus’ of epilepsy, will cure the condition—a postulation which has not changed since the time of Jackson (and which has its roots in earlier superstition). Such theories of epilepsy are surely gross simplifications, and the absence of any subsequent paradigm shift is why surgery has really not advanced conceptually much in the last 50 years. Technique and technology have profoundly changed, but the theoretical basis, generally speaking, has not.
Is the End of Epilepsy in Sight?
Authors: Schmidt Dieter , Shorvon Simon
Published: November 2017

The best proxy for the end of epilepsy is the complete cessation of seizures and the permanent ending of the need for further treatment. This marks the end of the biology of epilepsy, but not necessarily of all its societal consequences. The good news is that today over 80% of people developing epilepsy will reach this goal after a few years of treatment. Unfortunately, though, not all patients can reach this point, and it is for these patients that we seek improvements in the future. The end of epilepsy is not always easy to predict at the beginning. The taking of drugs is an issue, as always, of risk versus benefit, and although there are some benefits to discontinuation, this has to be balanced against the risk of seizure recurrence. Even if drugs alone don’t work, additional surgery may end epilepsy in as many as one in four people with amenable epilepsy. New thinking and new strategies for drug treatment, which not only control seizures but also address the underlying processes resulting in epilepsy, offer new horizons. The bottom line is that a revolution in discovery and development is needed. Epilepsy is, as pointed out throughout this book, more than having seizures, and so thus the scope of its treatment should be broader than simple seizure suppression. The end of epilepsy is, like the end of the rainbow, on the horizon, but equally tantalisingly difficult to reach.
The purpose and scope of this book
Authors: Brazier John , Ratcliffe Julie , Salomon Joshua A. , Tsuchiya Aki
Published: November 2017

This book provides the reader with an in-depth knowledge of one of the two key elements of economic evaluation in health care. It is written as a textbook which aims to include a comprehensive coverage of topics, while also being up-to-date at the time of going to press. It helps meet an important need that has been generated by the establishment of the National Institute for Health and Care Excellence (NICE) and similar international bodies requiring cost-effectiveness evidence in the form of incremental cost per quality-adjusted life year (QALY). It is aimed at academics and students of health economics as well as others concerned with the valuation of intangible benefits, such as: health practitioners from economics and other disciplines engaged in generating economic evaluations for research bodies; governmental agencies in health care (such as NICE); non-health care agencies whose programmes affect health; and pharmaceutical companies and private research consultancies.
Methods for obtaining health state utility values: generic preference-based measures of health
Authors: Brazier John , Ratcliffe Julie , Salomon Joshua A. , Tsuchiya Aki
Published: November 2017

This chapter describes the six most widely used generic preference-based measures of health (GPBMs) (also known as multiattribute utility scales): EQ-5D, SF-6D, HUI, AQoL, 15D, and QWB. GPBMs have become the most widely used method for obtaining health state utility values. They contain a health state classification with multilevel dimensions that together describe a universe of health states and a set of values (where full health = 1 and dead = 0) for each health state obtained by eliciting the preferences (typically) of members of the general population. These measures are reviewed in terms of their content, methods of valuation, the scores they generate, and the possible reasons for the differences found. Their performance is reviewed using published evidence on their validity across conditions, and the implications for their use in policy making discussed. The chapter also reviews the generic measures available for use in populations of children and adolescents.
Alternatives to generic preference-based measures: mapping, condition-specific measures, bolt-ons, vignettes, direct utility assessment, and well-being
Authors: Brazier John , Ratcliffe Julie , Salomon Joshua A. , Tsuchiya Aki
Published: November 2017

This chapter describes the methods and critically reviews the alternatives to generic preference-based measures (GPBMs) of health. Although there is considerable evidence for the validity and responsiveness of GPBMs in many conditions, but despite this, in these conditions they are often not used in clinical trials. Furthermore, GPBMs have been shown to be insensitive for some conditions. One alternative is to map from other health or clinical measures on to one of the GPBMs. Another is to devise a more relevant condition-specific preference-based measure, or use a bespoke vignette (scenario) describing the impact of the condition. A variant of this approach would be to add extra dimensions to GPBMs in order to improve their relevance to some conditions. Finally, there has been a growing interest in the measurement of well-being to help extend the descriptive component beyond health and the values to better reflect experience rather than preferences.
For objective, value-laden, contextualist pluralism
Authors: Dupré John
Published: November 2017

Chapter 3 is a commentary on Chapter 2, and revisits the discussion on views on the nature of scientific change (continuous or discontinuous; cumulative or revolutionary) and about the role of external considerations in science (corruptive or necessary), and how they depend on prior views about the nature of scientific knowledge. It revisits the principal epistemological ideas of logical empiricism, holism, and contextualism and outlines the attitudes toward change and external influence each licenses, and how the licensed attitudes are illustrated by reference to contemporary research on human aggression.
Introduction to “Expert disagreement and medical authority”
Authors: Kendler Kenneth S.
Published: November 2017

Chapter 7 introduces the subject discussed in Chapter 8, ‘Expert disagreement and medical authority’, which addresses the ideas of consensus, dissent, division of cognitive labor, social epistemology, scientific disagreement, epistemic authority, decision vector, and agnotology.
The role of cultural configurators in the formation of mental symptoms
Authors: Berrios German E.
Published: November 2017

Chapter 12 is a commentary on Chapter 11, which covers the ideas surrounding the varieties of social constructionism and the problem of progress in psychiatry. It specifically addresses issues surrounding schizophrenia, differences of opinion about psychiatric disorders, and the term ‘inclusionary social constructionism’.
Psychiatry made easy: operation(al)ism and some of its consequences
Authors: Parnas Josef , Bovet Pierre
Published: November 2017

Chapter 23 covers how tThe notion of "operational” diagnoses/criteria is ubiquitously revered in psychiatry, evoking a reassuring sense of reliability and objectivity. However, most psychiatrists are unaware of what the term “operational” actually signifies. It also addresses the origins of this term, its historical permutations, and its current status in the diagnostic manuals, and that the descriptive psychiatric terms are not (and cannot be) “operational” in any remotely significant scientific or theoretical sense. This is partly so because the individuation of symptoms and signs involve an articulation of Gestaltic, context-dependent wholes, comprising the “outer” (expressivity, behavior) and the “inner” (subjectivity, experience). The so-called operational revolution entailed an oversimplification of psychopathological discourse to a lay level, rendering irrelevant the previously achieved clinical and conceptual insights. The chapter discusses the widely recognized lack of progress in clinical psychiatry as one, inevitable, epistemological consequence of the “operational” remake of psychiatry.
Hempel as a critic of Bridgman’s operationalism: lessons for psychiatry from the history of science
Authors: Schaffner Kenneth F. , Tabb Kathryn
Published: November 2017

Chapter 24 is a commentary on Chapter 23, which covers operationalism, Bridgman, DSM-III, the structured interview, phenomenology, and the origins of this term, its historical permutations, and its current status in the diagnostic manuals.
Introduction to “Dopamine hypothesis of schizophrenia: an updated perspective”
Authors: Parnas Josef
Published: November 2017

Chapter 31 is an introduction to Chapter 32, which discusses the dopamine hypothesis of schizophrenia, and brings up to date a prior historical and philosophical review of this theory, and explores the role of empirical and nonempirical factors that impacted on the DHS during its development and subsequent history.
The dopamine hypothesis of schizophrenia: an updated perspective
Authors: Kendler Kenneth S.
Published: November 2017

Chapter 32 discusses how the dopamine hypothesis of schizophrenia (DHS) has, since its inception over 35 years ago, been one of the most prominent etiologic theories in psychiatry. This chapter brings up to date a prior historical and philosophical review of this theory. Then, utilizing the frameworks developed elsewhere in this book in Chapters 2 and 8, this chapter explores the role of empirical and nonempirical factors that impacted on the DHS during its development and subsequent history. Finally, the history of the DHS is contextualized in light of the histories of etiologic controversies in other medical disorders to clarify what features of the DHS might be typical versus more unique. A great deal can be learned about the multiple influences on the history of modern psychiatry through a study of the story of the DHS.
Why is the dopamine hypothesis of schizophrenia the only game in town?
Authors: Solomon Miriam
Published: November 2017

Chapter 33 is a commentary on Chapter 32, which discusses the dopamine hypothesis of schizophrenia, and brings up to date a prior historical and philosophical review of this theory, and explores the role of empirical and nonempirical factors that impacted on the DHS during its development and subsequent history.
Continuous subcutaneous infusions and syringe drivers
Authors: Dickman Andrew , Schneider Jennifer
Published: November 2017

Chapter one provides an overview of syringe pumps and CSCIs. The reader is introduced to the development of the syringe driver, or pump, and the need for a CSCI. Specific indications for a CSCI are described. Practical advice about how to avoid and manage the risks of an infusion site reaction are presented, as well as ten FAQs related to the set-up and use of the syringe pump. The currently available syringe pumps are then further discussed in more detail. The chapter closes with a discussion about the risk of needlestick injury, with reference to current legislation and techniques that can reduce the risk.
Stability and compatibility of drugs
Authors: Dickman Andrew , Schneider Jennifer
Published: November 2017

Medication safety has become an important healthcare topic due to the increasing awareness of the prevalence and incidence of errors and the implications in terms of rising healthcare costs. Drug administration is seen as a common cause of medication error or failure, with mixing of incompatible parenteral drugs seen as an important medication error. This chapter provides information relating to the pharmaceutical chemistry of compatibility and stability of drugs in solution. The terms incompatibility and instability are defined, along with some of the common causes. The possibility of predicting incompatibility from first principles using rudimentary acid–base chemistry is postulated. Factors that may affect the compatibility and stability of drug combinations administered by CSCI are discussed.
Compatibility and stability tables
Authors: Dickman Andrew , Schneider Jennifer
Published: November 2017

Chapter 5 contains referenced (where possible) tables of physical and chemical compatibility and stability data relating to over 600 drug combinations administered by CSCI. Compatibility and stability data come from two sources in this book—the laboratory and the clinical setting. Mixtures within this book are termed physically compatible if they remained colourless, clear, and free from particulate matter over the specified time; additionally, for clinical data, the expected outcome was realized. The outcomes of laboratory compatibility and stability studies, where available, are also included in the revised tables.
Imaging: sacroiliac joints
Authors: Maksymowych Walter P. , Lambert Robert G.W.
Published: November 2017

Radiography of the sacroiliac (SI) joints still forms the cornerstone of diagnosis of axial spondyloarthritis (axSpA), although its limitations in early disease preclude early diagnosis. Equivocal radiographic findings of sacroiliitis should be followed by MRI evaluation of the SI joints, especially if clinical suspicion of SpA is high. Routine diagnostic evaluation for SpA by MRI of the SI joints should include simultaneous evaluation of T1-weighted (T1W) and short tau inversion recovery (STIR) or T2 fat-suppressed scans. Bone marrow oedema (BME) in subchondral bone is the primary MRI feature that points to the diagnosis of SpA, although structural lesions such as erosion and fat metaplasia may also be evident in early disease and enhance confidence in the diagnosis. Both inflammatory and structural lesions in the SI joints on MRI can now be quantified in a reliable manner to facilitate therapeutic evaluation in clinical trials and for basic and clinical research.
Juvenile-onset spondyloarthritis
Authors: Burgos-Vargas Ruben , Tse Shirley M.L.
Published: November 2017

Juvenile-onset spondyloarthritis (JoSpA) refers to the group of HLA-B27-associated paediatric rheumatic diseases that involves the synovium and entheses of peripheral joints in the initial years and, in some patients, the sacroiliac and spinal joints several years later. Patients with JoSpA may also have extra-articular manifestations, including anterior uveitis, psoriasis and inflammatory bowel disease (IBD), and this represents a disease continuum with adult-onset SpA. JoSpA might include patients with enthesitis-related arthritis (ERA) and PsA categories of juvenile idiopathic arthritis (JIA), according to the International League of Associations for Rheumatology (ILAR). The opposite does not occur, since ILAR JIA classification does not allow the possibility of clinical overlapping among the different categories, one of the most important features of SpA.
Non-pharmacological management in axial spondyloarthritis
Authors: Passalent Laura , Ozgocmen Salih
Published: November 2017

The ASAS/EULAR panel recommends a multidisciplinary and patient-centred approach that includes a combination of pharmacological and non-pharmacological treatment modalities. These updated recommendations describe a number of non-pharmacological interventions as the cornerstone of treatment in patients with ankylosing spondylitis (AS). The aims of such treatment are to: (1) reduce pain and discomfort; (2) maintain or improve muscle strength, endurance, flexibility, mobility, balance, physical fitness, and social participation; and (3) prevent spinal abnormalities, joint contractures, and deformities. This chapter presents the evidence in support of common non-pharmacological interventions for axial spondyloarthritis (axSpA) and provides recommendations regarding the implementation of such treatment strategies.
Treatment: spinal surgery
Authors: Boehm Heinrich , Raja Rampersaud Y.
Published: November 2017

Despite remarkable progress in understanding the pathological processes and alleviating symptoms by TNFα‎ blocking medication, the mechanism that converts flexible tissue into bone still cannot be completely prevented or reversed. In axial spondyloarthritis, components of motion segments, such as zygoapophyseal joints, intervertebral discs, and spinal ligaments, can ossify in varying sequence, extent, and location between the ilium and occiput. Throughout this process, the spinal column is vulnerable to kyphotic deformity due to gravity, body weight, muscle action, and life’s flexion-based activities. Areas with low fusion tendency, such as atlanto-axial joints, and post-traumatically weakened spots of formerly ankylosed vertebral block (Andersson’s lesion) can endanger the spinal cord by instability, dislocation, and compression, from what is typically minor trauma or simple repetitive, but otherwise normal, stresses. Once functionally significant deformity or presence of instability and associated symptoms are established, conservative treatment options are lacking and surgical consideration is required.
Patient support and advocacy
Authors: Smith Seoirse , Savage Laurie M.
Published: November 2017

Patient advocacy groups grew out of a need to provide support to and education for patients and to fuel research to better understand diseases and their diagnosis, and treatment options for patients. These organizations have become integral partners with the medical community in developing healthcare policy, patient education, patient support, and scientific research. The Ankylosing Spondylitis International Federation (ASIF) of patient advocacy and support groups and the Spondylitis Association of America (SAA) are two of the leading patient advocacy organizations for millions of people affected by axial spondyloarthritis, increasing awareness of the disease, disseminating knowledge, sponsoring research, and influencing public policy.
Interrelated concepts in the epidemiology of disease: Natural history and incubation period, time trends in populations, spectrum, iceberg, and screening
Authors: Bhopal Raj S.
Published: November 2017

The natural history of disease is the uninterrupted progression of disease from its initiation to either spontaneous resolution, containment by the body’s repair mechanisms, or to a clinically detectable problem. Related concepts include the changing pattern of disease in populations and levels of severity (spectrum) of disease. Often the number of cases identified is exceeded by those not discovered. An illustrative metaphor for this is the iceberg. The pyramid of disease develops this into a population concept. Screening is the application of tests to diagnose disease (or precursors) in an earlier phase of the natural history of disease, often in well people, or in a less severe part of the disease spectrum than is achieved in routine medical practice. The potential of screening is vast but there are important limitations, such as the inability to influence the natural history of many diseases.
Epidemiological study designs and principles of data analysis: A conceptually integrated suite of methods and techniques
Authors: Bhopal Raj S.
Published: November 2017

Epidemiological studies are unified by their common goals and by their basis in defined populations. The case series (or register-based study) includes examination of trends in deaths, cancers, notifiable diseases, and hospitalizations. Case–control studies are analysed by comparing the exposure to risk factors in cases to those in controls. In a population studied at a specific time and place (a cross-sectional study), measurements can be made of disease, the factors which may cause disease, or both simultaneously. Cohort studies produce data on disease incidence and are especially good on associations between risk factors and disease outcomes. Trials compare treated and untreated populations and are used, primarily, for information on effectiveness of health interventions. Natural experiments, including Mendelian randomization studies, may provide causal evidence. The principles for the analysis of all studies are similar. The design and interpretation should be in the context of traditional, systematic, and meta-analytic reviews.
Epidemiology in the past, present, and the future: Theory, ethics, context, and critical appraisal
Authors: Bhopal Raj S.
Published: November 2017

The philosophy and theory underpinning epidemiology is seldom made explicit but it is a positivist discipline. The basic theory is that systematic variations in the pattern of health and disease exist in populations and these are a product of differences in the prevalence of, or susceptibility to, the causal factors. Epidemiology using data on whole populations, comprising tens of millions, if not hundreds of millions of people, is on the horizon. Studies on billions of people may occur within this century. The health applications of epidemiology obligate a code of ethics and good conduct that serves both its scientific and its applied purposes. Ethical, professional, and social obligations also require epidemiologists to have an understanding of the wider determinants of health and disease and of the history of the discipline. Only then can a productive future be shaped.
Operationalizing patient-centredness to enhance recovery and primary care for mental disorders
Authors: Furler John , Palmer Victoria J. , Gunn Jane
Published: November 2017

Patient-centred practice has deep historical roots and offers exceptional potential in addressing the challenges of caring for people with mental disorders in primary care. In fact, primary care with its professional commitment to holistic care has been a champion and advocate for patient-centred practice. While the evidence base for patient centredness is complex, there are suggestions it can optimize some outcomes that are important to the notion of recovery in mental disorders. Patient centredness has been given new impetus as a model of care through its centrality in the Patient Centred Medical Home movement in the US, which in particular is trying to reintegrate care for mental disorders into generalist primary care, with an emphasis on safety and quality. Nevertheless, patient-centred practice is challenging and not without tensions. Particularly at an individual level, patient-centred practice is a socially contingent form of practice as much as a technical one. We describe how shared decision making gives insight into the need for specific strategies to ensure people with mental disorders receive recovery-oriented care. The chapter concludes by naming reflective practice as a key strategy in the operationalizing of patient-centred practice for mental disorders in primary care.
Neurobiology of psychiatric disorders
Authors: Maletic Vladimir , DeMuri Bernadette
Published: November 2017

Recent decades have witnessed a burgeoning multidisciplinary research into the neurobiological underpinning of major psychiatric disorders. Despite recent discoveries, our psychiatric taxonomy, and hence diagnosis, continues to be based on phenomenology. We have summarized some of the major advancements in our understanding of the role that genetics, functional and structural brain changes, alterations in neurotransmission and neuroplasticity, and cytopathology may play in etiopathogenesis of psychiatric disorders, particularly focusing on major depressive disorder and anxiety disorders. Furthermore, recent research has unequivocally implicated peripheral immune, endocrine, and autonomic changes in the pathophysiology of psychiatric disorders, not only as correlates but also as major factors involved in shaping the clinical expression of these conditions. Better understanding of the pathophysiology underlying psychiatric disorders may assist us in developing markers to help identify subtypes of these highly biologically and phenotypically heterogeneous conditions. Additionally, greater knowledge of etiological mechanisms may help us adopt more effective therapeutic approaches.
The DSM-5: What should general practitioners know?
Authors: Paris Joel
Published: November 2017

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), was initially expected to be a radical revision of previous editions. However, there was insufficient evidence to support many of the proposals for changes, and the final product is not that different from DSM-IV. This having seen said, this chapter outlines what changes have been made, and what the future prospects for the classification of mental disorders may be.
ADHD across the lifespan
Authors: Goodman David W.
Published: November 2017

Attention deficit/hyperactivity disorder (ADHD) is a chronic neuropsychiatric condition that affects most patients throughout their lives and is associated with substantial underachievement and psychosocial dysfunction. Furthermore, ADHD is associated with a greater likelihood for psychiatric comorbidity and substance related disorders. Primary care practitioners are at the forefront of helping patients with ADHD manage their symptoms and overcoming functional impairments. The differential diagnosis of ADHD is challenging and the presentation of the illness is similar to other psychiatric conditions (e.g. ADHD in adults may appear similar to mood episodes, anxiety, or personality disorder). The developmental trajectory of ADHD appears to be moderated by family environment, personality characteristics, life events, and adaptive skills. The pharmacological treatment of ADHD is highly effective with stimulants as recommended first-line medications. The clinical use of these medications will be highlighted in this chapter along with behavioural/psychotherapeutic interventions individualized for patients and families.
Trauma and stressor-related disorders
Authors: Mello Andrea Feijo , Yeh Mary Sau Ling
Published: November 2017

After a traumatic event most people experience a period of distress, and usually a resilient response is observed and no intervention is necessary. However, one-fifth of subjects can develop an Acute Stress Disorder (ASD) within the first month after exposure, and if the reaction lasts for more than a month, a diagnosis of Posttraumatic Stress Disorder (PTSD) is usually made. Despite its prevalence, PTSD is likely to be under-recognized and under-treated, mostly in primary care settings. Primary care physicians can play an important role in identifying people with symptoms of ASD and PTSD, early detection and collaborative care treatment may improve prognosis.
Depressive disorders
Authors: Fagiolini Andrea , Amodeo Giovanni , Maina Giuseppe
Published: November 2017

Depressive disorders are one of the leading causes of death and disability worldwide, affect both mind and body, and are distressing for both the patient and the carer.

Those with depression often experience troubles with sleeping, concentration, appetite, and a reduction in the ability to work or enjoy daily activities.
Bipolar disorder
Authors: Neto Paulo R. Nunes , Köhler Cristiano A. , Berk Michael , Carvalho André F.
Published: November 2017

Bipolar disorder (BD) is a prevalent, chronic, and recurring mental disorder. Individuals with BD spend about half of their lifetime with affective symptoms, and depressive symptoms predominate over its long-term course. Residual symptoms and mixed states are also common. Evidence indicates that a significant proportion of individuals with BD seek treatment in primary care (PC) settings. Nevertheless, BD frequently goes under-recognized in PC settings and is not always properly treated. Patients with BD can be misdiagnosed as having unipolar depression or schizophrenia, and people with other disorders such as borderline personality disorder can have symptoms that overlap with BD. Consequently, general practitioners play a significant role in the management of patients with BD and severe or refractory cases should be referred to specialized care. This chapter provides a clinical overview of the epidemiology, diagnosis, and treatment of BD in PC.
Somatic symptom and related disorders
Authors: Murray Alexandra , Toussaint Anne , Löwe Bernd
Published: November 2017

Somatoform disorders are common in primary care and are associated with impairment and high health care costs. The biopsychosocial approach is central to the foundations of optimal care for these patients. Potential psychosocial influences on patient suffering should be identified and discussed early in the diagnostic process which is consistent with the new emphasis on positive psychological symptoms in DSM-5. Primary care practitioners (PCPs) should use a stepped-care approach when considering treatment depending on risk profiles. While patients with lower severity can be managed by the PCP, patients with a higher risk profile may need psychotherapy or other specialist care. Psychotherapy, new generation antidepressants, and natural pharmacological products are potentially effective interventions. This chapter also describes Sofu-Net, an example of a complex intervention to help strengthen the connection and communication between PCPs and psychotherapists. An alternative collaborative care approach integrates mental health care and management into primary care.
Motivational interviewing: Its role for the management of mental disorders in primary care
Authors: Haibach Jeffrey P. , DiNapoli Elizabeth A. , Finnell Deborah S. , Kasckow John W. , Gordon Adam J.
Published: November 2017

People with mental disorders are more likely than those without mental disorders to have a higher prevalence of both physical health problems and health-risk behaviours. Maintaining healthy behaviours is also important for maintaining optimum mental health. Motivational interviewing (MI) is one of the leading counselling methods for the management of mental disorders, and is used successfully in primary care. MI is predominately intended to promote health behaviour change and treatment engagement through a collaborative patient-provider relationship. This chapter serves as an overview and primer for MI with presentation of the MI method, processes and skills, a case example demonstration, methods for evaluation of practitioner competence and proficiency, and a brief narrative review of MI research. Using MI, practitioners can better motivate patients to utilize health services and to improve their health-related behaviour for the management of mental disorders through primary care.