bluuebunny/crossref_metadata_2025 huggingface dataset:
Bioterrorism
Authors: Gallagher Megan C. , Artenstein Andrew W.
Published: January 2022

This chapter describes bioterrorism (BT), the deliberate use of microbial agents or their toxins as weapons for political gain. BT represents a persistent global threat due to the widespread availability of biothreat agents and opportunities for terrorists to deploy them against civilian targets. BT agents are considered weapons of mass terror because of their potential for large-scale morbidity and mortality. BT agents are unlike conventional, chemical, and nuclear weapons because they are associated with a clinical latency period during which transmission may occur and detection is difficult. The US Centers for Disease Control and Prevention (CDC) has classified BT threats into priority groupings based on their feasibility for deployment and their potential for mortality, morbidity, and public health impact.
Bordetella
Authors: Souder Emily , Long Sarah S.
Published: January 2022

This chapter details the Bordetellae as fastidious, non–carbohydrate-fermenting, tiny, gram-negative coccobacilli that grow aerobically on starch blood agar or synthetic medium. The Bordetellae’s attachment proteins include a 69-kDa outer membrane protein, filamentous hemagglutinin, and fimbriae. Bordetella pertussis is an exclusive human pathogen that causes epidemic pertussis, and it is also the usual cause of endemic and sporadic pertussis. B. parapertussis is an infrequent cause of pertussis in the United States and is genetically more closely aligned with B. bronchiseptica, a common veterinary pathogen that causes upper respiratory tract illnesses in animals. The chapter also examines B. holmesii, which can cause pertussis-like illness in otherwise healthy persons.
Enterococcus
Authors: Jones Ronald N. , Mendes Rodrigo E.
Published: January 2022

This chapter discloses the emergence of enterococci as an important hospital-acquired or nosocomial pathogen since the early 1970s. It looks at the statistics from the National Nosocomial Infections Surveillance System (NNISS) and subsequent Centers for Disease Control and Prevention (CDC) programs (National Healthcare Safety Network), which places enterococci as the second most common gram-positive cause of nosocomial and bloodstream infections worldwide. It also analyzes the data from the SENTRY Antimicrobial Surveillance Program, which confirmed enterococci as the second most common gram-positive organisms responsible for bloodstream infections in US hospitals. This chapter examines the increased occurrence of enterococci since the mid-1970s in relation to patterns of general antimicrobial use in the hospital. It highlights the widespread use of extended-spectrum cephalosporins, penicillin-β‎-lactamase inhibitor combinations, fluoroquinolones, and carbapenems.
Helicobacter pylori
Authors: Graham David Y. , Rimbara Emiko
Published: January 2022

This chapter discusses Helicobacter pylori, a gram-negative spiral-shaped bacteria that infects more than 50% of humans globally. H. pylori infection is a serious, chronic, transmissible infectious disease that causes progressive, destructive inflammation of the stomach and is etiologically related to a number of important diseases, including gastric and duodenal ulcer disease, gastric cancer, primary B-cell gastric lymphoma, and atrophic gastritis. This chapter explores the prevalence of H. pylori infection that is inversely related to the general health, well-being, and degree of development of a society. It investigates the acquisition of H. pylori infection, which is often associated with transient symptoms.
Nocardia
Authors: Haglund Lisa
Published: January 2022

This chapter concentrates on the Nocardia species, which are soilborne bacteria that are aerobic and slow-growing. It describes Nocardia as thin, filamentous, beaded gram-positive rods that are variably acid-fast at 0.5 to 1.0 μ‎m in diameter, with branching at right angles. It explores the taxonomy of the Nocardia species, which has evolved considerably into 92 named species with the use of molecular identification techniques. The chapter talks about Nocardia nova complex, Nocardia brasiliensis, Nocardia farcinica, Nocardia cyriageorgica, Nocardia abscessus complex, and Nocardia transvalensis complex as the most frequent nocardial species pathogen for humans. It also mentions less common human pathogens, such as Nocardia otitidiscaviarum, Nocardia brevicatena-N. paucivorans complex, and Nocardia pseudobrasiliensis.
Pneumococcus
Authors: Mufson Maurice A. , Norton Nancy B.
Published: January 2022

Streptococcus pneumoniae or S. pneumococcus has proved to be an enduring pathogen since its discovery in 1881. S. pneumoniae is most commonly found in cases of community-acquired pneumonia (CAP), bacterial meningitis among adults, and sepsis and meningitis among children. The high case fatality rates from invasive pneumococcal disease (IPD) associated with S. pneumoniae attest to its importance as a pervasive pathogen during the second half of the twentieth century. This factor drove the development and licensure of polysaccharide vaccines for adults and children against the disease, despite effective antibiotic treatment regimens. The chapter discusses the diagnosis of S. pneumoniae pneumonia following patient testing and evaluation, and it details the treatment of disease caused by this dangerous pathogen.
Rat-bite fevers
Authors: Lipman Neil S.
Published: January 2022

This chapter introduces the illness associated with rat bites that has been recognized in India for 2300 years, which is believed to be the country of origin for the disease. It also describes clinically similar but distinct bacterial diseases that comprises Rat-bite fever, which are caused by unrelated agents called Streptobacillus moniliformis, Streptobacillus notomytis, and Spirillum minus. The chapter discusses the streptobacillary disease that is reported to be common in the United States and Europe, and spirillary disease that is common in the Far East. It confirms the genetic analysis of several recent disease-associated isolates that has revealed S. notomytis as the cause of rat-bite fever cases when exposed to the black rat, Rattus rattus.
Poststreptococcal immunologic complications
Authors: Stechenberg Barbara W.
Published: January 2022

Group A β‎-hemolytic streptococci are implicated in several nonsuppurative complications, acute rheumatic fever (ARF), and acute glomerulonephritis (AGN). ARF is a multisystem collagen vascular disease that follows untreated or undetected group A streptococcal pharyngitis in fewer than 1% of patients and can lead to rheumatologic, cardiac, and neurologic sequelae. Poststreptococcal AGN, another disease caused by Group A β‎-hemolytic streptococci, is an inflammatory disorder of the glomeruli that occurs when soluble immunoglobulin G immune complexes are deposited at the glomerular basement membrane following infection. The chapter discusses the testing, evaluation, and treatment of patients infected by Group A β‎-hemolytic streptococci.
Tuberculosis
Authors: Mehta Jay B. , Dutt Asim K.
Published: January 2022

This chapter investigates how the epidemiology of tuberculosis (TB) has changed in recent years due to shifting demographic trends. Although the incidence of TB in the United States has followed a generally downward trend in recent decades, the HIV/AIDS epidemic and an increase in homelessness, poverty, and drug abuse continue to remain the major risk factors for infection by Mycobacterium tuberculosis, the bacteria causing TB. Influxes of refugees and immigrants from areas of the globe endemic to tuberculosis contribute to the growing incidence of TB. Although M. tuberculosis is thought of primarily as a disease of the lungs, the bacteria can attack any organ in the body, most commonly the kidney, brain, and spine. This chapter details the testing, evaluation, surveillance, and treatment of patients with TB.
Mycoplasma
Authors: Waites Ken B. , Leal Sixto M.
Published: January 2022

This chapter deals with mycoplasmas, which are the smallest free-living organisms and are unique among prokaryotes in that they lack a cell wall; this is largely responsible for their biologic properties and lack of susceptibility to many commonly prescribed antimicrobial agents. Mycoplasmas are usually mucosally associated, residing primarily in the respiratory and urogenital tracts and rarely penetrating the submucosa, except in the case of immunosuppression or instrumentation. The chapter analyzes the intracellular localization that occurs in some species, such as M. genitalium and M. pneumoniae, which contribute to the chronicity that characterizes many mycoplasmal infections. The chapter investigates several species of mycoplasmas and ureaplasmas for which humans and other animals are believed to be the primary host; disease often occurs in the setting of immunosuppression. It identifies five species responsible for the majority of clinically significant infections: M. pneumoniae, M. hominis, M. genitalium, Ureaplasma urealyticum, and U. parvum.
Mucormycosis (and entomophthoramycosis)
Authors: Davies Scott F.
Published: January 2022

This chapter explores mucormycosis, which refers to a group of highly lethal, angioinvasive fungal infections that are mostly found in immunocompromised hosts. It identifies members of the order Mucorales, which include various species of the genera Rhizopus, Lichtheimia, Mucor, and Saksenaea, as pathogens in this disease. It also includes other genera of Mucorales that have been implicated in human disease, such as Cunninghamella, Apophysomyces, Rhizomucor, and Rhizopus. In addition, the chapter describes entomophthoramycosis, which are infections caused by members of the separate genera Conidiobolus and Basidiobolus and that generally occur in the tropics and cause chronic subcutaneous infection in immunocompetent hosts. The chapter further details the testing, evaluation, and treatment of patients presenting with mucormycosis and entomophthoramycosis.
Cryptococcus
Authors: Powderly William G.
Published: January 2022

This chapter analyzes Cryptococcus neoformans, which is found worldwide as a soil organism and thought to be transmitted by inhalation and often causes disease in patients with abnormal cell-mediated immunity. It discusses the infection of Cryptococcus neoformans on patients with human immunodeficiency virus (HIV) infection, solid organ transplant recipients, immunocompetent persons. It also looks into cases of invasive cryptococcal infection that occur annually in patients with acquired immunodeficiency syndrome (AIDS) worldwide with more than 150,000 deaths each year. The chapter investigates two varieties of C. neoformans that distinguishable by serology: C. neoformans var. neoformans and C. neoformans var. gattii. It explains that C. neoformans var. gattii is endemic in Australia and recent outbreaks of its infection have occurred in the Pacific northwestern parts of North America.
Histoplasmosis
Authors: Beeler Cole , Goldman Mitchell
Published: January 2022

This chapter talks about Histoplasma capsulatum, which is a thermally dimorphic fungus found most frequently in soil in the midwestern United States (US), Central and South America, Africa, Asia, and Australia. It mentions bird and bat excreta that are rich in organic nitrogen that support the growth of Histoplasma capsulatum. It looks at recent outbreaks of histoplasmosis that have occurred after cleaning a campsite contaminated by bat excreta, rototilling soil in a schoolyard below a bird roost, whitewater rafting, and digging for buried treasure. The chapter explains how individuals infected with H. capsulatum develop adequate cell-mediated immunity (CMI). It analyzes histoplasmosis-associated hospitalizations of patients with transplants, diabetes, and autoimmune conditions requiring biologic therapies that have increased in the US for the last decades.
Coccidioidomycosis
Authors: Vu Trung T. , Cadena Jose , Anstead Gregory M.
Published: January 2022

This chapter talks about coccidioidomycosis (CM), which is caused by dimorphic fungi of the genus Coccidioides and is presented as an acute and chronic pulmonary disease. It reviews how infection from CM may disseminate to cutaneous, osseous, and central nervous system sites and how it causes a significant health problem in the southwestern USA and Latin America. It also mentions Coccidioides, which grows as a mold with colonies that are usually colored white and has hyphae that are thin, septate, and hyaline. The chapter discusses C. immitis that are mostly California isolates and C. posadasii that are isolates for other areas. It describes the mycelial form of Coccidioides that grows just beneath the soil surface and is composed of arthroconidia intercalated with nonviable segments.
Enteroviruses
Authors: Dennehy Penelope
Published: January 2022

This chapter gives the overview on enterovirus, a virus found worldwide that can cause a wide variety of illnesses, ranging from asymptomatic infection to severe illness and death. It examines the human enteroviruses that belong to the family Picornaviridae, such as rhinoviruses, hepatitis A, and parechoviruses. It also describes enteroviruses as small, spherical, non-enveloped viruses with icosahedral symmetry and have a linear single-stranded, positive-sense RNA that functions as mRNA. The chapter characterizes enteroviruses as relatively acid resistant and stable over a wide range of pH, which allows the virus to pass through the gastrointestinal tract. It investigates how enteroviruses attach to specific cell membrane receptor proteins that determine host cell susceptibility.
Human herpes virus 6, 7, 8
Authors: Magira Eleni E.
Published: January 2022

This chapter deals with human herpesvirus-6 (HHV-6), human herpesvirus-7 (HHV-7), and Kaposi's sarcoma virus or human herpesvirus-8 (KSV/HHV-8). Herpesviruses consist of large double-stranded DNA packaged inside an icosahedral capsid, which is surrounded by a mixture of protein tegument and an outer lipid envelope where the viral glycoprotein spikes. Herpesviruses produce lytic and latent infection of lymphocytes and other cell types and serve as reservoirs for endogenous viral reactivation during times of immune suppression or as potential vectors of transmission to susceptible individuals. The chapter discusses the clinical presentation of HHV-6, HHV-7, and HHV-8 that ranges from asymptomatic infection or mild illnesses febrile exanthems to life-threatening disease in the immune-compromised host. HHV-6 and HHV-7 infect a broader array of cell types in comparison to HHV-8.
Influenza
Authors: Herati Ramin Sedaghat , Friedman Harvey M.
Published: January 2022

Influenza infections have caused significant morbidity and mortality throughout recorded human history. This chapter reviews a particularly severe pandemic in 1918, dubbed the “Spanish flu,” which led to the rapid spread of influenza and resulted in at least 20 million deaths worldwide. It also analyzes significant resources worldwide that have been dedicated to the detection and containment of influenza outbreaks and the development of response plans to influenza epidemics at international, national, and local levels. Influenza is an enveloped, single-stranded, negative-sense RNA virus in the family Orthomyxoviridae, which include the genera Influenzavirus types A, B, and C. Influenza A and B viruses cause the majority of human infections with influenza, while influenza C virus causes only sporadic upper respiratory infections.
Coronavirus-19
Authors: Gudipati Smitha , Maki Gina , Zervos Marcus , Ramesh Mayur
Published: January 2022

Coronaviruses are a large group of viruses that can infect humans as well as many animal species and result in a wide range of primarily respiratory illnesses in humans. This chapter focuses on the recent coronavirus that has swept around the globe from 2019 to 2020, now termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The World Health Organization (WHO) declared the coronavirus-19 disease (COVID-19) caused by SARS-CoV-2 as a pandemic on March 11, 2020. The chapter looks at the first cases reported in the city of Wuhan, Hubei Province, in December 2019, which presented a cluster of pneumonia cases of unknown etiology. It reviews original cases of COVID-19 that were traced back to the Huanan seafood market where seafood as well as exotic animals such as snakes, birds, and bats were sold.
Acute and chronic parvovirus infection
Authors: Young Neal S.
Published: January 2022

This chapter discusses parvoviruses, small viruses with unenveloped icosahedral capsids that contain a single-stranded DNA genome. The B19 parvovirus is the only member of the Parvoviridae family that is known to cause diseases in humans. It is the pathogen responsible for the childhood “fifth disease,” and presents differently in adults and children. The chapter reviews the taxonomy of the parvovirus family, in which B19 and closely related simian parvoviruses constitute the Erythrovirus genus, and it discusses the B19 parvovirus’s peculiar and extreme tropism for human erythroid progenitor cells that are responsible for the generation of circulating erythrocytes. The chapter details the testing, evaluation, and treatment of patients presenting with parvovirus disease.
Rabies
Authors: Mahadevan Anita , Shankar Susarla K. , Nath Avindra
Published: January 2022

This chapter traces the first clear reference to rabies from writings by Aristotle in circa 380 bc, in which he described the symptoms and transmission of rabies in dogs. Louis Pasteur developed the first rabies vaccine in Paris by intracerebral inoculation in rabbits, which he used to protect dogs from the infection. It also cites countries where dogs are commonly infected with rabies virus, in which nearly 99% of transmission to humans occurs through dog bites. Rabies is caused by a number of different species of neurotropic viruses in the Rhabdoviridae family and is typically transmitted by saliva of the infected animal through a bite or scratch. Mucosal exposure to the rabies virus, such as to the eyes, nose, or mouth can also transmit the virus.
Viral hemorrhagic fevers
Authors: Bausch Daniel G.
Published: January 2022

This chapter discusses viral hemorrhagic fevers (VHF), a group of acute systemic illnesses that classically involve fever, a constellation of initially nonspecific signs and symptoms, and a propensity for bleeding and shock. VHFs are caused by small, single-stranded, lipid-enveloped RNA viruses from four families: Arenaviridae, Bunyaviridae, Filoviridae, and Flaviviridae. Because the hemorrhagic fever viruses are zoonotic, a reservoir is constantly maintained in nature in mammals. The endemic area of any given VHF is restricted by the distribution of its natural reservoir and/or its arthropod vector, although the distribution of any virus is often less vast than that of its reservoir. Infection with a VHF is usually the result of inadvertent inoculation of virus-contaminated excreta into mucous membranes or broken skin, or through mosquito or tick bites.
Babesiosis
Authors: Chen Tempe K. , Mamoun Choukri Ben , Krause Peter J.
Published: January 2022

This chapter describes babesiosis as an emerging zoonotic disease caused by intraerythrocytic protozoa of the Apicomplexa phylum and transmitted by hard-bodied ticks. It reviews the first well-documented case of human Babesia infection, reported in 1957 in a splenectomized resident of Yugoslavia. Babesia spp. have been found to cause disease in humans; these include B. microti, B. duncani, and B. divergens-like spp. in North America, and B. divergens, B. microti and B. venatorum in Europe. Normally, humans are an uncommon and terminal host for Babesia spp., which depend on other species for their development and transmission. Ixodes scapularis is the primary vector of B. microti in the northeastern and upper midwestern United States. This tick also transmits Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis; Borrelia burgdorferi and Borrelia miyonii, etiologic agents of Lyme disease; Borrelia miyamotoi that causes relapsing fever, Powassan virus that causes encephalitis, and Ehrlichiosis muris-like infection.
Intestinal protozoa
Authors: Paul Kelly M.
Published: January 2022

This chapter analyzes intestinal protozoal infection that produces substantial morbidity and mortality in people of all ages, particularly in tropical and subtropical parts of the world. It cites amebiasis, giardiasis, cryptosporidiosis, and infections associated with AIDS as important problems for health in many parts of the world. It also examines intestinal protozoa that produce important human infections and different impacts in patients with AIDS. The chapter discusses Entamoeba histolytica, which causes dysentery, chronic colonic amebiasis, and hepatic amebiasis. It also reviews amebic dysentery, a syndrome of bloody diarrhea that is caused by invasion of the colonic wall by trophozoites of E. histolytica.
Antiviral therapy
Authors: Shah Rajeev , Cunha Cheston B.
Published: January 2022

Antiviral therapy continues to be one of the many challenges facing the healthcare provider. This chapter describes viruses that parasitize host cell enzymes and structures to varying degrees and discusses the difficulty of designing or discovering drugs that specifically target viral enzymes without affecting host cell machinery. The chapter examines viruses that establish a latent infection in the host, during which time they are essentially quiescent. It reviews some serious viral infections that stem from the reactivation of latent viruses during periods of impaired cell-mediated immunity. It discusses the development of drug resistance due to viral mutagenicity as an ongoing challenge in antiviral therapy.
Managing Uncertainty in Mental Health Care
Authors: Silveira Jose , Rockman Patricia
Published: January 2022

This book is about coming to grips with the uncertainty and complexity inherent to the assessment of people presenting with possible mental disorders. It is an exploration of the impact of objective uncertainty on clinical judgment and decision making and its relevance to mental health care. This is often not emphasized in clinical care and training. The book examines the relative utility of current nosology and clinical approaches in managing these challenges. The high prevalence of error in diagnosis and risk assessment related to existing clinical approaches is illustrated. An expanded view of common harms and impairments related to disrupted mental health is provided. These are used to populate a cognitive framework, to be used as a clinical tool during assessment. This transdiagnostic approach is intended to assist clinicians in identifying potential harm and impairment in their clients, independent of diagnostic clarity or errors. Finally, the book explores implications of irreducible uncertainty and complexity on approaches to clinician training and continuing professional development.
Limitations of Prioritizing Diagnosis
Authors: Silveira José , Rockman Patricia
Published: January 2022

This chapter examines the problem of how diagnosis is prioritized at the expense of directly addressing harm. Features of the nosology used in mental health and addiction as they relate to uncertainty in diagnosis and management are described. It is demonstrated that the nosology is incomplete and limited as a result of the gaps in the current understanding of the brain, mind, and mental disorders. The evidence suggests that current nosologies are failing. This is supported by studies of clinician error and the global failure to reduce the burden of illness. The chapter examines how the nosology ignores uncertainty and complexity. Discussing nosology within a framework of objective uncertainty is critical because both medicine and clinical psychology are governed by the principle that treatment begins with diagnosis.
Priorities in Risk Assessment
Authors: Silveira José , Rockman Patricia
Published: January 2022

This chapter addresses the importance of mitigating the deficiencies in the diagnostic assessment of mental disorders using a transdiagnostic approach that prioritizes the identification of potential harm and impairment. Current approaches to identifying harm and impairment in mental health care, and their inadequate scope, are discussed. The need to expand the set of impairments and risks of harm that are currently assessed is also discussed. The chapter examines key issues that need to be addressed in developing an approach to comprehensive risk identification, including its prioritization, the range of contributors to mortality, the influence of comorbidity, and current approaches to risk assessment and their accuracy. The importance of considering unintentional forms of injury and death in risk assessment is highlighted.
The Science of Human Flourishing
Authors: VanderWeele Tyler J.
Published: January 2022

Virtues play an important role in mental health and in human flourishing. Virtues are arguably both constitutive of human flourishing, and promote other aspects of flourishing that extend beyond character. Certain virtues play an important role in preserving and restoring mental health. Indeed, randomized trials of interventions focused on developing or making use of certain virtues, such as gratitude, forgiveness, and benevolence, have been shown to alleviate symptoms of depression and anxiety, and promote psychological well-being. Such interventions could be added to psychiatrists’ toolkits as supplemental resources and could be offered in addition to other cognitive, behavioral, psychodynamic, and pharmaceutical approaches. More subtly, psychiatrists can also potentially look for opportunities to encourage patients’ growth in character, when appropriate. While the virtues have potential to play an important role in psychiatric practice, cautions are also necessary, including not blaming the patient for mental health difficulties, acknowledging that actions in accord with virtue to serve others can themselves sometimes bring about hardship, and acknowledging the possible role of hardship, suffering, and mental distress in the development of virtue. Appropriately incorporating approaches to facilitate virtue—of both patient and clinician—in psychiatric care holds considerable promise for the promotion of mental health and human flourishing.
Dying Trajectories and Prognostication
Authors: Hallenbeck James L.
Published: January 2022

This chapter discusses the issues of prognostication and dying trajectories in relation to palliative care. Prognostication refers to prediction about future health and it relates not only to predicting death but also to other outcome states such as what percentage of patients with a cancer of a certain stage on initial presentation will eventually develop metastatic disease. Prognostication is also an act of communication. The concept of dying trajectory refers to the change in health status over time as a patient approaches death and it is usually plotted with time on the X axis and health status on the Y axis.
Communication
Authors: Hallenbeck James L.
Published: January 2022

This chapter discusses the importance of good communication in palliative care. The chapter provides an introduction to the field of intercultural communication and gives suggestions for how to use the principles of intercultural communication in better communicating with others in palliative care. A narrative approach is taken to understanding the positions of participants in any act of communication. Basic skills in sharing bad news, assessing goals of care, and holding a family meeting are presented. The chapter discusses the importance of incorporating patient and family preferences into difficult decisions, using the acronym GOOD, which stands for goals, options, opinion, and document. Suggestions are made for how best to pronounce patients and communicate with family members after a person has died. Suggestions are made for how best to communicate regarding requests for a hastened death.
Palliative Care Consults
Authors: Hallenbeck James L.
Published: January 2022

This chapter discusses palliative care consults, noting that the phrase “palliative care consult” may represent a variety of activities. Most consults are not straightforward requests for advice regarding a particular symptom but rather very difficult processes of communication and relationship building in emotionally charged situations. The chapter explains how the GOOD acronym may be modified to accommodate the consult process. The GOOD acronym stands for identifying goals and options, giving one’s opinion, and then documenting the consult. The chapter also discusses how to use a narrative approach to understanding participants’ perspectives and working toward a positive outcome. Differences among palliative care consults in different venues (acute care, outpatient clinics, home care, and nursing homes) are discussed.
Best Practices in Antistigma Programming Targeting Youth
Authors: Koller Michelle , Stuart Heather
Published: January 2022

This chapter describes the results of a multisite comparison of contact-based antistigma programs for middle and high school youth. Contact-based education occurs when people who have had experience with a mental illness provide education about mental illnesses and recovery and give students opportunities for discussion. Ideally, contact-based education creates a transformative learning experience that results in improved attitudes and social acceptance of people who have a mental illness. The proportion of students receiving an “A grade” equivalent on each scale (e.g., 80% are more nonstigmatizing answers) was the main outcome. Programs varied in their effectiveness, but the pooled estimate of effect across all of the interventions indicated that students were 2.57 times more likely to receive an A grade at posttest compared to pretest, indicating a positive outcome overall. Results suggest that contact-based interventions evaluated in this study generally improved social acceptance toward people with a mental illness.
Overcoming Antisocial Personality Disorder
Authors: Black Donald W.
Published: January 2022

This chapter evaluates current treatment recommendations for antisocial personality disorder (ASPD) and the other disorders that frequently accompany it. The path to recovery has many barriers, including the infrequency with which ASPD is diagnosed and the fact that few antisocial persons seek treatment. Because there are no standard treatments for ASPD, it is essential to identify coexisting problems that can respond. A thorough evaluation should confirm the diagnosis of ASPD and seek evidence for accompanying depression, alcohol or drug addiction, attention-deficit/hyperactivity disorder (ADHD), or other disorders. Treating coexisting disorders—depression, for instance, may respond to medication—can help reduce antisocial behaviors and prepare the person for the more complicated task of addressing ASPD. With the diagnosis confirmed and the person agreeing to seek help, the psychiatrist then develops a treatment plan. This might include medication, such as the selective serotonin reuptake inhibitors (SSRIs), but almost always involves talk therapy. The chapter then considers the use of cognitive behavioral therapy in treating antisocial persons.
Research on homelessness and mental health: What we’ve learned from the United States and nations in Europe
Authors: Struble Cara A. , Toro Paul A.
Published: January 2022

This chapter reviews important methodological considerations relevant to comparing and contrasting estimated rates of mental illness among homeless populations in the US and nations in Europe. Existing research on international prevalence estimates is presented to highlight the impact of definitional and methodological differences on obtained rates of mental illness among the homeless. It is suggested that variation in estimates across nations observed in existing studies is due primarily to varying operationalizations of homelessness, sampling methodology, and mental health measures. The chapter also describes recommendations for future research on this topic.
Homelessness and mental illness in Hong Kong
Authors: Yim Larina Chi-Lap , Leung Henry Chi-Ming
Published: January 2022

The homeless population in Hong Kong is growing, largely due to high rental costs, the rising gross domestic product, and suboptimal living conditions in homeless hostels and rented units. In a local study, approximately half of the homeless subjects were mentally ill at the time of the interview. Although 41% of subjects with mental illness had previously undergone a psychiatric assessment, only 13% were receiving psychiatric care at the time of interview. These figures are likely to underestimate the actual situation. Although Hong Kong provides a free healthcare service in the public sector for residents who cannot afford to pay for medical care, the rate of undertreatment of both physical and mental illnesses remains unreasonably high. This phenomenon suggests a significant service gap in the current healthcare system that renders severely mentally ill homeless patients unable to receive timely assessments and treatment. Lately, non-governmental organizations and volunteer medical staff have collaborated to establish a medical outreach service for homeless mentally ill people. Hopefully, this new service model can be applied to other currently underserved groups in the near future.
Coronavirus disease 2019 (COVID-19) and homelessness: Global perspectives on the ‘dual pandemic’
Authors: Banerjee Debanjan , Bhattacharya Prama
Published: January 2022

The world is facing a new public health crisis due to the coronavirus disease 2019 (COVID-19) pandemic. It is being described as a ‘public health emergency of international concern’ by the World Health Organization and one of the most contagious large-scale outbreaks that the modern world has ever seen. During any such infectious outbreak, certain populations are much more vulnerable due to their unique physical health and psychosocial challenges. One such group are the homeless, for whom the impact of the infection can long outlast the pandemic itself. The ‘social evil’ of homelessness is thus an ever-evolving pandemic in itself. Even though their global numbers are increasing every day, administrative unaccountability, lack of policy inclusion, and societal apathy further make them marginalized. Their numbers are rarely known among the millions that have been affected by COVID-19 so far. Besides their usual challenges of overcrowding, poor sanitary measures, lack of permanent shelter, poor healthcare access, associated mental illness, and substance abuse, pandemics can further corner them with increased infection and fatality rates, inadequate food, and lack of treatment. Inappropriate quarantine facilities and inadequate testing add to the risk. Past outbreaks have led to the formulation of certain pandemic preparedness measures in various countries, but they are far from implementation. As the construct of homelessness developed beyond just ‘lack of shelter’ to ‘lack of self-dignity and identity’, this chapter looks at the global problem statements of COVID-19 and homelessness, the unmet needs of this population during such outbreaks, and highlights the ways to fight this ‘dual pandemic’.
Mental health services for homeless people
Authors: Timms Philip
Published: January 2022

Specialist mental health services for homeless people have developed since the 1980s, in response to the increased awareness of the numbers of homeless people with mental health problems on the street. They have employed many of the principles of assertive outreach but have engaged, not with people who are already, to some extent, engaged with mental health services, but with those homeless people who have become completely disengaged from medical and mental health services. They have pioneered ways of working in non-clinical settings, such as the street, day centres, and hostels for the homeless. They have developed models for closer collaboration with voluntary sector services and non-medical housing and social services. In the last few years, they have developed more sophisticated outreach models. These use psychological notions of complex trauma to facilitate engagement with people who have a history of rejecting help—and to enable the subsequent provision of effective services to homeless people.
The epidemiology of cardiovascular disease
Authors: De Backer Guy , Graham Ian , Lira María Teresa , Hayman Laura L. , Uchmanowicz Izabella
Published: January 2022

Cardiovascular disease (CVD) remains the major cause of total mortality in Europe. Important inequalities are evident in that CVD deaths account for more than 50% of all deaths in some countries, compared with less than 30% in others. An important indicator of the burden of CVD morbidity is the hospitalization rate for cardiovascular conditions, which is 30% higher in men than in women, in particular for acute myocardial infarction admissions, although across the lifespan CVD is an equal opportunity disease. Global risk calculation has been considered the best tool for comprehensive cardiovascular primary prevention, to deal with the risk of developing atherosclerotic CVD. Guidelines highlight the importance of identifying asymptomatic patients who would be candidates for more intensive, evidence-based medical interventions that reduce CVD risk. Challenges in cardiovascular risk estimation efforts have included how to estimate risk in vulnerable groups more accurately, such as children and adolescents, young adults, older adults, and immigrants, and how other factors, such as social status or literacy, may influence expected outcomes. The nurse or nurse specialist is uniquely well placed to play a pivotal role in risk estimation and management. Prevention of CVD should take a multidisciplinary, multifactorial, and societal approach including strategies to improve health literacy, empowerment, self-care management, and environmental adaptations. Nurses must take an active part in reducing the burden of CVD through these strategies.
Delivering high-quality cardiovascular care
Authors: Neubeck Lis , Lira María Teresa , Vellone Ercole , Fitzsimons Donna , Dullaghan Lisa , Sanders Julie
Published: January 2022

The World Health Organization provides a framework that identifies the core elements of high-quality care which should be safe, effective, timely, equitable, efficient, and people centred. Nurses need to understand the fundamentals of high-quality professional practices and the metrics used to evaluate key performance indicators. Nurses have a central role to play in advocating for and delivering high-quality care across the continuum as the largest healthcare workforce worldwide. The use of patient-reported outcome measures and patient-reported experience measures helps to bring the patient voice into high-quality care. Quality management includes planning, control, and improvement. Measurement and audit are important tools to drive up the quality of care. It is imperative that nurses develop cultural competence. Understanding the barriers to high-quality care can help to develop effective interdisciplinary solutions to ensure that patient well-being is preserved.
Anatomy and physiology of the healthy heart
Authors: Lee Geraldine , McKee Gabrielle , Protopapas Andreas , Jones Ian D.
Published: January 2022

A normally functioning heart is essential to create a pressure gradient in the blood vessels that will enable blood flow to the organs. The coronary circulation is adapted to meet the high metabolic needs of the heart because it has a greater blood flow, an extensive capillary network, and greater oxygen extraction than other organs. The heart contains myocardial cells and autorhythmic cells that enable it to conduct electricity and contract, respectively. While the heart possesses its own internal automaticity, its activity is influenced by a combination of factors, the most important of which are neural and hormonal. Heart rate is ordinarily determined by the pacemaker activity of the sinoatrial node, which has the highest intrinsic firing rate of the automaticity cells. The cardiac cycle describes all of the activities of the heart through a single complete heartbeat. The 12-lead electrocardiogram is composed of specific components that reflect the action potential—P wave, QRS complex, and T wave. A 12-lead electrocardiogram should be reviewed in a logical, comprehensive manner examining each of the leads so that rate, rhythm, axis, and any abnormalities can be detected.
Care of the patient with coronary artery disease
Authors: Oriolo Valentino , Cupples Margaret , Angus Neil , Connolly Susan , Astin Felicity
Published: January 2022

Atherosclerosis is a disease of ageing that causes coronary heart disease. Coronary artery disease can manifest as acute or chronic coronary syndromes. Rapid and accurate risk stratification and assessment of patients presenting with chest pain improves patients’ outcomes. There is no single diagnostic test for acute coronary syndromes. Accurate interpretation of the patient’s history and presenting symptoms, electrocardiogram changes, and biomarkers form the foundation of clinical decision-making. Patients and those close to them need emotional support to help them through what can be a life-threatening experience. Tailored information and cardiovascular prevention and rehabilitation are needed to help patients to recover and self-manage their medications and lifestyle to optimize health and well-being. The coronavirus disease 2019 pandemic has necessitated rapid changes in the way cardiovascular services are configured.
Diabetes Mellitus
Authors: Lehmann Roger
Published: January 2022

Diabetes mellitus may present as type 1 (juvenile diabetes) or type 2 diabetes. While the former is due to a lack of insulin secretion, type 2 diabetes is due to insulin resistance and only at later stages reduced insulin secretion. Diabetes is defined as a plasma glucose ≥ 11.1 mmol/L at any time or fasting plasma glucose ≥ 7 mmol/L, or a plasma glucose ≥ 11.1 mmol/L 2 h after 75 g oral glucose or haemoglobin A1c ≥ 6.5%. Type 2 diabetes is one of the major cardiovascular risk factors leading to myocardial infarction, stroke, and premature death. It occurs more frequently with increasing body weight and accordingly, the increasing body weight in the Western population has led to an epidemic of type 2 diabetes. Primarily, it should be treated with lifestyle changes, such as weight reduction, avoidance of high caloric food, and, if not successful, with anti-diabetic drugs. The 2019 ESC Guidelines recommend in diabetes without atherosclerotic cardiovascular disease, primarily metformin and if not successful the addition of a sodium glucose transport type 2 inhibitor or a glucagon-like peptide agonist, while those with atherosclerotic cardiovascular disease should be primarily treated with the latter two drugs that have shown to reduce major cardiovascular events in diabetics.
Cardiovascular Assessment in Athletes
Authors: Sharma Sanjay , Schmied Christian
Published: January 2022

Regular exercise has immense benefit on cardiovascular risk and outcomes of patients with cardiac disease. Importantly, exercise has to be regular and if individuals adhere to it, it reduces adverse cardiovascular events by approximately half and prolongs life by 3–7 years, compared to sedentary individuals. On the other hand, intensive exercise may trigger fatal arrhythmias and cause sudden cardiac death, in particular in those prone to it. The incidence of sudden cardiac death in sport is rare and approximates 1 in 50,000, most commonly occurring in males and recreational athletes of 45–50 years old. The causes involved are cardiomyopathies, anomalous coronary origins, and general opathies. Therefore, young athletes, as well as the elderly, taking up exercise should be assessed cardiologically through history, clinical examination, and 12-lead ECG. In elderly individuals, with a cardiovascular history, assessment of cardiovascular risk factors is important as well. Both groups should be encouraged to exercise regularly, unless cardiovascular risk is markedly increased and requires special management.
Acute Coronary Syndromes
Authors: Guttmann Oliver P. , Binder Ronald , Baumbach Andreas
Published: January 2022

Acute coronary syndromes (ACS) are caused by complete (ST-segment elevation myocardial infarction or STEMI) or sub-total (non-STEMI) occlusion of an epicardial coronary artery, typically with persistent chest pain up to cardiogenic shock and sudden death. The diagnosis is made clinically and by ECG, as well as biomarkers (troponin, creatinine kinase, natriuretic peptides) and eventually coronary angiography. ACS is an emergency and requires rapid diagnosis and risk stratification, and either immediate (STEMI) or rapid (within 24–48 hours for non-STEMI) coronary angiography and commonly primary percutaneous coronary intervention (PCI). Thrombolysis may be an option in centres without primary PCI ability and located at long-distance to PCI centres. Secondary prevention involves dual antiplatelet therapy, lipid-lowering, and control of risk factors, such as hypertension and diabetes.
Takotsubo Syndrome
Authors: Templin Christian , Templin-Ghadri Jelena R. , Lüscher Thomas F.
Published: January 2022

Takotsubo syndrome is named after the octopus trap used by Japanese fisherman and reflects the shape of the left ventricle during systole in patients with this condition. Takotsubo is an acute cardiac syndrome (ACS), starting with chest pain, dyspnoea, ECG changes, sometimes presenting as STEMI or non-STEMI, and in some cases with hypotension, arrhythmias, pump failure, and sudden death. In most patients, the massive left ventricular dysfunction with a reduction in ejection fraction down to 35% is reversible over days, weeks, and months. However, around 4% of patients do not survive the acute condition. The mechanisms are thought to be neurological in nature, involving abnormalities of the amygdala and hippocampus of the mid-brain with over-activation of the sympathetic nervous and endothelin systems, leading to microvascular ischaemia and myocardial stunning. Treatment currently is not evidence-based, but for patients presenting in cardiogenic shock may involve left ventricular assist devices such as ImpelllaR and ECMO (extra corporeal membrane oxygenation), as in apical ballooning inotropes may worsen the condition by creating a pressure gradient across the left ventricular outflow tract.
Acute Aortic Syndrome
Authors: Nienaber Christoph A. , Alkadhi Hatem
Published: January 2022

Acute aortic syndrome encompasses different forms of acute cardiovascular conditions, i.e. aortic dissection, intramural haematoma, limited intimal tear and penetrating aortic ulcerations, often leading to acute haemodynamic deterioration with circulatory shock and high mortality. Risk factors are hypertension, age, and genetic conditions leading to abnormal fibrillin proteins facilitating aortic wall pathologies. Type A dissection starts from the aortic root and extends to the ascending and often descending aorta, while Type B dissections starts in the descending artery and may develop distally down to the iliac or femoral arteries. Risk factors are genetic mutations of pertinent genes leading to Marfan’s syndrome and other connective tissue diseases, hypertension, and bicuspid aortic valves. The diagnosis involves primarily imaging with transoesophageal echocardiography, computer tomography, or magnetic resonance imaging. Therapeutically, Type A dissection is an absolute emergency and requires an immediate operative intervention. Type B dissection, on the other hand, is often treated conservatively with blood pressure control.