bluuebunny/crossref_metadata_2025 huggingface dataset:
Myelitis and peripheral neuropathy
Authors: Samudralwar Rohini , Hasbun Rodrigo
Published: January 2022

This chapter addresses myelitis and peripheral neuropathy, syndromes which complicate many infections. It considers major infectious etiologies of myelitis, peripheral neuropathy, polymorphic syndromes, and neuropathic syndromes seen in human immunodeficiency virus (HIV) infection. Myelitis refers to inflammation of the spinal cord. It may be infectious or noninfectious and primary—directly attacking cord structures—or secondary—adjacent processes altering cord function. Primary myelitis can present as one of three discrete clinical patterns: (1) anterior poliomyelitis, (2) leukomyelitis, or (3) transverse myelitis. This chapter also looks at acute disseminated encephalomyelitis (ADEM). ADEM may be considered as one among a spectrum of similar diseases including transverse myelitis, multiple sclerosis, and neuromyelitis optica.
Infections in patients with neoplastic disease
Authors: Safdar Amar , Armstrong Donald
Published: January 2022

This chapter examines infections in patients with neoplastic disease. Patients with neoplastic disease and suspected infection require several main factors to be considered in their evaluation. These include (1) geographic predisposition for exposure to and to acquire infection including prior colonization with drug-resistant organisms and alteration in hosts' micro-biota; (2) known and unrecognized immune defect or defects due to underlying malignancy or antineoplastic therapy, or both; (3) breakthrough infections due to drug-resistant pathogens in patients receiving antimicrobial chemoprophylaxis, and (4) familial/genetic predisposition to certain infections in the immunocompromised host. The febrile cancer patient may also have fever from noninfectious conditions such as tumor fever or drug fever. After evaluation, the next question is whether to treat empirically.
Intravascular catheter-related infection
Authors: Fares Johny , Malek Alexandre E. , Raad Issam I.
Published: January 2022

This chapter discusses the importance of central venous catheters (CVC) in securing vascular access for fluids, medications, blood products, total parenteral nutrition (TPN), and hemodialysis. It covers central line-associated blood stream infections (CLABSI) as major healthcare-associated infections in high-risk patients. It also mentions the National Healthcare Safety Network (NHSN), which emphasized that CLABSI are associated with a high mortality rate of 12% to 25%. The chapter looks at electron microscopy studies of catheter surfaces and shows how adherent microorganisms can be found in either a free-floating form or a sessile form embedded in a biofilm. It examines the process of adherence that results from intrinsic properties of the catheter, host-derived proteins, and microbial factors.
Bartonella bacilliformis
Authors: Clemente Nuria Sanchez
Published: January 2022

This chapter discusses Bartonella bacilliformis, a gram-negative, facultative intracellular, aerobic coccobacillus and a member of the α‎-proteobacteria group, along with Rickettsia and Brucella. It explains how B. bacilliformis is responsible for a spectrum of diseases, such as bartonellosis, Carrion's disease, Oroya fever, and verruga peruana. Diseases caused by B. bacilliformis are restricted to the Andean cordillera in Peru, Ecuador, and Colombia, with sporadic cases being reported in Bolivia, Chile, and Guatemala. The chapter examines the characteristics of B. bacilliformis's putative principal sandfly vector, Lutzomyia verrucarum, which has a weak, hopping flight and is intolerant of extreme temperatures. Young children under 10 are the most affected age group in communities endemic to B. bacilliformis due to the presumed protective immunity that develops with repeated infection.
Haemophilus
Authors: Spallone Amy , Musher Daniel
Published: January 2022

This chapter examines Haemophilus influenzae, an extracellular, fastidious Gram-negative coccobacillus that commonly colonizes the human upper respiratory tract. Until the early 1980’s, an encapsulated form, H. influenzae type b, was the prevalent recognized pathogen, causing invasive disease such as meningitis or bacteteremic pneumonia; since that time, widespread use of a protein-conjugated capsular polysaccharide vaccine has largely eliminated this organism from the population. Most Haenophilus disease at the present time is due to unencapsulated (nontypeable) isolates which are common causes of respiratory tract infections, including otitis media, sinusitis, bronchitis, and pneumonia. These organisms are generally not invasive, i.e., they are not isolated from blood cultures, but morbidity may still be substantial. In the US, about one-third produce beta-lactamase, which is an important consideration in empiric therapy for disease that might be caused by nontypeable H. influenzae.
Shigella
Authors: Rodríguez-Noriega Eduardo
Published: January 2022

This chapter examines shigellosis, an inflammatory, infectious diarrheal disease that is endemic in children living in high-risk countries. It cites how shigellosis can be acquired by travelers, and the risk of the disease is generally higher among men that have sex with men. It also mentions Shigella spp. as a gram-negative rod that belongs to the Enterobacteriaceae family of bacteria. The chapter looks at the four species of Shigella and different types of Shigella dysenteriae, Shigella flexneri, Shigella boydii, and Shigella sonnei. It emphasizes how humans are the only known natural host of Shigella, and the infection of shigellosis is transmitted via the fecal-oral route from person to person.
Vibrios
Authors: Vugia Duc J.
Published: January 2022

Vibrios are motile, rod-shaped, facultative-anaerobic, gram-negative bacteria that can cause gastroenteritis, wound infection, and septicemia in humans. Vibrios are naturally found in marine, estuarine, and brackish waters in the United States and in other parts of the world and have been isolated from a variety of fish and shellfish, including oysters, clams, mussels, crabs, and shrimp. The chapter summarizes human cases of illness associated with Vibrio infection that occur mostly in summer and fall and usually follow ingestion of raw or undercooked shellfish, particularly oysters, or exposure of a wound to fish, shellfish, or seawater. Over one hundred Vibrio species have been identified, of which about a dozen have caused human illnesses.
Syphilis and other treponematoses
Authors: Seña Arlene C. , Adimora Adaora A.
Published: January 2022

This chapter begins with a discussion on Treponemes, which are members of the family Spirochaetaceae that contains Borrelia and Leptospira. Although most treponemes do not cause disease in human beings, those few that do cause substantial morbidity. It also briefly reviews the clinical manifestations and treatment of syphilis in adults and the nonvenereal treponematoses: yaws, pinta, and bejel. The chapter discusses syphilis, which is primarily transmitted through sexual contact with infectious mucocutaneous lesions in primary and secondary syphilis. It explains the mother-to-child transmission of syphilis that can occur from transfer of the spirochete through the placenta or, less commonly, from contact with infectious exudates or blood through the birth canal.
Ehrlichiosis and anaplasmosis
Authors: Bakken Johan S. , Dumler J. Stephen
Published: January 2022

This chapter considers ehrlichiosis as the collective name for infections caused by obligate intracellular gram-negative bacteria belonging to the genera Ehrlichia, Anaplasma, and Neoehrlichia, family Anaplasmataceae. It covers E. chaffeensis, the agent of human monocytic ehrlichiosis (HME); E. ewingii, the agent of human ewingii ehrlichiosis (HEE); and Anaplasma phagocytophilum, the agent of human granulocytic anaplasmosis (HGA). It also includes the Panola Mountain ehrlichia, an agent phylogenetically similar to E. ruminantium that has caused fever in humans in the United States; E. canis, thought to be limited to canids but recently identified as an agent of human febrile illness in Venezuela; and Candidatus neoehrlichia mikurensis, which has caused severe sepsis-like conditions in Europe.
Pneumocystis jirovecii (carinii)
Authors: Gilroy Shelley A. , Bennett Nicholas J.
Published: January 2022

This chapter cites Pneumocystis jirovecii (PJP), formerly known as Pneumocystis carinii, as an opportunistic pathogen that causes pneumonia in the immunocompromised individual. It explains how the disease caused by PJP occurs when both cellular and humoral immunity are impaired. It also looks at serologic studies that show the worldwide distributions of Pneumocystis and prevalence of antibodies to specific antigens that varies among different geographic regions. The chapter traces how PJP first came to attention when it caused interstitial pneumonia in severely malnourished and premature infants in Central and Eastern Europe during World War II. It describes PJP as one of several life-threatening opportunistic infections in patients with human immunodeficiency virus (HIV) infection worldwide and as the most common AIDS-defining illness in patients with advanced HIV infection.
Hantavirus cardiopulmonary syndrome
Authors: Mertz Gregory
Published: January 2022

This chapter talks about hantavirus cardiopulmonary syndrome (HCPS), which is a viral zoonosis that may result in cardiogenic shock and respiratory failure with significant associated mortality. It discusses hantavirus infection in humans that have been identified throughout much of North, Central, and South America. It also describes hantaviruses as enveloped, single-stranded, negative-strand RNA viruses, in which over 20 New World hantaviruses have been identified since HCPS was first recognized in 1993. The chapter analyzes how cardiopulmonary disease caused by New World hantaviruses differs from the disease with predominant renal manifestations, hemorrhagic fever with renal syndrome, that results from infection with Old World hantaviruses and occurs primarily in Asia and Europe. It mentions New World hantaviruses that include highly pathogenic hantaviruses with high case fatality rates, such as Sin Nombre virus (SNV) and Andes virus (ANDV).
The Brain as a Complex Adaptive System
Authors: Silveira José , Rockman Patricia
Published: January 2022

This chapter introduces complexity and its contribution to objective uncertainty in mental health and addiction. The view of the brain as a complex adaptive system is discussed, and the conceptualization of the mind as emergent from the brain is introduced. Limits that complexity imposes on the accuracy of establishing causation, pattern recognition, and predictions—all three of which are fundamental to clinical practice and the research that informs it—are explained. The pragmatic utility of viewing the brain and mind through a lens of complex adaptive systems is discussed with emphasis on how it makes many sources of clinical uncertainty irreducible.
Diagnostic Errors in Practice
Authors: Silveira José , Rockman Patricia
Published: January 2022

Objective methods of verifying or falsifying diagnoses of mental disorders do not currently exist. Consequently, it is the reliability, completeness, and accuracy of the information gathered in mental health assessments, combined with the “correct” application of the Diagnostic and Statistical Manual of Mental Disorders criteria, that currently determine whether diagnoses are accurate. This chapter discusses diagnostic accuracy and error and how these relate to the nosology. The absence of objective methods of verifying or falsifying diagnoses of mental disorders is linked to diagnostic uncertainty. The limitations of current methods of assessment are examined. The fragility of information sources used in assessment is considered.
Mitigating Diagnostic Error Through Transdiagnostic Approaches
Authors: Silveira José , Rockman Patricia
Published: January 2022

This chapter explores transdiagnostic approaches to patient assessment and how these may help mitigate the negative consequences of diagnostic limitations. The lack of validity and reliability of Diagnostic and Statistical Manual of Mental Disorders diagnoses is explored as a limitation to the confidence clinicians can have in assessment and management. The axiom that accurate diagnosis is critical to effective treatment is discussed in light of the inability to verify such accuracy in mental disorders. How current approaches to mental health assessment and care encourage rapid narrowing of clinical thinking is considered. The way in which traditional diagnostic approaches may be responsible for delays in implementing effective interventions is discussed using the example of bipolar affective disorder.
Accountability
Authors: Witvliet Charlotte V. O. , Peteet John R.
Published: January 2022

Accountability is widely recognized as important in a number of disciplines, yet it has received limited attention in mental health. We propose that accountability to others for fulfilling relational responsibilities facilitates flourishing mental health. Conversely, difficulties in appropriately responding to others with answerability or impairments in self-regulation to carry out relational commitments pose challenges for flourishing. We begin by considering the personality, neurobiological, and developmental aspects of accountability. We then consider the importance of the virtue for clinical practice, professionalism, and growth. Flourishing is likely to emerge not only when people become more autonomous, but also when they develop the capacity of accountability—to seek out and respond well to feedback in order to fulfill responsibilities in relationships.
Equanimity
Authors: Tom Michael R. , Vago David R.
Published: January 2022

Equanimity consists of an accepting and unattached disposition, and it facilitates more rapid physiological and emotional recovery following an acute stressor. Mindfulness and meditation practices, in general, are well-established methods of cultivating equanimity and exposure to such practices has been shown to correlate with self-reported, neuroimaging, and molecular indices of relevant clinical change. For example, mindfulness has been shown to promote equanimity through skills that improve distress tolerance and emotion regulation. Equanimity is valued in a range of cultures, faiths, and psychotherapies. Yet, mindfulness has come to the forefront in third-wave cognitive-behavioral therapies such as dialectical behavior therapy, mindfulness-based cognitive therapy, mentalization-based treatment, and it is also apparent in psychodynamic psychotherapy. Equanimity can also be promoted through psychopharmacology in addition to psychotherapy, as we discuss in several clinical cases. We suggest that equanimity is valuable in a variety of clinical contexts, for both the patient and the psychiatrist.
Compassion
Authors: Gilbert Paul
Published: January 2022

The concept of compassion as a virtue is thousands of years old. The last 20 to 30 years have seen a major growth of scientific research on exploring compassion’s psychological, physiological and social processes. This chapter traces compassion back to its evolutionary roots in child parent caring and attachment systems and explores how “motives to care” evolved to texture many forms of caring behavior. Humans are different from other animals to the extent that we have advanced cognitive competencies that allow for high-level forms of reasoning, self-awareness, and mindfulness. It is when the motivation to care is channeled through these competencies and is wisely and intentionally pursued that caring becomes compassion, and thus a virtue, partly because it can be chosen and cultivated.
50 Studies Every Doctor Should Know
Authors: Hochman Michael E. , Hochman Steven D.
Published: January 2022

50 Studies Every Doctor Should Know provides summaries of landmark studies every clinician should know. The book is divided into eight sections—Preventive Medicine, Internal Medicine, Surgery, Obstetrics, Pediatrics, Radiology, Neurology and Psychiatry, and Systems-Based Practice. Each chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study overview, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Screening for Lung Cancer with Low-Dose Computed Tomography versus Chest Radiography
Authors: White Kathryn
Published: January 2022

This chapter provides a summary of a landmark study in preventive medicine. Is screening for lung cancer with a low-dose CT scan effective? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study overview, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Palliative Care Perspectives
Authors: Hallenbeck James L.
Published: January 2022

This book is intended for clinicians relatively new to palliative care, with an emphasis on topics that are important but too often neglected in formal training. Lay readers, seeking to learn more about chronic and terminal illness, may also find something of value. For both professionals and the lay public, Dr. Hallenbeck takes a narrative approach to explaining palliative care. Why did palliative care evolve in the United States as it did? How did troublesome symptoms such as pain, nausea, and shortness of breath evolve, and how does understanding this assist in symptom management? How might we better understand what aging and dying are all about—both from a nitty-gritty physiological and a more personal/human perspective? Dr. Hallenbeck highlights such an approach to illness with personal stories and anecdotes, drawn from his decades of practice experience. Major topics include an abbreviated history of palliative care in the United States, symptom management, communication skills, system change, burnout, and care at the end of life. While well grounded in the academic literature, the second edition of Palliative Care Perspectives is an introduction to the emerging field of palliative care, presented in a personal and accessible form.
Special Therapeutic Issues
Authors: Hallenbeck James L.
Published: January 2022

This chapter discusses special therapeutic issues in end-of-life care, particularly hydration, nutrition, and antibiotics. Hydration and nutrition are the means of accomplishing the two overt goals of sustaining life through the provision of calories, nutrients, and water and the alleviation of suffering associated with hunger, thirst, and decreased functional status. However, in palliative care, distinctions between life-prolonging and life-enhancing goals are often required because confusion about goals in this area causes a great deal of distress in palliative and end-of-life care. The chapter suggests that the main consideration in using these therapies is whether or not they will be helpful in reaching certain goals.
Improving the System and Making a Difference
Authors: Hallenbeck James L.
Published: January 2022

This chapter discusses proposed interventions to effect significant change and make improvements in the provision of care. Clinicians working in palliative care have a responsibility not just to provide good clinical care but also to improve the overall system of care. It provides a list of suggested activities in different areas of palliative care, including educational initiatives, decision making, and psychosocial and spiritual issues. The chapter calls on all practitioners to play their part in improving the system of care. Suggestions are made for how to improve one’s self-directed learning regarding system change as an aspect of professional development for evolving leaders in palliative care.
Best and Promising Practices in Stigma Reduction
Authors: Stuart Heather
Published: January 2022

This chapter examines six approaches to antistigma programming, moving from broad structural interventions to specific individual-level interventions. Three of these approaches (education, contact, and protest) have been widely discussed in the antistigma literature. This chapter also examines legislative reform, advocacy, and stigma self-management strategies. Stigma reduction is likely to be enhanced when multilayered approaches are created to simultaneously address individual, organizational, cultural, and structural change. When determining what strategy may best disrupt the stigmatization process, it is important to tailor the intervention to the nature of the problem, the needs of the target audience, and the specific outcomes to be achieved. To maximize success, antistigma programs must be based on a plausible theory of change and incorporate methods to systematically monitor program outcomes.
Stigma Reduction for Substance Use and Opioids
Authors: Knaak Stephanie , Stuart Heather
Published: January 2022

Responses to the global substance use and opioid crisis require attention to the problem of stigmatization toward people with opioid use problems. This problem includes policy responses, interpersonal and individual-level stigma, help-seeking behaviors, and other aspects of service organization, delivery, and treatment. This chapter details some of the critical features of programs to reduce stigma for substance use and opioids and presents results from intervention work in Canada. Key features of successful programming, such as tailored programs with flexible delivery, are provided to enable future use of these and similar programs. System-level barriers, including the ongoing criminalization of certain opioids and other substances, harms, service and treatment gaps require prioritized attention. There is also an urgent need to evaluate, understand, and address issues related to punitive or barrier-creating policies and practices.
Dissemination and Implementation Science in Stigma Programs
Authors: Dobson Keith S. , Stuart Heather
Published: January 2022

This chapter begins with a brief review of the major accomplishments in stigma theory, measurement, and intervention that are manifest throughout this volume. It then argues that the field is on the verge of a major transition, to engage in dissemination and implementation studies of evidence-based programs to reduce various forms of stigma. The concepts of development and evaluation, dissemination, and implementation are defined, and examples are provided of how this type of methodology could be used to develop and evaluation programs in diverse cultures and contexts, with different language groups or even diverse subgroups within a given society. A major challenge in this type of research, which is the tenson between fidelity to an existing program and adaptation and flexibility, is discussed, and several directions for future theory development and research are given.
Bad Boys, Bad Men 3rd edition
Authors: Black Donald W.
Published: January 2022

This book describes much of what has been learned about antisocial personality disorder (ASPD) and traces the continuing search for answers. Perhaps the best, most concise definition of ASPD comes from psychiatrists Donald Goodwin and Samuel Guze: “Sociopathy (sociopathic personality or antisocial personality) is a pattern of recurrent antisocial, delinquent, or criminal behavior that begins in early childhood or early adolescence and is manifested by disturbances in many areas of life: family relations, schooling, work, military service, and marriage.” Thus, the diagnosis of ASPD relies on a mental health professional’s ability to uncover this pattern and trace it through a patient’s life. The book explores the possibility that ASPD may be at the root of a substantial amount of the troubles that plague society, and that learning more about the disorder might help in fighting crime, violence, and other social ills. It also highlights how ASPD is more common in men than women.
A Lurking Threat
Authors: Black Donald W.
Published: January 2022

This chapter begins by briefly recounting the author’s early experience with antisocial personality disorder (ASPD) before describing its occurrence throughout society, even when it goes unrecognized. The nature of ASPD implies that it wreaks more havoc on society than most other mental illnesses do, because the disorder primarily involves reactions against the social environment that drag other people into its destructive web. Antisocial criminals are responsible for untold losses and require billions of dollars to police and punish them. Moreover, the despair and anxiety wrought by antisocial persons tragically affect families and communities, leaving deep physical and emotional scars—especially on their children, who often grow up to follow their parents’ difficult paths through life. But the true price of ASPD is expressed in more subtle ways as well, including a diffuse sense of mistrust about the intentions of others. Today’s concerns about crime, corruption, and social cohesion make this a good time to explore ASPD and its role in the social problems we witness.
Searching for Answers
Authors: Black Donald W.
Published: January 2022

This chapter traces the history of antisocial personality disorder (ASPD) as a psychiatric disorder, from the first recorded case studies of antisocial individuals to the development of contemporary standards for diagnosis and the discovery of correlations between ASPD and gender, age, socioeconomic status, and other important risk factors. It also tells the story of Ernie, a man whose lifetime of antisocial behavior underscores the fact that ASPD is a real and destructive psychiatric problem. The term “antisocial personality” was introduced in 1968, with the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II), which gave the condition an identity separate from the addictions and deviant sexuality. Using the contemporary definition of ASPD, a number of studies have shown that it is more likely to be found among certain groups, including men and people living in poverty, even while it crosses cultural, racial, and other boundaries. These findings offer psychiatrists and other mental health professionals additional clues with which to pursue the disorder, both in working with patients and in carrying out research.
Bad Boys to Bad Men
Authors: Black Donald W.
Published: January 2022

This chapter outlines the symptoms of antisocial personality disorder (ASPD), including the link between childhood and adult misbehavior that renders ASPD a lifelong problem. The American Psychiatric Association’s fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) requires that adults diagnosed with ASPD have a history of conduct disorder, even though it may have gone unrecognized at the time. Like ASPD, conduct disorder occurs mainly in boys, many of whom are also diagnosed with attention-deficit/hyperactivity disorder. The DSM-5 criteria for ASPD include failure to conform to social norms, deceitfulness, irritability and aggressiveness, consistent irresponsibility, and lack of remorse. Although antisocial persons can understand the concepts of right and wrong on an intellectual level, they have no emotional connection to commonly held standards of behavior. This conscience deficit underlies ASPD’s range of symptoms. The chapter then looks at the special features that mark the antisocial woman.
Divergent Paths
Authors: Black Donald W.
Published: January 2022

This chapter discusses the course and outcome of antisocial personality disorder (ASPD). It details the stories of two men whose lives bear the startling similarities found across cases of ASPD, but whose stories also show how this disorder can have more than one outcome. As the parents of many antisocial persons would attest, the behaviors that grow into full-fledged ASPD begin early, often before children enter school. Boys who later develop the disorder usually have behavior problems by ages eight to 10, although their mothers may recall serious troubles much earlier. In girls, symptoms may not emerge until puberty. Because misbehavior is common in children, early troubles may be overlooked or explained away as short-term problems, while their true significance goes unrecognized. Research by Sheldon and Eleanor Glueck, Lee Robins, and others show that some adults who commit antisocial acts are continuing a pattern of behavioral problems established in childhood. Some antisocial persons improve, but the reasons are difficult to gauge, making it hard to predict which ones will improve or what will trigger the change. The chapter then looks at the link between ASPD and other mental illnesses.
Antisocial Personality Disorder and Families
Authors: Black Donald W.
Published: January 2022

This chapter provides advice to antisocial persons and families coping with antisocial personality disorder (ASPD). Families of antisocial men and women must come to grips with the disorder and acknowledge that ASPD exists, even when the antisocial relative does not. Although antisocial patients must develop insight and get serious about therapy on their own, having close relatives behind them makes it all the more likely that they will pursue treatment and then stay the course. It is also important for parents to take a stand against antisocial behavior in their children. The chapter then considers the threat of domestic violence. When abuse enters a relationship, the best response is to get out fast. In the end, what happens after an ASPD diagnosis is up to the antisocial themselves. It is thus extremely important to accept the diagnosis, educate oneself, and be patient with therapy.
Street children in Latin America
Authors: Pluck Graham
Published: January 2022

‘Street children in Latin America’ examines the phenomenon of street-connected youth in Latin American countries, in particular, associations with mental illness and substance abuse. Children may be street-connected for many reasons, including being homeless. However, many street children do have family homes to return to, and their unsupervised presence in the urban environment is a consequence of their need to work. Nevertheless, exposure to traumatic events is extremely common among street children, some of which is due to family dysfunction, but also to the vulnerability associated with living or spending long periods in the urban environment. Evidence is limited, but street children in Latin American countries appear to be at high risk of developing post-traumatic stress disorder, depression, and anxiety disorders. Substance abuse is also a considerable problem, further challenging the mental health of street-connected youth. For geographical reasons, cocaine use is particularly associated with street children in Latin America. Inhalant abuse is also problematic, but as with other substances, this may be more associated with homeless street children as compared to domiciled and working children. Overall, street children in Latin America face a great number of challenges and risks to their mental health, most of which are consequences of the various correlates of extreme poverty, including lack of available mental health care, vulnerability to abuse, and family dysfunction.
Dental care when homeless
Authors: Mago Anjali , Brondani Mario A. , MacEntee Michael I.
Published: January 2022

Homelessness contributes hugely to physical and mental illness compounded by substance abuse, malnutrition, trauma, and poverty. Nonetheless, homeless people, like others, believe for the most part that good oral health is a necessary component of general health and well-being, and they are greatly disturbed, indeed angered, when they cannot get appropriate treatment for dental problems. Although they avoid dentists for fear of traumatic, painful, and inappropriate treatments, many willingly and gratefully accept dental services when offered in a culturally sensitive and empathetic environment. It seems that public policy and professional responsibilities in rich and poor societies fully grasp the extent of this health and social problem. The aim of this chapter is to review the relationship between homelessness and personal abuse, finances, mental health and stigma, substance-use disorder, living conditions, and access to dental care. It concludes with a pathway to oral healthcare for homeless and other vulnerable populations, and a list of references supporting the evidence for these relationships.
Depression in homeless
Authors: Maestrelli Luiz Gustavo , Martins da Silva Anderson Sousa , Castaldelli-Maia João Mauricio
Published: January 2022

Homeless people form a very vulnerable group in the population and are subject to a considerable number of clinical pathologies. Similarly, they are more susceptible to psychiatric illness, including depression. According to this review, it is possible to establish that there is a high prevalence of depression in this subpopulation. This is a fact that is reflected in several cities in the world, identifying a global issue. In addition, homeless people also have high suicidal ideation, especially when having depression, further contributing to poor mental health in these individuals. Early diagnosis of depression in homeless people promotes a significant improvement in the health of these individuals. Given the great vulnerability to which the homeless are subjected, the special therapeutic attention they need is evident. The high prevalence of depression also suggests that this group does not have adequate treatment for this condition. The few intervention studies (e.g. ACCESS programme, nursing interventions, mindfulness) reported positive results in reducing depressive symptoms. Therefore, it seems possible to control depression and to increase the quality of life of homeless people affected by depression.
Mental health and post-traumatic stress disorder in homeless migrants
Authors: Idemudia Erhabor Sunday
Published: January 2022

Statistics have shown that there is a high upsurge in the number of migrants worldwide, rising from 173 million in 2000 to 258 million in 2017, with 84% of the world refugee burden on developing countries, contributing to the problem of homelessness which gravely affects the mental health and post-traumatic stress of migrants and refugees. While a considerable body of scholarly and policy research exists on homelessness in general, unfortunately, homelessness among migrants and among refugees have been low areas of concern for social science researchers. Using databases including PubMed, ISI Web, and SCOPUS, current studies indexed mainly from 2014 to 2018 were analysed for this chapter. Categories of studies included were original articles, meta-analyses, monographs, reviews, newspaper articles, and conference presentations. By reviewing recent studies, this chapter demonstrates that homelessness and mental health problems are common in refugees and migrants and are majorly precipitated by pre-migration, mid-migration, and post-migration stressors. The chapter recommends that host countries provide comprehensive mental health services for these vulnerable groups in order to mitigate the exacerbation of psychological disorders.
LGBT homelessness and mental health
Authors: Garcia Marcos Roberto Vieira
Published: January 2022

This chapter presents a review of the literature on homeless lesbian, gay, bisexual, and transgender (LGBT) individuals, especially on youth, a segment that has been the focus of the vast majority of studies on the subject. The relationship between the existence of a large contingent of homeless LGBT youth in several Western countries and the heterosexism and cisgenderism that exist in these societies is discussed. These prejudices are frequently present in the family, school, and work environment and make these people vulnerable concerning homelessness. Next, the difficulties specific to the lives of these young people on the streets, including exposure to multiple forms of violence, survival sex, sex work, and drug abuse, and in institutions for them, which often reproduce heterosexism and cisgenderism in their practices, are discussed. Mental health problems are also analysed: these occur more frequently in this segment than among homeless youth in general or among LGBT youth who have somewhere to live, as a consequence of the social marginalization process to which they are exposed. The specificities of segments within the homeless LGBT youth segment are examined, especially regarding transgender people, along with the intersectionality with race. Lastly, some remarks are made regarding the elements necessary for care practices in institutions that aim to provide care for this segment, with critical reflection on heterosexism, cisgenderism, and systemic racism, along with acceptance of the multiplicity of constructs of subjectivities by these people, thus enabling construction of dialogue-based care responses.
Homelessness among intellectual and developmental disability populations: Implications for practice developments
Authors: Brown Michael J. , McCann Edward
Published: January 2022

While the issue of homelessness is one that is attracting global concern and attention, the situation of people with intellectual and developmental disabilities (IDD) is one that has been the subject of limited attention. As a population, people with IDD often experience stigma and discrimination and are socially marginalized. Additionally, many experience significant health inequalities that directly impact their life expectancy and quality of life. There is clear international evidence that many continue to experience significant barriers when attempting to access care and support with important consequences for their health and social well-being. Many people with IDD have mental health issues and challenging behaviours that can have an impact upon their becoming homeless. Other factors include relationship and family breakdown, and bereavements, with men with IDD having a greater likelihood of becoming homeless. Therefore, there is a need for a sustained policy and service development focus on the specific needs of people with IDD who are at risk of homelessness and those who are homeless, and the services and supports necessary to assist people in exiting homelessness. Further research is also required to develop the evidence base in this area and in particular around the views and experiences of people with IDD who have been homeless.
Homelessness among youth who identify as LGBTQ+
Authors: McCann Edward , Brown Michael J.
Published: January 2022

Homelessness is a growing concern globally, and there is an increasing focus on the impact and implications for youth. In parallel, the topic of lesbian, gay, bisexual, transgender, and questioning plus (LGBTQ+) continues to be an area that attracts interest and debate, ranging from acceptance and equality through to controversies such as intolerance, discrimination, and even death. Furthermore, some youth who identify as LGBTQ+ will experience homelessness and the available statistics indicate that there are as many as 40% LGBTQ+ youth living on the streets, in emergency shelters, or temporary accommodation. While there is increased interest in LGBTQ+ homeless youth, the research evidence remains limited and is an area that requires further development. Therefore, this chapter aims to provide an overview of the evidence, issues, and concerns that lead to homelessness for LGBTQ+ youth. The pathways into homelessness for LGBTQ+ youth will be presented and the factors that may contribute to homelessness. Further, the evidence of the impact and effect of homelessness, the routes out of homelessness, and the interventions and supports required, will also be considered.
Care of the patient with cardiac arrhythmias
Authors: Lee Geraldine , Fålun Nina , Angus Neil , Hendriks Jeroen , Norekvål Tone M. , Berg Selina Kikkenborg , Fitzsimons Donna
Published: January 2022

Cardiac arrhythmia is a common complication of acute coronary syndrome, cardiomyopathy, and inherited cardiac conditions. Other regulatory imbalances such as electrolyte disturbance, thyroid dysfunction, or drug interactions can also predispose to arrhythmias. Patients can be asymptomatic, but in many cases palpitations, dyspnoea, chest pain, or syncope are experienced. Some arrhythmias can be life-threatening and require emergency intervention. Cardiac monitoring and interpretation of the 12-lead electrocardiogram is the cornerstone of diagnosis. There are a variety of therapies, devices, and interventions available to manage arrhythmia. However, the psychosocial impact and lifestyle implications of cardiac arrhythmia can be challenging for patients and their families. Nursing care should focus on education and support to facilitate shared decision-making and adherence to selected therapies.
Arterial Hypertension
Authors: Lüscher Thomas F. , Beuschlein Felix , Sudano Isabella
Published: January 2022

Blood pressure is closely associated with major cardiovascular events, such as myocardial infarction, stroke, and premature death. Hypertension is one of the most important cardiovascular risk factors. The new 2018 ESC Guidelines define ideal blood pressure as <120/80 mmHg; normal blood pressure <120–129/80–84 mmHg and higher levels of blood pressure as high normal and stage 1 to 3 hypertension. More than 95% of hypertension is primary in nature, while a minority of secondary forms of hypertension, mostly treatable conditions, are due to endocrine and renal disease. In hypertension, lowering blood pressure markedly reduces stroke and cardiovascular deaths, and to a lesser degree, myocardial infarction. This can be achieved by anti-hypertensive drugs, i.e. diuretics, calcium antagonists, RAAS inhibitors, beta blockers. More recently renal nerve ablation with radiofrequency and ultrasound energy has been used in resistant hypertension.
Metabolic Syndrome
Authors: Lehmann Roger
Published: January 2022

A diagnosis of metabolic syndrome relies on 3 out of 5 criteria, i.e. (1) central obesity, (2) elevated blood pressure, (3) elevated triglycerides, (4) low HDL cholesterol, and (5) elevated fasting plasma glucose. The most important aspect of the metabolic syndrome is its impact on cardiovascular risk and for the development of type 2 diabetes. Treatment, primarily, focuses on lifestyle changes, i.e. reduced carbohydrate consumption, avoidance of high caloric nutrients, increase in nutrients with high protein content and in particular regular exercise.
Pulmonary Hypertension
Authors: Ulrich Silvia
Published: January 2022

Pulmonary hypertension (PH) can be divided into precapillary, isolated postcapillary, and combined pre- and postcapillary PH. In general, in these patients mean pulmonary arterial pressure is above 20 mmHg, pulmonary artery wedge pressure is below 15 mmHg in precapillary forms, and above 15 mmHg in isolated post-capillary PH. Pulmonary vascular resistance is usually 3 Wood Units or higher in precapillary PH, while in isolated postcapillary PH pulmonary vascular resistance is below 3 Wood Units. Pulmonary arterial hypertension is either idiopathic, hereditary, drug or toxin induced or associated with distinct conditions such as connective tissue diseases, HIV infection, portal hypertension, congenital heart diseases or schistosomiasis. Postcapillary PH is caused by heart failure with reduced ejected fraction (HFrEF), particularly in the context of valvular heart disease or heart failure with preserved ejection fraction (HFpEF). PH may also be due to lung disease, pulmonary artery obstruction, or unclear multifactorial mechanisms. The typical symptom is exertional dyspnoea. Management depends on the underlying cause and may involve specific drugs lowering pulmonary arterial pressure or management of heart failure, depending on patient presentation.
Atrial Tachycardia Including Atrial Flutter
Authors: Guarguagli Silvia , Ernst Sabine
Published: January 2022

Atrial tachycardia (AT) is a regular atrial rhythm at a constant rate of >100 beats per minute originating outside of the sinus node. AT originates exclusively in the atrial substrate (without involving the conduction system) and results from abnormal impulse generation in the atria leading to focal or micro or macro re-entrant AT, the latter also called atrial flutter. Causes involve prior cardiac surgery, atrial remodelling due to heart failure, mitral or tricuspid regurgitation, or stenosis or hypertension. Furthermore, it may occur after catheter ablation, in cardiomyopathies, due to electrolyte imbalance (e.g. hypokalaemia), and due to alcohol, cocaine, and other stimulants. Atrial flutter may require synchronized cardioversion in those haemodynamically unstable or symptomatic despite medications. Alternatively, acute pharmacological cardioversion maybe considered. Catheter ablation is highly effective to prevent recurrences of atrial flutter. Anticoagulation may be considered.
Acute Heart Failure
Authors: Metra Marco , Lüscher Thomas F.
Published: January 2022

Acute heart failure is defined as a rapid onset of worsening of symptoms and/or signs of heart failure such as dyspnoea, orthopnoea, peripheral oedema up to cardiogenic shock, and acute cardiac death. It may be an acute condition, but more commonly a consequence of acute decompensation of chronic heart failure. Acute heart failure is often precipitated by acute myocardial ischaemia, infection, hypertension, arrhythmia, drugs, and toxins, as well as non-compliance with heart failure drugs. The clinical examination reveals peripheral oedema, pulmonary rales, extended jugular veins, third heart sounds, and mitral and/or aortic regurgitation or stenosis. Laboratory findings show elevated levels of natriuretic peptides and often, also, troponins, while chest X-ray reveals pulmonary congestion and echocardiography reduced left ventricular ejection fraction and/or valvular heart disease. The therapeutic strategy differs on whether the patient has congestion or suffers mainly from impaired organ perfusion. As such, patients may be warm and dry, warm and wet, cold and dry, or cold and wet. Depending on these clinical features intravenous vasodilators or vasoconstrictors or diuretics may be the appropriate treatment option. In severe cases, left ventricular assist devices may be considered.
Adults with Congenital Heart Disease (ACHD)
Authors: Diller Gerhard-Paul , Gatzoulis Michael A.
Published: January 2022

Congenital heart disease affects about 1% of human births. Some defects are incompatible with life, if left unrepaired, while others only lead to symptoms in adulthood. Before reconstructive surgery and interventional techniques became available, most children with congenital heart defects died before reaching adulthood, while today over 90% survive. However, these patients are not cured and require lifelong management to prevent and treat heart failure, arrhythmias, pulmonary hypertension, infections, respiratory disease, hepatic and renal dysfunction, as well as symptoms of exercise intolerance and psychosocial problems. Congenital heart disease is divided into low complexity, moderate complexity, and high complexity lesions. The most common complications are atrial and ventricular arrhythmias, heart failure, thrombus formation, and endocarditis among others. Female individuals reaching adulthood need pregnancy counselling, and most of the patients require treatment with cardiovascular drugs, pacemakers, as well as electrophysiological studies with ablation, re-do surgery, and/or structural interventions.
Aortic Stenosis
Authors: Khan Faisal , Windecker Stephan
Published: January 2022

The aortic valve may become dysfunctional due to degenerative, rheumatic, and congenital causes leading to leaflet calcification and, in turn, obstruction of blood flow from the left ventricle into the aorta. Generally, an aortic valve area <1 cm2 is considered severe and is commonly treated with aortic valve replacement (AVR) and trans-arterial valve implantation (TAVI). Most patients with aortic stenosis are elderly and, hence, with the aging population, the prevalence and incidence of aortic stenosis has increased remarkably. Left untreated, aortic stenosis leads to angina pectoris, exercise intolerance, heart failure, arrhythmias, and premature death. Even after surgical AVR or TAVI, outcomes are less favourable then in healthy, age-matched, control populations.