bluuebunny/crossref_metadata_2025 huggingface dataset:
Autonomic Testing
Authors: Novak Peter
Published: April 2019

Autonomic testing is an important addition to neurological evaluations. While there are many excellent textbooks on autonomic disorders, only a few texts focus on how to perform and interpret autonomic tests. This manual fills the gap, dealing mainly with the practical aspects of autonomic testing. In accord with the maxim that “a good picture is worth a thousand words,” signal drawings are heavily used throughout the text to explain and illuminate test results. This book has two parts. The first part describes in detail the Brigham protocol of autonomic tests, which includes cardiovascular tests (deep breathing, Valsalva maneuver, tilt tests), sudomotor assessment (quantitative sudomotor axonal reflex test and electrochemical skin conductance), and skin biopsies for assessment of epidermal and sweat gland small fibers. The cardiovascular tests use heart rate, blood pressure, respiratory parameters (respiratory rate and end tidal CO2), and cerebral blood flow velocity. All tests are graded with an updated quantitative scale for cardiovascular reflex tests and transcranial Doppler—the Quantitative Sudomotor Axon Reflex Test (QASAT)—and small fiber (epidermal sensory and sweat gland) densities from skin biopsies. The second part of the book describes 100 cases covering a variety of autonomic disorders. The cases are thematically grouped into orthostatic intolerance syndromes (neurally mediated syncope, orthostatic hypotension, postural tachycardia syndrome, inappropriate sinus tachycardia, orthostatic cerebral hypoperfusion syndrome, hypocapnic cerebral hypoperfusion, and pseudosyncope), dysautonomia in neurodegenerative disorders, small fiber neuropathies (idiopathic, secondary, inflammatory), and autonomic overactivity. The case descriptions are presented in a consistent format featuring pertinent clinical information, autonomic tests results, interpretation of testing, conclusions, and recommendations.
This text is intended to be a guide for autonomic fellows, and for residents in neurology, general medicine, and other specialties, and for anyone who is interested in performing and interpreting autonomic tests.
Autonomic Tests
Authors: Novak Peter
Published: April 2019

Autonomic tests are focused on the cardiovascular and sudomotor systems. Established cardiovascular reflex function tests are heart rate variability during paced deep breathing, Valsalva maneuver, and tilt test. Transcranial Doppler is essential to assess cerebral vasculature and blood flow regulation to orthostatic stress. Skin biopsy also assesses small sensory and sudomotor fibers. The test results can be graded by a quantitative scale for grading of cardiovascular reflex tests, transcranial Doppler, quantitative sudomotor axon reflex test, and small fiber (epidermal sensory and sweat gland) densities from skin biopsies (QASAT). The QASAT is the validated objective instrument for grading of dysautonomia, related small fiber neuropathy, and cerebral blood flow.
Case 2: Syncope, Neurally Mediated, Mixed
Authors: Novak Peter
Published: April 2019

This chapter describes a characteristic pattern of neurally mediated mixed syncope on the tilt test.
Case 8: Syncope Due to Autonomic Failure
Authors: Novak Peter
Published: April 2019

This chapter describes a characteristic pattern of neurally mediated mixed syncope associated with autonomic failure.
Case 11: Postural Tachycardia Syndrome with Positive Antibodies Against the P/Q-type of Calcium Channel
Authors: Novak Peter
Published: April 2019

Orthostatic symptoms in postural tachycardia syndrome (POTS) (shortness of breath, lightheadedness, fatigue, and others) are due cerebral hypoperfusion associated with reduced cerebral blood flow velocity (CBFv), which is induced by hyperventilation. Immunomodulatory therapy using immune globulins may be effective in small fiber neuropathy with a positive antibody against the P/Q-type calcium channel.
Case 14: Postural Tachycardia Syndrome with Hypermobile Ehlers-Danlos Syndrome
Authors: Novak Peter
Published: April 2019

Postural tachycardia syndrome (POTS), syncope, and small fiber neuropathy is associated with hypermobile Ehlers-Danlos syndrome.
Case 20: Postural Tachycardia Syndrome Versus Syncope with Loss of Vision
Authors: Novak Peter
Published: April 2019

Syncopal reaction can mimic postural tachycardia syndrome.
Case 22: Orthostatic Cerebral Hypoperfusion Syndrome in Anaphylaxis
Authors: Novak Peter
Published: April 2019

Tilt test showed a typical orthostatic cerebral hypoperfusion syndrome (OCHOS). The OCHOS pattern is characterized by reduced orthostatic cerebral blood flow velocity (CBFv) without orthostatic hypotension, tachycardia, or hypocapnia and no evidence of adrenergic autonomic failure.
Case 26: Inappropriate Sinus Tachycardia and Orthostatic Cerebral Hypoperfusion Syndrome
Authors: Novak Peter
Published: April 2019

Autonomic testing is useful to differentiate between postural tachycardia syndrome (POTS) and inappropriate sinus tachycardia. Inappropriate sinus tachycardia and orthostatic cerebral hypoperfusion syndrome may coexist.
Case 27: Inappropriate Sinus Tachycardia Versus Postural Tachycardia Syndrome
Authors: Novak Peter
Published: April 2019

Autonomic testing is useful to differentiate between postural tachycardia syndrome (POTS) and inappropriate sinus tachycardia (IST). IST can be comorbid with orthostatic cerebral hypoperfusion syndrome.
Case 33: Hypocapnic Cerebral Hypoperfusion with Cholinergic Small Fiber Neuropathy
Authors: Novak Peter
Published: April 2019

Patient experienced symptoms of orthostatic intolerance, most likely due to mild cerebral hypoperfusion due to hypocapnic hyperventilation and normal heart rate responses, which is typical for hypocapnic cerebral hypoperfusion (HYCH). In addition, there was significant small fiber cholinergic neuropathy affecting predominantly autonomic fibers, biopsy-proven.
Case 40: Parkinson’s Disease with Compensated Orthostatic Hypotension
Authors: Novak Peter
Published: April 2019

Autonomic failure manifesting as neurogenic orthostatic hypotension and supine hypertension are common manifestations of cardiovascular dysautonomia in Parkinson’s disease. Depending on the cerebral blood flow, neurogenic orthostatic hypotension can be either compensated (with stable orthostatic cerebral blood flow) and noncompensated (with reduced flow).
Case 42: Multiple System Atrophy Versus Parkinson’s Disease?
Authors: Novak Peter
Published: April 2019

This patient showed evidence of mild but widespread autonomic dysfunction. These findings are nonspecific and can be seen in variety of central (α‎-synucleinopathies) and peripheral (autonomic neuropathy/ganglionopathy) disorders. Clinical workup for neuropathy showed elevated acetylcholine ganglionic neuronal antibodies. Immunotherapy with intravenous immunoglobulins for suspected autoimmune autonomic neuropathy was recommended.
Case 51: Small Fiber Neuropathy and Transient Orthostatic Hypotension in Diabetes
Authors: Novak Peter
Published: April 2019

This patient is an example of a typical autonomic failure associated with diabetes mellitus. Autonomic testing showed generalized autonomic failure with orthostatic hypotension and severe small fiber neuropathy affecting both sensory and autonomic fibers.
Case 56: Autoimmune Small Fiber Neuropathy with Positive Ganglionic Acetylcholine Receptor Antibody
Authors: Novak Peter
Published: April 2019

In this patient, autonomic tests were positive for small fiber neuropathy, mixed, length-dependent. Clinical workup was positive for ganglionic acetylcholine receptor antibody. Patient subsequently improved with immunotherapy with intravenous immunoglobulins.
Prevention of HIV and Prevention of Infection in PLWH
Authors: Bartlett John G. , Redfield Robert R. , Pham Paul A.
Published: April 2019

This chapter is about the prevention of HIV and the prevention of opportunistic infections in people living with HIV/AIDs (PLWH). It covers treatment as prevention (TasP), HIV pre-exposure prophylaxis (PrEP) (including indications, initial assessment, and contraindications to PrEP), HIV post-exposure prophylaxis (PEP) (including estimating risk of transmission, timing of PEP initiation, counseling at time of PEP evaluation, and overlap of PEP and PrEP), Mycobacterium tuberculosis (MTB), infections due to bacteria, Treponema pallidum (syphilis), infections due to viruses, human papilloma virus (HPV), influenza A and B, JC polyomavirus (JCV), cryptosporidiosis, mycobacterium avium complex infection, and Pneumocystis jiroveci (formerly Pneumocystis carinii) pneumonia.
HIV in Resource-Limited Settings
Authors: Bartlett John G. , Redfield Robert R. , Pham Paul A.
Published: April 2019

Abstract: This chapter reviews the diagnosis, assessment, testing, and treatment of HIV in resource-limited settings around the world. The chapter covers the current status of the HIV pandemic, diagnosis of HIV (i.e., who to test), HIV testing, HIV diagnostic tests, World Health Organization (WHO) guidelines and treatment recommendations, monitoring ART efficacy and toxicity, treatment and prophylaxis of opportunistic infections and other comorbid conditions, treatment of tuberculosis and cryptococcal meningitis, co-trimoxazole prophylaxis, HIV vaccines, differentiated service delivery models of HIV care, important global trials, and further recommended reading.
Selection of Less-Prevalent Overgrowth Syndromes
Authors: Stevenson Roger E. , Hall Bryan D.
Published: April 2019

In addition to the major generalized overgrowth syndromes described in this text, there is a rich case report literature on less common and less well-defined disorders in which overgrowth has been noted. The latter disorders are described concisely in this chapter. In some cases there have been multiple cases reported and the causative gene or genomic alterations have been identified. Although others are suspected to be genetic or genomic disorders, no specific cause has been implicated. These disorders are sufficiently uncommon that a body of literature has not accumulated and the manifestations are sufficiently variable that most are not clinically recognized. In addition, the chapter takes note of those environmental influences that can produce overgrowth. Maternal diabetes is the most common of the environmental influences that cause overgrowth during fetal life and carries a several-fold increased risk of malformations.
Physics of ultrasound
Authors: Reddi Ben , Fletcher Nick
Published: April 2019

This chapter will describe the ultrasound wave, how it is produced, and what effect body tissues have on it as it passes through the body. It will describe the key principles that underpin image resolution and discuss the importance of the ultrasound pulse. The advanced section will introduce how Doppler ultrasound and aliasing are produced.
Atrial assessment
Authors: Diprose Paul
Published: April 2019

This chapter will describe the important anatomical features of both atria and how these can be identified using two-dimensional echo. It will explain how to recognize atrial dilatation and how to make inferences about atrial pressure from the position of the atrial septum. It will discuss atrial masses, including thrombus and tumour, and other more commonly seen structures that may be misinterpreted as such. The advanced section will introduce atrial volume assessment, as well as how colour Doppler and bubble contrast can be used to recognize midline septal defects.
Mitral valve assessment
Authors: Clark Thomas , Bruemmer-Smith Stefanie
Published: April 2019

This chapter will describe normal and abnormal two-dimensional sonoanatomy of the mitral valve and explain how focused cardiac ultrasound (FoCUS) can be used to screen for haemodynamically significant mitral valve obstruction or regurgitation. It will discuss the acute and adaptive changes that occur with these conditions and explain how to recognize them. The advanced section of this chapter will introduce how colour and spectral Doppler can be used to support the diagnosis in acute/severe disease.
Lung assessment
Authors: Walden Andrew
Published: April 2019

This chapter describes the ultrasound appearances of common pathology involving the lung parenchyma. The features of consolidation and atelectasis are described and differentiated. The alveolar-interstitial syndrome is outlined, and the ultrasound characteristics that allow acute respiratory distress syndrome and cardiogenic pulmonary oedema to be differentiated are listed. The advanced section describes the use of ultrasound to assess diaphragmatic function.
Vascular assessment
Authors: Bigham Colin
Published: April 2019

Ultrasound-guided vascular access requires knowledge of the anatomy and the ultrasound appearances of normal and abnormal vessels in all regions where vascular access may be undertaken. This chapter describes the optimal ultrasound technique for imaging vessels, how to differentiate arteries and veins, and the normal appearances of the jugular, axillary, femoral, and upper and lower limb vessels. The technique for undertaking a lower limb scan to assess for venous thrombosis is outlined.
Cardiac arrest
Authors: Kanaganayagam Gajen Sunthar , Constantine Andrew , Price Susanna
Published: April 2019

This chapter will present how advanced life support-compliant focused cardiac ultrasound can help confirm the cardiac rhythm, diagnose reversible causes, and predict favourable outcomes during cardiopulmonary resuscitation. It will describe how to recognize severe hypovolaemia, cardiac tamponade, coronary artery thrombosis, massive pulmonary embolus, and tension pneumothorax, and when to intervene. It will conclude by introducing how echo can assist clinical management during post-resuscitation care.
Failure to wean from mechanical ventilation
Authors: Walden Andrew
Published: April 2019

Failure to wean from mechanical ventilation is a common problem in intensive care and represents a significant burden in terms of prolonged intensive care stay with associated morbidity and mortality. Ultrasound examination can aid the systematic assessment of the underlying pathophysiology that is often complex and multifactorial. This chapter reviews the role of ultrasound in assessing the contribution of inadequate lung aeration, pleural effusion, and diaphragmatic and cardiac function to weaning failure.
Paracentesis
Authors: Ashton-Cleary David
Published: April 2019

Ultrasound readily identifies ascites and is used to improve the safety and success of performing therapeutic and diagnostic paracentesis, when compared to a technique based on clinical signs. This chapter outlines the indications, preparation, and technique for undertaking ultrasound-guided paracentesis.
Common ECG patterns in the athlete’s heart
Authors: Stein Ricardo , Froelicher Victor
Published: April 2019

Chronic exercise can lead to phenotypic changes in athletes that are directly related to the type, duration, intensity, and years of sport training. The clinical expression can be influenced by the individual’s genetic, gender, humoral, and metabolic factors. Alterations founded in the athlete’s electrocardiogram (ECG) have been considered to be an electrical expression of these adaptations and usually reflect benign remodelling of the heart (athlete’s heart) and autonomic adaptations. In this chapter, we discuss the most prevalent normal features found on the 12-lead ECG of athletes.
Evaluation of ischaemia, blood pressure, QT interval, and arrhythmias
Authors: Schnell Frédéric , Carré François
Published: April 2019

Exercise is a major stress for the cardiovascular system, and therefore many adverse cardiac events can occur during intense exercise. Thus it makes sense to perform maximal exercise testing when assessing an athlete presenting with exertional symptoms, with a known cardiac disease, or for pre-participation evaluation. Nevertheless, the limits of exercise testing must be kept in mind. Exercise testing has a high rate of false-positive results for identifying ischaemia in an asymptomatic athlete. The value of exercise testing in the evaluation of arrhythmias is proved, but the constraints of an exercise test in a laboratory do not reflect those induced on the field. It seems more appropriate to analyse the kinetics of blood pressure (BP) responses during exercise testing rather than to check only the maximal systolic BP. Regular intense training may prolong QTc duration; nevertheless, because of the lack of specific studies on athletes, the same interpretation of QT responses to exercise validated in the general population is used for athletes.
Ambulatory (24-hour Holter monitoring, event recorders) and signal-averaged ECG for arrhythmia registration in the athlete’s heart
Authors: Sareban Mahdi , Niebauer Josef
Published: April 2019

Systematic physical exercise leads to structural, functional, and electrical cardiovascular changes summarized in the term ‘athlete’s heart’. Arrhythmias that are common features in the resting ECG of otherwise healthy athletes may be an expression of the athlete’s heart, but on the other hand may be caused by underlying cardiac pathology, opening up a grey zone of diagnostic uncertainty. Differentiating adaptive changes from pathological cardiac conditions is of great clinical importance because some cardiomyopathies are leading causes of sudden cardiac death in athletes. In addition, there is increasing evidence that excessive endurance training may induce intermittent atrial arrhythmias, which can be hard to detect by resting ECG. Therefore this chapter will highlight 24-hour Holter monitoring, event recorders, and signal-averaged ECGs in the emerging field of ambulatory arrhythmia registration as part of the diagnostic work-up of athlete’s heart.
Hypertrophic cardiomyopathy in athletes
Authors: Malhotra Aneil , Sharma Sanjay
Published: April 2019

The diagnosis of hypertrophic cardiomyopathy can be challenging in the athlete. A morphologically mild phenotype of the condition may mimic physiological left ventricular hypertrophy and requires careful evaluation of the athlete with an array of clinical tools. Correct interpretation of the results in such cases is crucial, as falsely labelling a young athlete with hypertrophic cardiomyopathy could curtail a flourishing career. Conversely, falsely attributing left ventricular hypertrophy to physiological adaptation in an individual with hypertrophic cardiomyopathy can increase their risk of exercise-associated sudden cardiac arrest. This chapter highlights a number of clinical methods that can be utilized to aid the sports physician when assessing such individuals and discusses historical and contemporary literature on hypertrophic cardiomyopathy in athletes.
Less frequent causes of SCD (aortic rupture): non-cardiac causes (asthma, extreme environmental conditions (heat, cold, altitude))—Part 2
Authors: Solberg Erik Ekker , Adami Paolo Emilio
Published: April 2019

It is important to be aware of the clinical features of less frequent causes of SCD in Europe (e.g. commotio cordis and aortic rupture) and non-cardiac causes (e.g. drug abuse, hyperpyrexia, rhabdomyolysis, sickle cell trait, asthma, and extreme environmental conditions). Lay people and health personnel may not understand the mechanisms leading to sudden cardiac arrest and therefore not act properly. This chapter is the second part of this topic and continues to describes these conditions their relation to SCA, and provides advice for prevention and action in actual cases.
Monitoring exercise programmes and improving cardiovascular performance
Authors: Mueller Stephan , Baldassarri Flavia , Schönfeld Julia , Halle Martin
Published: April 2019

Cardiovascular exercise performance is associated with lower morbidity and mortality. In addition to maximal load, heart rate, and peak oxygen consumption, cardiopulmonary exercise testing and lactate analyses can provide relevant information on cardiovascular performance, diagnosis, exercise prescription, and monitoring of exercise programmes based on submaximal parameters. Using submaximal thresholds has the advantage that the prescription and effect of exercise training are directly linked to the underlying energy metabolism and therefore can reveal the specific needs of the individual. There are several methods ofr strength testing that are all based on maximum parameters and should be chosen according to the best-fit principle to the underlying strength training programme. In addition, new media such as wearables, innovative gadgets and telemonitoring have become increasingly popular in recent years and can be used to monitor the exercise training sessions, providing information for evaluation and adjustment of training if necessary.
Nutrition and ergogenic aids prescription for competitive athletes
Authors: Maughan Ronald J. , Shirreffs S.M.
Published: April 2019

Appropriate nutrition support can help sustain an athlete in consistent intensive training without succumbing to chronic fatigue, illness, and injury, and can also help to promote the adaptations in muscle and other tissues that occur in response to the training stimulus. Special strategies before and during competition can be employed to achieve short-term objectives. Energy intake, relative to energy expenditure, will influence body mass and can be modified to influence proportions of lean and fat mass. Carbohydrate and protein recommendations for athletes are extensively researched from a performance and body composition perspective and vary according to many factors, including the size of the athlete, the training load, and their training and competition aims. The available evidence favours a high carbohydrate diet for most athletes in training and prior to competition. Protein recommendations are typically about 2–2.5 times higher than for sedentary individuals: the need to distribute protein intake over the day may be as important as the total intake. Water and electrolyte losses can be significantly increased as a result of sweating, especially in prolonged exercise in hot and humid environments during exercise. Performance will be negatively affected if losses are high and are not replaced. Nutritional supplement use is widespread in the athletic population, although not all supplements are supported by evidence of efficacy or safety.
Electrolyte and acid–base disorders
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

The kidneys are tasked with maintaining electrolyte and acid–base homeostasis. This means that the kidneys adjust urinary excretion, so that the concentrations of the various electrolytes in the plasma are maintained in the normal range. In this chapter, the various electrolyte and acid–base disorders are discussed with an emphasis on the underlying physiological principles. Recognition of these principles is critical, as correct identification of the underlying problem is key to adequate treatment.
Systemic disease affecting the kidney
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

Many systemic diseases affect the kidney. This chapter describes the most common and significant ones.
Renal dysplasia and other manifestations in syndromic diseases
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

Renal abnormalities can occur alone or as part of a syndrome. Many children with chromosomal defects have renal abnormalities.
Hypertension
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

In children, hypertension by definition affects <5% of the paediatric population. In contrast to adults, where hypertension is typically idiopathic, a primary cause is often identified, especially in young children. This chapter reviews the definition and diagnosis of hypertension and the work-up to identify a potentially underlying cause. The latter is critical to instigate appropriate treatment.
Extracorporeal treatment
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

This chapter focuses on all aspects of haemodialysis: the principles, including vascular access; the machine, dialysate, and water; the prescription; complications; assessment of adequacy; and blood-borne viruses. Continuous renal replacement therapy, plasmapheresis, and immunoadsorption are also discussed.
Psychosocial issues
Authors: Rees Lesley , Webb Nicholas J.A , Bockenhauer Detlef , Punaro Marilynn G.
Published: April 2019

In common with many chronic disease populations, children with chronic kidney disease experience high rates of psychosocial problems. Non-adherence with prescribed therapy is a major issue, particularly during the teenage years, and is associated with reduced transplant survival and other adverse outcomes. Many children have multiple co-morbidities and complex ethical issues may arise relating to the commencement of invasive life-prolonging interventions, including dialysis and transplantation. Where a decision is made to discontinue life-sustaining therapy, it is essential that appropriate palliative care is provided.
Health for all children: philosophy and principles
Authors: Emond Alan
Published: April 2019

The first United Nations Sustainable Development Goal is to ‘ensure that all human beings can fulfil their potential in dignity and equality’. Protecting, promoting, and supporting early childhood development is essential to achieve this goal. The foundations of child health and well-being, and of adult health in later life, are laid down in pregnancy and the early years. So this review of evidence takes a life course approach, starting in pregnancy and extending to the age of 7 years, to include transition into school and to cover the ‘early years’.
Promoting infant and child mental health through support for parenting
Authors: Barlow Jane
Published: April 2019

Mental health in the early years is underpinned by the capacity of young children for emotion regulation, and the child’s early relational context (i.e. the parenting that they receive) has been identified as being key to the development of this ability. However, many children show signs of regulatory difficulties including sleeping and crying difficulties, and emotional and behavioural problems in the early years; this is as such an important window of opportunity to intervene to optimize parenting, and prevent early parent–child relationship problems using a range of primary and secondary preventive approaches. This chapter provides an overview of the nature and prevalence of early regulatory problems, and some of the main universal and targeted intervention approaches that have been developed to address such problems, alongside the evidence about their effectiveness in improving outcomes for both parents and children.
Promoting healthy nutrition
Authors: Wright Charlotte M.
Published: April 2019

Key nutritional issues affecting preschool children discussed in this chapter are breastfeeding, complementary feeding, and promoting a healthy diet. The evidence on iron deficiency and vitamin D deficiency is reviewed. Recommendations are made for commissioning of services to support breastfeeding, and evidence-based advice given for practitioners.
Recommended universal components by age across the UK
Authors: Burton Alison
Published: April 2019

Each nation in the UK has a child health programme, based on the principle of proportionate universalism. This chapter covers the common shared themes and principles, and summarizes the four individual programmes and their policy context. An appraisal of the evidence underpinning the programmes is not included.
Conflict, disasters, and humanitarian response
Authors: Orcutt Miriam , Shortall Clare , Abbara Aula
Published: April 2019

With a growing number of people affected by conflict and protracted humanitarian crises worldwide and the increasing frequency of natural disasters, provision of healthcare to the most vulnerable within these populations, especially women and children, is a priority. From 1990 to 2013, almost 217 million people per year were affected by natural disasters and by 2015, at least 60 million people had fled their homes because of conflict and violence, nearly half of them were children. Armed conflict and natural disasters create morbidity and mortality spikes, with children under five being particularly affected. They also lead to mass population displacement and breakdown of health infrastructure; in turn leading to increases in communicable and non-communicable diseases. The current provision of services in these contexts are insufficient and there is increased emphasis on effective inclusion of these areas in the formation of all stages of humanitarian response.
Adolescent sexual and reproductive health
Authors: Mullick Saiqa , Pleaner Melanie , Radebe Mopo , Morroni Chelsea
Published: April 2019

This chapter provides a high level overview of key sexual and reproductive health (SRH) issues in adolescent health with a focus on sub-Saharan Africa. The chapter begins by providing an overview of key targets and definitions relating to adolescent SRH and then goes on to describe the heterogenous nature of SRH needs of adolescents, highlighting their often overlapping and multiple needs as well as challenges and barriers to access. The chapter then provides a synopsis of selected SRH issues, including prevalence and public health relevance, as well as a summary of evidence-based interventions. The chapter ends with controversies and challenges, as well as recommendations for future areas for research. It should be read in conjunction with Chapter 31 on HIV in adolescents.
Adolescent non-communicable diseases
Authors: Pitchforth Jacqueline , Hargreaves Dougal
Published: April 2019

Four non-communicable diseases (NCDs): cardiovascular disease, cancer, diabetes, and chronic respiratory conditions, are responsible for 63% of deaths worldwide. Most of these deaths (86%) occur in low and middle-income countries, where the highest proportion of adolescents live. Four shared behavioural risk factors for NCDs (tobacco use, unhealthy diet, physical inactivity, and harmful use of alcohol) are usually acquired during adolescence and persist throughout life. For example, globally 100,000 young people start smoking each day and over 90% of adults who smoke started during childhood or adolescence. This chapter will explore each of these risk factors, the impact on adolescent health and what steps are being taken to address these problems, as well as the contribution of chronic disease to the NCDs.
Adolescent HIV and infection
Authors: Ferrand Rashida
Published: April 2019

Infectious diseases remain the leading cause of death in adolescents despite the improvements in public health that have occurred in the past decades. While mortality rates from infections are slowly declining in this age group, an exception is HIV, with HIV-related deaths having tripled in the last decade. As with other infections, the risk of acquiring HIV is partly explained by the biological and physical environment. However, the biological changes and the social and behavioural context of adolescence play an important role in determining risk. Notably, infections can result in long-term complications and consequent disability. While effective methods to prevent and treat many common infections do exist, the major challenges are to make these accessible to adolescents, an age-group that is often neglected by health programmes. In addition, adherence to treatment for chronic infections such as HIV, remains a major barrier to ensuring successful outcomes.
Contraception and abortion
Authors: Hall Jennifer
Published: April 2019

This chapter explains how family planning is key to sexual and reproductive health rights and sustainable development and the significant health, economic, and developmental benefits it has at individual, national and global levels. The range of contraceptives available is described and their relative effectiveness discussed to inform contraceptive choices. Abortion remains the major challenge to the realisation of sexual and reproductive rights globally. The consequences of a failure to meet women’s family planning needs, in the form of unsafe abortion is also highlighted. Family planning is highly cost-effective and is unique in the extent of its benefits at individual, household, national, and global levels. Finally, key evidence is summarised to show how family planning services can be better designed to meet women’s needs.
Introduction to newborn health
Authors: Sadoo Samantha , Blencowe Hannah , Oza Shefali , Lawn Joy
Published: April 2019

Since 1990, child and maternal mortality rates have halved worldwide; however, progress for neonatal mortality has been slower and it now accounts for 46% of all child deaths under five. The Sustainable Development Goal (SDG) targets have been set to end preventable neonatal deaths (≤12 neonatal deaths per 1000 livebirths in every country by 2030). Over 80% of all neonatal deaths are caused by direct complications of prematurity, intrapartum-related events, and infection. Over a third of deaths occurring on the day of birth, and targeting care around the time of birth can reduce maternal deaths, stillbirths, and newborn deaths and disability. There is an urgent need to improve data in order to track progress and prioritise programmatic action; currently half of all newborns are not registered at birth, and less than 5% of all neonatal deaths have a death certificate.
Child infection
Authors: Lee Mark , Williams Bhanu , Goenka Anu
Published: April 2019

The significant progress in reducing child deaths in the last thirty years has been driven in large part by reductions in deaths attributable to the commonest infections. Yet still, pneumonia, diarrhoea, and malaria remain the biggest killers and drivers of morbidity in children outside the neonatal period. Key determinants of mortality from childhood infectious diseases include poverty, maternal education, food security, and feeding practices. And although effective evidence-based interventions exist to reduce mortality and morbidity from childhood infectious diseases, their impact has been undermined by inadequacies in implementation. Future approaches will seek to address these issues through an integrated approach to reducing inequality and improving access to interventions such as vaccination, alongside tackling more recent threats such as antimicrobial resistance and emerging infections.
Child injury, maltreatment, and safeguarding
Authors: Debelle Geoff , Li Qingfeng , Devakumar Delan
Published: April 2019

Child maltreatment and intentional injuries are major public health challenges, incurring huge costs for both individuals and society. Violence is an abuse of power comprising acts of commission and omission, and can have lasting consequences for survivors. It includes abuse in the home and collective violence, resulting in children being orphaned or abandoned, forced to become child soldiers, ‘street kids’ or trafficked for domestic work or sexual exploitation. In addition to physical violence, emotional abuse can involve bullying and seeing or hearing the ill treatment of another, such as a child witnessing intimate partner violence. Child maltreatment rates are higher in countries affected by war, famine, social inequality, and economic transition and in communities with marginalised indigenous and disabled groups. Comprehensive interventions, based on child rights principles, are needed that focus on prevention, detection, and intervention.
Strategies to improve child health
Authors: Martineau Fred
Published: April 2019

This chapter analyses key approaches for health practitioners and policymakers to improve child health and wellbeing worldwide. It examines how evidence of what has worked in improving child health to date, namely scaling up key health interventions and improving underlying social determinants, can best address today’s strategic priority: to equitably improve child wellbeing and development as well as survival. It reviews the United Nations’ Global Strategy for Women’s, Children’s, and Adolescents’ Health, analysing how the strategy can best be achieved across the continuum of care within a lifecycle approach. It reviews implementation gaps and priorities in primary health, hospital, and community settings, as well as broader health system and social determinants of child health. The evidence base supporting child development and wellbeing interventions in resource-poor settings emphasises the importance of responsive and nurturing care, the treatment and rehabilitation of disabilities, maternal mental health, and adequate social protection to reduce and protect against poverty.
Taking an epistemological perspective on advocacy
Authors: Grisold Thomas , Lukitsch Oliver
Published: April 2019

Drawing on various definitions of ‘advocacy’, this chapter takes an epistemological perspective on the term. It focuses on patients’ knowledge of personal needs that require advocacy. While patients can be able to articulate knowledge of their needs, they might also lack the ability to express it linguistically. On that account, one can distinguish between (1) explicit, and (2) tacit knowledge. If patients access their personal needs only by way of tacitly knowing them, then this poses a challenge for the advocate. We propose three types of strategies in order to make the patients tacit needs accessible: (i) physician-centred; (ii) patient-centred; and (iii) collaborative strategies. Furthermore, we introduce a framework to guide an advocate through the process from initiating to realizing an advocacy project.
Advocacy, campaigning, lobbying: Good or bad?
Authors: Wasay Mohammad
Published: April 2019

Advocacy is a strong tool to bring about changes and improvements in society. Healthcare advocacy is increasing globally. Objectives of advocacy, formulation of message, and proper analysis of conflicts of opinion and interests are mandatory for designing an advocacy campaign. Both short- and long-term outcomes should be discussed and planned before starting a project. The methodology may be extremely important in defining the outcome of a project. Good or bad advocacy is dependent upon objectives and outcomes of a project. There could be multiple stakeholders relating to an advocacy campaign. Collaboration with stakeholders is a must for any successful campaign but roles should be well-thought out and discussed. This interaction and collaboration is called lobbying. It is an integral part and important component of advocacy. The dangers of advocacy include increased intensity of conflicts and counter-advocacy.
Advocacy in amyotrophic lateral sclerosis
Authors: Ludolph Albert C.
Published: April 2019

Amyotrophic lateral sclerosis (ALS) is among the most severe neurological conditions which leaves the patient in a speechless (deefferentiated) state. Advocacy is yielded to give patients a voice and to recognize patient’s actual preferences and needs. The chapter reviews the most important levels where advocacy is required: the affected families, professionals, the public, and health and science politics. When advocacy is performed in a considerate and thoughtful manner, patient’s coping mechanisms can be activated and quality of life can be secured to facilitate life in dignity; caregiver’s burden can be substantially reduced. For the public and scientific world, advocacy may lead to more efficient therapeutic approaches and allows for patient-centred care.
Advocacy for stroke
Authors: Wijeratne Tissa , Crewther Sheila , Crewther David
Published: April 2019

Stroke advocacy, defined as acting on behalf of stroke victims and families to promote their welfare policies that include education, clinical service development, and translational clinical research, is the key in improving stroke care globally. Stroke is the second commonest cause of death for people over 60 worldwide and is a leading cause of adult disability. It is estimated that each year 16 million people worldwide suffer a stroke, with approximately 6 million dying and another 5 million being left permanently disabled. Recent research also suggests that nearly 90% of all such stroke cases are preventable and treatable if seen rapidly. This chapter discusses the step-by-step effective stroke advocacy in setting up a state-of-the-art stroke service in a less privileged public hospital in Australia followed by stroke advocacy case studies from Canada, Europe, Latin America, Nigeria, and Sri Lanka. Key tips in effective stroke advocacy and nine steps to achieve changes are also discussed.
Nigeria
Authors: Ayinde Olatunde Olayinka , Ogundele Adefolakemi Temitope
Published: April 2019

The burden of dementia and Alzheimer’s disease, the commonest type of dementia in Nigeria, is expected to rise, necessitating adequate health and social systems to meet the challenge. Late presentation for orthodox care is the norm, due to poor public awareness of the disease process and unfavourable cultural beliefs. Orthodox care and psychotropic drugs are available but remain largely inaccessible to the majority of people with dementia. The preferred and predominant care model in late dementia is one within the family, as opposed to institutional care, which is largely unavailable. Family caregivers of the person with dementia are often uninformed, unsupported, and heavily burdened. There is no National Strategy for dementia care, and social security for the elderly is almost non-existent. There is an urgent need for policy formulation and implementation, vigorous advocacy, and awareness creation, as well as adequate social security for the person with dementia and psycho-social interventions for their families and caregivers.
Tunisia
Authors: Ouali Uta , Jomli Rabaa , Zgueb Yosra , Nacef Fethi , Douki Dedieu Saïda
Published: April 2019

This chapter provides an overview of the current situation and the challenges Tunisia faces in the field of dementia care. Tunisia is a country in full demographic transition, witnessing an ageing of its population and an increase in dementia incidence and prevalence. There is growing awareness that the healthcare system needs to be better oriented towards this emerging problem. During the last 10 years, a number of public and private initiatives were implemented to improve diagnosis, treatment, training, and research on dementia. The major challenges facing dementia care in Tunisia include the need for early diagnosis and intervention, better coordination of care circuits, wider implementation of day care and residential care with the concurrent establishment of rigorous quality standards, and financial and psychological support for caregivers. Currently, a National Dementia Strategy is being developed in order to address these challenges. There is growing awareness among politicians and healthcare providers that the healthcare system needs to be more oriented towards the emerging problem of dementia in Tunisia. During the last ten years, a number of public and private institutions with focus on dementia care have been created. However, family members remain the cornerstone of dementia care in Tunisia. Currently, a National Dementia Strategy is being developed in order to address the following challenges: (1) the need for early diagnosis and intervention; (2) better coordination of care circuits; (3) wider implementation of day care and residential care with the concurrent establishment of rigorous quality standards; and (4) financial and psychological support for caregivers.
Japan
Authors: Shindo Yumi , Homma Akira
Published: April 2019

There are two strengths of dementia care services available in Japan. One strength is the creation of the Integrated Community Care System, which aims to provide various services that the elderly might need within their areas of residence. It is the responsibility of local governments to set up the ICCS, because each community has different social resources, as well as differences in the local population and the number of elderly individuals. The other strength lies in the various educational opportunities in dementia available to medical and long-term care professionals. In 2001, the national government introduced educational programmes for care workers in the field of dementia care. In addition, educational programmes for medical doctors, managers of facilities/service centres for people with dementia, medical professionals working in hospitals, pharmacists, and dentists are currently provided under the government’s policies.
Singapore
Authors: Heok Kua Ee , Rawtaer Iris
Published: April 2019

The main caregivers of elderly people with dementia in Singapore are the family. In recent years, community services like day care centres, home care, respite care, and nursing homes have expanded. Non-governmental organizations are actively involved in providing a spectrum of services, ranging from medical, nursing, physiotherapy, occupational therapy, and counselling. General hospitals have set up geriatric and psycho-geriatric teams for dementia patients. There is now a focus on dementia prevention, and a successful prevention programme has been extended to three additional community centres. The challenge ahead is not only having sufficient dementia services, but also ensuring there are sufficient trained health professionals to provide the services. Current strengths in dementia care include strong emphasis on family care, increased availability of dementia community services like day care centres, and increased number of health professionals trained in dementia care. Future priorities include integrating hospital care into the community, keeping down the cost of dementia care, and creating dementia-friendly environments.
Czech Republic
Authors: Holmerová Iva
Published: April 2019

The Czech Republic has a very long history of dementia research, and the findings of Professor Pick and Dr Fischer at the end of the nineteenth and the beginning of the twentieth century, respectively, are worth mentioning. At present, dementia is a topic of increasing importance for health and social care systems in the Czech Republic, and the National Action Plan on Alzheimer´s Disease (NAPAD) was approved by the Government in 2016. It outlines the main challenges in dementia care and also formulates the necessary steps towards improvement in this area, as well as the general principles that are necessary for improving the quality of life of people with dementia and their families. Health and social care systems have undergone substantial changes in the last decades. Despite the many achievements and improvements in both the health and social care systems, there are persistent shortcomings, particularly with regard to their coordination.
United States
Authors: Lunde Angela M , Petersen Ronald C , Lucas John A
Published: April 2019

In the United States, the National Alzheimer’s Project Act was signed into law in January 2011, and the first National Plan appeared just over 12 months later, with five goals: to prevent and effectively treat Alzheimer’s disease by 2025, to enhance care quality and efficiency, to expand support for people with Alzheimer’s disease and their families, to enhance public awareness and engagement, and to improve data to track progress. The National Plan has seen a rise in research funding (currently standing at US$1.4 billion). Individual states, at the same time, began discussions about initiatives aimed at addressing personal, societal, and financial implications of Alzheimer’s disease. An example is from Minnesota where counselling and support for caregivers are provided, with an estimated saving for the state of Minnesota of US$970 million by 2025. In addition, a number of treatment trials are under way, looking at the effect of monoclonal antibodies on Alzheimer’s disease and a series of genetic studies.