bluuebunny/crossref_metadata_2025 huggingface dataset:
Inflammatory bowel disease
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The inflammatory bowel disease (IBD) chapter explores the umbrella term that encompasses Crohn’s disease, ulcerative colitis, indeterminate colitis and microscopic colitis. These diseases are increasing in incidence in the UK and worldwide. Symptoms can be debilitating and may not be curable. Treatment can include medication, diet and surgery but there can be extra-intestinal of IBD. There will be an in-depth focus on Crohn’s disease and ulcerative colitis to explore the definitions, symptoms, causes and incidence of each disease. Investigations for both diseases are then explained. Concise explorations on the issues related to inflammatory bowel disease, particularly ulcerative colitis and Crohn’s disease can be used within clinical environment by the nurse.
Paediatric gastrointestinal care
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The paediatric gastrointestinal care chapter explores problems with the gastrointestinal tract with a focus on paediatric care. Commonly seen conditions in babies and children are described with the more frequently presenting symptoms listed for the nurse. The occurrence rates of these paediatric conditions are defined and any potential causes described. The investigations that are used to diagnose the condition are explored. Treatment options are also explored with a description of any potential complications. Issues include congenital anomalies, such as imperforate anus, also termed anorectal atresia, when a baby is born without a formed anus. Other gastrointestinal diseases that can affect children include duplication cysts, Hirschsprung’s disease, malrotation, and volvulus. Developmental issues, such as childhood toilet training, are also explored within this chapter. Succinct explorations on the issues related to children and infants can be undertaken within clinical practice by the nurse.
A psychosocial approach to working with victims of trafficking with means of sexual exploitation
Authors: Alves Catarina , Gordillo Nadia Morales
Published: February 2021

In recent years research about the mental health consequences of human trafficking has increased as the revelation of cases became more common in the media and were more present in social and mental health services. Also called twenty-first-century slavery, human trafficking for sexual exploitation can be understood as a generic term for a series of complex phenomena that cover a broad spectrum of issues, such as globalization, migration, and gender inequality, combined with a series of personal experiences, which include several forms of violence and abuse (mainly interpersonal, psychological, physical, and sexual violence). In this chapter we explore the main symptoms of mental health distress in victims of human trafficking for sexual exploitation, as well as some of the cultural determinants for the expression of this distress. Further, we elaborate some of the professional competences a mental health professional should apply, as we discuss the specific idiosyncrasies of the treatment of a victim of trafficking. Finally, we suggest a multidisciplinary intervention with a strong presence of the mental health professional and some of the strategies that both research and our own practice reveal to have been effective in the treatment and recovery of victims of human trafficking for sexual exploitation.
Internal migration
Authors: Raghuraman Bharathram Sathur , Chaturvedi Santosh
Published: February 2021

This chapter reviews existing literature on the statistics of internal migration spanning across all the continents of the world to better understand the gigantic nature of this constantly occurring phenomenon especially in low- and middle-income countries. The chapter also focuses on the impact of internal migration on health by reviewing literature on phenomenon such as the ‘healthy migrant’. The possible implications of internal migration on mental health are detailed, including possible hypotheses underpinning the development of mental health issues in migrants and the chapter briefly reviews the possible resilient protective factors in migrants. Various studies on the impact of internal migration on the prevalence of common and severe mental illnesses from across the world are discussed in the text. The chapter ends with a section reviewing the existing literature on the problems faced by internal migrants in terms of availability and accessibility to quality health care and the need for macro-level healthcare reforms especially in developing nations such as India.
Refugees and asylum seekers
Authors: Craig Tom K.J.
Published: February 2021

The number of people displaced from their homes as the result of war, civil unrest, and persecution worldwide is now at the highest level on record. Around a fifth make it to affluent Western nations, prompting a marked rise in tension and in efforts to stem the tide by tightening quotas, clamping down on ‘illegals’, and erecting physical barriers. Given the traumas that drive people to flee their homes and the struggles many face in resettlement, it is hardly surprising that there is a high prevalence of mental health problems. While these conditions can be successfully treated using methods known to be effective in non-migrants, the interventions typically rely on expert therapists delivering a Westernized model of therapy. More research is needed to develop and test effective interventions that could be delivered by a much broader workforce, including those in the developing countries where the majority of refugees remain.
Refugee and asylum seekers’ experiences
Authors: Tribe Rachel , Jalonen Angelina
Published: February 2021

This chapter reviews the socio-political environment and legal factors that provide the context and influence the lived experience of many refugees and asylum seekers. These factors are considered in relation to flight, arrival, and settlement in a new country. How these contextual factors may impact upon refugees and asylum seekers, their sense of identity, and mental health will be reviewed. The chapter reflects upon the possible challenges faced by many refugees and asylum seekers, as well as arguing that the strengths, resilience, and coping strategies that many asylum seekers and refugees exhibit need to be adequately considered by clinicians, if a meaningful service is to be provided. The importance of clinicians being culturally curious and listening to service users’ meaning-making is vital. An overview of some other issues that clinicians may need to consider is provided. The chapter contains a number of case studies to illustrate the related issues.
Community-based mental health care and narrative exposure therapy
Authors: Pottie Kevin , Kassam Azaad , Gruner Douglas
Published: February 2021

Global mental health explores cultural differences and country-specific conditions, it deals with the epidemiology of mental disorders in different countries, their treatment options, mental health education, the structure of mental health care systems, and human rights issues. Specifically, this chapter focuses on community-based mental health approaches to trauma-related illness in refugees and related comorbidities. We develop an argument for shared mental health care, enhanced psychoeducation and other training for primary care practitioners working with refugees. We discuss cultural safety, trauma-informed care approaches, and narrative exposure therapy. We provide examples of these approaches and therapies, and explore how a narrative approach may provide an opportunity to involve students and primary care practitioners in more nuanced communication and care of refugees and other migrants.
Migrant acculturation and adaptation
Authors: Berry John W.
Published: February 2021

The migration of peoples around the world has initiated the process of acculturation. This phenomenon includes changes at both cultural (group) and psychological (individual) levels. Acculturation takes place in various ways, including integration, assimilation, separation, and marginalization. The process results in various forms of adaptation, including psychological, sociocultural, and intercultural. The conceptual and empirical relationships between how acculturation takes place, and how well people adapt, are reviewed. International studies of immigrants’ acculturation strategies and their adaptation reveal a general pattern: those who acculturate using the integration strategy, being engaged in both their heritage culture and in the society of settlement, achieve higher levels of adaptation. Implications of these findings for the development of public policy and practice are discussed.
Cultural bereavement, cultural congruity, and identities
Authors: Watson Cameron , Ventriglio Antonio , Bhugra Dinesh
Published: February 2021

Acculturation and cultural identity are influenced by a number of factors. The concepts of cultural consonance and cultural congruity may need to be taken into account in clinical settings to ensure that clinicians are aware of cultural variations. Cultural consonance is related to the observations that culture is both in the individual and in the group the individual belongs to. Culture congruity is the process of understanding whether the individual living with other members of their culture carry similar dimensions of culture. The likelihood of culture conflict within the same culture and across the majority culture needs to be taken into account while assessing individuals. Personality factors will also play a role in the development of various psychiatric disorders, as will cultural dimensions and cultures within which individuals live, work, play, and age in.
Intercultural mediation in mental health care
Authors: Qureshi Adil , Ananyeva Olga , Collazos Francisco
Published: February 2021

As healthcare systems are challenged to respond to the linguistic and cultural diversity that accompanies migrations, a common response is the deployment of the figure of the ‘intercultural mediator’ (ICM). This chapter will explore some of the key issues related to intercultural mediation that complicate the ICM being an effective component of interculturally competent mental health care. We provide a background of the rationale for the existence of the ICM and outline some of the serious factors, both conceptual and practical, which complicate matters, and explore the specific role possibilities for effective functioning in mental health care settings.
Post-traumatic stress disorder in refugee and migrant mental health
Authors: Andermann Lisa , Kanagaratnam Pushpa , Wondimagegn Dawit , Pain Clare
Published: February 2021

Refugees and migrants may encounter a variety of traumatic events, from the pre-migration to the post-migration phases of their journeys to safety, having fled conflict, war, human rights violations, and other life-threatening situations. These stressful and frightening events and their psychological sequelae can then adversely affect the refugees’ subsequent adjustment in their host countries and sometimes have longstanding mental health impacts. Post-traumatic stress disorder (PTSD) is only one of the outcomes following a trauma; however, it is important to discuss this concept in refugee and migrants because most PTSD guidelines were derived for mainstream populations. There have been concerns about the medicalization of suffering, and the exportation of a Western model of psychiatric diagnosis and treatment to non-Western populations. This chapter will review the concept of PTSD as a psychiatric diagnosis often associated with migrants and refugees, with acknowledgement of its history, prevalence, applicability to non-Western populations, and limitations in both diagnosis and management. The concept of ‘distress versus disorder’ will be discussed, as well as tracing back to the origins of PTSD and looking at issues of validity, culture, and phenomenology. Principles of management will be reviewed. The chapter will conclude with a section on resilience and post-traumatic growth.
Oxygen pulse
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter outlines how dividing the volume of oxygen uptake (VO2) by the pulse rate gives an estimate of the stroke volume of the heart. The amount of oxygen taken up with each heartbeat is called the oxygen pulse (O2 pulse). It should increase steadily on exercise to a value above 10 ml/beat and may continue to rise during the recovery phase. A low O2 pulse can be an indicator of low cardiac output. If the maximum VO2 (VO2max) is normal, caution should be used in the interpretation of a low O2 pulse. Sometimes the O2 pulse is abnormal because of a fall in peripheral arterial oxygen saturation (SpO2) or mixed venous oxygen levels.
Ventilatory equivalents
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter shows how dividing the minute ventilation (VE) by the volume of carbon dioxide exhaled, or the volume of oxygen taken up, gives the ventilatory equivalents (VeqCO2 or VeqO2, respectively). VeqCO2 show how much ventilation is needed to get a given volume of carbon dioxide out of the body. In a normal subject, the VeqCO2 fall gradually during exercise, as ventilation–perfusion matching improves, to a value of <30. In lung disease, the lowest value remains >30. Beyond the anaerobic threshold (AT), VE increases in order to get rid of CO2 produced from buffering of lactic acid. Since there is no corresponding increase in VO2, the VeqO2 start to rise, giving one of several ways of looking at the AT.
Presentation of results
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter explains how a combination of tables and graphs are needed to analyse a cardiopulmonary exercise test, and how to navigate through them. The nine-panel display is the most common format, but a series of four-panel plots are sometimes used. Much of the most useful information can be presented in a single four-panel plot. The steps of the ABCDEF approach are as follows: Accurate—are the test results valid? Best—did the subject push themselves? Capacity—is exercise capacity impaired? Detect—what limited exercise? Extra value—is there any other useful information which can add value to the report? Finish—review all the graphs again before concluding.
Exercise prescription
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter outlines the health benefits of exercise. A cardiopulmonary exercise test (CPET) can reassure the subject that exercise is safe for them. Exercise can be prescribed using heart rate zones derived from the CPET. Exercise should be taken for at least 30 minutes each day, or more intense exercise for 20 minutes three times per week. A common daily target for steps is 10,000.
The role of religion in suicide prevention
Authors: Praag Herman M. van
Published: February 2021

Studies show that if religiosity is experienced as a source of hope and confidence, it reduces the risk of depression in times of mounting stress, facilitates recovery, and diminishes suicide risk. Religiosity experienced as a source of guilt and fear probably has the opposite effects. Social bonding and confidence in God are a modus operandi. The psychiatrist cannot and should not ignore or reject religion, irrespective of personal beliefs. In the interest of the evolution of the practice and for the best of their patients, psychiatrists need to reorient towards matters of spirituality, religion, and meaning. Taking into account the present state of the discipline, the data on religion and suicide are relatively scarce. The role religion can play in suicide prevention is discussed throughout this chapter.
Suicide in the Jewish scriptures
Authors: Rabinowitz Aron , Orbach Israel
Published: February 2021

The Jewish scriptures and the commentaries of the scriptures throughout history present a very complex approach towards suicide. There is a categorical prohibition against suicide, but also an obligation to submit to death when there is an external coercion to transgress Jewish laws that pertain to the essence of the faith. Talmudic sages have shown a psychological and empathic understanding of the suicidal state of mind, but they have harshly condemned suicide and punished it by omissions of certain religious rituals for the dead. Yet, Jewish law defines suicide in a very minimalistic way, so it is very rare that a death is defined as a suicide. Inherent in this approach is the attempt to avoid further suffering by the family, to show respect for the frailty of the human being, but at the same time, to condemn self-destructive behaviour.
Suicide and Islam
Authors: Okasha Ahmed , Okasha Tarek
Published: February 2021

The historical and philosophical aspects of suicide in Islam, as well as the influences of Islamic culture on the phenomena of suicide and attempted suicide are discussed, focusing chiefly on attitudes in Egypt. All studies show that suicide is less prevalent in Islamic societies compared to countries associated with other religions. Here, the reasons for suicide in different Islamic and Arabic countries are evaluated in relation to the sociocultural context. The cognitive schemata of Muslims follow the phrases of the Koran that humans were created for the main reason of worshipping God, and that life and death issues should be controlled by God and not by self-destruction. This faith can be a factor in preventing suicide attempts, especially in those practising their religious rituals. The phenomenology of psychiatric disorders in Islamic culture is characterized and dominated in its content, whether hallucinations or delusions by religious themes.
Development of definitions of suicidal behaviours
Authors: Bertolote José M. , Wasserman Danuta
Published: February 2021

This chapter covers definitions of suicidal behaviours and how they vary over time, reflecting predominant philosophies and schools of thought. The limitations in the quality of information about suicide mortality, as a common feature affecting the whole vital registration system, are discussed. The smaller the coverage a country receives, the greater the probability of distortions, which adds to any previous distortions already flawing the data. It should be strongly emphasized that these shortcomings affect the system as a whole, and hence all causes of death. However, suicidologists seem to be much more punctilious about under-reporting of suicide, and the essential unreliability of this information, than experts dealing with mortality from other causes. Coordinated efforts should be made to strengthen those systems, paying attention to the specificity of sociocultural factors’ influence on defining, recording, and reporting suicide as a cause of death.
A global perspective on suicides and suicide attempts
Authors: Paul Elise
Published: February 2021

Specific populations at risk for suicide differ considerably according to region, country, sex, age, and the most common suicide methods used, highlighting the need for ongoing systematic surveillance to inform prevention efforts. The magnitude of the problem is not limited to suicide deaths. It is estimated that for every suicide, there are 20 more persons who have made an attempt. Individuals who have made a suicide attempt are at increased risk for dying by suicide. This chapter explores differences in the suicide and suicide attempt rates in the general population on different continents, by examining data from the World Health Organization (WHO) Global Health Estimates and the World Mental Health Survey Initiative. Differences across contexts in suicidal behaviours and the need for ongoing monitoring are emphasized.
Suicide attempts with a focus on Europe
Authors: Björkenstam Emma , Mittendorfer-Rutz Ellenor , Schmidtke Armin
Published: February 2021

The comparison of international statistics on suicide attempts across European countries is challenged by differences in definitions and the lack of compulsory registration. Among studies, the WHO/EURO multicentre study on parasuicide provided comprehensive data on both the occurrence and background factors of suicide attempts in different European countries. Besides the WHO/EURO study, this text summarizes findings from other clinical and community surveys as well as nationwide register data. Additionally, data about the relationship between different components of the suicidal spectrum by examining the WHO Multisite Intervention Study on Suicidal Behaviours (SUPRE-MISS) is presented. Peculiarities of the inter-European variation in patterns and trends of the phenomenon and various social and psychiatric determinants are also described. The WHO/EURO study was continued as the MONSUE (monitoring suicidal behaviour in Europe) study, which supplied even more detailed data on specific risk groups. These can then be supported by tailor-made suicide prevention strategies.
Extended suicide
Authors: Lester David
Published: February 2021

Analyses of individuals choosing to die in suicide pacts and by groups of people in mass suicides are presented. Those involved appear to differ demographically and psychologically from suicides acting alone. In addition, examples of murderers who died by suicide after killing are presented, including mass murderers who have a high suicide rate and serial killers who have a much lower suicide rate than do mass murderers. In other cases, individuals chose suicide after murdering family members, sometimes in mercy killings but often after murdering family members. Today people appear to want company in death, and why suicide pacts, even between strangers, are becoming more common. Suicide is increasingly moving from being a solitary act to becoming a social behaviour.
Adjustment disorder and suicide in adult and youth population
Authors: Frenk Mira Levis , Apter Alan
Published: February 2021

This chapter outlines adjustment disorder (AD) as a psychiatric determinant of suicide and suicidality. AD appears to be highly correlated to suicidality. The role of stress in suicide has been investigated extensively and there is an extensive amount of research in this area encompassing a wide variety of theoretical paradigms including sociology, endocrinology, genetics, and psychology. Nevertheless, since the topic of stress and suicide is too vast to be tackled here, this chapter will limit itself to the nosological entity of AD as adapted in the fifth edition of the Diagnostic and Statistical Manual (DSM-5) and the eleventh International Classification of Disease (ICD-11). A review of the diagnostic category, including its definition, clinical presentation, and aetiology is given, followed by a summary of the epidemiological literature.
Neuroimaging of suicidal behaviour
Authors: Sudol Katherin , Oquendo Maria A.
Published: February 2021

To understand suicidal behaviour and how to prevent it we must appreciate its neurobiological substrates. Neuroimaging provides an in vivo structural, functional, and molecular snapshot of the suicidal brain. Over the past decade, the use of neuroimaging techniques in studying suicidal behaviour has gained momentum, with a notable expansion in structural approaches as well as molecular and functional techniques. Findings from these studies point towards structural and functional changes in the fronto-temporo-limbic circuitry of suicide attempters that affect areas associated with decision-making, cognitive control, and emotion processing. Although these results show promise, direct comparison between studies is often challenging due to methodological inconsistencies between studies. A focus on more uniform, goal-directed methodology with a prospective component can aid future comparisons, and further our understanding of the neural underpinnings of suicidal behaviour.
Early detection and management of suicidal patients in primary care
Authors: Rihmer Zoltán , Rutz Wolfgang
Published: February 2021

Although suicidal behaviour is a relatively rare event in society in general, it is very common among psychiatric patients who contact their general practitioners (GP) before the suicide event. The most common current psychiatric diagnosis among suicide victims and attempters is major depressive episodes. The current prevalence of major depressive episodes in GP practice is around 10%, but around half of these cases are not recognized and treated adequately by GPs. Successful acute and long-term treatment of depression significantly reduces the risk of suicidal behaviour. Given that more than half of all suicide victims contact their GPs within four weeks before their death, GPs play an important role in early detection and management of suicide risk. Several large-scale community studies and multilevel intervention programmes show that these activities improve the identification and treatment of depression and reduce the frequency of suicidal behaviour.
Clinicians after the suicide of their patients
Authors: Grad Onja T.
Published: February 2021

Emotional turmoil, disruption, shock, post-traumatic stress disorder (PTSD), doubts in own competences as a professional: these are only few of many feelings and reactions that clinicians might experience when faced with the fact that patients they had treated took their lives. The range of reactions can span from none, which is rare, to severe disorders, and can sometimes result in more precautious treatment of future patients, or even in leaving the field of working with suicidal patients. How clinicians respond depends on many factors, such as the length and intensity of the treatment, the understanding of patients’ suicide, the knowledge and past experiences the clinicians have as well as the response of the patients’ family, and the response and support of the colleagues and the institution in which the treatment took place. Some of these factors can help—while others can hinder—the process of overcoming the traumatic event of patients’ suicide.
The role of the internet in suicide prevention from the public health perspective
Authors: Westerlund Michael , Krysinska Karolina
Published: February 2021

An overview of research on suicide and the internet, as well as the practical applications of online interventions in suicide prevention efforts is given. The text presents how much material about suicide is available online and what are the contents, with a special focus on pro-suicide and harmful online material and communication, and how people at risk of suicide use the internet. The topic of advantages and dangers of suicide-related material available on social media platforms will be covered. The range and effectiveness of online and web-based crisis interventions are discussed, along with support available online for people bereaved by suicide. The text also presents existing efforts on regulation and legislation in relation to suicide-related websites and content.
The World Health Organization’s (WHO) role in suicide prevention
Authors: Wasserman Danuta
Published: February 2021

The World Health Organization (WHO)—a specialized agency of the United Nations (UN)—is a global organization that stimulates international action on global health issues, with the ultimate goal of having the highest possible level of health attained by all people. In 1993, the UN and WHO International Expert Meeting on Guidelines for the Formulation and Implementation of Comprehensive National Strategies for the Prevention of Suicidal Behaviour was held, which resulted in a set of guidelines that encourage national suicide prevention strategies. Moreover, suicide prevention became a global health priority and was integrated into the WHO Mental Health Action Plan 2013–2020. This text will discuss the WHO’s key roles in suicide prevention, such as: establishing international and interdisciplinary partnerships; collecting, compiling, and disseminating essential information; providing sound, clear, and reliable guidance; and establishing effective, cost-effective, and innovative services for suicide prevention.
The International Academy of Suicide Research (IASR)
Authors: Wasserman Danuta , John Mann J.
Published: February 2021

The International Academy of Suicide Research (IASR) was founded in 1990 with the intention of decreasing suicide mortality by creating a network of the foremost academics in the field of suicidology. Promoting and increasing research on the psychopathological, cognitive and biological characteristics of suicidal individuals and conduct of controlled trials to test suicide prevention methods were goals that sought to improve suicide prevention. Given the small number of such academics in each country, bring the best experts and their findings together, comparing results across nations, cultures and ethnic groups facilitates identifying identify which components of an intervention are effective, and improving strategies for future suicide-preventive programmes. Here, the history, goals and efforts of the IASR are described to guide future international research efforts.
The International Association for Suicide Prevention (IASP)
Authors: Mehlum Lars , Arensman Ella
Published: February 2021

Founded in Vienna in 1960 by Erwin Ringel, the International Association for Suicide Prevention (IASP) aims to prevent suicidal behaviour, to alleviate its effects, and to provide a forum for academicians, mental health professionals, crisis workers, volunteers, and suicide survivors. The leading international organization concerned with suicide prevention, is in official relations with the World Health Organization (WHO), and acts as an umbrella organization embracing members from nearly 50 national and international organizations on all continents. IASP provides several forums for interchange of experience and knowledge such as the scientific journal Crisis, a news bulletin, a multilanguage website, international and regional scientific meetings, and several special interest groups and task forces. IASP awards several prestigious prizes biennially to researchers and champions of suicide prevention. To increase public awareness of the problem of suicide, and the need for preventive measures, the IASP annually promotes ‘The World Suicide Prevention Day’.
Narrative ethics
Authors: Martinez Richard , Candilis Philip
Published: February 2021

Narrative ethics developed as a critique of analytic moral philosophy and the principles that shaped early developments in healthcare’s bioethics movement. It resulted in a method for understanding health care ethical dilemmas at the level of individual cases. This chapter reviews the various moral theories preceding narrative ethics, then provides a description of the narrative approach that places emphasis on the telling and listening to the patient’s story as a path toward moral reflection when patient and health care professional join on the occasion of the patient’s illness experience. Two cases illustrate the potential for narrative ethics to enrich the care of persons facing difficult emotional and psychological challenges, one a story of end-of-life decision-making, the other a case involving trauma and depression.
Psychiatric diagnosis
Authors: Laney Michael , Sadler John Z.
Published: February 2021

Prior discussions of ethics in psychiatric diagnosis have focused on the development of classifications of psychopathology and the social features and implications of the use of psychiatric diagnostic categories. This chapter focuses instead on the ethics and values involved in the conduct of psychiatric diagnostic assessment ethics in the practice of diagnosing in mental health. The authors build an account of ethics of diagnostic practice using virtue epistemology theory, undergirded by Pellegrino’s account of medical morality as helping, healing, caring, and curing. The authors develop a set of diagnostic virtues (receptivity, empathy, inquisitiveness, self-knowledge, rigour, resolve, fallibilism, fecundity, practical wisdom, and faithfulness) and apply them to an illustrative case scenario.
Allocation of mental health resources
Authors: Sabin James E. , Daniels Norman
Published: February 2021

Resource allocation in mental health occurs at four levels. First, within the total allocation a society makes to health care, how much should go to mental health? In most societies, mental health services have been discriminated against. The quest for parity with medical and surgical services reflects the effort to undo this discrimination. In the Oregon priority-setting process, mental health conditions ranked high among community choices. Second, within the mental health sector, which conditions should receive priority? Some priority should be given to those with the most severe impairments, but no principles tell us just how much priority the sickest should receive. Third, within a particular area, such as schizophrenia, how much resource should be devoted to prevention, treatment of acute episodes, or rehabilitation of those with chronic conditions? Finally, in the care of individual patients, how much treatment is ‘enough’? Where and how is the line drawn between interventions regarded as ‘medically necessary’ versus interventions that are desirable but ‘optional’? In the absence of shared principles for making these allocational decisions, societies must establish fair decision-making processes, in which the rationales for policies and decisions are shared with the public, the rationales address meeting population needs in the context of available resources, and a robust appeals process allows patients, families, and clinicians to challenge decisions and policies. Because societies will develop their own distinctive approaches to resource allocation, progress requires looking at the allocation process in an international context.
Suicide
Authors: Bloch Sidney , Heyd David
Published: February 2021

Beyond the clinical difficulties in treating suicidal patients, suicide is a unique ethical challenge to psychiatrists. For unlike therapy in which patients and doctors share the desirability of the treatment’s goal, suicidal patients and doctors diverge in the way they consider the value of life as such. This makes the traditional standards of informed consent, beneficence, and the ‘do not harm’ principle hard to apply. After shortly outlining the history of the philosophical attitude towards suicide, including its ‘medicalization’ in modern times, the article tackles the problem of intervention in preventing suicidal behaviour, by examining four clinical cases that are distinguished by the intention of the patient, the effectiveness of treatment, and the rationality of the motive. The following section then addresses the heated debate on physician-assisted death, which is more controversial than suicide prevention. Two real-life cases, Bouvia and Chabot, are discussed in detail. Finally, the article focuses on the unique ethical features of research of suicide behaviour and treatment.
Child and adolescent psychiatry
Authors: Sondheimer Adrian , Karnik Niranjan , Jensen Peter
Published: February 2021

Ethical dilemmas unique to child and adolescent psychiatry are consequences of the child psychiatrist’s duty to serve as advocate for child patients while simultaneously having professional responsibilities to the parents and guardians of the children, as well as to child-related institutions inclusive of schools, juvenile justice systems, and childcare agencies. In addition, awareness of developmental differences is paramount, as continuous maturation occurs from ages zero through eighteen years and beyond. With this in mind, the chapter first reviews ethical principles and reasoning and the influence of context on such ever-present matters as assent/consent/dissent, agency, assessment, treatments, and confidentiality, and then hones in on current and future dilemmas posed by the needs of transitional age youth and the impacts of social media, marijuana decriminalization, alternative sexual and gender expressions, minority vulnerabilities, and casualties of global conflicts. A separate section focuses on ethical considerations relevant to research performed with child subjects.
Important points of pre-pregnancy counselling
Authors: Østensen Monika
Published: February 2021

Progress in rheumatology, obstetric medicine, and paediatrics has made it possible for many women with rheumatic disease to have successful pregnancies, however, varying degrees of risk remain for maternal and foetal outcome. Family planning should be discussed with all patients of fertile age and address the concerns of the patient regarding pregnancy and raising children. Occurrence of an unplanned pregnancy at a time of active or complicated disease or under treatment with teratogenic drugs may be the result of missed family planning opportunities. Comprehensive counselling, coordinated interdisciplinary care, and shared decision making are the best prerequisites to ensure a successful pregnancy outcome for mother and child.
Antiphospholipid syndrome
Authors: Schreiber Karen , Sciascia Savino
Published: February 2021

Antiphospholipid syndrome (APS) is characterized by arterial and/or venous thromboses and/or obstetric morbidity in patients persistently positive for moderate to high titres of antiphospholipid antibodies (aPL) according to the current classification criteria. Pregnancy morbidity includes unexplained consecutive recurrent 1st trimester pregnancy loss (<10 weeks’ gestation), any 2nd or 3rd trimester pregnancy loss, premature birth before 34 weeks of gestation due to conditions associated with ischemic placental dysfunction including severe pre-eclampsia, eclampsia, foetal growth restriction, and intrauterine death. Current treatment to prevent obstetrical morbidity is based on low-dose aspirin and/or low molecular-weight heparin and has improved pregnancy outcomes to achieve successful live birth in >70% of pregnancies. Although hydroxychloroquine and pravastatin might further improve pregnancy outcomes, prospective clinical trials are required to confirm these findings.
Vasculitis in pregnancy
Authors: Clowse Megan , Golenbiewski Jon
Published: February 2021

A growing number of women with vasculitis are becoming pregnant, largely the result of improved patient outcomes in vasculitis as a whole. Given such pregnancies are infrequent, there is a paucity of outcomes data from which to guide care. Women with vasculitis have higher rates of pregnancy loss and pre-term birth than the general population, and active disease contributes to negative results for the mother and foetus. Pregnancies have been reported in a variety of vasculitis types, with Takayasu arteritis and Behçet’s disease more commonly observed. The majority of pregnancies in women with vasculitis can result in favorable outcomes for both the mother and baby; planning prior to conception, well-controlled disease, the use of pregnancy compatible medications and close follow up with a multidisciplinary team are key to a successful pregnancy.
A Dutch phase III randomized multicenter trial: whole brain radiotherapy versus stereotactic radiotherapy for 4–10 brain metastases
Authors: Hartgerink Dianne , Bruynzeel Anna , Eekers Danielle , Swinnen Ans , Hurkmans Coen , Wiggenraad Ruud , Swaak-Kragten Annemarie , Dieleman Edith , van der Toorn Peter-Paul , Oei Bing , van Veelen Lieneke , Verhoeff Joost , Lagerwaard Frank , de Ruysscher Dirk , Lambin Philippe , Zindler Jaap
Published: February 2021

Background

The clinical value of whole brain radiotherapy (WBRT) for brain metastases (BM) is a matter of debate due to the significant side effects involved. Stereotactic radiosurgery (SRS) is an attractive alternative treatment option that may avoid these side effects and improve local tumor control. We initiated a randomized trial (NCT02353000) to investigate whether quality of life is better preserved after SRS compared with WBRT in patients with multiple brain metastases.

Methods

Patients with 4–10 BM were randomized between the standard arm WBRT (total dose 20 Gy in 5 fractions) or SRS (single fraction or 3 fractions). The primary endpoint was the difference in quality of life (QOL) at 3 months post-treatment.

Results

The study was prematurely closed due to poor accrual. A total of 29 patients (13%) were randomized, of which 15 patients have been treated with SRS and 14 patients with WBRT. The median number of lesions were 6 (range: 4–9) and the median total treatment volume was 13.0 cc3 (range: 1.8–25.9 cc3). QOL at 3 months decreased in the SRS group by 0.1 (SD = 0.2), compared to 0.2 (SD = 0.2) in the WBRT group (P = .23). The actuarial 1-year survival rates were 57% (SRS) and 31% (WBRT) (P = .52). The actuarial 1-year brain salvage-free survival rates were 50% (SRS) and 78% (WBRT) (P = .22).

Conclusion

In patients with 4–10 BM, SRS alone resulted in 1-year survival for 57% of patients while maintaining quality of life. Due to the premature closure of the trial, no statistically significant differences could be determined.
The relation between short- and long-term deformation in actively deforming plate boundary zones
Authors: Lamb Simon
Published: February 2021

Satellite-based measuring systems are making it possible to monitor deformation of the Earth's surface at a high spatial resolution over periods of several decades and a significant fraction of the seismic cycle. It is widely assumed that this short-term deformation directly reflects the long-term pattern of crustal deformation, although modified in detail by local elastic effects related to locking on individual faults. This way, short-term deformation is often jointly inverted with long-term estimates of fault slip rates, or even stress, over periods of 10 s to 100 s kyrs. Here, I examine the relation between these two timescales of deformation for subduction, continental shortening and rifting tectonic settings, with examples from the active New Zealand and Central Andean plate boundary zone. I show that the relation is inherently non-unique, and simple models of locking on a deep-seated megathrust or decollement, or mantle flow, provide excellent fits to the short-term observations without requiring any information about the geometry and rate of surface faulting. The short-term deformation, in these settings at least, cannot be used to determine the behaviour of individual faults, but instead places constraints on the forces that drive deformation. Thus, there is a fundamental difference between the stress loading and stress relief parts of the earthquake cycle, with failure determined by dynamical rather than kinematic constraints; the same stress loading can give rise to widely different modes of long-term deformation, depending on the strength and rheology of the deforming zone, and the role of gravitational stresses. The process of slip on networks of active faults may have an intermediate timescale of kyrs to 10 s kyrs, where individual faults fail piecemeal without any characteristic behaviour. Physics-based dynamical models of short-term deformation may be the best way to make full use of the increasing quality of this type of data in the future.

This article is part of a discussion meeting issue ‘Understanding earthquakes using the geological record’.
Caspase-6-cleaved tau is relevant in Alzheimer’s disease but not in other tauopathies: diagnostic and therapeutic implications
Authors: Theofilas Panos , Piergies Antonia M.H. , Li Song Hua , Petersen Cathrine , Ehrenberg Alexander J. , Eser Rana A. , Chin Brian , Yang Teddy , Khan Shireen , Ng Raymond , Spina Salvatore , Seeley Willian W. , Miller Bruce L. , Arkin Michelle R. , Grinberg Lea T.
Published: February 2021

Aim

Tau truncation (tr-tau) by active caspase-6 (aCasp-6) generates toxic tau fragments prone to self-aggregation. Yet, the relationship between aCasp-6, different forms of tr-tau, and hyperphosphorylated tau (p-tau) accumulation in human brains with Alzheimer’s disease (AD) and other tauopathies remains unclear.

Methods

We generated two neoepitope monoclonal antibodies against tr-tau sites (D402 and D13) targeted by aCasp-6. Then, we used 5-plex immunofluorescence to quantify the neuronal and astroglial burden of aCasp-6, tr-tau, p-tau, and their co-occurrence in healthy controls, AD, and primary tauopathies.

Results

Casp-6 activation was strongest in AD, followed by Pick’s disease (PiD), but almost absent in 4-repeat (4R) tauopathies. In neurons, the tr-tau burden was much more abundant in AD than in 4R tauopathies, and disproportionally higher when normalizing by p-tau pathology. Tr-tau astrogliopathy was detected in low numbers in 4R tauopathies. Unexpectedly, about half of tr-tau positive neurons in AD lacked p-tau aggregates.

Conclusions

Early modulation of aCasp-6 to reduce tr-tau pathology is a promising therapeutic strategy for AD, and possibly PiD, but is unlikely to benefit 4R tauopathies. The large percentage of tr-tau-positive neurons lacking p-tau suggests that not all neurons that are vulnerable to tau pathology are detected by a conventional p-tau Ser 202 antibody and that AD has distinct mechanisms of tangle formation. Therapeutic strategies against tr-tau pathology could be necessary to modulate tau abnormalities in AD. The disproportionally higher burden of tr-tau in AD supports the investigation of biofluid biomarkers against N-terminus tr-tau, which could detect AD and differentiate it from 4R tauopathies at a single patient level.

3 - sentence summary

Tau truncation (tr-tau) by active caspase-6 (aCasp-6) generates toxic tau fragments prone to self-aggregation, but the relationship between aCasp-6, tr-tau, and hyperphosphorylated tau (p-tau) accumulation in Alzheimer’s disease (AD) and other tauopathies remains unclear. We generated two neoepitope monoclonal antibodies against tr-tau sites (D402 and D13) targeted by aCasp-6 and used 5-plex immunofluorescence to quantify the neuronal and astroglial burden of aCasp-6, tr-tau, p-tau, and their co-occurrence in brains from healthy controls, AD, and primary tauopathies. We detected relatively high Casp-6 activation in AD, followed by Pick’s disease (PiD). aCasp-6 was almost absent in 4-repeat (4R) tauopathies, suggesting that early modulation of aCasp-6 to reduce tr-tau pathology is a promising therapeutic strategy in AD, and possibly PiD, but is unlikely to benefit 4R tauopathies.
Discrimination of SARS-Cov 2 and arboviruses (DENV, ZIKV and CHIKV) clinical features using machine learning techniques: a fast and inexpensive clinical screening for countries simultaneously affected by both diseases
Authors: Castro João Daniel S.
Published: February 2021

SARS-Cov-2 (Covid-19) has spread rapidly throughout the world, and especially in tropical countries already affected by outbreaks of arboviruses, such as Dengue, Zika and Chikungunya, and may lead these locations to a collapse of health systems. Thus, the present work aims to develop a methodology using a machine learning algorithm (Support Vector Machine) for the prediction and discrimination of patients affected by Covid-19 and arboviruses (DENV, ZIKV and CHIKV). Clinical data from 204 patients with both Covid-19 and arboviruses obtained from 23 scientific articles and 1 dataset were used. The developed model was able to predict 93.1% of Covid-19 cases and 82.1% of arbovirus cases, with an accuracy of 89.1% and Area under Roc Curve of 95.6%, proving to be effective in prediction and possible screening of these patients, especially those affected by Covid-19, allowing early isolation.