bluuebunny/crossref_metadata_2025 huggingface dataset:
Physical factors in arterial ageing
Authors: Hashimoto Junichiro , O’Rourke Michael F.
Published: December 2017

Arterial structure and function change progressively with advancing age. Owing to long-lasting repetitive stretch with intermittent cardiac contraction, elastic fibres in the tunica media of large arteries progressively degenerate and are replaced by collagenous fibres. Such degeneration causes elastic arteries to stiffen and dilate. Stiffening of the large arteries not only increases amplitude of the incident pressure wave but also hastens the return of the reflected pressure wave, thereby widening the pulse pressure in the central aorta. This widening increases the cardiac afterload during systole, while it decreases coronary flow during diastole, thus predisposing to heart failure and coronary ischaemia. Also, the excessive pulsatile pressure is transmitted deeply into the renal and cerebral microvasculature causing microalbuminuria and lacunar infarction. Although arterial ageing is considered an inevitable and irreversible process, it can be delayed through optimal blood pressure control.
Aneurysmal diseases
Authors: Gemayel Gino , Kalangos Afksendiyos
Published: December 2017

Abdominal aortic aneurysm (AAA) is a pathology commonly observed in older adults with an estimated incidence of around 5% of men older than 65 years. The precise aetiology of this disease is still not fully uncovered; most aneurysms are classified as degenerative with complex interaction between genetic predisposition and environmental factors. Most AAA remain asymptomatic until they rupture. At this stage, they have a 90% mortality rate. Screening programmes are the best method to detect AAA and thus treating them electively. Open repair was once the gold standard of treatment, as no medical treatment has proven a clear benefit in reducing or stopping AAA growth. Recently endovascular repair; a new less invasive approach; has emerged and is rapidly replacing open repair with better mortality and morbidity rates.
Management of tachyarrhythmias
Authors: Harrison James L. , O’Neill Mark D.
Published: December 2017

The process of ageing is associated with an increased incidence of cardiac tachyarrhythmias, which are responsible for significant morbidity and mortality. Structural and functional changes, both mechanical and electrical, occur in the ageing heart, together with alterations in cardiac energetics and metabolism. However, the molecular mechanisms underlying tachyarrhythmias are not fully understood and there is a lack of evidence to guide treatments in older adults. Ventricular tachyarrhythmias are a major cause of unexpected death in older adults, especially in people with coronary artery disease. Sudden cardiac death is responsible for 13% of all natural deaths and 50% of cardiovascular deaths in older adults. The prevalence of asymptomatic and symptomatic supraventricular tachycardias also increases with age. With careful consideration of risks and benefits, age should not be seen as a contraindication to invasive device or ablation therapy for cardiac tachyarrhythmias.
Cardiopulmonary resuscitation: outcomes and decision-making processes for older adults
Authors: van de Glind Esther M. M. , van Munster Barbara C. , Hamaker Marije E.
Published: December 2017

Cardiopulmonary resuscitation (CPR) was developed in the 1950s as a treatment for cardiopulmonary arrest. Outcome of CPR remains poor, particularly in older people, as demonstrated by two recent meta-analyses. The first addressed out-of-hospital resuscitation in patients aged 70 years and over, and found pooled overall rates of survival to discharge of 4.1%. For in-hospital resuscitation, the overall pooled rate of survival to discharge was 18.7% for patients aged 70–79 years, 15.4% for patients aged 80–89 years and 11.6% for those aged 90 or over. It is not clear if age alone is a limiting factor, or rather a marker of comorbidity. Overall, information about the quality of life after surviving CPR is lacking. Older patients should be adequately informed about their chances of survival in good condition in order to make a decision about the desirability of CPR.
Traumatic brain injury and subdural haematoma
Authors: Bin Zahid Abdullah , Samadani Uzma
Published: December 2017

Traumatic brain injury (TBI) in elders is a common problem that is frequently accompanied by the other comorbidities. The advanced trauma life support (ATLS) protocol guides initial evaluation and stabilization. The cornerstone of management is to prevent secondary brain injury caused primarily by hypoxia and hypotension. TBI may be accompanied by intracranial haematomas, of which subdural haematoma (SDH) is the most common. SDH may also arise in the absence of TBI, and is easy to miss especially in its chronic form. Treatment is to drain the haematoma if large or symptomatic, otherwise simple observation is sufficient. Primary investigations in both TBI and SDH are CT head and coagulation profile. Prognosis in both is usually indicated by age and neurologic exam findings. Older people with chronic complications of TBI (e.g. chronic traumatic encephalopathy) may be seen. Diagnostics remain elusive for this condition and management is primarily symptomatic.
Assessment and diagnosis of the non-Alzheimer dementias
Authors: Onyike Chiadi U.
Published: December 2017

Non-Alzheimer dementias are commonly distinguished from Alzheimer disease by younger age at onset (midlife or earlier), positive family history, and presentations characterized by non-amnesic cognitive deficits, psychiatric states (such as depression, compulsions, paranoia, and hallucinations) and motor dysfunctions (like parkinsonism, ataxia, and apraxia). Missed diagnosis is a common problem, with the conditions being mistaken for psychiatric or movement disorder. Timely diagnosis depends on methodical examinations that characterize the chronology and tempo of key symptoms, family history, and neurological features, and brain images that reveal telltale patterns of atrophy or dysfunction. Genetic, blood, and CSF assays, and EEG are indicated where family history is positive or illness progression rapid. As non-Alzheimer dementias pose many clinical and psychosocial problems, optimal care requires a multidisciplinary team, empowered carers, and leverage of community resources. The latest discoveries in neuroimaging, particularly amyloid-PET, tau-PET, and clinical genetics, promise improvements in diagnostics and new therapeutic opportunities.
Non-pharmacologic behavioural activity interventions to prevent dementia
Authors: Carlson Michelle C. , Varma Vijay R.
Published: December 2017

Behavioural interventions to prevent and delay dementia onset and progression are on the rise. Physical, sensory, electrical, and multimodal lifestyle activity may impact cognitive and brain health in multiple ways that impact directly or indirectly the neuropathology and clinical symptoms of Alzheimer’s disease and dementias. Many of these programmes are scalable through existing clinical settings and community infrastructure, including schools, community and retirement centres, religious institutions, and other public and private non-profit organizations. At the same time, much remains to be learned about the specific physical and lifestyle activities that contribute to cognitive health or offer resilience to pathology, and the limits of their effectiveness. An important objective for these studies will be to explore the additive and interactive effects of different interventions, both behavioural and pharmacologic.
Mental health: epidemiology, pathophysiology, diagnosis, and management
Authors: Rozzini Renzo , Trabucchi Marco
Published: December 2017

Mental health of older people is one of the most challenging tasks for the society and medicine of our time. The epidemiology of the different psychogeriatric problems indicates that the well-being of a large part of population is jeopardized, and impose large scale specific programmes to prevent, cure, and rehabilitate the most prevalent and severe diseases in old age. Interventions should be directed to the multidimensional events determining and characterizing the specific pathological conditions, since mental health is influenced by biological factors, but also by living conditions (i.e. socioeconomic status, human relationship, available support). Mental health of population in advanced age must be the centre of interest of our society in order to create the conditions for age-friendly communities.
Elder abuse
Authors: Crome Peter , Arora Amit
Published: December 2017

The problem of elder abuse is still underreported and underrecognized in many cases. This chapter discusses various definitions of elder abuse and key issues related to this serious problem including barriers which prevent vulnerable older people seeking help. This chapter also examines the role of health professionals in early identification and management of elder abuse. It also explores some of the indicators of elder abuse which can help non-clinicians identify older people at risk of harm. This chapter describes the current procedure for management of elder abuse in England and some other countries. It also covers information about laws in relation to elder abuse. Support services and non-governmental organizations are an important resource for helping abused person and their role is described briefly in this chapter.
Common geriatric emergencies
Authors: Conroy Simon , McNamara Rosa
Published: December 2017

Older adults make up an increasing share of emergency department (ED) users, as the proportion of those aged 65 years and older increases in the general population. Older adults often have physical, physiological, psychological, and social considerations which demand a different approach to evaluation, management, and discharge planning compared to most younger adults using the ED. Older people are also more likely to have accumulated morbidity throughout their life course. Thus, a focus on geriatric emergency medicine has become an increasingly important as clinicians adapt to meet the challenges of population ageing. Here we outline the current trends in ED usage by older adults and give an overview of how care of older people is structured in emergency medicine.
Age-associated breathlessness
Authors: Won Won Chang , Kim Sunyoung
Published: December 2017

Breathlessness in older adults is a common symptom of cardiovascular, respiratory diseases, psychological disorders such as panic disorder, and respiratory muscle weakness, but this symptom is also prevalent during daily activities as a result of age-related changes. With ageing, physical fitness, the strength of respiratory muscles and elastic recoil of the small airways all decline, and, as a result, breathing becomes more difficult and gas exchange less efficient. Differentiation between cardiac and pulmonary cause of dyspneoa is very important and sometimes difficult. In acutely breathless elderly patients, an elevated level of brain natriuretic peptide is a sensitive and specific marker for the presence of ventricular failure. Once a diagnosis is made, the reversible factors contributing to the breathlessness should be corrected as far as possible, and the initial focus should be on optimizing treatment of the patient’s underlying disease, followed by reducing the impact of breathless on everyday activities and quality of life.
Anaemia
Authors: Fager Ammon M. , Cohen Harvey Jay
Published: December 2017

Anaemia is an important problem in the older population. As it is usually mild and insidious in onset, the symptoms of anemia are often overlooked by older adults who attribute their symptoms to an inevitable consequence of ageing while clinicians may ignore mild anaemia in favour of focusing on more prominent comorbidities. However, anaemia in older adults is associated with significant mortality and decreased quality of life due to functional decline. As our understanding of anaemia in elderly people on a biological and clinical level increases, our ability to impact the functional deficits associated with it will improve. However, quality clinical trial evidence on the impact of anaemia and its treatment on crucial outcomes in older patients is currently lacking. The completion of such trials will be critical to assure the safety and efficacy of future interventions designed to improve the treatment and quality of life for older adults.
Sexuality in older persons
Authors: Maggio Marcello , Lauretani Fulvio , Ceda Gian Paolo
Published: December 2017

Sexuality is defined as the dynamic outcome of physical capacity, motivation, attitudes, opportunity for partnership, and sexual conduct. Sexual health in older persons is a topic deserving increasing interest and attention for both a public audience and physicians. Over half of people over 65 years of age, report sexual dysfunction, women more so than men. Since sexual health is dependent on general health and can be considered a mirror of general health, its assessment should be part of the routine clinical assessment, even in older subjects. However, asking about sexual health especially in older persons is often a difficult or embarrassing task for many primary care physicians. In addition, many patients find difficult to raise sexual issues with their doctor. Early recognition of sexual symptoms is the first step to starting multimodal treatments aimed at improving sexual health and related quality of life in older persons.
Skin diseases more common in older adults
Authors: Trivalle Christophe , Wallach Daniel
Published: December 2017

In this chapter, we briefly survey the more common skin diseases seen in older adults. All elderly people have cutaneous lesions, and knowledge of the principles of dermatology is needed for their management, because some of these lesions have potentially severe and lethal consequences. Older people are rarely free from skin problems and a certain degree of dermatological expertise is required to distinguish between benign consequences of ageing, dermatitis requiring intervention, and life-threatening dermatoses. Older people do not usually have easy access to dermatologists. Preliminary experiments of telemedicine showed that for specific situations, such as leg ulcers or for an expert advice, remote consultations can be useful. Meanwhile, close attention and early referral may be needed to avoid unnecessary suffering.
Dizziness and vertigo
Authors: Lyons Declan , Beirne Avril , Lawson Joanna
Published: December 2017

Dizziness is one of the commonest symptoms described by older adults, particularly women, and is associated with reduced quality of life, functional decline, and falls. The term dizziness is used by patients to describe a variety of symptoms, including a hallucination of movement (vertigo), light-headedness, and a true appreciation of unsteadiness associated with gait disorders. Although there are age-related decrements in the somatosensory, visual, vestibular, and motor systems, dizziness should not be regarded as part of normal ageing. Diagnosis can usually be reached without specialist investigations, through focused history taking and bedside clinical assessment, including careful examination of eye movements and the Dix-Hallpike test. The underlying cause may be in one or several physiological systems and this will guide treatment plans. Benign paroxysmal positional vertigo (BPPV) and neuritis are more common than Meniere’s. The presence of red flag symptoms or signs suggesting central vestibular disease will require further imaging.
Pain assessment and management in cognitively intact and impaired patients
Authors: Van Den Noortgate Nele , Sampson Elizabeth
Published: December 2017

Pain is common in older people, affecting up to 60% of older community-dwelling older persons with and without dementia. Chronic pain has a significant impact on the quality of life of older people. Since pain is often underrecognized in the older population, systematic screening and assessment with appropriate tools for the target population, is recommended. A holistic, multidisciplinary approach may offer meaningful support. There are no neurophysiological arguments that pain perception and tolerance are affected by the ageing process. Dementia does not change the sensory perception of pain but can cause changes in the meaning and recognition of the sensation. It is possible to safely use non-pharmacological treatments and available analgesics, provided the clinician has a good knowledge of the side effects of the treatments. In patients with advanced dementia and patients at the end of life, alternative routes of administration of analgesics should be considered.
Rehabilitation: additional palliative care approaches
Authors: Maddocks Matthew , Payne Sheila
Published: December 2017

Palliative care and rehabilitation share many common traits. When codelivered, these specialties can provide a holistic, patient-centred approach to care that maximizes function irrespective of diagnosis. This chapter considers how palliative care and rehabilitation can be delivered together in practice, and outlines commonly used interventions with examples of evidence from hospice, acute, and community care settings. The text covers treatments offered by different allied health professionals, including physical activity and exercise, hydrotherapy, non-drug interventions for breathlessness, adaptations, and assistive devices, as well as speech and language, music, and art therapies. Thereafter, the chapter looks at how palliative rehabilitation treatments can be evaluated, both using conventional outcome measures and through the use of goal setting and goal attainment scaling. In addition to direct benefits to patients, rehabilitation approaches offer secondary benefits for family caregivers, especially when deterioration leads to the family assisting with physical caregiving and transfers.
Midlife risk factors of diseases and geriatric syndromes
Authors: Strandberg Timo E.
Published: December 2017

Environmental risk factors for adverse health outcomes are usually evident by midlife. Genes and the ageing process modify the risk factor actions, and together become the main causes of chronic non-communicable diseases, including cardiovascular diseases, diabetes, chronic kidney disease, and the most common forms of cancer (breast, prostate, colon) later in life. The most important lifestyle-related or environmental risk factors include diet, smoking, and physical inactivity, which often contribute to traditional or medical risk factors including hypertension, dyslipidemia, obesity, and hyperglycemia, which are the downstream antecedents of many other disease states. Further, it is increasingly evident that the occurrence of common geriatric syndromes, including frailty and mild cognitive impairment, can also be predicted by midlife risk factors. Current knowledge of risk factor development during the life course, and evidence-based prevention should be better utilized in the long-term prevention of health problems in old age.
Nutrition, ageing, and longevity
Authors: Cederholm Tommy , Hellénius Mai-Lis
Published: December 2017

Long-term food intake can have a profound impact on cellular and organ functions affecting the development of multiple chronic disease states as well as the rate of the ageing processes. Over the last two centuries, longevity of mankind has increased by two years per decade. Improved food habits are important contributing factors. Epidemiological, intervention and mechanistic studies (e.g. on traditional Mediterranean and Okinawa Island diets) provide a basis to recommend vegetables, legumes, fruits, non-tropical oils as basic fat, light meat (e.g. poultry) of moderate amounts, plenty of fish, and moderate beverage intakes of wine, coffee, and tea. Oxidative damage is suggested as one major reason for ageing. Healthy foods are often rich in antioxidant compounds, but there is no evidence that extra antioxidant supplementation has any beneficial effects.
Preserving mental health and well-being
Authors: Almeida Osvaldo P.
Published: December 2017

Well-being is a state characterized by contentment with one’s emotional, physical, and social circumstances that is undermined by the presence of depression, dementia, and frailty. Numerous potentially modifiable risk factors have been associated with these common conditions of later life, and there is growing evidence that multidomain interventions that target them in a systematic fashion hold potential to reduce the incidence and prevalence of frailty, dementia, and depression in older age. Some of the potential targets for interventions include physical inactivity, suboptimal education or cognitive activity, smoking, harmful alcohol use, obesity, diabetes, hypertension, high plasma homocysteine, low vitamin D, and testosterone. These interventions are still in their infancy, but preliminary data offer hope that an increasing number of people will be able to enjoy good health and well-being in their later years.
Clinical translation of interventions that target ageing: towards a longevity dividend
Authors: Palmer Allyson K. , Kirkland James L.
Published: December 2017

Exciting advances have been made recently in understanding the mechanistic underpinnings of ageing. Mounting evidence suggests that progression of ageing changes can be modulated. Interventions that extend healthspan and lifespan in model organisms have been developed. The time is approaching for translation of these interventions into clinical treatments. By targeting fundamental ageing mechanisms, it may be possible to delay, prevent, or alleviate chronic diseases as a group, rather than individually, and enhance healthspan. Such a compression of morbidity would have profound clinical and economic benefits, with reductions in life-years spent with chronic disease and age-related dysfunction. However, barriers remain, including lack of clinical and regulatory paradigms for translating agents that target fundamental ageing processes into clinical interventions, and a shortage of personnel trained to do so. Here we consider research findings that support the potential value of translational ageing research and strategies to move these findings from bench to bedside.
Gerontechnology
Authors: Dutta Tilak , Taati Babak , Holliday Pamela , Li Yue , Pong Steven , Mihailidis Alex , Fernie Geoff
Published: December 2017

As we age, we become more likely to encounter disabilities. Most are health-related conditions that can make it difficult to maintain our quality of life and make us more susceptible to further illness and injury. These conditions also make the lives of our caregivers (paid and informal) more difficult and place them at risk of burnout, illness, or injury of their own. The vast majority of us want to continue living in our own homes as we age but the challenge of living with disability can make this difficult. This chapter describes how the right tools can limit the negative effects of disability and support successful ageing whether in our homes or in an institution to help us be happier and healthier, for longer.
Personalized medicine for older adults
Authors: Akner Gunnar
Published: December 2017

Each older person presents with a unique clinical phenotype. This clinical heterogeneity in older adults calls for a high degree of personalized/individualized approach to geriatric medicine and to the care of older adults. Individualized clinical health analysis and management could be performed according to the DTF-model (i.e. Diagnostics-Treatment-Follow-up), which has implications for education/training, medical records, organization, and financing of care for older people. A four-step clinical analysis process based on the DTF-model is presented, aiming to operationalize how a comprehensive geriatric assessment could be visualized, thereby serving as a much longed for ‘geroscope’. A main challenge for the future is to restructure healthcare to suit the most common long-term health problem (i.e. multimorbidity). Future medical developments should be based on geriatric principles and preferably be organized to allow clinical research in clinical routine care to stimulate relevance and development of new methods for clinical treatment trials.
Dematiaceous fungi
Authors: Kidd Sarah E. , Halliday Catriona L.
Published: December 2017

The dematiaceous fungal pathogens, classified by their darkly pigmented hyphae, cause infection in both immunosuppressed and immunocompetent individuals. Infections may present as chromoblastomycosis, mycetoma, and a spectrum of phaeohyphomycoses varying in severity. The route of infection may be through traumatic inoculation, or inhalation with or without dissemination. A number of species are considered neurotropic and can cause cerebral abscesses in immunocompetent persons. Infections can occur worldwide, but are most common in the tropics, and some species appear to have specific geographic ranges. Diagnosis requires sampling at the site of infection; direct microscopy using KOH (potassium hydroxide), haematoxylin and eosin, and/or Fontana-Masson stains; and culturing. Accurate species identification is essential. Treatment includes antifungal therapy with or without surgery, and antifungal susceptibility testing is recommended for all cultures.
Mucoraceous moulds
Authors: Rogers Thomas R. , Johnson Elizabeth M.
Published: December 2017

The mucoraceous moulds are members of the order Mucorales and comprise a number of genera within which are species that typically cause life-threatening infections in immunocompromised hosts, but are also pathogens of patients with diabetes mellitus or burns, or following traumatic injuries or near-drowning incidents, and in iron overload. Clinical presentations may be of rhinocerebral, pulmonary, cutaneous, or disseminated disease. Once established at its initial focus, the infection can progress rapidly. Diagnosis is challenging because this is a relatively rare disease, cultures from sites of infection may be negative, and few biomarkers exist to aid laboratory diagnosis. Histopathological examination of infected tissue is useful in diagnosis. Clinicians should have a high level of suspicion when immunocompromised patients present with sinus infection, facial swelling, orbital bone erosion, nodular lung infiltration, or necrotic skin eschars. The only currently available antifungal agents with evidence of clinical utility in mucormycosis are amphotericin B, posaconazole, and isavuconazole.
Fungal bone and joint infections
Authors: Mack Damien , Warren Simon , Palanivel Shara , Conlon Christopher P.
Published: December 2017

Although fungal infections of bones and joints are rare, the increasing incidence of invasive fungal disease, along with an increased population of immunosuppressed patients and individuals with multiple comorbidities, means that these infections are also increasing. The most common organisms are Candida and Aspergillus species, although the endemic dimorphic fungi are responsible for significant numbers of cases in some parts of the world. Most infections occur following haematogenous spread, but invasion from contiguous infection occurs, as does direct inoculation after trauma or surgery. Clinical presentations differ somewhat between children and adults, with the latter more likely to have vertebral osteomyelitis. Clinical presentations may be subtle, often without fever or raised inflammatory markers, and diagnosis may be delayed as a consequence. Diagnosis rests on clinical suspicion coupled with the need to obtain tissue for culture and for histology. Appropriate antifungal therapy usually needs to be prolonged and combined with surgical debridement.
Fungal diseases of the gastrointestinal tract
Authors: Schelenz Silke
Published: December 2017

Fungal diseases of the gastrointestinal (GI) tract can occur because of an overgrowth of yeast in the gut, exposure to contaminated food and water, or as part of disseminated invasive fungal infections from other sites. The extent of the disease depends on the underlying risk factors, such as diabetes or immunosuppression, and ranges from colonization, localized infection, or fungaemia, to aggressive life-threatening GI tract infections. Candida spp. are the commonest cause of mucosal infection, although mould infections are increasingly reported. Serious invasive mould infections are difficult to diagnose as symptoms are often non-specific. Early recognition, prompt antifungal treatment, and surgical intervention can be lifesaving.
Fungal infections of the kidney and those associated with renal failure, dialysis, and renal transplantation
Authors: Maziarz Eileen K. , Perfect John R.
Published: December 2017

Fungal infections involving the kidney are often a manifestation of disseminated fungal infection, although primary renal fungal infections do occur, usually from a lower urinary tract source or in the setting of renal transplantation. Candida spp. cause the vast majority of these infections and are the representative pathogen for understanding the pathogenesis of these types of infections. The risk factors and mycology of acute renal candidiasis reflect those of invasive candidiasis. Unique risk factors are observed in chronic renal candidiasis, which manifests differently and requires distinct management approaches. This chapter discusses the spectrum of invasive mycoses involving the kidney, as well as those associated with chronic renal failure, dialysis, and renal transplantation.
Fungal infections in neonates
Authors: Warris Adilia
Published: December 2017

Fungal infections in the neonatal population are caused predominantly by Candida species and invasive fungal disease mainly affects extremely low birth weight infants. The vast majority of Candida infections are due to C. albicans and C. parapsilosis, while the more fluconazole-resistant Candida species are only sporadically observed. Invasive candidiasis typically occurs during the first month of life and presents with non-specific signs of sepsis. Despite antifungal treatment, 20% of neonates developing invasive candidiasis die and neurodevelopmental impairment occurs in nearly 60% of survivors. Antifungal prophylaxis reduces the incidence in neonatal intensive care units with high rates of invasive candidiasis (>10%). Amphotericin B, fluconazole, micafungin, and caspofungin can be used to treat neonatal candidiasis, although optimal dosing for fluconazole and the two echinocandins has not yet been established.
Histopathology of fungal disease
Authors: Lucas Sebastian B.
Published: December 2017

Histopathology has a critical role in the diagnosis of fungal infections. Often it is the first or only sample of a lesion. A rapid, confident diagnosis can significantly affect patient management. However, the morphologies of yeast and hyphae are not necessarily diagnostic at the genus or species level, and the experience of histopathologists is variable. A primary decision is whether the lesion is fungal or another infection or not infectious at all, and the next is whether the fungus is a yeast or a hyphal (mould) infection. Further histopathological genus and species discrimination can be made in many cases, but not all. Increasingly, molecular diagnostic DNA technology works effectively on formalin-fixed paraffin-embedded biopsy/autopsy material, and such information can be added to the multidisciplinary input for an optimal diagnosis.
Molecular diagnosis of fungal disease
Authors: White P. Lewis , Barnes Rosemary A.
Published: December 2017

Molecular techniques to aid in the diagnosis of fungal disease have been in use for over two decades. However, for polymerase chain reaction (PCR) to gain widespread acceptance outside of specialist centres, methodology must be standardized and in line with general microbiological molecular diagnostics assays, yet for infections other than fungal disease. Apart from Aspergillus PCR, standardized methodology is lacking. It is also essential to identify the optimal role for an assay. Whether this is to confirm a specific disease in symptomatic patients or to exclude disease and prevent the unnecessary use of antifungals will, in part, be determined by prevalence, but will also, along with the disease manifestation, dictate specimen choice and subsequent methodological procedure. This chapter will focus on disease processes determining optimal sample types, before concentrating on the clinical validation of molecular tests for the diagnosis of the main causes of invasive fungal disease, concluding with recent developments. The clinical utility of molecular approaches and potential future benefits that can address emerging issues, such as azole resistance, will also be discussed.
Mild Cognitive Impairment
Authors: Hsu David C. , Ellison James M.
Published: December 2017

Mild cognitive impairment (MCI), and the newly described DSM-5 diagnosis of mild neurocognitive disorder, often lie at the intersection of geriatric and forensic psychiatry. The concept of MCI as a distinct syndrome between normal cognitive aging and major neurocognitive disorder (dementia) has continued to evolve over the past decade. Given MCI’s range of potential etiologies, as well as its increasing prevalence in an aging population, its evaluation and management can perplex the seasoned clinician and complicate legal proceedings. This chapter describes the clinical phenomenon of MCI, as well as its corresponding forensic implications. Capacity assessments, risk management, competence to stand trial, and cognitive malingering are covered.
Stigma and Its Implications for Health: Introduction and Overview
Authors: Major Brenda , Dovidio John F. , Link Bruce G. , Calabrese Sarah K.
Published: December 2017

There is growing recognition that stigma plays an important role in producing health disparities between members of socially advantaged and disadvantaged (marginalized) groups. This chapter defines stigma, describes differences among stigmatized marks, and discusses the functions that stigma may serve for individuals, groups, and societies. It also provides a conceptual model of the pathways by which stigma relates to health. This model posits that socially conferred marks that are devalued in society are the basis for four key stigma processes: enacted stigma, felt stigma, internalized stigma, and anticipated stigma. These stigma processes lead to stress and accompanying individual-level affective, cognitive, behavioral, and physiological responses, as well as to social and community-level exclusion from important domains of life that collectively have downstream negative consequences for health. This chapter provides an integrative overview of the chapters in the current volume and concludes with suggestions for future research on stigma and health.
Affective Reactions as Mediators of the Relationship Between Stigma and Health
Authors: Mendes Wendy Berry , Muscatell Keely A.
Published: December 2017

This chapter provides an overview of how emotions can contribute to poorer health among stigmatized populations. First, it describes some of the primary affective responses that stigmatized individuals might experience, including externalizing emotions, uncertainty, and anxious affect. These affective responses can occur as a result of interacting with individuals who display subtle or overt signs of bias or perceiving a system as unfair, or they can occur from expectations based on prior experiences that shape perception. Second, this chapter reviews how these affective states may alter underlying biological processes to directly influence health. Finally, it examines indirect pathways whereby emotion processes potentiate health-damaging behaviors, such as poor eating habits, restless sleep, excessive alcohol and drug abuse, and risky behavior. Overall, research in this area suggests that affective experiences resulting from stigmatization can change biology and behavior in ways that can ultimately lead to poor health.
Social Stigma and Health: An Identity-Based Motivation Perspective
Authors: Oyserman Daphna , Fisher Oliver
Published: December 2017

American culture highlights the power of individuals to steer their own course and be masters of their own destiny. In American cultural context, low place in social hierarchy due to low socioeconomic status is taken to imply some deficiency in the persons who occupy this place. This association seems bidirectional: Low place is stigmatizing, and membership in a negatively marked group implies low place in social hierarchy. Low place in social hierarchy limits individuals’ choice and experienced control, influencing identity-based motivational processes. Identity-based motivation theory and its three components: dynamic construction of identity, action-readiness, and procedural-readiness, are used to articulate the health consequences of this interplay. The identities that come to mind and what these identities imply for health is a function of momentary and chronic context. Accessible identities can elicit health-promoting or health-undermining behaviors and interpretations of experienced difficulty. This has implications for intervention.
Structural Stigma and Health
Authors: Hatzenbuehler Mark L.
Published: December 2017

This chapter introduces readers to the relatively new area of research on structural stigma through addressing four issues. First, it defines structural stigma and describes how this construct differs from stigma at individual and interpersonal levels. Second, the chapter discusses various measurement and methodological approaches that have been employed to study structural stigma. Third, it evaluates emerging research on the consequences of structural stigma for the health of stigmatized groups. In particular, it discusses illustrative research from several stigmatized statuses and reviews numerous health outcomes associated with structural stigma. Fourth, the chapter describes several promising areas for future research on structural stigma and health. The chapter concludes by arguing that accumulating evidence indicates that structural stigma has robust health consequences for stigmatized groups across the life course and thus represents an underrecognized mechanism underlying health inequalities between members of stigmatized and nonstigmatized groups.
Public Health and Social Justice: An Argument Against Stigma as a Tool of Health Promotion and Disease Prevention
Authors: Blacksher Erika
Published: December 2017

This chapter argues against the use of stigma-inducing measures as tools of public health on grounds of social justice. The value of social justice in public health includes both a distributive demand for a fair share of health and the social determinants thereof and a recognitional demand to be treated as a peer in public life. The use of stigma-inducing measures violates the first demand by thwarting people’s access to important intra- and interpersonal, communal, and institutional resources that confer a health advantage; it violates the second by denying people’s shared humanity and ignoring complex non-dominant identities. The position taken in this chapter does not preclude public health measures that regulate and ban health-harming substances or try to move people toward healthier behaviors. It does require that public health partner with people to identify their communities’ health challenges and opportunities and to treat people as resourceful agents of change.
Public Health with a Punch: Fear, Stigma, and Hard-Hitting Media Campaigns
Authors: Fairchild Amy L. , Bayer Ron
Published: December 2017

The conventional perspective that fear is a bad motivator for behavioral change, so critical to public health, is both an empirical observation and a moral judgment. This chapter challenges the belief that fear cannot work and is, indeed, counterproductive. The chapter then turns to the ethical debate, which for years was shaped by bioethics. The chapter concludes by arguing that the perspective of bioethics, so centrally concerned with the individual, provides an inadequate moral frame for thinking about fear-based campaigns. Instead, the chapter proposes the notion of public health ethics, which has as its grounding principle the enhancement of population well-being. Fear-based campaigns may be morally legitimate once the population benefits are clearly articulated and the potential social costs carefully evaluated in a process that is open, transparent, and engages the populations toward whom fear-based campaigns will be directed.
Stigma as a Fundamental Cause of Health Inequality
Authors: Link Bruce G. , Phelan Jo C. , Hatzenbuehler Mark L.
Published: December 2017

Accumulating evidence shows that stigma has health-harming consequences that build health disparities between those who are stigmatized and those who are not. However, most research has considered one stigmatized status at a time as it affects (generally) one outcome at a time. Moving from this singular focus to consider all forms of stigma as they affect multiple outcomes suggests a large and pervasive effect of stigma on life chances. This chapter considers whether stigma should be classified as a “fundamental cause”—an especially pernicious social factor that remains persistently associated with health inequalities over time. The chapter concludes by observing that if the stigma-as-a-fundamental-cause idea is supported, it follows that reductive efforts to address disparities via biomedical interventions will fail. Stigma stands as a factor that needs to be addressed in its own right if health inequalities are to be addressed and population health improved.
Racial Discrimination and Racial Disparities in Health
Authors: Priest Naomi , Williams David R.
Published: December 2017

This chapter provides a review and critique of empirical research on perceived discrimination and health. The patterns of racial disparities in health suggest that there are multiple ways by which racism can affect health. Perceived discrimination is one such pathway, and this chapter reviews the published research on discrimination and health. This recent research continues to document an inverse association between discrimination and health. This pattern is now evident in a wider range of contexts and for a broader array of outcomes. Advancing our understanding of the relationship between perceived discrimination and health will require more attention to situating discrimination within the context of other health-relevant aspects of racism, measuring it comprehensively and accurately, assessing its stressful dimensions, and identifying the mechanisms that link discrimination to health.
Women, Work, and Family
Authors: Blau Francine D. , Winkler Anne E.
Published: December 2017

This chapter focuses on women, work, and family, with a particular focus on differences by educational attainment. First, we review long-term trends regarding family structure, participation in the labor market, and time spent in household production, including time with children. In looking at family, we focus on mothers with children. Next we examine key challenges faced by mothers as they seek to combine motherhood and paid work: workforce interruptions associated with childbearing, the impact of home and family responsibilities, and constraints posed by workplace culture. We also consider the role that gendered norms play in shaping outcomes for mothers. We conclude by discussing policies that have the potential to increase gender equality in the workplace and mitigate the considerable conflicts faced by many women as they seek to balance work and family.
Intelligence and National Security Decision Making
Authors: Rovner Joshua
Published: December 2017

This chapter provides a brief overview of the history of the modern U.S. intelligence community, with specific reference to the causes and consequences of major reform efforts. Pearl Harbor generated intense pressure to build an intelligence system capable of providing warning of future attacks, culminating in the creation of the modern intelligence community in 1947. Sixty years later, the September 11 attacks led to another round of organizational changes. This chapter describes and evaluates those changes, noting that the jury is still out on basic questions about the relationship between organizational design and intelligence performance. It then turns to contemporary debates over analysis, intelligence-policy relations, and politicization. The conclusion suggests avenues of future research on these issues.
Personhood
Authors: Rosfort René
Published: December 2017

Personhood plays a fundamental, but obscure role in contemporary mental health care. The notion is of vital importance to phenomenological psychopathology because it articulates the interplay of autonomy and heteronomy, self and otherness, at work in mental suffering. The complexity of personhood is connected with the circumstance that to be a person is both a fact and a norm. To see every human being (ourselves as well as the other) as a person is a normative task that is rooted in the fact that a human being is an individual being who experiences herself as a unique and irreplaceable person. This experience of being a person is more than a sense of selfhood. It involves an otherness (e.g. body, world, other people) that is constitutive of our personal identity. Narrative explorations of the fragility of personal identity can help us to make sense of mental suffering.
Jean-Paul Sartre
Authors: Hatzimoysis Anthony
Published: December 2017

Sartre articulated a phenomenological conception the “human being-in-situation,” which forms the ontological background of a therapeutic method that he called “existential psychoanalysis.” The overall principle of existential psychoanalysis is that each agent is a totality and not a collection, and thus she expresses herself even in the most insignificant or superficial of her behaviors; its goal is to decode and interpret the behavioral patterns, so as to articulate them conceptually; its point of departure is the pre-reflective awareness of lived experience; and its overall goal is to reach not some past psychic complex, but the choice that renders meaningful how one lives—so that the analysand achieves authenticity, owning up to the projects through which she, as a situated freedom, is making herself into the person she is.
Complementarity and Convergence?
Authors: Chowdhury Fink Naureen , Davidian Alison
Published: December 2017

This chapter analyses the gender dimension of terrorism and counterterrorism efforts. It explores women’s roles as both supporters and preventers of terrorism. It tracks the increasing incorporation of gender in the counterterrorism strategy of the United Nations and the growing focus on the intersections between the Women, Peace, and Security (WPS) and countering terrorism agendas. The chapter suggests that the WPS Agenda and the countering violent extremism program are convergent and complementary. At the same time, counterterrorism measures have had gendered collateral effects and continue to utilize gender stereotypes. The chapter provides suggestions for what a more gender-sensitive approach would mean for counterterrorism efforts.
Humanitarian Intervention and Gender Dynamics
Authors: Heathcote Gina
Published: December 2017

This chapter looks at the gendered dynamics of Security Council–authorized humanitarian interventions. The chapter focuses on the Libyan intervention to demonstrate the failure of the Security Council to consult women or gender experts regarding the decision to intervene. The chapter shows how the focus on women’s insecurity in humanitarian crises reinforces gendered political outcomes due to the lack of feminist consciousness within the Security Council deliberations and actions. It concludes with suggestions for feminist engagement, including consultation with communities where interventions have occurred in the past. The chapter also suggests utilizing Security Council resolution 2122 to disrupt gendered dynamics.