bluuebunny/crossref_metadata_2025 huggingface dataset:
Vasopressin versus Norepinephrine Infusion in Patients with Septic Shock
Authors: Fikry Karim
Published: February 2018

The Vasopressin and Septic Shock Trial (VASST) compares the use of vasopressin to norepinephrine in patients with septic shock. This chapter includes an overview of the study design and interventions. It also outlines the primary and secondary outcomes used in this trial, as well as the results found. It also discusses some criticisms and limitations of the study. To help readers fully understand the impact of the VASST, this chapter includes a quick review of several post hoc analyses from the trial as well as other relevant studies, including some important post hoc analyses, in addition to other related studies. Finally, this chapter concludes with a case example and a suggested approach on how to clinically apply the results of the VASST.
Comparison of Dopamine and Norepinephrine in the Treatment of Shock
Authors: Johnson Daniel W.
Published: February 2018

SOAP II, a multi-center, randomized trial comparing dopamine to norepinephrine in treatment of shock, followed 1679 patients for 12 months. Patients with hypotension persisting despite fluid administration were randomized either to norepinephrine infusion or to dopamine infusion to restore normal blood pressure. The chapter discusses primary and secondary outcomes, including mortality rates in the ICU and hospital at 6 and 12 months. A predefined subgroup analysis was performed according to type of underlying shock (septic, cardiogenic, or hypovolemic). There was no significant difference between the dopamine group and the norepinephrine group in mortality rate or in ICU length of stay or need for organ support. The rate of arrhythmias was significantly higher in the dopamine group (24%) than in the norepinephrine group (12%). Among patients whose shock was cardiogenic in nature, the 28-day mortality was significantly higher in the dopamine group than in the norepinephrine group (p = 0.03).
CPR with Chest Compression Alone or with Rescue Breathing
Authors: Tainter Christopher “Kit” , Wardi Gabriel
Published: February 2018

The benefit of rescue breathing performed by the layperson during cardiopulmonary resuscitation (CPR) is uncertain. The study article by Rea et al. compared the outcomes of 1941 patients randomly assigned to a compression-only CPR approach versus the traditional compression and rescue breath CPR performed by laypeople. The authors found no significant difference in the percentage of patients who survived until hospital discharge or in the proportion who survived with a favorable neurologic outcome. However, there was a trend toward improved outcomes in patients with shockable rhythms and cardiac causes of arrest in the compression only group. The results support a strategy compression-only CPR when performed by laypersons versus the traditional compression and rescue breath CPR.
Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device
Authors: Dudzinski David M. , Guseh James Sawalla
Published: February 2018

This chapter provides a summary of the landmark study entitled “Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device.” This study and this chapter explores how a second-generation continuous-flow left ventricular assist device compares with a first generation pulsatile-flow device with regard to the clinical endpoints of survival, freedom from stroke, and freedom from device exchange. Starting with this comparison, this chapter describes the study basics, including funding, study location, who was studied, patient numbers, study design, study intervention, follow-up, endpoints, results, criticisms, and limitations. The chapter briefly reviews other relevant studies and related topics while discussing implications. It concludes with a relevant clinical case.
Intraaortic Balloon Support in Myocardial Infarction Complicated by Cardiogenic Shock
Authors: Bernard Samuel , Dudzinski David M.
Published: February 2018

This chapter provides a summary of the landmark study known as Intraaortic Balloon Support in Myocardial Infarction Complicated by Cardiogenic Shock. Compared to optimal medical therapy (OMT) alone, does intraaortic balloon pump (IABP) counterpulsation reduce mortality in patients with acute myocardial infarction (MI) complicated by cardiogenic shock in whom early revascularization in planned? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Angioplasty versus Fibrinolytics in Acute ST-Elevation Myocardial Infarction
Authors: Simmons Bryan
Published: February 2018

The Danish trial in Acute Myocardial Infarction 2 (DANAMI-2) compares the immediate administration of an intravenous thrombolytic agent versus transfer to a treatment center capable of percutaneous coronary intervention (PCI) in patients presenting with acute ST-elevation myocardial infarction (STEMI). The study included 1,572 patients randomized to onsite fibrinolysis or PCI. Using a primary composite outcome of death, reinfarction, or stroke at 30 days, the DANAMI-2 investigators found PCI superior to onsite fibrinolysis. This superiority was driven largely by the lower occurrence of reinfarction at 30 days. Although it excluded higher-risk patient populations, the DANAMI-2 trial contributed to the ACC/AHA STEMI management recommendation of immediate transfer to a PCI-capable facility if the anticipated time from first-medical-contact to balloon inflation is less than 120 minutes.
Efficacy and Economic Assessment of Conventional Ventilatory Support versus Extracorporeal Membrane Oxygenation for Severe Adult Respiratory Failure (CESAR)
Authors: Sigakis Matthew
Published: February 2018

The CESAR trial aimed to determine whether extracorporeal membrane oxygenation (ECMO) increased survival without disability by six months in patients with severe but potentially reversible respiratory failure. Patients were randomized to either conventional ventilator support or care at an ECMO referral center. The primary outcome measured was death or severe disability at 6 months. Secondary outcomes were also described such as non-ECMO support, length of stay, and ECMO characteristics. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The CESAR trial results indicate that patients with severe but potentially reversible respiratory failure have improved survival without severe disability when transferred to a high volume center with expertise in ECMO. Although survival without severe disability was improved, it was at a significantly increased cost and length of hospital stay. Concerns regarding the generalizability of the findings warrant further investigation.
Efficacy and Safety of Corticosteroids for Persistent Acute Respiratory Distress Syndrome
Authors: Levy Sean , Bajwa Ednan
Published: February 2018

The role of corticosteroids in the treatment of acute respiratory distress syndrome (ARDS), and in particular, those patients with persistent ARDS (defined as > 7 days since onset) has been controversial. In this ARDSNet study, subjects who received corticosteroids had similar outcomes as compared with placebo. Particular harm was seen in subjects with ARDS onset more than 14 days prior to treatment. Overall adverse events were similar between groups, although a higher rate of neuromyopathy was noted in those receiving steroids. Despite these findings, improvements in physiologic parameters and certain secondary endpoints suggest a possible role for steroids, perhaps with a more prolonged tapering of the drug following liberation from mechanical ventilation.
High-Frequency Oscillation in Early Acute Respiratory Distress Syndrome
Authors: Wilcox Susan R. , Al Ashry Haitham S.
Published: February 2018

Although prior studies suggested that high frequency oscillatory ventilation (HFOV) improved survival in patients with moderate to severe acute respiratory distress syndrome (ARDS), these studies were observational, had small sample sizes, or used large tidal volumes in the conventional ventilation arms. The OSCILLATE trial randomized patients with moderate to severe ARDS to HFOV or low tidal volume ventilation. The trial was stopped early due to increased mortality in the HFOV arm. HFOV should not be used routinely in moderate to severe ARDS, and should only be considered as salvage therapy.
Early versus Late Parenteral Nutrition in the ICU
Authors: Yeh D. Dante
Published: February 2018

The EPaNIC study enrolled 4,640 critically ill adults who were nutritionally at risk and randomized them to either early (ICU day 3) or late (ICU day 8) supplemental parenteral nutrition (PN). In this study involving relatively thin patients with short ICU stays who were receiving tight glycemic control, early PN did not result in lower rates of mortality vs. late PN despite delivering significantly more calories in the first ICU week. In fact, late initiation of PN was associated with shorter duration of mechanical ventilation, lower incidence of renal replacement therapy, lower incidence of infections, and shorter ICU and hospital length of stay. Features of this study limiting external validity: most subjects had BMI 20–30, over 60% of subjects were post-cardiac surgery, overall median ICU stay was only 3 days, overall mortality was only 6%, nutritional management after ICU discharge was not controlled.
Initial Trophic versus Full Enteral Feeding in Patients with Acute Lung Injury
Authors: Sharifpour Milad , Mendez-Tellez Pedro
Published: February 2018

This chapter provides a summary of the landmark study known as the EDEN trial. In patients with acute lung injury (ALI) and without malnutrition does trophic enteral feeding during the first 6 days of critical illness increase ventilator-free days (VFDs) and decrease gastrointestinal intolerance compared with full enteral feeding? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter then briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case.
Low-Dose Dopamine in Patients with Early Renal Dysfunction
Authors: Shen Tao
Published: February 2018

This study was a multicenter, double-blinded, randomized controlled trial that investigated the effects of starting low-dose dopamine in fusion in critically ill patients who had evidence of SIRS and early renal dysfunction. 328 patients admitted to 23 intensive care units for a variety of medical and surgical conditions were randomized to receive dopamine infused at 2 mcg/kg/min or placebo. No significant differences were found between the two groups in both the primary outcome (peak serum creatinine concentration) and secondary outcomes (including urine output, need for renal replacement therapy, and duration of ICU and hospital stay). The study concluded that low-dose dopamine does not confer any benefit to critically ill patients at risk for renal failure.
A Multicenter, Randomized, Controlled Clinical Trial of Transfusion Requirements in Critical Care
Authors: Guenzer Joseph R. , Vardanian Andrew
Published: February 2018

This chapter provides a summary of the landmark study known as the TRICC trial. Is a restrictive strategy of red-cell transfusion equivalent to a liberal transfusion strategy in critically ill patients? Starting with that question, the chapter describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism, and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. Although this first large trial to examine the impact of transfusion thresholds on mortality in critically ill patients was underpowered, the trend toward decreased mortality in the restrictive group suggests that it is unlikely that the lower transfusion threshold subjects patients to increased harm. However, care must be taken in generalizing these results to cardiac surgery patients or to actively bleeding patients based on this study alone.
Transfusion of plasma, platelets, and Red Blood Cells in a 1:1:1 versus a 1:1:2 Ration and Mortality in Patients with Severe Trauma
Authors: Liu Yuk Ming , Butler Kathryn
Published: February 2018

This chapter provides a summary of the landmark study known as the PROPPR trial. How effective and safe is rapid transfusion of patients with severe traumatic hemorrhage using plasma, platelets, and red blood cells in a 1:1:1 ratio compared to a 1:1:2 ratio? Starting with that question, it describes the basics of the study, including funding, study location, who was studied, how many patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. A growing body of literature suggests that massive transfusion protocols confer mortality benefits for trauma patients in hemorrhagic shock; however, such protocols still require standardization. In the PROPPR trial, there was suggestion of improved hemostasis and less death from exsanguinations with a 1:1:1 transfusion ratio versus a 1:1:2 approach; however, further trials are warranted.
Hydrocortisone Therapy for Patients with Septic Shock
Authors: Horvath Ryan J. , Bittner Edward
Published: February 2018

This chapter provides a summary of the landmark study known as the CORTICUS trial. Among patients suffering from septic shock, does low dose hydrocortisone improve mortality? Starting with that question, it describes the basics of the study, including funding, study location, the population studies, number of patients, study design, study intervention, follow-up, endpoints, results, and criticism and limitations. The chapter briefly reviews other relevant studies and information, discusses implications, and concludes with a relevant clinical case. The CORTICUS trial failed to demonstrate a benefit on mortality with steroid therapy among patients with septic shock. Based on CORTICUS and other studies, the Surviving Sepsis Campaign guidelines no longer recommend steroids for all patients with septic shock. Corticosteroids should be considered, however, for patients with septic shock who do not respond to fluids and vasopressor therapy.
Daily Interruption of Sedation with Physical and Occupational Therapy in Mechanically Ventilated Patients
Authors: Wolfe Michael , Saddawi-Konefka Daniel
Published: February 2018

Schweickert et al. studied effects of early physical and occupational therapy in mechanically ventilated patients. 109 mechanically ventilated medical ICU patients (with independent functional status prior to hospitalization) were randomized to receive physical and occupational therapy initiated at time of enrollment (intervention group) vs. physical and occupational therapy ordered at the discretion of the primary team (control group), with both groups receiving daily interruptions of sedation. The primary outcome, independent functional status at time of discharge, was met in 59% of the intervention group vs. 35% of the control group (p = 0.02). Lower rates of ICU and hospital delirium were observed in the intervention group. Hospital length of stay and mortality were unaffected. This study demonstrated that physical and occupational therapy can be safely accomplished in critically ill, mechanically ventilated medical ICU patients, and that early implementation of therapy may improve return to independent functional status at hospital discharge.
The Clavicle, the Acromioclavicular Joint, and the Sternoclavicular Joint
Authors: Sanchez-Sotelo Joaquin
Published: February 2018

The management of traumatic injuries to the clavicle and its two joints, acromioclavicular and sternoclavicular, has evolved substantially over the last few years. Regarding clavicle fractures, we now realize that nonoperative treatment of certain fracture patterns does lead to poor outcomes more frequently than previously thought; precontoured plates and modern intramedullary devices facilitate fixation techniques. Regarding the acromioclavicular joint, more emphasis is placed on anatomical reconstruction of all ligamentous structures, and there is substantial interest in arthroscopically assisted techniques. Fear of a major vascular complication when dealing with sternoclavicular joint pathology still lingers, but more and more surgeons feel they can manage this particular area of the shoulder region with reliable reconstructive techniques.
Adhesive Capsulitis
Authors: Sanchez-Sotelo Joaquin
Published: February 2018

Some individuals experience a condition characterized by spontaneous shoulder pain and stiffness due to synovitis, fibrosis, and loss of capsule elasticity without a clear-cut inciting cause. Most commonly, this condition is named adhesive capsulitis or frozen shoulder, terms applied only when shoulder radiographs are essentially normal and other reasons for shoulder pain and stiffness (e.g., cuff disease, fractures, dislocations, and arthritis) can be excluded. Although this condition resolves spontaneously in many patients, its course is protracted and a number of individuals may experience permanent restrictions in motion and function. This chapter discusses various aspects of adhesive capsulitis including pathogenesis, natural history, patient evaluation, and treatment.
Salvage Procedures
Authors: Sanchez-Sotelo Joaquin
Published: February 2018

The many surgical procedures summarized in previous chapters allow successful management of most shoulder conditions and result in improved pain, motion, and function. However, salvage procedures that sacrifice the glenohumeral joint or the scapulothoracic joint represent the best surgical option for a few patients. These salvage procedures are uncommon, but shoulder surgeons need to be familiar with their indications, surgical technique, and reported outcomes. This chapter addresses glenohumeral arthrodesis, scapulothoracic arthrodesis, and glenohumeral resection arthroplasty.
Psychiatry of Workplace Dysfunction
Authors: Committee on Work and Organizations Group for Advancement of Psychiatry
Published: February 2018

Relationships have always been at the heart of business. Successful businesses develop and sustain solid relationships with suppliers, employees and customers. However, the forces of technology, globalization and litigation have dramatically reshaped workplace relationships, transforming them and in some instances damaging or dissolving them. As humans have a fundamental need to work, organizations have a similar need for workers to perform tasks optimally. Data show that attending to workplace relationships and engaging employees increases productivity, creativity, and loyalty, yielding both short-term and long-term benefits. Disruptions of these relationships can lead to significant impairment in performance as well as deterioration in workers’ mental health. The tools that managers once relied upon to restore relationships have been weakened in part because of technology, globalization and litigation. The principles discussed in this book are designed to foster high-functioning workplace relationships. The authors’ psychiatric training, coupled with the breadth of their collective years of business and legal consultation experience, offers unique wisdom about developing and sustaining a relationship-focused perspective at work. The insights integrate cutting edge previously unpublished information with prior research and understanding of the psychological dynamics and principles of the workplace on both macro and micro levels—all presented in lay terminology punctuated by useful graphics with a minimum of technical terms, making the book easily understood by mental health professionals, managers, and employees audiences alike.
Forces Disrupting Relationships at Work: Litigation
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

This chapter discusses the psychological impact of litigation on workers and the workplace. Litigation disrupts workplace relationships because of the personal nature of the legal process. Employees and management alike experience litigation as a major breach of trust accompanied by anger, fear, shame, and over time, increasing dependency on legal representatives. Defendant companies may retreat behind organizational defenses that arise in response to litigation, including the creation of new policies and procedures, while managers are caught in the middle in negotiating conflict between aggrieved employees and the company. Litigant employees, who often feel that they have performed a positive societal action in revealing workplace deficiencies, may find themselves increasingly isolated by coworkers and managers. All of the emotional responses can create human and financial costs because of dysfunctional workplace behaviors and the resulting mental disorders such as depression, anxiety, and somatic or paranoid symptoms.
Champion Emotional Resilience
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

Technology, litigation, and globalization present many challenges today for individuals and organizations. Instead of ignoring problems or responding with fear, managers who foster courage and organizations that recognize and reward courage are more likely to overcome challenges and adapt to change. Courageous workers demonstrate emotional resilience by staying the course despite difficulty or danger and not accepting defeat. This chapter discusses opportunities for managers to champion emotional resilience in employees through awareness of the psychological contract. Case examples are used to demonstrate the varied ways in which employees and organizations may respond to physical injury, psychological trauma, and interpersonal conflict.
Business Is Still Personal
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

The evidence and the tools presented in this book show the advantages of putting personal relationships at the forefront of business practice. The principles of relationship productivity discussed here should be on the minds of all those seeking to improve significantly the bottom line. Too often the human aspects of business are trivialized, but this sacrifices long-term business growth and success for short term-achievement of business goals. Attention to relationships and awareness of the unique nature of each person’s psychological contract fosters empathy. This permits the kind of deep human connection that builds teamwork and loyalty, enhances performance, and facilitates problem solving.
Future Directions
Authors: Brown Andrew , Flinton Christopher T. , Gibson Josh , Grant Brian , Greiff Barrie , Hagen Duane , Heidel Stephen , Hunter Ben , Larsen Robert , Long Barbara , “Daven” Morrison David E. , Morrison David E. , Sassano-Higgins Sean , Post Jerrold , Sperry Len
Published: February 2018

In this book, the authors have focused on three challenges to the human aspect of work—technology, globalization, and litigation—and have provided tools for managing the types of challenges these forces present. The workplace is an ever-changing scene, and we can only hypothesize how the relationships among globalization, litigation, and technology may change in the future. Nonetheless, maintaining emotional health in work and workplace relationships will remain ever-important for the success of employees, managers, employers, and the company as a whole. Increasing challenges to the integrity of culture and relationships in the workplace demand greater involvement from mental health professionals. Because of the substantial potential benefit both to the 21st-century business world and the field of psychiatry, the development of formal training in workplace issues, including courses, mentorship, and fellowships, would present an important opportunity for future psychiatric residency training.
Classification
Authors: Tanislav Christian , Kaps Manfred
Published: February 2018

The classification of a cerebrovascular event distils information obtained in the workup and other related case history to a category indicating a specific pathophysiology, with direct implications for the subsequent secondary prevention management. A minimum standard of diagnostics is required for a precise classification. In young stroke victims, the conventional Trial of Org 10172 in Acute Stroke Treatment (TOAST) stroke subtype classification may only address the aetiopathogenesis in 30–60% of the individuals who are affected by vascular risk factors. Applying the criteria defined by TOAST for large-artery atherosclerosis, cardioembolism, and small artery disease is reliable for young stroke victims as verified in many clinical investigations. However, in a considerable proportion of stroke patients, the stroke aetiology remains unclear. For this group, some patients need to be treated in a particular manner, such as those with two or more possible aetiologies or those with suspected paradoxical embolism. In patients remaining purely cryptogenic despite an extensive diagnostic workup, imaging findings may help to identify potential triggers, particularly when an embolic infarction pattern in the acute brain imaging is obvious. Despite its shortcomings, the TOAST classification is the most universally used classification in ischaemic stroke patients. New developments in the field are addressed in this chapter and aspects are incorporated for the nominated classification adapted for the specific group of young stroke patients.
Special aetiologies
Authors: Jood Katarina , Tatlisumak Turgut
Published: February 2018

The chapter ‘Special aetiologies of ischaemic stroke in young adults’ provides an overview of the broad spectrum of non-conventional causes of ischaemic stroke. It reviews the more common of these unusual conditions categorized as non-atherosclerotic non-inflammatory arteriopathies, non-atherosclerotic inflammatory arteriopathies, vasospastic syndromes, haematological disorders, genetic disorders, and miscellaneous disorders. It discusses strategies for aetiological diagnosis in young ischaemic stroke, provides a detailed overview of useful clinical clues obtained from patient history and physical examinations, and describes a patient-tailored step-wise diagnostic strategy based on clinical clues and findings from a group of basic diagnostic tests.
Stroke in children
Authors: Henzi Bettina , Steinlin Maja
Published: February 2018

Stroke in children is a rare, but terrifying disease and its lifelong sequelae weigh heavy on patients and families. It is also increasingly recognized as a socioeconomic burden, ongoing for many years after the acute manifestation. There is a significant delay in diagnosis of childhood stroke. This is caused by several factors: lack of awareness among the public and professionals, childhood-specific manifestations, numerous stroke mimics, and last but not least, limited access to emergency neuroimaging for children. Fast stroke recognition tools need adaption to the special needs in children. Childhood arterial ischaemic stroke differs in aetiology from adult stroke with cerebral vasculopathies being the leading cause and cardioembolic aetiology ranking second. However, treatment guidelines are largely based on adult guidelines and expert consensus. Future research has to put emphasis on understanding pathophysiology, defining specific treatment options, and providing evidence for treatment guidelines in paediatric stroke.
Blue landscapes and public health
Authors: White Mathew P. , Lovell Rebecca , Wheeler Benedict W. , Pahl Sabine , Völker Sebastian , Depledge Michael H.
Published: February 2018

Although aquatic (blue) landscapes have been used to promote health for centuries, systematic research to explore these issues is relatively recent. We identify four strands of evidence, using different methodological approaches. Preference-based approaches use revealed (e.g. house prices), and stated (e.g. willingness to visit) preferences to examine people’s choice behaviours and intentions in relation to blue landscapes. Experiential approaches tap into people’s experiences in and around blue landscapes (e.g. during and after visits). Experimental approaches deconstruct blue landscapes and explore their impact under controlled conditions, in particular in comparison with the impacts of other landscape types. Finally, quantitative spatial approaches use epidemiological methods to explore health and well-being in relation to how close individuals live to aquatic environments. Broadly speaking, all four approaches suggest important potential for health benefits from blue landscapes, though important caveats, such as the quality of the blue landscape, were also found.
Technological nature and human well-being
Authors: Kahn Peter H.
Published: February 2018

In terms of physical and psychological well-being, does it matter that on a worldwide level we are replacing interactions with actual nature with technological nature—technologies that mediate, simulate, and augment the natural word? Research from three forms of technological nature are reviewed: a technological nature window, robot pets, and a telegarden. Results suggest that while interacting with technological nature is better than nothing, it is not as good as interacting with real nature. A concern with accepting technological nature is that it can shift the baseline downward for what counts as optimal well-being, as people across generations lose experiences with healthy baselines, a process referred to as environmental generational amnesia. One result is that we ask too little of the idea of urban sustainability, confusing biological living with human flourishing.
Vulnerable populations, health inequalities, and nature
Authors: Mitchell Richard , Africa Julia , Logan Alan
Published: February 2018

Vulnerable people are those whose characteristics and settings tend to render them less able to stay healthy and well. We assert that access to and use of nature plays a key role in reducing health inequalities stemming from vulnerability. First, we explore ways in which vulnerability might affect the likelihood of beneficial contact with nature. Second, we explore the idea that the health benefits of contact with nature may be greater for more vulnerable populations than for others, as an additional avenue for reducing health inequalities. Third, we consider changes in our relationships with nature over time, and their potential implications both for vulnerability and health. We conclude by noting that the burdens of global environmental change fall disproportionately on those considered vulnerable. Equitable access to nature and ecosystem services to support health and maintain resilience is a critical horizon for social justice in the twenty-first century.
Allergenic pollen emissions from vegetation—threats and prevention
Authors: Dahl Åslög , van den Bosch Matilda , Ogren Thomas
Published: February 2018

Allergic diseases are caused by hypersensitivity of the immune system to a certain environmental exposure. Many different agents may induce an allergic reaction. This chapter concerns reactions to pollen. Although allergies to animals, for example dogs and cats, may be considered as part of nature-induced allergy, the focus here is on vegetation. Allergic reactions to pollen depend on the type of pollen, biological properties, location, and individual factors. Changes in our immune systems, our living environments and lifestyles, and climate change may play a role in the increasing prevalence of pollen allergies. This chapter contains three major sections: first, the basics of pollen biology are outlined; secondly, pollen’s impact on human health are introduced; and finally, the chapter includes a section on how practitioners and policymakers can plan our cities to be green, and yet limited in allergenic exposure.
Population health deficits due to biodiversity loss, climate change, and other environmental degradation
Authors: McMichael Anthony J.
Published: February 2018

Humankind faces increasing disruptions to the ecological and biophysical foundations of health and life from large-scale, often global, and systemic human-driven changes. This is historically unfamiliar territory. Extraordinary prospects now face societies around the world. Among the environmental manifestations of this syndrome of human-driven changes to the Earth system are climate change, the loss of biodiversity, and the pervasive spread and persistence of toxic chemicals. These provide good, and contrasting, examples—including the intrinsic difficulties in detecting, modelling, and quantifying the health losses or deficits that result from these changes to components of nature’s life-supporting system. A much greater understanding and application of systems science, and the use of dynamic systems modelling, are needed if our societies (many of them largely ‘cocooned’ from the natural world) are to understand the population health risks we face now and in the future, and the optimal ways of averting and managing those risks.
Environmental assessment and health impact assessment
Authors: Vohra Salim , Orenstein Marla , Viliani Francesca , Cave Ben , Harris-Roxas Ben , Silva Filipe
Published: February 2018

Systematically and holistically considering the community health impacts of new policies and projects is critical. Impact assessment (IA) is a key component of national, international, and many commercial policy and project development and decision-making processes. Health impact assessment (HIA) and the health component of environmental assessment (health in EA) analyses both the potential positive and negative health impacts of policies and projects. HIA and health in EA by engaging stakeholders and incorporating a range of sources and types of evidence can maximize the positive and minimize the negative impacts. This means that precautionary principle is implicitly or explicitly a part of the IA process. There are a range of significant challenges in applying IAs and in applying the precautionary principle, particularly in the IA process. Public health professionals need to engage in the IA process, in HIAs and in Health in EAs, to protect and promote community health and well-being.
Systems thinking for global health and strategic sustainable development
Authors: Robèrt Karl-Henrik , Hernke Michael T. , Fortney Luke , Podein Rian J.
Published: February 2018

Population health can be considered the ultimate goal of sustainability. The planetary system, with its boundaries and constraints for civilization, is the necessary starting point for a systems perspective sufficiently broad to operationalize sustainability and advance global health. Both detailed scientific information and the basic aetiology of unsustainability are needed to inform specific strategies, and tools, to resolve current and potentially unrecognized nature–health problems. The Framework for Strategic Sustainable Development (FSSD) operationalizes sustainable development from a long-term, global perspective. It provides a thorough understanding of humans’ dependence on sustainable development, and utilizes scientifically robust, operational principles of social and ecological sustainability. The principles address the fundamental mechanisms that underpin health, enabling a backcasting approach—that is, ‘looking back’ from a robust idea of sustainability in the future, and then innovating smart transition routes to systematically pursue global health.
Unifying mechanisms: nature deficiency, chronic stress, and inflammation
Authors: Bird William , Epel Elissa , Ickovics Jeannette R. , van den Bosch Matilda
Published: February 2018

Disconnection from nature seems to increase the risk of chronic stress. This is followed by a range of deleterious influences on our bodily systems. Many of these changes are related to chronic inflammation. This chapter evolves around the premise that natural environments are prerequisites for resilience to the various stressors of our daily lives. If our resilience and coping mechanisms are insufficient, we are at risk of entering a vicious circle of negative organ reactions and feedback loops. As stress is prolonged, stress hormones and poor health behaviour are followed by alterations in the gut microbiota and an increase in visceral fat. These reactions lead to damage of the cells’ mitochondria from oxidative stress and release of reactive oxidative species. Finally, the results of oxidative damage and chronic inflammation lead to the shortening of telomeres, the DNA-proteins which protect the chromosomes. Shorter telomeres are associated with accelerated ageing and disease.
Environmental psychology
Authors: van den Berg Agnes E. , Staats Henk
Published: February 2018

Within the field of environmental psychology, a theoretical perspective on the health effects of nature has developed. This chapter begins with a discussion of theories on scenic beauty and environmental preference as a backdrop for understanding which environments are benign for human health and well-being. It then reports on theories on the restorative, or stress-relieving, effects of contact with natural environments. The third section discusses advances in environmental psychology, including theories on basic visual processes that may underlie restoration. The chapter concludes with some closing comments regarding the contribution of environmental psychology to health promotion, along with suggestions for new directions in theorizing and empirical research.
Oxford Handbook of Geriatric Medicine 3e
Authors: Bowker Lesley K. , Price James D. , Shah Ku S. , Smith Sarah C.
Published: February 2018

The Oxford Handbook of Geriatric Medicine includes all the information required to deliver effective geriatric care. It covers a range of key treatment areas, indicating where practice differs from that of younger adults or is ill informed by evidence and where dangers lurk for the inexperienced clinician, and the many ethical and clinical dilemmas common in geriatric practice. A practical, accessible, and essential guidance for all junior doctors and specialist trainees in geriatric and general internal medicine, and for all medical and nursing staff who manage older people.
Ageing
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing person, the theories of ageing, and demographics—life expectancy, population age structure, and ageing and illness, as well as illness in older people.
Clinical assessment of older people
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on consultation skills, multiple pathology and frailty, taking a history, other sources of information, problem lists, general physical examination, investigations, common blood test abnormalities, and comprehensive geriatric assessment.
Stroke
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on definition and classification, predisposing factors, acute assessment, investigations, acute management, stroke units, thrombolysis, intra-arterial therapies, ongoing management, complications, longer-term issues, and transient ischaemic attack clinics.
Psychiatry
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on cognitive ageing, impairments in cognitive function without dementia, overview of dementia, assessment of dementia, dementia and common diseases, dementia and parkinsonism, normal pressure hydrocephalus, dementia and less common diseases, general management of dementia, risk management and abuse in dementia, prevention of dementia, use of acetylcholinesterase inhibitors in dementia, other drug treatments for dementia, managing behavioural problems in dementia, compulsory detention and treatment, psychosis, diagnosis of delirium, causes of delirium, clinical assessment of delirium, treatment issues in delirium, non-drug management of delirium, drug treatments for delirium, confusion and alcohol, squalor syndrome, presentation of depression, clinical features of depression, non-drug management of depression, drug treatments for depression, and suicide and attempted suicide.
Renal medicine
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing kidney, acute kidney injury, management of acute kidney injury, chronic kidney disease, complications of chronic kidney disease, dialysis in renal replacement therapy, transplantation in renal replacement therapy, nephrotic syndrome, glomerulonephritis, and renal artery stenosis.
Haematology
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing haematopoietic system, investigating anaemia in older people, diagnosis of iron deficiency anaemia, treatment of iron deficiency anaemia, macrocytic anaemia, anaemia of chronic disease, paraproteinaemias, multiple myeloma, myelodysplasia and myelodysplastic syndrome, and chronic lymphocytic leukaemia.
Incontinence
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on causes of urinary incontinence, assessment of urinary incontinence, management of urinary incontinence, catheters, causes of faecal incontinence, assessment of faecal incontinence, and management of faecal incontinence.
Skin
Authors: Bowker Lesley K. , Price James D. , Shah Ku , Smith Sarah C.
Published: February 2018

This chapter provides information on the ageing skin, photoageing, cellulitis, other bacterial skin infections, fungal skin infections, chronic venous insufficiency, leg ulcers, management of venous leg ulcers, pruritus, pruritic conditions, blistering diseases, skin cancers and pre-cancers, and other skin lesions.
The epidemiological concept of population
Authors: Bhopal Raj S.
Published: February 2018

Epidemiology is a population science in several senses. First, it studies populations’ disease patterns, which are hugely influenced by the interaction of individuals living in communities. Secondly, it depends heavily upon demographic population data to achieve its goals. Thirdly, its findings are drawn from, and applied to, groups (or populations) of people. One critical yet that the causes of disease in individuals is not synonymous with the causes of disease in populations. This has implications for epidemiology and its application to public health. Populations are dynamic, changing in age structure, ethnic composition, and behaviours. Epidemiology needs to work within the context of demographic and epidemiological transitions as societies change. One prime purpose of epidemiology is applying findings in health promotion, health care, and health policy to improve the health of populations. The focus on population in epidemiology distinguishes it from other medical sciences.
Temporomandibular joint and surrounding musculature
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

The temporomandibular joint in relation to dentistry is the topic of this chapter. The first part of the chapter describes the muscle environment of the mandible and its movement in function. The treatment of temporomandibular disorders is followed by a discussion of occlusion and its clinical assessment. The final sections of the chapter describe the jaw reflexes, their physiology, and muscle function.
Liver
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

Liver in relation to dentistry is the topic of this chapter. Structure and function of the liver are discussed: metabolism of nutrients and toxins, exocrine functions, and synthesis of key proteins. Drugs and the liver are then discussed: the role of plasma proteins in transport or binding drugs; the liver’s role in metabolizing drugs; and the liver’s role in excreting some drug products into the bile. The effects of chronic excess alcohol on the liver are described and the role of the dentist in spotting potential liver problems in dental patients. The impact of liver disease on patient physiology is next explored, and the relevance for management of the dental patient. Types of hepatitis are described with relevance to dental care for hepatitis transmission. Key tests of liver function are described. The concluding section deals with the dental care of patients with impaired liver function.
Kidneys and chronic renal disease
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

Kidneys and chronic renal disease in relation to dentistry is the topic of this chapter. The chapter starts with the structure and function of the kidneys. The functions of acid-base balance and electrolyte balance are described. Chronic renal disease/failure (CRD/CRF) is then considered in terms of its impact on drug metabolism and excretion, anaemia, and bone pathology. Finally, the bleeding tendency associated with chronic renal failure is discussed, together with its clinical implications.
Diabetes
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

Diabetes in relation to dentistry is the topic of this chapter. The incidence of diabetes is increasingly rapidly, hand-in-hand with the increase in obesity. Obesity predisposes patients to an increased insulin resistance, i.e. reduces their ability to increase the glucose transport into adipocytes, muscle, and liver cells. The pancreas responds by producing more insulin but when it can no longer produce enough to overcome the insulin resistance, the blood glucose rises. Diabetes is characterized by raised blood glucose. We describe the devastating long-term effects of diabetes, in particular the microvascular and macrovascular medical complications. The dental complications include an increased severity of periodontal disease, oral candidiasis, and dry mouth but in those who are poorly controlled the impaired defence mechanisms can lead to severe head and neck infections and osteomyelitis. A final summary lists the important clinical recommendations for treatment of diabetic patients.
The respiratory system
Authors: Devlin Hugh , Craven Rebecca
Published: February 2018

The respiratory system in relation to dentistry is the topic of this chapter. Gaseous exchange in the lungs is mainly controlled by central chemoreceptors sensing a change in the pH of the cerebrospinal fluid. These receptors then activate a respiratory response which returns the blood and cerebrospinal fluid pH to normal. Localized airway obstruction, obstructive sleep apnoea, and lung disease can cause hypoxaemia (a low arterial oxygen oncentration) and hypercapnia (a raised carbon dioxide concentration in the blood). We emphasize the specific dental issues in patients with asthma, i.e. the dry mouth when taking β‎‎2-adrenergic agonists and the management of an acute asthmatic attack. Specific points of relevance to the dentist are summarized in sections throughout the chapter.