bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Neurosurgery
Authors: Smith Jodi L.
Published: November 2017

Common pediatric neurosurgical problems treated by neurosurgeons will be included on the American Board of Neurological Surgeons (ABNS) Oral Board Examination. Therefore, the candidate should be familiar with the neurosurgical management of such problems, which include disorders of cerebrospinal fluid (CSF) dynamics, congenital cranial and spinal malformations, tumors, vascular congenital and acquired disorders, intracranial and spinal infections, and intractable epilepsy. Neurological disorders that mimic pediatric neurosurgical conditions may also be on the examination. In this chapter, clinical vignettes of common pediatric neurosurgical conditions are presented, including hydrocephalus, myelomeningocele, intraventricular hemorrhage (IVH) of prematurity, craniosynostosis, and posterior fossa tumors. The examinee will be given the history, physical examination, pertinent imaging studies, and test results and will then be expected to provide a rational differential diagnosis and plan of management, outline the risks of surgery and describe the operation if proposed, and handle intraoperative and postoperative complications that occur.
Complications
Authors: Levi Allan D. , Heros Roberto C.
Published: November 2017

Complications form a very significant element of the Oral Board Examination, and questions about complications should be expected. The scoring system gives a grade for the handling of complications relevant to the treatment. The good news is that there are a limited number of complications in neurosurgery. The most common complications are postoperative neuropathic pain, postoperative wound infection, cerebrospinal fluid leak, C5 nerve palsy, postoperative cranial or spinal hematoma, hyponatremia, vasospasm, intraoperative aneurysm rupture—open or endovascular, major arterial injuries with cranial and spinal surgery, uncontrolled intracranial pressure, brain swelling during operative exposure, and esophageal injury; all these are discussed in this chapter.
Introduction
Authors: Hellman Samuel
Published: November 2017

This introduction to Learning While Caring is about education and learning both for the doctor and her or his patient: what has changed in the more than half-century of the author’s career and, perhaps more important, what has not and remains essential. Education of both an informed medical professional as well as an informed general public is necessary in order to properly consider the moral, political, and social consequences of the rapid increase in capabilities resulting from the molecular biological revolution and those wrought by semi-conductor exponential expansion of capacity and resulting capabilities. This introduction comprises the author’s remarks to beginning college undergraduates, college graduates, and medical graduates. They all emphasize the importance of critical thinking and the study of the humanities as well as a scientific education. Science, ethics, and politics can no longer be considered as separate and distinct, but rather are increasingly interdependent.
Medical Ethics and Learning
Authors: Hellman Samuel
Published: November 2017

Randomized clinical trials have become the preferred method of medical learning, but the author believes that they are often in conflict with an appropriate doctor-patient relationship. The physician’s primary obligation is to the individual patient rather than patients in general. Medical knowledge, by being gained by inductive reasoning, is always conditional and subject to being disproved. Medicine must be practiced with awareness of this uncertainty; while learned for patients as a group, it must be modified for the particular patient. From Tuskegee and Willowbrook to the Helsinki Declaration, medical ethics continues to evolve to favor individual rights rather than utilitarian benefit, and this trend should and will continue.
Perceptions of Cancer
Authors: Hellman Samuel
Published: November 2017

Cancer has major metaphoric significance not only to the public, but also to different medical specialties. This perception can determine patients’ attitudes toward the disease, as well as whether and when cancer is diagnosed and treated. The public has the same inexorably doomed image of the many diseases included in the term “cancer.” Some cancers are highly curable, and most are more likely cured if found early. As Susan Sontag has emphasized, the disease must be demythologized. Not only do the varying perceptions of cancer affect the public, these images also influence the different medical specialties. This chapter presents the differing presentations in medicine, the press, public discussion, and literature. All of these can distort the understanding and appropriate treatment of cancer, the most curable of the serious chronic diseases. Special attention is given to the preparation of the young oncologist in training.
More than a Survivor
Authors: Webster Lynn R.
Published: November 2017

“More than a Survivor” details the horrifying mass shooting in which Carolyn Tuft received severe injuries and her daughter died, then goes on to tell how Tuft has dealt with her ongoing pain problem. Her story illustrates the suddenness with which a pain problem can come upon any of us. It also shows the struggles that people in pain often face in navigating a normal day and trying to get adequate pain treatment. Yet Tuft remains determined to get the most joy she can out of her days. Chapter key idea: Even in the worst pain situations, it’s possible to pursue a fulfilling life.
Caught in a Web
Authors: Webster Lynn R.
Published: November 2017

“Caught in a Web” presents Rachel Hutchins, a young woman who battled chronic pain from both migraine headaches and an ovarian cyst. Although she had wanted to avoid becoming a drug user, because of the damage she had seen drug use do to others in her family, she began taking prescription opioids. Stress from family problems eventually contributed to her becoming addicted to the medications. After a while, she even began buying drugs illegally. Her life was going downhill. She tried breaking her dependency to the medications on her own, but because of her lack of supportive relationships, she wasn’t successful. It was only when she found compassionate medical professionals to come alongside her that she finally managed to wean herself off opioids. Chapter key idea: Pain influences, and is influenced by, everything else going on in a person’s life.
Coming of Age
Authors: Webster Lynn R.
Published: November 2017

In “Coming of Age,” readers learn about Ali Goldsmith, a teenage girl who developed chronic regional pain syndrome after bunion surgery and thus grew into adulthood while experiencing constant pain. Ali tried a wide range of treatments, including an unconventional ketamine infusion, and experienced gradual improvement. Meanwhile, teachers and fellow students didn’t always understand her or know how to act around her. Ali and her whole family had to adjust to the fact that, because of her pain, she was different from other kids her age and had limitations. As she grew up, Ali transitioned from relying on her parents’ management of her care to taking responsibility for her own medical care as well as her overall well-being and success in life. Chapter key idea: The best advocate for a person in pain is the person in pain.
Genetics and pathophysiology
Authors: Horsley Alex
Published: November 2017

This chapter describes the genetics and inheritance of CF. Different mutations have different effects on the CFTR protein, some leading to no CFTR being expressed at all and others to a poorly functioning variant. In the new era of mutation-specific therapies, the specific mutation expressed in a patient has important implications for their treatment.
Diagnosis and process of care
Authors: Cunningham Steve
Published: November 2017

Children with CF are now identified by newborn screening programmes, but not in every country, nor is every case is identified by newborn screening. Methods of diagnosis have become more complex as the CF gene has been mapped and more mutations identified, some of which may not be associated with disease. The sweat test remains the primary method of diagnosis, along with clinical symptoms. Clinical care is increasingly orientated to reduce the risk of cross-infection between patients. The range of organisms for which cross-infection measures are put in place is increasing. Routine clinic review is outlined and recommendations made. Annual review is described in detail. Transition is a pivotal period in patient management requiring structure and support. Patients (and parents) should be informed about the transition plan early and the delivery standard across all patients, but delivered at an age and pace commensurate with the adolescent’s clinical and psychological needs.
Microbiology of CF lung disease
Authors: Govan John , Jones Andrew
Published: November 2017

This chapter presents the microbiology of CF and describes the classical bacterial pathogens including Staphylococcus aureus, Haemophilus influenza, Pseudomonas aeruginosa and organisms of the Burkholderia cepacia complex. The dominant of these is P. aeruginosa. Infections with other opportunistic pathogens including non-tuberculous mycobacteria, Stenotrophomonas maltophila, and Achromobacter (Alcaligenes) xylosoxidans are also encountered. This chapter details measures to prevent the onset of chronic infection with these organisms include regular screening of respiratory tract samples for bacterial pathogens and the use of aggressive antibiotic therapy to eradicate initial infection before the pathogen can adapt to the environment of the CF lung. Patient-to-patient spread of transmissible strains of bacterial pathogens has led to the implementation of strict infection control measures at CF centres, including patient segregation. In addition to bacterial pathogens, the contribution of fungal infection in CF lung disease is increasingly recognized.
Future treatments
Authors: Thursfield Rebecca , Orchard Chris , Featherstone Rosanna , Davies Jane C
Published: November 2017

There are only a relatively limited armoury of drugs, the majority of which are aimed at downstream symptoms of cystic fibrosis. Therapies targeting the basic defect in CF as well as continued availability of more conventional drugs are required. Progress in gene therapy has been limited by the significant barriers to gene transfer of the CF lung, but the UK is hosting a large repeated dose trial of nebulized non-viral gene therapy designed around clinically meaningful outcomes. The UK CF Gene Therapy Consortium is also seeking to develop a promising modified lentiviral approach, although this is some years off. Perhaps the exciting development of recent decades has come from small molecule CFTR modulators, driven by an understanding of basic pathophysiological mechanisms. Ivacaftor is the first drug to be licensed, having proved itself highly clinically efficacious in patients with the class-3 gating mutation G551D. The trial pipeline seeks to expand indications for this and to explore the potential of Phe508del correctors. Finally, a number of anti-inflammatory and anti-infective strategies are being pursued. The emerging global problem of antibiotic resistance is leading to exciting alternatives such as biofilm disruption and bacteriophage to be explored.
Health leadership in Africa
Authors: Omaswa Francis
Published: November 2017

Chapter 2 describes the challenge facing African health leaders in stark terms: ‘Until and unless we Africans, individually and collectively, feel the pain and the shame of our condition, we will not have the commitment to take the actions needed to right the situation.’ It describes developments in Africa from the author’s experience over the last 40 years and, in particular, the way in which relationships between donors and African countries has simultaneously helped improve health and slowed down the development of national capacity and systems. This account sets the scene for the following chapters in which individual leaders describe the way they have struggled with this complex relationship as they have worked to improve health in their own countries.
Community health, community workers, and community governance
Authors: Were Miriam Khamadi
Published: November 2017

Chapter 8 describes how, as a medical student, the author realized that improving the environment and the health of people in local communities was the foundation for improving the health of the nation as a whole. It also covers the importance of creating new community norms of behaviour that promote health and hygiene and prevent disease. Lastly, it shows how it is possible to empower communities, contrary to most professional opinions, and integrate locally based community workers into a national system.
Politics, economics, and society
Authors: Gawanas Bience
Published: November 2017

Chapter 10 describes the way in which African organizations have developed their leadership roles, and covers the socio-economic and political context, as well as the way health is interconnected with all other aspects of life and the disproportionate burden that women bear. It also documents the deliberations and decision-making of the African Union and associated bodies, demonstrating how it has enabled African leaders to work cooperatively to exercise their leadership roles.
Indigenous knowledge systems
Authors: Odora-Hoppers Catherine A.
Published: November 2017

Chapter 15 describes the tensions that exist between Western scientific approaches and Indigenous Knowledge Systems. It illustrates the way in which traditional knowledge of, for example, herbal medicines, has a potentially very high economic value and describes how this can be developed in partnership between local and global interests. It also covers the author’s role as Professor of Development Education in creating a new interdisciplinary field of study, which strengthens the role of Indigenous Knowledge Systems in the social and economic development of Africa and opens out new ways of seeing the world and acting to improve it.
Health for the whole population
Authors: Kadama Patrick , Eriki Peter
Published: November 2017

Chapter 20 describes the way in which the support system provided by the traditional African extended family has given way in recent years to a new dependency by individuals on state organized health systems, charities, and private concerns. It discusses that the result has been increasing health costs and growing inequalities, and how it is now the poorest people who pay proportionately the highest amount for their healthcare out of their own pockets. The chapter sets out in broad terms the challenges faced by countries seeking to offer universal access to health and healthcare for their citizens. These are challenges that, as discussed in earlier chapters, require countries to find a way to meet these challenges that is based both on their culture and history, and on their financial capabilities and circumstances.
The future: vision and challenges
Authors: Omaswa Francis , Crisp Nigel
Published: November 2017

Chapter 24 draws together the major themes from throughout the book and identifies the lessons that can be learned for Africa and for the rest of the world. It concludes by offering a vision for the future, which can be achieved if Africans ‘claim their own future’, if there continues to be sufficient global solidarity to support health around the world, and if the countries of the continent develop a clear vision of ‘health made at home’.
The same specialty—but different approaches!
Authors: McCann Shaun R.
Published: November 2017

When did haematology as a specialty begin? It was the middle of the nineteenth century, as it required the development of the microscope and good staining techniques. It evolved differently in different countries, sometimes from internal medicine and sometimes from pathology. In this chapter, the development of haematology as a specialty in the United States, some European countries and India is outlined, showing how the specialty has grown from different evolutionary paths. There are many other countries in which haematology is practised, so this is not an exhaustive list; rather, it is an attempt to show how the specialty has grown from different evolutionary paths. In addition, the origins of the European Blood and Marrow Transplant Group (EBMT), the Center for International Blood and Marrow Transplant Research (CIBMTR), the International Society on Thrombosis and Haemostasis (ISTH), and the International Society of Blood Transfusion (ISBT) are discussed.
Macronutrients and fibre requirements during pregnancy
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

In this chapter, the impact of varying intakes of protein, carbohydrate and lipids, which are the key nutrients that contribute to calorie intake, is examined. Fibre is also an important food component that needs to be considered. The maternal macronutrient profile can influence embryonic and fetal development. For instance, both low and excessively high protein intakes during pregnancy are associated with restricted growth, increased adiposity, and impaired glucose tolerance. High-fat maternal diets can significantly increase the susceptibility to diet-induced obesity and percentage total body fat in offspring, although types of fats need to be considered, as intake of polyunsaturated fatty acids is important for fetal development. The type and content of carbohydrate (high- vs low-glycaemic sources) in the maternal diet influences blood glucose concentration, which has a direct effect on fetal glucose levels and metabolism.
Polyunsaturated fatty acids in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Evidence for the importance of the long-chain omega-3 polyunsaturated fatty acids in fetal and infant development is growing, as is interest in what constitutes an appropriate intake from sources such as oily fish or dietary supplements for pregnant women and/or infants. Polyunsaturated fatty acids have been implicated in maternal mental health and aspects of infant development, including cognitive and visual function, adiposity, and allergy. Western diets have become imbalanced with regard to the ratio of omega-6:omega-3 fatty acids, and recommendations to correct this imbalance include increasing the maternal intake of oily fish. However, this recommendation needs to be evaluated in light of the increased risk of exposure to contaminants such as mercury. Vegetable oils and cereals are important sources of polyunsaturated fatty acids for vegetarians.
Vitamin B3 (niacin) in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Niacin (as nicotinamide) is a component of coenzyme systems that function in the reductive biosynthesis of fatty acids and steroids, including cholesterol, and are involved in cell signalling. Niacin deficiency is rare, as the daily requirement can usually be met by food sources, and also via synthesis from tryptophan, which is present in dietary proteins. The prevalence of niacin deficiency is higher in populations consuming mainly corn or sorghum as a dietary staple. Corn contains niacin, but only in a bound form that is nutritionally unavailable. The additional needs for niacin during pregnancy are mirrored by the increased energy intake needs, and dietary supplementation is only necessary in cases of overall poor nutritional intake.
Vitamin B6 (pyridoxine) in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Vitamin B6 is required for the activity of a large number of enzymes with varied essential functions. Along with other B vitamins, it is involved in the metabolism of homocysteine to cysteine; if this reaction is disrupted, blood homocysteine levels rise, along with increased risks for cardiovascular disease, neuropsychiatric problems, and other adverse effects. Elevated homocysteine in pregnancy it is associated with anaemia, pre-eclampsia, preterm birth, and low birthweight. Vitamin B6 deficiency can also affect fetal brain development, as well as weight gain and linear growth in infancy. Although vitamin B6 is widely available in foods, mild to moderate deficiency is still common, even in developed countries. A #amp;#x2018;Mediterranean-style#amp;#x2019; diet is recommended to supply sufficient amounts of vitamin B6. In individuals with an adequate and balanced diet and healthy lifestyle, supplementation is generally unnecessary.
Vitamin B7 (biotin) in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Biotin is a water-soluble B vitamin (vitamin B7) which acts as a coenzyme to carboxylases and has roles in gluconeogenesis, fatty acid synthesis, and amino acid catabolism. Reduced activity of biotin-dependent enzymes (acetyl-CoA carboxylase I and II, and propionyl-CoA carboxylase) alters lipid metabolism and may impair synthesis of polyunsaturated fatty acids and prostaglandins; in addition, biotin has effects on gene expression by binding covalently to histones. Deficiency can be caused by prolonged consumption of egg whites, which contain the biotin-binding protein avidin. Smoking accelerates the degradation of biotin, which can result in marginal biotin deficiency. The effects of deficiency include disruption of immune function and lipid metabolism, with some evidence of teratogenicity in animals. Dietary deficiency is unlikely, although high consumption of egg whites should be avoided in pregnancy.
Vitamin B9 (folate) in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Folate is a coenzyme in multiple biochemical pathways involving one-carbon metabolism, including amino acid metabolism, DNA and RNA synthesis, homocysteine metabolism, and methylation of DNA. The most overt consequence of folate deficiency is megaloblastic anaemia caused by the inhibition of DNA synthesis in red blood cell production. Folate deficiency may also influence the ability to maintain DNA methylation patterns in replicating cells, resulting in lasting phenotypic changes. Embryogenesis and fetal growth require higher levels of folate, which must be supplied maternally during pregnancy. A link between low maternal folate levels and the occurrence of neural tube defects has long been recognized. Other effects in pregnancy include increased risks of pre-eclampsia and placental vascular disorders. The general recommendation is for supplementation prior to conception and throughout pregnancy with 400 #amp;#x03BC;g of folic acid in tablet form, in addition to dietary sources, which can reduce the risk of neural tube defects.
Choline in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Choline is required for the structural integrity of cell membranes and is involved in methyl-group metabolism, neurotransmission, transmembrane signalling, and lipid and cholesterol transport and metabolism. Choline is critical during fetal and neonatal life to ensure optimal brain and cognitive development. There is an intersection of the pathways of choline, folate, and vitamin B12 in the formation of methionine from homocysteine. Maternal peri-conceptional deficiency for choline, like folate, is associated with an increased risk of neural tube defects in the offspring. It is recommended that pregnant women do not restrict fat severely from their diets, as choline is derived from the lipid content of food. Strict vegetarian or vegan diets may be low in choline. The high secretion rate of choline into breast milk means that lactating women have a high demand, and multivitamins containing choline may be helpful for both pregnancy and breastfeeding.
Iodine in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Iodine is a key component of thyroid hormones. Development of the fetal brain and nervous system are dependent on thyroid hormones supplied by the mother via the placenta, increasing the maternal demand for iodine throughout pregnancy. Women with adequate iodine intake before conception (~150 #amp;#x03BC;g/day) can adapt to the increased demand for thyroid hormones during pregnancy, because the thyroid gland adjusts its hormonal output; but this depends on sufficient availability of dietary iodine and the integrity of the thyroid gland. Iodine deficiency causes congenital hypothyroidism, and in severe form, the irreversible brain damage associated with cretinism. Moderate iodine deficiency in pregnancy is associated with lower learning capacity, reduced IQ, hearing impairment, and increased risk of attention deficit disorder. Pregnant women should take a daily multivitamin that contains 150 #amp;#x00B5;g of iodine, unless they regularly consume concentrated food sources of iodine.
Copper in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Copper is an essential trace mineral with a central role in oxidation#amp;#x2013;reduction reactions. It is involved in connective tissue formation and disulphide bonding of keratin. Clinical deficiency for copper is uncommon but has been increasing in prevalence, resulting from malnutrition or lack of trace metals in the food source, even in Western diets. Secondary copper deficiency can be induced by excess intake of zinc or iron and is sometimes seen in individuals taking supplements of these minerals. Copper requirements are increased in pregnancy, and suboptimal supply may have adverse effects on developing tissues and organ systems including the lung, skin, bones, and immune system. Despite the increased need, supplementation is generally not recommended in pregnancy. An increased intake of foods high in copper, such as nuts, and a proportionate lowering of low-copper foods (e.g. fats/oils) may be advisable in women with potentially marginal copper status.
Prebiotics and probiotics in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Probiotics are live, non-pathogenic commensal microorganisms with beneficial effects on the host organism; they improve and/or maintain intestinal flora balance by suppressing and displacing harmful bacteria. Prebiotics are nondigestible food components that stimulate growth or activity of these beneficial intestinal bacteria. Such microorganisms form an integral part of the intestinal mucosal defence system and are important for the development and maturation of the infant#amp;#x2019;s gastrointestinal tract. Maternal ingestion of probiotics and prebiotics from dietary sources during pregnancy, or by the infant at weaning, may enhance the development and maturation of the neonatal gastrointestinal tract. Probiotic foods may also help control insulin resistance and the development of gestational diabetes.
Foods, exposures, and lifestyle risk factors in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Advice for pregnant women on food avoidance, dangerous exposures, and inappropriate behaviours abounds on the internet and through various information sources. This chapter reviews the evidence base for such advice and clarifies issues where common advice is not supported by credible data. Foods containing potential teratogens, mutagens, or toxicants that need consideration include liver (high vitamin A), some herbal teas, contaminated grains, predatory fish, caffeine-containing foods, and various sources of foodborne infections. Exposure to environmental toxicants such as lead, pesticides, herbicides, polycyclic aromatic hydrocarbons, bisphenol-A, and other endocrine-disrupting chemicals should be avoided, as should alcohol consumption and cigarette smoking. Restrictive diets and unusual dietary cravings (pica) need to be properly managed. Evidence for harm from personal care products is generally weak, but pregnant women may choose to avoid some unnecessary exposures.
Cultural and traditional food practices in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Cultural beliefs and practices can markedly influence a woman’s pregnancy and childbirth experiences, and may shape her mothering behaviour. In addition, dietary intake before and during pregnancy and through lactation is often influenced by cultural beliefs and practices. As some traditional health care beliefs and food practices favoured in different cultures appear to result from efforts to address specific environmental challenges, it is important to recognize and respect these beliefs while guiding women towards optimum nutrition and away from harmful practices or prohibitions. This chapter discusses the implications of some common food practices, as well as cultural practices that are specific to pregnancy and lactation, on maternal and infant health.
Maternal stress in pregnancy and breastfeeding
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Acute and/or chronic stress in pregnancy is potentially detrimental to the health of both the mother and the developing fetus. The stress response triggers the release of glucocorticoids, mainly cortisol, into the maternal bloodstream, with subsequent effects on energy metabolism, growth processes, and in the functioning of the immune system and brain. The placenta provides a barrier to natural glucocorticoids, buffering the fetus from minor changes in maternal cortisol levels but can be saturated by high maternal levels of cortisol and under conditions of maternal under-nutrition or compromised placental function. Various outcomes can be affected, including birthweight and infant behaviour. Severe stress is not always easily avoided, but daily stress, and specifically that associated with pregnancy itself, should be minimized as much as possible.
Effects of maternal age on pregnancy outcomes
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

Maternal age on both ends of the reproductive spectrum (teenage and 35+) is associated with increased risk of adverse pregnancy outcomes, as compared with the age range from 20–34 years old. Some of the increase in pregnancy complications in older mothers is caused by underlying age-related health issues such as hypertension and diabetes, the prevalence of which increases linearly with age. The risks associated with young maternal age are more related to nutritional deficits and the fact that pregnant adolescents may still be growing themselves. Poor fetal growth often seen in adolescent pregnancies possibly results from competition for nutrients. Maternal bone loss is also a concern, as adolescent diets are commonly low in calcium and vitamin D. Pregnant adolescents may benefit from calcium supplementation to compensate for the increased need for their own bone growth and should at minimum receive vitamin D supplements, as recommended for all pregnant women.
Paternal factors that affect conception and pregnancy
Authors: Gluckman Sir Peter , Hanson Mark , Seng Chong Yap , Bardsley Anne
Published: November 2017

The father’s nutrition and lifestyle can influence pregnancy outcomes in a number of ways. In the pre-conception period, several modifiable factors in paternal behaviour and nutrition can influence sperm count and quality, and consequently affect fertility. For example, sperm count and quality is affected by alcohol, recreational drugs, prescription drugs, infections, tobacco, and environmental toxins, as well as the man’s BMI and metabolic health state. A father’s metabolic status may also have some impact on the metabolic trajectory of his offspring. Other aspects of a father’s behaviour can indirectly affect the developing fetus through occupational and environmental exposures. Prospective fathers need to be conscious of their personal health and nutrition, as well as of environmental factors that may influence both their ability to conceive and the health of their future offspring.
Foundations in welfare economics and utility theory: what should be valued?
Authors: Brazier John , Ratcliffe Julie , Salomon Joshua A. , Tsuchiya Aki
Published: November 2017

This chapter examines what is to be valued in economic evaluation of health care interventions. It starts by reviewing economic theory on resource allocation through the market mechanism and applying this to the health care sector. It then presents the alternative of resource allocation by government intervention and the implications this has for the use of economic evaluation and the measure of benefit. This is followed by a consideration of the welfarist foundation for a measure of health such as the QALY, and finally some non-welfarist arguments for this. The aim of this chapter is to examine what is important for the purpose of economic evaluation and, specifically, the place of the QALY measure.
Valuing health
Authors: Brazier John , Ratcliffe Julie , Salomon Joshua A. , Tsuchiya Aki
Published: November 2017

This chapter explores the methods for valuing health, sometimes known as preference elicitation techniques. It begins by describing and reviewing the main cardinal techniques used in the health economics literature for valuing health states (i.e. those methods that produce responses that are already on some interval scale). Different techniques can generate different values, and so this chapter also addresses the advantages and disadvantages of each technique. It goes on to examine the variants of each technique and the resulting implications of these for the values obtained. Finally, this chapter addresses the question of who should be asked to value health states, and considers whether values should be based on preferences (as is usually the case in economics) or experiences.
A QALY is a QALY is a QALY—or is it not?
Authors: Brazier John , Ratcliffe Julie , Salomon Joshua A. , Tsuchiya Aki
Published: November 2017

This chapter looks at a theoretical framework for diversions from the assumption that all units of health gain have equal social value, and examins different ways in which welfarists and non-welfarists may call for cost per weighted QALY analyses, for efficiency-based reasons, and equity-motivated reasons. A distinction is drawn between the value of health to individuals (which is a matter of preference) and the value of health of different people to society (which is a matter of normative judgement). Another distinction is drawn between weighting QALYs across different people because of who they are and weighting QALYs across different people because of the level of their baseline health. The chapter also presents a brief look at the challenges associated with empirical research in the topic, their findings, and the practicalities of cost per weighted QALYs.
Introduction to “History and epistemology of psychopathology”
Authors: Parnas Josef
Published: November 2017

Chapter 4 is an introduction to Chapter 2, which discusses the history and epistemology of psychopathology, and covers the definition of change as a feature or a general concept of psychiatry, and the definition’s relation to specific ontological regions (e.g., physics, biology, and sociology).
Expert disagreement and medical authority
Authors: Solomon Miriam
Published: November 2017

Chapter 8 discusses how scientific disagreement is, on the whole, good for science and bad for medicine. It covers how it is good for science because it can produce useful criticism, divide cognitive labor, and distribute knowledge, and bad for medicine because expert disagreement typically reduces medical authority, making the practice of medicine too vulnerable to commercial or political interests. In this chapter the case of disagreement over screening mammography guidelines is discussed, to show both the production and the management of disagreement in the medical context. Four general ways of managing disagreement in the medical context are explored. It then looks briefly at a psychiatric case, and finds that the Diagnostic and Statistical Manual of Mental Disorders plays a role in managing dissent in the psychiatric context.
Trust, dissent, and decision vectors
Authors: Hacking Ian
Published: November 2017

Chapter 9 is a commentary on Chapter 8, which discusses various topics around the ideas of consensus, dissent, division of cognitive labor, social epistemology, scientific disagreement, epistemic authority, decision vector, and agnotology as they relate to eExpert disagreement and medical authority.
Interdisciplinarity versus compartmentalization: an eternal dilemma in psychiatry
Authors: Sato Yuji
Published: November 2017

Chapter 18 is a commentary on Chapter 17, which covers attitudes toward philosophy and psychology in German psychiatry between 1867–1917, including discussion related to Wilhelm Wundt, Emil Kraepelin, Theodore Ziehen, interdisciplinary history, philosophy, psychiatry, and experimental psychology, and how interdisciplinarity versus compartmentalization is an ongoing dilemma in psychiatry.
Decline of psychoanalysis to the advantage of what?
Authors: Parnas Josef
Published: November 2017

Chapter 21 is a commentary on Chapter 20, which covers the development of psychoanalysis in the context of American psychiatry, including its origin in nineteenth-century medicine and neurology, and the clinical success of psychopharmacology, the growth of neuroscience.
Introduction to “Psychiatry made easy: operation(al)ism and some of its consequences”
Authors: Kendler Kenneth S.
Published: November 2017

Chapter 22 is an introduction to Chapter 23, which covers operationalism, Bridgman, DSM-III, the structured interview, phenomenology, and the origins of this term, its historical permutations, and its current status in the diagnostic manuals.
Depression in a biopsychosocioeconomic context
Authors: Sato Yuji
Published: November 2017

Chapter 35 discusses how, despite ongoing efforts to improve its diagnostic reliability by operational criteria, the concept of depression still remains controversial, primarily due to its complicated composition involving not only medical/nosological factors but also significant nonmedical factors, for example, socioeconomic environment and the zeitgeist which dominates the intellectual milieu of the twenty-first century. This chapter outlines major biopsychosocioeconomic components of the depression concept today, and illustrates some notable wide-ranging consequences brought about by the conceptual complexities of depression, then attempts to suggest several remedial measures and paths forward to cope with, and hopefully improve, the depression concept today and its multifaceted sequelae.
The shaping of autism and other psychiatric disorders: an alternative perspective
Authors: Kendler Kenneth S.
Published: November 2017

Chapter 39 is a commentary on Chapter 38, which covers the ratio of science to activism in the shaping of autism, and includes discussion about the DSM, looping effects, philosophy, activism, the Internet, the “internal” and the “external” factors that have shaped autism. It also offers an alternative perspective on the shaping of autism and other psychiatric disorders.
Drug information
Authors: Dickman Andrew , Schneider Jennifer
Published: November 2017

This chapter provides a concise summary of pertinent information for 37 drugs that are administered by CSCI. Each monograph includes information relating to clinical pharmacology, indications, adverse effects, doses, drug interactions, and an exhaustive list of compatibility and stability data. Opioid equianalgesia is discussed because several opioids are used in palliative care and it is often necessary to either change the drug or route of administration as a patient’s condition changes.
Symptom control with the syringe driver
Authors: Dickman Andrew , Schneider Jennifer
Published: November 2017

Symptoms tend to increase during the last days and weeks of life and pharmacological interventions are essential for adequate alleviation. Common symptoms experienced by patients at the end of life include pain, respiratory tract secretions, agitation, delirium, restlessness, nausea, and vomiting. The oral route should be used where possible, but as the patient’s condition deteriorates, it may no longer be feasible to administer medication this way. It is likely that patients will require a combination of drugs to control their coexisting medical conditions as well as for pain and other symptom management. A CSCI provides a simple and effective way to maintain control of commonly encountered symptoms experienced by patients with advanced disease. This chapter discusses how CSCIs of certain drugs can be used to manage such symptoms.
Spondyloarthritis in antiquity and in history
Authors: Rothschild Bruce , Feldtkeller Ernst
Published: November 2017

Spondyloarthropathy has a long history in the fossil record, one that even predates dinosaurs. It is prevalent in contemporary animals, especially apes, bears, rhinoceros, and Komodo dragons. Prevalence in the archaeologic record is predominantly uniform, independent of geology, except in areas where sanitation is compromised. Major advance in its diagnosis came about with the introduction of radiologic techniques, HLA-B27 tissue typing, and recognition that it was not a rheumatoid variant. In spondyloarthritis therapy, immobilization was replaced by active physiotherapy and thorough patient education.
Epidemiology of axial spondyloarthritis
Authors: Gensler Lianne , Weisman Michael , Caplan Liron
Published: November 2017

Axial spondyloarthritis (axSpA) is an inflammatory arthritis of the sacroiliac joints and spine. The prototype is ankylosing spondylitis, the radiographic form of the disease; however, more recently, an earlier or less-differentiated presentation has been described termed non-radiographic axial spondyloarthritis (nr-axSpA). Extra-articular manifestations commonly include anterior uveitis, inflammatory bowel disease, and psoriasis. There is a strong association with the human leukocyte antigen B27 (HLA-B27) allele, and the prevalence of the disease tends to follow the frequency of the allele. Epidemiological studies in axSpA are relevant in the population studied and therefore have limited external validity. This chapter describes the epidemiology of axSpA.
Diagnosis, classification, and management of peripheral spondyloarthritis
Authors: Rudwaleit Martin , Deodhar Atul
Published: November 2017

Spondyloarthritis (SpA) can affect the axial skeleton (axSpA) but also manifest as peripheral arthritis, enthesitis, and dactylitis (peripheral SpA). Peripheral SpA can occur after bacterial infections (reactive arthritis) or be associated with psoriasis or inflammatory bowel disease. The arthritis is usually asymmetric, affects predominantly the lower extremity, and can be self-limiting but can also run a chronic course. The frequency of HLA-B27 is around 50% in purely peripheral SpA, while it is 70–90% in axSpA. For classification, the Amor, ESSG, or more recent ASAS criteria for peripheral SpA can be used. The ASAS criteria are likely to capture early peripheral SpA better than the other two. Therapy includes NSAIDs, local steroid injections, and synthetic disease-modifying antirheumatic drugs, of which sulfasalazine is best studied and the preferred drug for peripheral arthritis. A recent, placebo-controlled clinical trial with adalimumab may lead to the first approval of a biologic in peripheral SpA.
Genetics of spondyloarthritis
Authors: Brown Matthew A. , Reveille John
Published: November 2017

In addition to sharing clinical, histopathological, and immunological features, spondyloarthritis (SpA) encompasses a group of diseases that are genetically linked through shared associations with HLA-B27, as well as other genes of the IL-23R and aminopeptidase groups. Great progress has been made since the development of the genome-wide association study approach, with better dissection of the HLA associations of this group of diseases, as well as the discovery of multiple genetic loci found outside of the major histocompatibility complex, in ankylosing spondylitis (AS) in particular. These genetic data shed light on the related pathogenesis of AS and psoriatic arthritis (PsA), inflammatory bowel disease (IBD)-related arthritis, and reactive arthritis (ReA). Genetic associations also strengthen the suggestive data that Behçet’s disease (BD) and Familial Mediterranean Fever (FMF) are related to the more classical forms of SpA.
Immune mechanisms: innate immunity
Authors: Noordenbos Troy , Baeten Dominique
Published: November 2017

Innate immune mechanisms are strongly implied in the pathophysiology of spondyloarthritis (SpA). This chapter discusses available data on the role of the innate immune system in relation to HLA-B27, genetic associations, and the cellular and molecular characteristics of disease target tissue. Regarding the linkage with MCH-class I molecule HLA-B27, the chapter discusses the arthritogenic peptide hypothesis and three popular antigen-independent theories. The genetic architecture of the disease argues against a role for the adaptive immune system and identifies cytokine pathways, such as IL-1, TNF, and IL-23/IL-17. In experimental as well as in human SpA, the importance of these cytokine pathways are confirmed by effective reduction of signs and symptoms upon blockade of specific molecules. In-depth cellular and molecular analysis of the target tissue identifies a contribution of cells with strong innate features, rather than cells of the adaptive immune system.
Imaging: spine
Authors: Baraliakos Xenofon , Hermann Kay-Geert A.
Published: November 2017

Although axial spondyloarthritis (axSpA) starts in the sacroiliac joints in the vast majority of cases, the spine can be clinically affected with similar severity and frequency, especially in long-standing disease. In addition, not only the inflammatory but also structural changes seen in the sacroiliac joints can be visualized in the same way in the spine when using the appropriate imaging techniques. For the interpretation of imaging findings in axSpA, typical and frequent differential diagnoses need to be taken into account, such as degenerative changes, bacterial inflammation, and fractures, and also non-pathological findings such as haemangioma. This chapter concentrates on the imaging of the spine in axSpA, giving an extensive overview of the relevant diagnostic and differential diagnostic findings in patients with axSpA and the most common differential diagnoses.
Extra-articular manifestations: uveitis
Authors: Rosenbaum James T.
Published: November 2017

Acute anterior uveitis (AAU) is the most common, extra-articular, clinical manifestation of spondyloarthritis. In some patients, it is the dominant manifestation. This chapter reviews the definition of uveitis, the epidemiology of uveitis, the differential diagnosis, the relationship of HLA-B27 to uveitis, laboratory testing for suspected HLA-B27-associated uveitis, treatment considerations, and experimental models in which both uveitis and spondylitis co-exist. Although acute anterior uveitis rarely precedes spondyloarthritis, acute anterior uveitis is often the clue that chronic back pain is due to sacroiliac inflammation. Uveitis is sometimes the dominant clinical manifestation of spondyloarthritis and it can influence the choice for appropriate therapy.