{"title":"Promoting healthy nutrition","authors":"C. Wright","doi":"10.1093/med/9780198788850.003.0011","DOIUrl":"https://doi.org/10.1093/med/9780198788850.003.0011","url":null,"abstract":"Key nutritional issues affecting preschool children discussed in this chapter are breastfeeding, complementary feeding, and promoting a healthy diet. The evidence on iron deficiency and vitamin D deficiency is reviewed. Recommendations are made for commissioning of services to support breastfeeding, and evidence-based advice given for practitioners.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82342898","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Developmental reviews and the identification of impairments/disorders","authors":"P. Wilson, J. Law","doi":"10.1093/MED/9780198788850.003.0022","DOIUrl":"https://doi.org/10.1093/MED/9780198788850.003.0022","url":null,"abstract":"There is a considerable international variation in preventative child health programmes suggesting variability in the available evidence. More socially disadvantaged families may be more likely to have children with developmental difficulties but are less likely to make use of such services. Family perceptions of child development and difficulties are likely to be culturally sensitive and professionals need to pay attention to this. Many developmental problems are on continua which border typical development but also overlap and interact with one another. There is evidence for the effectiveness of some interventions but these are rarely tied into population-level health surveillance programmes.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85703277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Dietary and environmental exposures in pregnancy","authors":"C. Taylor","doi":"10.1093/MED/9780198788850.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780198788850.003.0003","url":null,"abstract":"There is increasing recognition of the importance of both nutrition and environmental exposures in pregnancy as prenatal events are increasingly thought to have a significant impact on the emergence of later disease, as well as on many crucial aspects of child development. This chapter provides an overview of the evidence for the importance of nutrition and environmental exposures both preconceptually and in pregnancy on the long-term health and development of the child, and provides some recommendations for action points by health professionals.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2019-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90280047","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oxford Medicine OnlinePub Date : 2018-12-01DOI: 10.1093/MED/9780198784906.003.0415_UPDATE_001
Francesco Paneni, Massimo Volpe
{"title":"Co-morbidity (HFrEF and HFpEF): hypertension","authors":"Francesco Paneni, Massimo Volpe","doi":"10.1093/MED/9780198784906.003.0415_UPDATE_001","DOIUrl":"https://doi.org/10.1093/MED/9780198784906.003.0415_UPDATE_001","url":null,"abstract":"Hypertensive heart disease is a major cause of heart failure (HF) and mortality. Hypertension precedes HF occurrence in 75% of cases, and carries a sixfold increase in HF risk as compared to non-hypertensive individuals. Most importantly, a minority of patients survive 5 years after the onset of hypertensive HF. In hypertensive patients, the heart may present different patterns of adaptive remodelling: concentric remodelling, concentric hypertrophy, and eccentric hypertrophy. Although most hypertensive patients are at high risk of developing concentric hypertrophy, a growing proportion of subjects display a concentric-to-eccentric progression eventually leading to left ventricular dilation and systolic dysfunction. Several factors including myocardial ischaemia, ethnicity, genetic background, history of diabetes, and blood pressure pattern may significantly influence the pathway from hypertension to left ventricular dilation. Patients with a concentric hypertrophy usually develop HF with preserved ejection fraction (HFpEF), whereas those with an eccentric (dilated) phenotype develop HF with reduced ejection fraction (HFrEF). Lowering blood pressure has a striking effect in reducing the risk of HF. Although available antihypertensive drugs are all successful in lowering blood pressure, angiotensin-converting enzyme inhibitors, angiotensin receptor blocker (ARBs), and diuretics are more effective than other drug classes in preventing HF. The combination of the neprilysin inhibitor sacubitril with the ARB valsartan (LCZ696) has recently been shown to be highly effective in reducing HF-related outcomes in hypertensive subjects. An individualized treatment scheme taking into account blood pressure levels, type of HF (HFpEF or HFrEF), and relevant co-morbidities (i.e. renal disease, diabetes) is currently the best approach to improve morbidity and mortality in hypertensive patients with HF.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83415220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Cultures and their roles: An overview","authors":"D. Bhugra, A. Ventriglio, K. Bhui","doi":"10.1093/MED/9780198723196.003.0001","DOIUrl":"https://doi.org/10.1093/MED/9780198723196.003.0001","url":null,"abstract":"Cultures are an integral part of our being. We are born in cultures, which mould our behaviours, attitudes, and cognitions. Culture is a system of meanings and knowledge, belief systems, and morals as well as laws. Culture is acquired, and people change in response to culture and, in return, individuals change culture. Culture informs our world view and offers symbols with specific meanings, not only for individuals in that particular culture but also for others looking in. Culture needs to be differentiated from race and ethnicity. Furthermore, for migrants there are stages in the process of migration that affect their processes of acculturation, which can result in different types of adjustment in the new country, including assimilation, biculturalism, and deculturation. The response of the new country is also important in welcoming or rejecting migrants whatever their reason for migration. Cultural competence is a part of good clinical practice.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85950096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Managing Personality Disordered Offenders","authors":"","doi":"10.1093/med/9780198791874.001.0001","DOIUrl":"https://doi.org/10.1093/med/9780198791874.001.0001","url":null,"abstract":"Managing Personality Disordered Offenders: A Pathways Approach describes the development and implementation of the Offender Personality Disorder (OPD) strategy in the UK. It begins by reviewing the existing evidence base for interventions for personality disordered offenders in the UK and elsewhere, before outlining the principles and requirements of the strategy and how it has been implemented in the community and secure settings in London and south-east England by the London Pathways Partnership (LPP). The LPP is a consortium of four mental health trusts working together with the probation and prison services to deliver community and secure OPD services: individual chapters, written by leaders within the LPP and wider OPD pathway, address key aspects, including staff selection and training; case identification and formulation; intervening in the community and in secure settings; service user involvement; and commissioning and joint working. Each chapter includes an authoritative review of the relevant evidence base, together with consideration of available options and the rational for the approach chosen for services in London. This is followed by a practical ‘how to do it’ guide and review of what has worked and what has not during the first four years of service delivery. Each chapter includes a section on evaluation and proposals regarding possible ‘next steps’. The book concludes with a formulation-based analysis of whether or not the OPD strategy has had any impact on its stated outcomes and how these might be re-evaluated as the mechanisms by which change is achieved in the pathway become better understood.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87886492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Case identification and formulation","authors":"P. Minoudis, J. Shaw","doi":"10.1093/MED/9780198791874.003.0003","DOIUrl":"https://doi.org/10.1093/MED/9780198791874.003.0003","url":null,"abstract":"The aims of this chapter are twofold. First, it outlines methods by which high-risk offenders with personality disorder can be identified in large samples of offenders. It presents a summary of the available evidence that relates to this task, while also drawing on the authors’ experience of implementing systems of case identification while working in the probation service in the UK. It is argued that adopting proactive systems of case identification not only is achievable but also holds a number of potential benefits. Second, the chapter considers approaches to formulation in the Offender Personality Disorder (OPD) community pathways services. Following a review of the literature and available models, the authors discuss how the London Pathways Partnership selected its current approach and provide a description of its practical application and the lessons learned from our experiences. The chapter ends with a discussion of future directions for both case identification and formulation.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86807496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Psychotherapy: General principles","authors":"D. Bhugra, A. Ventriglio, K. Bhui","doi":"10.1093/MED/9780198723196.003.0007","DOIUrl":"https://doi.org/10.1093/MED/9780198723196.003.0007","url":null,"abstract":"Psychotherapy is a process based on different types of schools of thought, with patient and therapist working together through talking therapies to bring about a sustained change. Three types of psychotherapy have been described: supportive, re-educative, and constructive. Each has a specific set of rules and strategies that the therapist must follow. Once again, the explanatory models of patients and their families will influence whether they engage in therapy or not. Those from minority cultural groups may enter therapy with a pre-existing defence, such as seeing the majority population as the problem, and the therapist may find it difficult to engage them. It is worth recognizing that different schools of therapy may not always apply to other cultural groups. In addition, it may be that ethnic minority therapists have faced discrimination and this experience will affect their attitudes. Furthermore, they may not be willing to share negative experiences.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73257537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Intervening in the community","authors":"J. Craissati, R. Halsey","doi":"10.1093/MED/9780198791874.003.0004","DOIUrl":"https://doi.org/10.1093/MED/9780198791874.003.0004","url":null,"abstract":"The Offender Personality Disorder (OPD) pathway strategy explicitly begins and ends with the community, and this ethos lies at the heart of the pathway approach to management. This chapter therefore focuses on the question of how best to deploy limited resources to greatest effect when facing the challenge of high levels of morbidity and offending, a large geographical area, and a changing staff group. Having reviewed the rather sparse literature on relevant and effective community treatment interventions, the authors consider the relative benefits of stand-alone treatment approaches, partnership working, and indirect support, before describing the mixed model chosen by the London Pathways Partnership. The chapter concludes with a reflection on progress and challenges four years on; unbalanced by politically driven changes midway, the service nevertheless has flourished, although partnership working requires constant attention if staff are to be supported to make a real difference.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75640343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Meaningful service user participation in the pathway","authors":"Nikki Jeffcote, Karen Van Gerko, E. Nicklin","doi":"10.1093/MED/9780198791874.003.0006","DOIUrl":"https://doi.org/10.1093/MED/9780198791874.003.0006","url":null,"abstract":"This chapter describes the context, aims, challenges, and growth of a user involvement programme spanning both prison and community services in the Offender Personality Disorder (OPD) pathway. Involving and empowering high-risk individuals to enhance pathway service provision has the potential to bring significant benefits in terms of social integration, well-being, and desistance from offending, while also requiring careful management of internal and external safety. The chapter describes the particular challenges involved and the support and governance framework that has enabled the user involvement programme to flourish within the London Community Pathway. Successful initiatives are described and service users’ own narrative accounts of their experience of involvement are included throughout. The chapter concludes with a review of the challenges that have emerged as the programme has grown, the learning they have afforded, and ideas for future continuing developments.","PeriodicalId":19711,"journal":{"name":"Oxford Medicine Online","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81676918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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