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Promoting healthy nutrition 促进健康营养
Pub Date : 2019-02-28 DOI: 10.1093/med/9780198788850.003.0011
C. Wright
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.
本章讨论的影响学龄前儿童的主要营养问题是母乳喂养、补充喂养和促进健康饮食。对铁缺乏和维生素D缺乏的证据进行了综述。建议委托服务机构支持母乳喂养,并向从业人员提供基于证据的咨询意见。
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引用次数: 5
Developmental reviews and the identification of impairments/disorders 发育回顾和缺陷/障碍的识别
Pub Date : 2019-02-28 DOI: 10.1093/MED/9780198788850.003.0022
P. Wilson, J. Law
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.
预防性儿童保健方案在国际上存在相当大的差异,这表明现有证据存在差异。更多处于社会不利地位的家庭可能更有可能有发育困难的儿童,但不太可能利用这种服务。家庭对儿童发展和困难的看法可能具有文化敏感性,专业人员需要注意这一点。许多发展问题是连续的,它们与典型的发展相边界,但也相互重叠和相互影响。有证据表明一些干预措施是有效的,但这些干预措施很少与人口水平的健康监测规划联系起来。
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引用次数: 4
Dietary and environmental exposures in pregnancy 怀孕期间的饮食和环境暴露
Pub Date : 2019-02-28 DOI: 10.1093/MED/9780198788850.003.0003
C. Taylor
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.
人们日益认识到怀孕期间营养和环境暴露的重要性,因为产前事件日益被认为对以后疾病的出现以及对儿童发展的许多关键方面有重大影响。本章概述了营养和环境暴露在孕前和怀孕期间对儿童长期健康和发育的重要性的证据,并为卫生专业人员提供了一些行动要点建议。
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引用次数: 0
Co-morbidity (HFrEF and HFpEF): hypertension 合并症(HFrEF和HFpEF):高血压
Pub Date : 2018-12-01 DOI: 10.1093/MED/9780198784906.003.0415_UPDATE_001
Francesco Paneni, Massimo Volpe
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.
高血压性心脏病是导致心力衰竭和死亡的主要原因。在75%的病例中,高血压先于心衰,与非高血压个体相比,高血压的风险增加了6倍。最重要的是,少数患者在高血压性心衰发病后能存活5年。在高血压患者中,心脏可能呈现不同的适应性重构模式:同心重构、同心肥厚和偏心肥厚。虽然大多数高血压患者都有发生同心肥厚的高风险,但越来越多的受试者表现出从同心到偏心的进展,最终导致左心室扩张和收缩功能障碍。包括心肌缺血、种族、遗传背景、糖尿病史和血压模式在内的几个因素可能显著影响高血压到左室扩张的途径。同心型肥厚患者通常发展为HF并保留射血分数(HFpEF),而偏心型(扩张型)患者发展为HF并降低射血分数(HFrEF)。降低血压对降低心衰的风险有显著的效果。虽然现有的降压药都能有效降低血压,但血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂(ARBs)和利尿剂在预防心衰方面比其他药物更有效。neprilysin抑制剂sacubitril与ARB缬沙坦(LCZ696)的联合用药最近被证明在降低高血压患者的hf相关结局方面非常有效。考虑到血压水平、HF类型(HFpEF或HFrEF)以及相关合并症(如肾脏疾病、糖尿病)的个体化治疗方案是目前改善高血压合并HF患者发病率和死亡率的最佳方法。
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引用次数: 0
Cultures and their roles: An overview 文化及其作用:概述
Pub Date : 2018-11-01 DOI: 10.1093/MED/9780198723196.003.0001
D. Bhugra, A. Ventriglio, K. Bhui
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.
文化是我们存在的一个组成部分。我们出生在文化中,文化塑造了我们的行为、态度和认知。文化是一个包含意义和知识、信仰体系、道德和法律的体系。文化是后天习得的,人们会因文化而改变,作为回报,个人也会改变文化。文化影响着我们的世界观,并提供具有特定含义的符号,这不仅适用于特定文化中的个人,也适用于其他文化中的人。文化需要与种族和民族区分开来。此外,对于移民来说,移民过程中的一些阶段会影响他们的文化适应过程,这可能导致他们在新的国家中进行不同类型的调整,包括同化、双文化主义和文化异化。无论移民的原因是什么,新国家的反应在欢迎或拒绝移民方面也很重要。文化能力是良好临床实践的一部分。
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引用次数: 0
Managing Personality Disordered Offenders 管理人格障碍罪犯
Pub Date : 2018-11-01 DOI: 10.1093/med/9780198791874.001.0001
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.
管理人格障碍罪犯:路径方法描述了罪犯人格障碍(OPD)策略在英国的发展和实施。在概述该策略的原则和要求,以及它是如何在伦敦和英格兰东南部的社区和安全环境中由伦敦途径伙伴关系(LPP)实施的之前,它首先回顾了英国和其他地方对人格障碍罪犯进行干预的现有证据基础。LPP是一个由四个精神卫生信托基金组成的联合体,与缓刑和监狱服务机构合作,提供社区和安全的门诊治疗服务:LPP和更广泛的门诊治疗途径内的领导人编写的个别章节涉及关键方面,包括工作人员的选择和培训;病例识别和制定;在社区和安全环境中进行干预;服务使用者参与;以及调试和联合工作。每章都包括对相关证据基础的权威审查,以及对可用选项的考虑以及为伦敦服务选择的方法的合理性。接下来是一份实用的“如何做”指南,并审查在服务提供的头四年中哪些工作有效,哪些工作无效。每一章都包括一节关于评估和建议可能的“下一步”。本书最后以基于公式的分析结束,分析了OPD战略是否对其所述结果产生了任何影响,以及随着对途径中实现变化的机制得到更好的理解,如何重新评估这些结果。
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引用次数: 3
Case identification and formulation 病例识别和表述
Pub Date : 2018-11-01 DOI: 10.1093/MED/9780198791874.003.0003
P. Minoudis, J. Shaw
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.
本章的目的是双重的。首先,它概述了在大量罪犯样本中识别具有人格障碍的高危罪犯的方法。它提出了与这项任务相关的现有证据的总结,同时也借鉴了作者在英国缓刑服务工作期间实施案件识别系统的经验。有人认为,采用主动的病例识别系统不仅是可以实现的,而且还具有许多潜在的好处。第二,本章考虑了罪犯人格障碍(OPD)社区途径服务的制定方法。在回顾文献和现有模型之后,作者讨论了伦敦路径伙伴关系如何选择其当前的方法,并描述了其实际应用以及从我们的经验中吸取的教训。本章最后讨论了案例识别和表述的未来方向。
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引用次数: 0
Psychotherapy: General principles 心理治疗:一般原则
Pub Date : 2018-11-01 DOI: 10.1093/MED/9780198723196.003.0007
D. Bhugra, A. Ventriglio, K. Bhui
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.
心理治疗是一个基于不同思想流派的过程,患者和治疗师通过谈话疗法共同努力,带来持续的改变。心理治疗有三种类型:支持性、再教育性和建设性。每一种都有治疗师必须遵循的一套特定的规则和策略。再一次,患者及其家庭的解释模式会影响他们是否参与治疗。那些来自少数文化群体的人可能会带着预先存在的防御来接受治疗,比如把大多数人视为问题所在,而治疗师可能会发现很难让他们参与进来。值得认识到的是,不同流派的治疗不一定适用于其他文化群体。此外,少数民族治疗师可能面临歧视,这种经历会影响他们的态度。此外,他们可能不愿意分享负面的经历。
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引用次数: 0
Intervening in the community 干预社区
Pub Date : 2018-11-01 DOI: 10.1093/MED/9780198791874.003.0004
J. Craissati, R. Halsey
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.
罪犯人格障碍(OPD)路径策略明确地以社区为起点和终点,这种精神是路径管理方法的核心。因此,本章的重点是在面对高发病率和犯罪、大地理区域和不断变化的工作人员群体的挑战时,如何最好地部署有限的资源以取得最大效果。在回顾了相关和有效的社区治疗干预的文献后,作者考虑了独立治疗方法、合作伙伴工作和间接支持的相对好处,然后描述了伦敦途径合作伙伴选择的混合模式。本章最后回顾了四年来的进展和挑战;中途由于政治驱动的变化而失去平衡,这项服务仍然蓬勃发展,尽管如果要支持工作人员发挥真正的作用,合作工作需要持续的关注。
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引用次数: 0
Meaningful service user participation in the pathway 有意义的服务用户参与途径
Pub Date : 2018-11-01 DOI: 10.1093/MED/9780198791874.003.0006
Nikki Jeffcote, Karen Van Gerko, E. Nicklin
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.
本章描述了罪犯人格障碍(OPD)途径中跨越监狱和社区服务的用户参与计划的背景、目标、挑战和发展。让高风险个人参与进来,并赋予他们权力,以加强路径服务的提供,有可能在社会融合、福祉和阻止犯罪方面带来重大好处,同时也需要仔细管理内部和外部安全。本章描述了所涉及的特殊挑战以及支持和治理框架,这些框架使用户参与计划在伦敦社区路径中蓬勃发展。书中描述了成功的计划,并包括了服务用户自己参与经验的叙述。本章最后回顾了随着该方案的发展而出现的挑战、这些挑战提供的教训以及对未来继续发展的想法。
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引用次数: 0
期刊
Oxford Medicine Online
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