Books on the topic 'Health Status Indications'

Cardiac rehabilitation (CR) services aim to restore the physical, psychosocial, and vocational status of cardiac patients. The role of these services has evolved due to the progress of interventional cardiology with its prompt and effective treatment of acute coronary syndromes. The focus has moved from the restoration of a patient’s health following an acute event towards a more pronounced long-term targeted secondary prevention intervention. As a consequence, CR services have also expanded their indication in order to include not only patients after myocardial infarction or surgery but also a variety of ’non-acuteʼ cardiovascular disease (CVD) states like stable coronary heart disease and peripheral obstructive artery disease as well as asymptomatic patients with no history of CVD but with a constellation of cardiovascular risk factors, especially metabolic syndrome or diabetes mellitus. This chapter provides a wide-ranging summary of the issues concerning outpatients and primary care.

Cardiac rehabilitation (CR) services aim to restore the physical, psychosocial, and vocational status of cardiac patients. The role of these services has evolved due to the progress of interventional cardiology with its prompt and effective treatment of acute coronary syndromes. The focus has moved from the restoration of a patient’s health following an acute event towards a more pronounced long-term targeted secondary prevention intervention. As a consequence, CR services have also expanded their indication in order to include not only patients after myocardial infarction or surgery but also a variety of ’non-acuteʼ cardiovascular disease (CVD) states like stable coronary heart disease and peripheral obstructive artery disease as well as asymptomatic patients with no history of CVD but with a constellation of cardiovascular risk factors, especially metabolic syndrome or diabetes mellitus. This chapter provides a wide-ranging summary of the issues concerning outpatients and primary care.

This chapter provides a brief overview of the need for measurement in the health sciences. As interventions are increasingly aimed at improving subjective states, such as quality of life or pain, it becomes ever more important to be able to measure these accurately. This means that the items must be clear, unambiguous, and as free from biases as possible. Test constructors must also be aware of the different options for responding to the items. Finally, issues of reliability and validity need to be addressed. The chapter also has a ‘road map’ and flow chart, outlining the steps in scale construction, and indicating the chapters addressing the relevant topics.

Innovating in Community Mental Health presents lively examples of successful attempts to change mental health service systems in innovative ways to achieve the goal of providing care for persons with severe mental illness. These examples are drawn from such diverse national settings as Italy, Russia, Germany, England, China, and the United States, and involve a range of stratgies from treatment teams of professionals, grassroots community organizations, consumer cooperatives, professional-volunteer teamwork, and housing-based alternatives. The stories of these varied innovations are told by established, knowledgeable scholars from each of the featured countries. The editors help us understand the triumphs and pitfalls involved in these innovations through the presentation of a broad, research-based theory of innovation and change, which is used to guide the presentation of the examples and subsequently to determine their similarities and differences. Through the theoretical framework presented, the nuances of the process of innovation are highlighted, including the importance of the type of innovation itself, the wider environmental influences, place of internal organizational structures, and the role of the individual change agent. Through this framework and the examples presented, the reader is given indications of how innovation and change may be possible in such diverse and seemingly difficult situations, and also of how effective strategies for change might be chosen by administrators, providers, and other policymakers.

Heart disease in pregnancy is a leading cause of maternal death worldwide. In the United Kingdom and United States, heart disease in pregnancy is the commonest cause of maternal death. In Europe, over 1% of maternal deaths are attributable to structural heart disease. In addition, heart disease in pregnancy is a significant cause of severe maternal and fetal morbidity. Whilst the vast majority of women with heart disease in pregnancy have underlying congenital heart disease, most maternal deaths are due to acquired heart disease (AHD). As the risk factors for AHD become ever more prevalent, the expectation is that disease burden from AHD in pregnancy will also increase. Women with AHD benefit from preconception or early assessment in pregnancy by a multidisciplinary team including obstetricians, cardiologists, and obstetric anaesthetists. Risk assessment using the modified World Health Organization classification of cardiac disease in pregnancy will inform frequency of review in pregnancy. A detailed plan for delivery should be agreed in the third trimester. Where possible, a vaginal delivery is advised: caesarean delivery is reserved for women with obstetric indications or with specific severe underlying cardiac conditions. Slow incremental epidural analgesia is usually recommended to reduce the cardiorespiratory work of labour and an assisted second-stage delivery will limit exertion due to pushing. Neuraxial anaesthesia for operative delivery is becoming a more familiar approach and techniques such as low-dose spinal component combined spinal–epidural or slow incremental epidural top-up maximize haemodynamic stability. Invasive monitoring is often beneficial. Post-delivery care is safely delivered in a high dependency or intensive therapy setting. This chapter looks at the general principles of management of women with AHD, and then examines in detail ischaemic heart disease, arrhythmias, cardiac transplantation, aortic pathology and aortic dissection, cardiomyopathy, valvular heart disease, and infective endocarditis.

Plasma potassium levels are maintained in health between 3.5 and 5.0 mmol/L, and reflect total body potassium only in stable states at normal pH. Most true hyperkalaemia results from renal insufficiency. The goals of therapy are myocardial protection and return of plasma potassium to a safe level. Measures are commonly initiated above 5.5 mmol/L; above 6.5 mmol/L, aggressive measures should be adopted and calcium salts given if there are cardiac dysrhythmias or QRS-broadening. Glucose-insulin infusions and beta-2-agonists promote potassium shifts into cells. Diuretics and sodium bicarbonate may be helpful, but persistent hyperkalaemia is an indication for renal replacement therapy. Hypokalaemia may lead to dangerous arrhythmias, skeletal muscle weakness, ileus, and reduced vascular smooth muscle contractility. Rapid replacement should only be undertaken for severe hypokalaemia or in the context of arrhythmias. Once the extracellular deficit is corrected, there will usually be a continuing need for potassium supplementation to replenish intracellular stores.

Plasma potassium levels are maintained in health between 3.5 and 5.0 mmol/L, and reflect total body potassium only in stable states at normal pH. Most true hyperkalaemia results from renal insufficiency. The goals of therapy are myocardial protection and return of plasma potassium to a safe level. Measures are commonly initiated above 5.5 mmol/L; above 6.5 mmol/L, aggressive measures should be adopted and calcium salts given if there are cardiac dysrhythmias or QRS-broadening. Glucose-insulin infusions and beta-2-agonists promote potassium shifts into cells. Diuretics and sodium bicarbonate may be helpful, but persistent hyperkalaemia is an indication for renal replacement therapy. Hypokalaemia may lead to dangerous arrhythmias, skeletal muscle weakness, ileus, and reduced vascular smooth muscle contractility. Rapid replacement should only be undertaken for severe hypokalaemia or in the context of arrhythmias. Once the extracellular deficit is corrected, there will usually be a continuing need for potassium supplementation to replenish intracellular stores.

Chronic infection with hepatitis C virus (HCV) is a leading cause of end-stage liver disease and is the most common indication for liver transplantation in the United States. Because of shared risk factors, individuals living with HIV infection are disproportionately affected by HCV. Moreover, co-infection with HIV accelerates the natural history of chronic HCV infection, increasing the risk of cirrhosis, hepatocellular carcinoma, hepatic decompensation, and death. Highly effective medications such as direct-acting antivirals (DAA) to cure HCV are now available and have the potential to profoundly improve the health of HIV-HCV-co-infected individuals. However, addressing the many gaps in the HCV care cascade is necessary to fully achieve the benefits of these drugs. This chapter reviews the natural history of HIV-HCV co-infection, the psychiatric comorbidities associated with HCV infection, the evolution of HCV treatment, and the barriers to care that HIV-HCV-co-infected individuals continue to face.

This chapter reviews the evidence linking post-traumatic stress disorder (PTSD) with changes in immune function. The chapter starts with a brief explanation of the components of the immune system, including cytokines, and of the mechanisms linking psychological and psychiatric phenomena with changes in immune function (i.e., psychoneuroimmunology). Specific studies on PTSD are then described, including the potential neurobiological and health consequences of these immune changes and, finally, the effects of PTSD treatment on both symptomology and the immune system. While there is a consistent pattern of findings indicating increased immune activation in this condition, there is a paucity of research on the immunological correlates of PTSD, especially compared with the large number of immunological studies on depression and other psychiatric disorders.

Patients with arrhythmogenic right ventricular cardiomyopathy (ARVC) have arrhythmia-related symptoms or are identified during screening of an affected family. Heart failure symptoms occur late in the disease’s natural history. As strenuous exercise has been associated with disease acceleration and worsening of ventricular arrhythmias, lifestyle modification with restricted athletic activities is recommended upon disease diagnosis or even identification of mutation carrier status. An episode of an haemodynamically unstable, sustained ventricular tachycardia or ventricular fibrillation as well as severe systolic ventricular dysfunction constitute definitive indications for implantable cardioverter defibrillator (ICD) implantation, which should also be considered following tolerated sustained or non-sustained ventricular tachycardia episodes, syncope, or in the presence of moderate ventricular dysfunction. Antiarrhythmic medications are used as an adjunct to device therapy. Catheter ablation is recommended for incessant ventricular tachycardia or frequent appropriate ICD interventions despite maximal pharmacological therapy. Amiodarone alone or in combination with beta blockers is most effective for symptomatic ventricular arrhythmias. Beta blockers are considered for use in all patients with a definite diagnosis but evidence for their prognostic benefit is sparse. Heart failure symptoms are managed using standard protocols and heart transplantation is considered for severe ventricular dysfunction or much less commonly uncontrollable ventricular arrhythmias.

Pregnancy-related heart disease is increasing worldwide and peripartum cardiomyopathy (PPCM) is an important contributor to early (<42 days postpartum) and late (up to 1 year postpartum) maternal death. PPCM is an idiopathic form of cardiomyopathy, presenting with heart failure secondary to left ventricular dysfunction towards the end of pregnancy, or in the months following delivery, where no other cause of heart failure is identified. It is a diagnosis of exclusion. Incidence and prognosis varies according to geography and is likely due to multiple factors. The recent specific pathophysiological hypothesis which states that the oxidative stress–cathepsin D-16 kDa prolactin cascade plays a key role in the development of PPCM in experimental models and in humans suggests that a therapeutic approach involving blockade of this pathway with bromocriptine may be a novel disease-specific approach. Despite ongoing research, numerous uncertainties regarding the incidence, pathophysiology, treatment, and prognosis of PPCM patients remain, indicating the need for further investigation. The establishment of the international registry on PPCM, under the umbrella of the EuroObservational research programme, will provide novel information and address many uncertainties.

This introductory chapter captures in brief the strained relations between the United States and the Soviet Union in the years following World War II. In particular it looks at the Olympic Games, indicating that, for U.S. officials, the war would also largely be fought in the trenches of public opinion. And in order to win what has so frequently been called a “battle for hearts and minds,” U.S. policymakers increasingly deployed techniques of persuasion that they referred to as propaganda or psychological warfare, which manifested in the way the U.S. employed culture against the Soviet Union—among them, sports. The chapter goes on to emphasize the significance of sports and the Olympics in understanding a facet of these Cold War relations, and lays out further contextual details as well as the thematic groundwork for the rest of this volume.

Non-cardiac surgery conveys a cardiac risk related to the status of the patient’s cardiovascular system. Cardiac-related risk of surgery can be assessed by integrating the risk and urgency of the procedure with cardiovascular risk factors, which include age, ischaemic heart disease, heart failure, stroke, diabetes mellitus, chronic obstructive pulmonary disease, and renal dysfunction. An individual assessment can include simple multivariate scoring systems, developed with the aim of evaluating cardiac risk prior to non-cardiac surgery. Patient assessment can be extended for indicated additional tests. The indications for further cardiac testing and treatments are the same as in the non-operative setting, but their timing is dependent on the urgency of surgery, and patient-specific and surgical risk factors. A delay in surgery, due to the use of both non-invasive and invasive preoperative testing, should be limited to those circumstances in which the results of such tests will clearly affect patient management. In high-risk patients, the result of the cardiac assessment helps to choose adequate perioperative monitoring and to indicate for an intensive care unit stay perioperatively. Chronic medications can be adjusted, according to the current knowledge on perioperative management. Drugs with the potential to reduce the incidence of post-operative cardiac events and mortality include beta-blockers, statins, and aspirin. Chronic platelet anti-aggregation and anticoagulation therapies have to be adapted by weighing the risk of bleeding against the risk of thrombotic complications.

Non-cardiac surgery conveys a cardiac risk related to the status of the patient’s cardiovascular system. Cardiac-related risk of surgery can be assessed by integrating the risk and urgency of the procedure with cardiovascular risk factors, which include age, ischaemic heart disease, heart failure, stroke, diabetes mellitus, chronic obstructive pulmonary disease, and renal dysfunction. An individual assessment can include simple multivariate scoring systems, developed with the aim of evaluating cardiac risk prior to non-cardiac surgery. Patient assessment can be extended for indicated additional tests. The indications for further cardiac testing and treatments are the same as in the non-operative setting, but their timing is dependent on the urgency of surgery, and patient-specific and surgical risk factors. A delay in surgery, due to the use of both non-invasive and invasive preoperative testing, should be limited to those circumstances in which the results of such tests will clearly affect patient management. In high-risk patients, the result of the cardiac assessment helps to choose adequate perioperative monitoring and to indicate for an intensive care unit stay perioperatively. Chronic medications can be adjusted, according to the current knowledge on perioperative management. Drugs with the potential to reduce the incidence of post-operative cardiac events and mortality include beta-blockers, statins, and aspirin. Chronic platelet anti-aggregation and anticoagulation therapies have to be adapted by weighing the risk of bleeding against the risk of thrombotic complications.

Non-cardiac surgery conveys a cardiac risk related to the status of the patient’s cardiovascular system. Cardiac-related risk of surgery can be assessed by integrating the risk and urgency of the procedure with cardiovascular risk factors, which include age, ischaemic heart disease, heart failure, stroke, diabetes mellitus, chronic obstructive pulmonary disease, and renal dysfunction. An individual assessment can include simple multivariate scoring systems, developed with the aim of evaluating cardiac risk prior to non-cardiac surgery. Patient assessment can be extended for indicated additional tests. The indications for further cardiac testing and treatments are the same as in the non-operative setting, but their timing is dependent on the urgency of surgery, and patient-specific and surgical risk factors. A delay in surgery, due to the use of both non-invasive and invasive preoperative testing, should be limited to those circumstances in which the results of such tests will clearly affect patient management. In high-risk patients, the result of the cardiac assessment helps to choose adequate perioperative monitoring and to indicate for an intensive care unit stay perioperatively. Chronic medications can be adjusted, according to the current knowledge on perioperative management. Drugs with the potential to reduce the incidence of post-operative cardiac events and mortality include beta-blockers, statins, and aspirin. Chronic platelet anti-aggregation and anticoagulation therapies have to be adapted by weighing the risk of bleeding against the risk of thrombotic complications.

A new threat is stalking nations, as terrorist organizations and rogue states alike appear intent on acquiring and using the poor man's nuclear weapon: biological agents such as anthrax, smallpox, and plague. Attacks against Americans during the past dozen years may be an indication of more worrisome events to come. U.S. military forces in Japan were attacked in April of 1990 with botulinum toxin by the Aum Shinrikyo cult. Hundreds in Oregon were sickened with Salmonella after an attack in 1984. And small amounts of anthrax resulted in widespread panic and frequent evacuations across the United States in the fall of 2001. Ten experts discuss in detail the threats posed by bio-weapons and assess the current state of U.S. biological defenses. Chapters highlight the future prospects for biological warfare, bio-weapons in the Middle East, potential agroterrorism, the emerging bio-cruise missile threat, prevalent myths and likely scenarios, as well as the public health response. The promise of future world peace after World War II was quickly shattered by the Cold War. Indeed, the nuclear age was born at a time when the world seemed to be emerging from a dark past into a hopeful future. Are we to repeat history? With the end of the Cold War, does the future hold even greater threats? Or is an old threat merely resurfacing with a new level of lethality? This book should be required reading for anyone interested in national security, as well as concerned citizens who wish to know what form this new enemy may take and what can be done to stop it.

Although girls and women account for approximately 40 percent of all athletes in the United States, they receive only 4 percent of the total sport media coverage. SportsCenter, ESPN’s flagship program, dedicates less than 2 percent of its airtime to women. Local news networks devote less than 5 percent of their programming to women’s sports. Excluding Sports Illustrated’s annual "Swimsuit Issue," women appear on just 4.9 percent of the magazine’s covers. Media is a powerful indication of the culture surrounding sport in the United States. Why are women underrepresented in sports media? Sports Illustrated journalist Andy Benoit infamously remarked that women’s sports "are not worth watching." Although he later apologized, Benoit’s comment points to more general lack of awareness. Consider, for example, the confusion surrounding Title IX, the U.S. Law that prohibits sex discrimination in any educational program that receives federal financial assistance. Is Title IX to blame when administrators drop men’s athletic programs? Is it lack of interest or lack of opportunity that causes girls and women to participate in sport at lower rates than boys and men? In Women’s Sports, Jaime Schultz tackles these questions, along with many others, to upend the misunderstandings that plague women’s sports. Using historical, contemporary, scholarly, and popular sources, Schultz traces the progress and pitfalls of women’s involvement in sport. In the signature question-and-answer format of the What Everyone Needs to Know® series, this short and accessible book clarifies misconceptions that dog women’s athletics and offers much needed context and history to illuminate the struggles and inequalities sportswomen continue to face. By exploring issues such as gender, sexuality, sex segregation, the Olympic and Paralympic Games, media coverage, and the sport-health connection, Schultz shows why women’s sports are not just worth watching, but worth playing, supporting, and fighting for.

TOWARDS THE NEW LIFE Theology and Importance of Christian Initiation for the Life of Faith The book is in equal parts a presentation and an invitation. The subject matter of both is the mystagogical initiation leading to the personal encounter with God and eventually to the union within the Church in Christ, which happens initially and particualry in the sacramental liturgy. Mystagogy was the essential experience of life in the early Church and now is being so intensely discussed and postulated by the ecclesial Magisterium and through the teaching of the recent popes and synods. Within the ten chapters of this book the reader proceeds through the aspects strictly associated with Christian initiation, noticeable in catechumenate and suggestive for further Christian life. It is not surprising then, that the study begins with answering the question about the sense of dealing with catechumenate at all. The response developed in the first chapter covers four key points: the contemporary state of our faith, the need for dialogue in evangelization, the importance of liturgy in the renewal of faith and the obvious requirement of follo- wing the Church’s Magisterium, quite explicit in the subject undertaken within this book. The introductory chapter is meant to evoke interest in catechumenate as such and encourage comprehension of its essence, in order to keep it in mind while planning contemporary evangelization. For doing this with success and avoiding pastoral archeology, we need a competent insight into the main message and goal of Christian initiation. Catechumenate is the first and most venerable model of formation and growth in faith and therefore worth knowing. The second chapter tries to cope with the reasons and ways of the present return to the sources of catechumenate with respect to Christian initiation understood to be the building of the relationship with God. The example of catechumenate helps us to discover, how to learn wisely from the history. This would definitely mean to keep the structure and liturgy of catechumenate as a vehicle of God’s message, which must be interpreted and adapted always anew and with careful and intelligent consideration of the historical flavour on particular stages within the history of salvation and cultural conditions of the recipients. For that reason we refer to the Biblical resources and to the historical examples of catechumenate including its flourishing and declining periods, after which we are slowly approaching the present reinterpretation of the catechumenal process enhanced by the official teaching of the Church. As the result of the latter, particularly owing to the Vatican Council II, we are now dealing with the renewed liturgy of baptism displayed in two liturgical books: The Rite of Baptism for Children and the Rite of Christian Initiation of Adults (RCIA). This version for adults is the subjectmatter of the whole chapter, in which a reader can find theological analyses of the particular rites as well as numerous indications for improving one’s life with Christ in the Church. You can find interesting associations among the rites of initiation themselves and astounding coherence between those rites and the sacraments of the Eucharist, penance and other sacraments, which simply means the ordinary life of faith. Deep and convincing theology of the process of initiation proves the inspiring spiritual power of the initial and constitutive sacraments of baptism and confirmation, which may seem attractive not only for catechumens but also for the faithful baptized in their infancy, and even more, since they might have not yet had a chance to see what a plausible treasure they have been conveying in their baptismal personality. How much challenge for further and constant realization in life may offer these introductory events of Christian initiation, yet not sufficiently appreciated by those who have already been baptized and confirmed! We all should submit to permanent re-evangelization according to this primary pattern, which always remains essential and fundamental. Very typical and very post-conciliar approach to Christian formation appears in the communal dimension, which guards and guarantees the ecclesial profile of initiation and prepares a person to be a living member of the Church. The sixth chapter of the book is dealing with ecclesial issues in liturgy. They refer to comprehending the word of God, especially in the context of liturgy, which brings about a peculiar theological sense to it and giving a special character to proclaiming the Gospel, which the Pope Francis calls “liturgical proclamation”. The ecclesial premises influence the responsibility for the fact of accompanying the candidates, who aim at becoming Christ’s disciples. As the Church is teaching also in the theological and pastoral introduction to the RCIA, this is the duty of all Christians, which means: priests, religious and the lay, because the Church is one organism in whose womb the new members are conceived and raised. As this fact is strongly claimed by the Church the method of initiation arises to great importance. The seventh chapter is dedicated to the analysis of the catechumenal method stemming from Christ’s pedagogy and His mystery of Incarnation introducing a very important issue of implementing the Divine into the human. The chapter concerning this method opens a more practical part of the book. The crucial message of it is to make mystagogy a natural and obvious method which is the way of building bonds with Christ in the community of the people who already have these bonds and who are eager to tighten them and are aware of the beauty and necessity of closeness with Christ. Christian initiation is the process of entering the Kingdom of God and meeting Christ up to the union with Him – not so much learning dogmas and moral requirements. This is a special time when candidates-catechumens-elected mature in love and in their attitude to Christ and people, which results in prayer and new way of life. As in the past catechumenate nowadays inspires the faithful in their imagination of love and mercy as well as reminds us about various important details of the paschal way of life, which constitute our baptismal vocation, but may be forgotten and now with the help of catechumenate can be recognized anew, while accompanying adults on their catechumenal way. The book is meant for those who are already involved in catechumenal process and are responsible for the rites and formation as well as for those who are interested in what the Church is offering to all who consciously decide to know and follow Christ. You can learn from this book, what is the nature and specificity of the method suggested by the Rite itself for guiding people to God the Saviour and to the community of His people. The aim of the study is to present the universal way of evangelization, which was suggested and revealed by God in His pedagogy, particularly through Jesus Christ and smoothly adopted by the early Church. This way, which can be called a method, is so complete, substantial and clear that it deserves rediscovery, description and promotion, which has already started in the Church’s teaching by making direct references to such categories as: initiation, catechumenate, liturgical formation, the rereading the Mystery of Christ, the living participation in the Mystery and faith nourished by the Mystery. The most engaging point with Christian initiation is the fact, that this seems to be the most effective way of reviving the parish, taking place on the solid and safe ground of liturgy with the most convincing and objective fact that is our baptism and our new identity born in baptismal regenerating bath. On the grounds of our personal relationship with God and our Christian vocation we can become active apostles of Christ. Evangelization begins with ourselves and in our hearts. Thinking about the Church’s mission, we should have in mind our personal mission within the Church and we should refer to it’s roots – first to our immersion into Christ’s death and resurrection and to the anointment with the Holy Spirit. In this Spirit we have all been sent to follow Christ wherever He goes, not necessarily where we would like to direct our steps, but He would. Let us cling to Him and follow Him! Together with the constantly transforming and growing Church! Towards the new life!