The electrical discharge of neurons associated with seizure activity stimulates a marked rise in cerebral metabolic activity. Estimates from animal experiments indicate that energy utilization during seizures increases by more than 200", while tissue adenosine triphosphate (ATP) levels remain at more than 95" of control, even during prolonged status epilepticus. The brain generally withstands the metabolic challenge of seizures quite well because enhanced cerebral blood flow delivers additional oxygen and glucose. Mild to moderate degrees of hypoxemia that commonly accompany seizures are usually harmless. However, severe seizures and status epilepticus can sometimes produce an imbalance between metabolic demands and cerebral perfusion, especially if severe hypotension or hypoglycemia is present. A marked increase in glutamate release, which occurs during a prolonged seizure, is likely to result in the activation of all types of glutamate receptors. Although kainic acid produces seizures in the immature brain, it produces little cytotoxicity.
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The concept of risk behaviors became a model for public health interventions in the late 1970s and 1980s. This chapter describes contemporary knowledge on the risk behaviors of gender and sexual minority (GSM) persons. It highlights research findings, with particular attention paid to studies of different GSM subgroups, and evaluates interventions that have sought to modify behaviors in the pursuit of better health outcomes. The chapter then focuses on the potential contributions of other theoretical frameworks to the study of GSM risk behaviors, including opportunities to incorporate disclosure, resilience, intersectionality, and minority stress theories. It also presents recommendations for future directions for researching health risk behaviors among GSM persons, addressing the risk of harming GSM populations, and diverting attention and resources from addressing justice and social determinants of GSM health. The chapter concludes with suggestions for future research and interventions in support of more equitable health outcomes.
As in the non-lesbian, gay, bisexual, and transgender (LGBT) community, gender and sexual minority (GSM) individuals who are also members of one or more racial/ethnic minority populations face unique sociocultural dynamics that impact the ability to achieve and maintain health. This chapter describes the literature that has examined racial/ethnic disparities in a variety of outcomes, and describes what is known regarding the actual impact of intersectionality whenever possible. Reflective of the current literature, the chapter centers on the African American and Hispanic sexual minority male population, HIV, substance use, and mental health as outcomes. It begins with an exploration of barriers to health that reach across outcomes and populations and discusses four specific outcomes with more developed bodies of literature (HIV/sexual health, substance use, mental health/suicide, and victimization). Finally the chapter summarizes the initial evidence from three emerging lines of inquiry (chronic conditions, incarceration, and women’s health).
Using Bronfenbrenner’s Ecological Systems Theory, this chapter highlights the unique strengths and challenges faced by gender and sexual minority (GSM) youth and highlights future directions for research that we believe hold promise in promoting the health and well-being of this special population. It presents a review of the research as applied to physical and mental health disparities that impact GSM youth and discusses the two dominant psychosocial models that explain the contributing factors to these disparities. Notably, public opinion has been shifting toward greater acceptance and inclusion of the lesbian, gay, bisexual, and transgender community, and the 21st century has seen a large increase in the number of protections and rights afforded to GSM individuals. Future research should continue to examine and replicate the impact of minority stress in more recent cohorts of GSM adolescents to determine whether improvements in the social environment result in decreases in health disparities.
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Recommendations for Practitioners for Providing Competent Care to Gender and Sexual Minority Individuals
Research on the health and health care needs of gender and sexual minority (GSM) people is burgeoning, in part due to increased awareness of the importance of identifying the health care needs of these long-neglected populations. This increase in knowledge related to GSM health is a critical part of improving the quality of GSM people’s health and health care. This chapter considers how practitioners might integrate existing knowledge about GSM health into their clinical work to establish an affirmative context for GSM patients. More contemporary approaches take a more process-oriented view, focused on the appreciation of cultural differences at personal, professional, organizational, and societal levels. These approaches place greater emphasis on training clinicians to think critically about how patients’ cultural backgrounds and identities impact their life experiences. The authors draw on these approaches to provide practical recommendations for providers to deliver competent care to GSM individuals.
This concluding chapter summarizes the major points regarding elder abuse (EA) presented in the preceding chapters. It concludes the chapter by taking one last opportunity to encourage exploration and initiation of system-level efforts to solve a major public health problem. The socioecological framework for violence prevention utilized within domestic and global public health work is applicable and extendable to EA. Throughout this book, the authors have argued that EA is a public health problem and that EA may well be among the most under-recognized and under-resourced population health problems of the early 21st century. Public health has frameworks, tools, approaches, relationships, structures, systems, and a variety of agents and organizations poised to address the problem of EA. The imprimatur of the growing population of older adults and the character of demographic transitions occurring globally provide the perfect rationale for action—now.
Recent advancements in molecular genetics have expanded our understanding of the etiology of many neurological diseases and neurodevelopmental abnormalities. Having a comprehensive understanding of genetics is essential in treating patients with metabolic epilepsies. Genetic counseling has been defined as a process of helping people understand and adapt to the medical, psychological, and familial implications of genetic contributions to disease. Some of the components of a genetic counseling interaction include interpretation of family and medical histories to assess the chance of disease occurrence or recurrence; education about inheritance, testing, management, prevention, resources, and research; and counseling to promote informed choices and adaptation to the risk or condition. The genetic counselor may also educate patients and their families about the underlying genetics of their epilepsy and the relevance of a genetic cause of epilepsy for family members, including recurrence risk, reproductive options and the possible teratogenic effect of antiepileptic drugs.Source:
This chapter presents a brief review of the enzymes, transporters, and cofactor producers of the urea cycle. Seizures have long been associated with urea cycle disorders (UCDs), thought to be caused by high levels of ammonia. Furthermore, the brain damage obtained during metabolic crisis has been thought to damage critical structures, leading to epilepsy after the conclusion of the crisis. The first and most critical step of successful treatment of UCDs is recognition. Neurologic monitoring is an essential part of the emergency management of UCDs. The neurological abnormalities observed in patients with urea cycle defects are vast. Controlling ammonia levels by dialysis and complementary medication are needed. EEG monitoring should be initiated early, as this may be very useful for clinical management and indication of untreated metabolic crises. Furthermore, aggressive treatment of clinical and subclinical seizure activity may be helpful in optimizing outcomes for these patients.Source:
The obesity epidemic is even more pronounced in rural America, and is a growing concern as rural adults and children are now more likely to be obese than urban adults and children. People who are overweight or obese are at increased risk for chronic disease and conditions such as hypertension, coronary heart disease, stroke, gallbladder disease, osteoarthritis, and some types of cancers. For women, obesity also is associated with complications of pregnancy, menstrual irregularities, hirsutism, and psychological disorders such as depression. Stress has been linked to obesity in adults and in children, and rural residents are continually subject to the stresses of poverty, limited access to health care, and geographical and social isolation. In rural communities, community organizations and families need to come together to identify common goals related to obesity prevention and identify and mobilize human and community assets to implement strategies they believe will work for their community.
Concurrent with the release of Education and Identity in 1969, the United States was at the nexus of social unrest and expanding funding and support for educational initiatives. The decades of the 1950s and 1960s saw a great increase in research and practice focused on developmental theorists working in the area of higher education. At the forefront of this work was theorist Arthur Chickering. The primary construct of Chickering’s (1969) work is the Seven Vectors of Development. The vectors are: (a) developing competence, (b) managing emotions, (c) moving through autonomy toward interdependence, (d) developing mature interpersonal relationships, (e) establishing identity, (f) developing purpose, and (g) developing integrity. This vector addresses competence across three domains: intellectual, physical and manual, and interpersonal. This chapter briefly outlines Chickering’s life work, and ways in which practitioners can apply his theory to their daily interactions with college students.