Small For Gestational Age: From 1 Different Sources
(SGA) describing a fetus or baby that has failed to reach the size or birth weight expected for its gestational age. This may be because the fetus or baby is constitutionally small or it may be due to *intrauterine growth restriction in the fetus. In the latter case, the perinatal outcome is less favourable.
Agenesis means incomplete development, or the failure of any part or organ of the body to develop normally.... agenesis
A substance, living or inanimate, or a force, sometimes rather intangible, the excessive presence or relative lack of which is the immediate or proximal cause of a particular disease.... agent
Chelating agents are compounds that will render an ion (usually a metal) biologically inactive by incorporating it into an inner ring structure in the molecule. (Hence the name, from the Greek chele = claw.) When the complex formed in this way is harmless to the body and is excreted in the urine, such an agent is an e?ective way of ridding the body of toxic metals such as mercury. The main chelating agents are DIMERCAPROL, PENICILLAMINE, desferrioxamine and sodium calciumedetate, used for example, in iron poisoning.... chelating agents
See OAT CELL.... small-cell carcinoma
The process of optimizing opportunities for health, participation and security in order to enhance quality of life as people age.... active ageing
An agent pertaining to aetiology.... aetiologic agent
The state of being old. A person may be defined as aged on a number of criteria including chronological age, functional assessment, legislation or cultural considerations.... aged
Services provided to people deemed to be aged or elderly.... aged care
Multidisciplinary team of health professionals that is responsible for comprehensive assessments of the needs of older persons, including their suitability for hospital, home or institutional care.... aged care assessment team
The lifelong process of growing older at cellular, organ or whole-body level throughout the life span.... ageing / aging
Meeting the desire and ability of people, through the provision of appropriate services and assistance, to remain living relatively independently in the community in his or her current home or an appropriate level of housing. Ageing in place is designed to prevent or delay more traumatic moves to a dependent facility, such as a nursing home.... ageing / aging in place
See “population ageing”.... ageing of the population
The negative stereotyping or discrimination of people on the basis of age.... ageism
A factor, such as a micro-organism, chemical substance, form of radiation, or excessive cold or heat, which is essential for the occurrence of a disease. A disease may be caused by more than one agent acting together or, in the case of deficiency diseases, by the absence of an agent.... agent (of disease)
An independent agency recently set up by the UK government. The aim is for the agency to protect consumers’ interests in every aspect of food safety and nutrition. The agency advises ministers and the food industry, conducts research and surveillance, and monitors enforcement of food safety and hygiene laws.... food standards agency
An approach which recognizes that growing older is a part of living; recognizes the interdependence of generations; recognizes that everyone has a responsibility to be fair in their demands on other generations; fosters a positive attitude throughout life to growing older; eliminates age as a reason to exclude any person from participating fully in community life; promotes a commitment to activities which enhance well-being and health, choice and independence, and quality of life for all ages; encourages communities to value and listen to older people and to cater for the diverse preferences, motivations, characteristics and circumstances of older persons in a variety of ways.... healthy ageing
See “residential care”; “assisted living facility”; “high dependency care facility”.... home for the aged
A public or private organization that provides home health services supervised by a licensed health professional in a person’s home, either directly or through arrangements with other organizations.... home health agency (hha) / home health care agency
An organization offering advice and practical assistance to older people who need to repair, improve or adapt their homes.... home improvement agency
See “healthy ageing”.... optimal ageing
The increase over time in the proportion of the population of a specified older age.... population ageing
See “healthy ageing”.... positive ageing
Any human beings, animals, arthropods, plants, soil, or inanimate matter in which an infectious agent normally lives and multiplies and on which it depends primarily for survival, reproducing itself in such manner that it can be transmitted to a susceptible host.... reservoir of infectious agent
See “residential care”; “assisted living facility”.... residential aged care facility
Involves care designed to improve the physical wellbeing and restore the health of older people to an optimum level following a serious illness.... short-term aged care
Before the advent of small-bowel transplants, long-term intravenous feeding (total parenteral nutrition or TPN) was the last option for patients with chronic intestinal failure. Most recipients are children, and small-bowel transplantation is currently reserved for patients unable to continue on long-term parenteral nutrition. The main constraints to small-bowel transplantation are the intensity of rejection (necessitating high levels of immunosuppression), and the lack of donors who are the same size as the recipient (a particular problem for children).... small-bowel transplantantion
People or groups who have an involvement or interest in the aged care system, including beneficiaries, providers and funders.... stakeholders (in aged care)
These are compounds with the property of breaking up blood clots in the circulatory system (see BLOOD CLOT; THROMBUS; THROMBOSIS; FIBRINOLYTIC DRUGS).... thrombolytic agents
An agent which assists constructive metabolism and assimilation: Saw Palmetto, Sarsaparilla. ... anabolic agent
These oral agents reduce the excessive amounts of GLUCOSE in the blood (HYPERGLYCAEMIA) in people with type 2 (INSULIN-resistant) diabetes (see DIABETES MELLITUS). Although the various drugs act di?erently, most depend on a supply of endogenous (secreted by the PANCREAS) insulin. Thus they are of no value in treating patients with type 1 diabetes (insulin-dependent diabetes mellitus (IDDM), in which the pancreas produces little or no insulin and the patient’s condition is stabilised using insulin injections). The traditional oral hypoglycaemic drugs have been the sulphonylureas and biguanides; new agents are now available – for example, thiazolidine-diones (insulin-enhancing agents) and alpha-glucosidase inhibitors, which delay the digestion of CARBOHYDRATE and the absorption of glucose. Hypoglycaemic agents should not be prescribed until diabetic patients have been shown not to respond adequately to at least three months’ restriction of energy and carbohydrate intake.
Sulphonylureas The main group of hypoglycaemic agents, these act on the beta cells to stimulate insulin release; consequently they are e?ective only when there is some residual pancreatic beta-cell activity (see INSULIN). They also act on peripheral tissues to increase sensitivity, although this is less important. All sulphonylureas may lead to HYPOGLYCAEMIA four hours or more after food, but this is relatively uncommon, and usually an indication of overdose.
There are several di?erent sulphonylureas; apart from some di?erences in their duration or action (and hence in their suitability for individual patients) there is little di?erence in their e?ectiveness. Only chlorpropamide has appreciably more side-effects – mainly because of its prolonged duration of action and consequent risk of hypoglycaemia. There is also the common and unpleasant chlorpropamide/ alcohol-?ush phenomenon when the patient takes alcohol. Selection of an individual sulphonylurea depends on the patient’s age and renal function, and often just on personal preference. Elderly patients are particularly prone to the risks of hypoglycaemia when long-acting drugs are used. In these patients chlorpropamide, and preferably glibenclamide, should be avoided and replaced by others such as gliclazide or tolbutamide.
These drugs may cause weight gain and are indicated only if poor control persists despite adequate attempts at dieting. They should not be used during breast feeding, and caution is necessary in the elderly and in those with renal or hepatic insu?ciency. They should also be avoided in porphyria (see PORPHYRIAS). During surgery and intercurrent illness (such as myocardial infarction, COMA, infection and trauma), insulin therapy should be temporarily substituted. Insulin is generally used during pregnancy and should be used in the presence of ketoacidosis.
Side-effects Chie?y gastrointestinal disturbances and headache; these are generally mild and infrequent. After drinking alcohol, chlorpropamide may cause facial ?ushing. It also may enhance the action of antidiuretic hormone (see VASOPRESSIN), very rarely causing HYPONATRAEMIA.
Sensitivity reactions are very rare, usually occurring in the ?rst six to eight weeks of therapy. They include transient rashes which rarely progress to erythema multiforme (see under ERYTHEMA) and exfoliate DERMATITIS, fever and jaundice; chlorpropamide may also occasionally result in photosensitivity. Rare blood disorders include THROMBOCYTOPENIA, AGRANULOCYTOSIS and aplastic ANAEMIA.
Biguanides Metformin, the only available member of this group, acts by reducing GLUCONEOGENESIS and by increasing peripheral utilisation of glucose. It can act only if there is some residual insulin activity, hence it is only of value in the treatment of non-insulin dependent (type 2) diabetics. It may be used alone or with a sulphonylurea, and is indicated when strict dieting and sulphonylurea treatment have failed to control the diabetes. It is particularly valuable in overweight patients, in whom it may be used ?rst. Metformin has several advantages: hypoglycaemia is not usually a problem; weight gain is uncommon; and plasma insulin levels are lowered. Gastrointestinal side-effects are initially common and persistent in some patients, especially when high doses are being taken. Lactic acidosis is a rarely seen hazard occurring in patients with renal impairment, in whom metformin should not be used.
Other antidiabetics Acarbose is an inhibitor of intestinal alpha glucosidases (enzymes that process GLUCOSIDES), delaying the digestion of starch and sucrose, and hence the increase in blood glucose concentrations after a meal containing carbohydrate. It has been introduced for the treatment of type 2 patients inadequately controlled by diet or diet with oral hypoglycaemics.
Guar gum, if taken in adequate doses, acts by delaying carbohydrate absorption, and therefore reducing the postprandial blood glucose levels. It is also used to relieve symptoms of the DUMPING SYNDROME.... hypoglycaemic agents
An organism, chiefly a microorganism but including helminths, that is capable of producing infection or infectious disease.... infectious agent
A range of health care, personal care and social services provided to individuals who, due to frailty or level of physical or intellectual disability, are no longer able to live independently. Services may be for varying periods of time and may be provided in a person’s home, in the community or in residential facilities (e.g. nursing homes or assisted living facilities). These people have relatively stable medical conditions and are unlikely to greatly improve their level of functioning through medical intervention.... long-term care (ltc) / long-term aged care
An executive agency of the Department of Health in the UK. Set up in 1994, it is responsible for regulating and advising on the sale or use of any product, other than a medicine, used in the health-care environment for the diagnosis, prevention, monitoring or treatment of illness or disease. Equipment ranges from pacemakers (see CARDIAC PACEMAKER) to prostheses (see PROSTHESIS), and from syringes to magnetic resonance imaging (see (MRI).... medical devices agency
An executive agency of the Department of Health with the prime function of safeguarding the public health. It ensures that branded and non-branded MEDICINES on the UK market meet appropriate standards of safety, quality and e?cacy. The agency applies the strict standards set by the UK Medicines Act (1968) and relevant European Community legislation.... medicines control agency
A National Health Service body intended to combat the increasing threat from infectious diseases and biological, chemical and radiological hazards. Covering England, the agency includes the Public Health Laboratory Service, the National Radiological Protection Board, the Centre for Applied Microbiology and Research, and the National Focus Group for Chemical Incidents.... national infection control and health protection agency
Diseases developing during a person’s lifetime may be the result of his or her lifestyle, environment, genetic factors and natural AGEING factors.
Lifestyle While this may change as people grow older – for instance, physical activity is commonly reduced – some lifestyle factors are unchanged: for example, cigarette smoking, commonly started in adolescence, may be continued as an adult, resulting in smoker’s cough and eventually chronic BRONCHITIS and EMPHYSEMA; widespread ATHEROSCLEROSIS causing heart attacks and STROKE; osteoporosis (see BONE, DISORDERS OF) producing bony fractures; and cancer affecting the lungs and bladder.
Genetic factors can cause sickle cell disease (see ANAEMIA), HUNTINGTON’S CHOREA and polycystic disease of the kidney.
Ageing process This is associated with the MENOPAUSE in women and, in both sexes, with a reduction in the body’s tissue elasticity and often a deterioration in mental and physical capabilities. When compared with illnesses described in much younger people, similar illnesses in old age present in an atypical manner
– for example, confusion and changed behaviour due to otherwise asymptomatic heart failure, causing a reduced supply of oxygen to the brain. Social adversity in old age may result from the combined effects of reduced body reserve, atypical presentation of illness, multiple disorders and POLYPHARMACY.
Age-related change in the presentation of illnesses This was ?rst recognised by the specialty of geriatric medicine (also called the medicine of ageing) which is concerned with the medical and social management of advanced age. The aim is to assess, treat and rehabilitate such patients. The number of institutional beds has been steadily cut, while availability of day-treatment centres and respite facilities has been boosted – although still inadequate to cope with the growing number of people over 65.
These developments, along with day social centres, provide relatives and carers with a break from the often demanding task of looking after the frail or ill elderly. As the proportion of elderly people in the population rises, along with the cost of hospital inpatient care, close cooperation between hospitals, COMMUNITY CARE services and primary care trusts (see under GENERAL PRACTITIONER (GP)) becomes increasingly important if senior citizens are not to suffer from the consequences of the tight operating budgets of the various medical and social agencies with responsibilities for the care of the elderly. Private or voluntary nursing and residential homes have expanded in the past 15 years and now care for many elderly people who previously would have been occupying NHS facilities. This trend has been accelerated by a tightening of the bene?t rules for funding such care. Local authorities are now responsible for assessing the needs of elderly people in the community and deciding whether they are eligible for ?nancial support (in full or in part) for nursing-home care.
With a substantial proportion of hospital inpatients in the United Kingdom being over 60, it is sometimes argued that all health professionals should be skilled in the care of the elderly; thus the need for doctors and nurses trained in the specialty of geriatrics is diminishing. Even so, as more people are reaching their 80s, there seems to be a reasonable case for training sta? in the type of care these individuals need and to facilitate research into illness at this stage of life.... medicine of ageing
The lack or an impairment of the sense of taste (see taste, loss of).... ageusia
a factor associated with the definitive onset of an illness (or other response, including an accident). Examples are bacteria and trauma. The relationship is more direct than in the case of a *risk factor; in general, the ill health only occurs if the agent is a precursor.... causal agent
a chemical compound whose molecules form complexes by binding metal ions. Some chelating agents, including *desferrioxamine and *penicillamine, are drugs used to treat metal poisoning: the metal is bound to the drug and excreted safely. Chelating agents often form the active centres of enzymes. The chelating agent ethylenediaminetetraacetic acid (EDTA) is used in dentistry to remove the *smear layer before root canal filling.... chelating agent
items that help to improve contact between the two paddles of a manual *defibrillator and the chest wall of the patient, thus reducing the *transthoracic impedance and the risk of contact burns. The most common agents are defibrillation gel pads, thin pads of electrically conductive material placed between the patient’s skin and the defibrillation paddles. The two pads must not touch during defibrillation or a short circuit will form between the paddles. Liquid gels can also be used, but there is a greater risk of short-circuiting as the gel can spread between the two paddles.... coupling agents
(GTD) a group of disorders spanning the conditions of complete and partial molar pregnancies (see hydatidiform mole) through to the malignant conditions of invasive mole, *choriocarcinoma, and the very rare placental site trophoblastic tumour (PSTT). If there is any evidence of persistence of GTD, most commonly defined as a persistent elevation of *human chorionic gonadotrophin, the condition is described as *gestational trophoblastic neoplasia.... gestational trophoblastic disease
(HPA) formerly, a nondepartmental public body set up as a special health authority in 2003 to protect the health of the UK population via advice and support to the NHS, local authorities, the Department of Health, emergency services, and others. The HPA was abolished in April 2013; its responsibilities were largely passed to *Public Health England. See Consultant in Health Protection.... health protection agency
diabetes or impaired glucose tolerance that is diagnosed during pregnancy (see glucose tolerance test). Women at increased risk of gestational diabetes include those with a personal history of the condition, obesity, or a family history of diabetes, and those who have had a previously unexplained stillbirth. In most cases gestational diabetes resolves at the end of the pregnancy, but such women are at increased risk of developing type 2 diabetes thereafter. It is treated by dietary control with or without insulin or metformin to avoid the fetal complications of *macrosomia and hypoglycaemia. See also pregestational diabetes.... gestational diabetes mellitus
(GTN) a group of disorders characterized by persistence of *gestational trophoblastic disease, with abnormal placental development and very high levels of *human chorionic gonadotrophin (hCG). The chorionic villi are fluid-filled with vacuolation of the placenta and destruction of the normal stroma. GTN is rare in the UK, with a calculated incidence of 1/714 live births. It may develop after a molar pregnancy (see hydatidiform mole), a nonmolar pregnancy, or a live birth. The incidence after a live birth is estimated at 1/50,000. A malignant condition may develop (see choriocarcinoma) if the abnormal tissue is not completely removed and the risk of this is monitored by the fall in hCG levels. Choriocarcinoma complicates approximately 3% of complete moles, although in 50% of cases of choriocarcinoma there is no history of immediately preceding trophoblastic disease. It may also occur following a normal pregnancy. In the UK, there is an effective registration and treatment programme. The programme has achieved impressive results, with high cure (98–100%) and low chemotherapy (5–8%) rates.... gestational trophoblastic neoplasia
HPV (two doses)... girls aged 12–13 years
the ability to make moral judgments and to take responsibility for choices and actions.... moral agency
(NPSA) formerly, a special health authority that led and coordinated work to improve all aspects of patient safety in England. The NPSA comprised three divisions: the National Reporting and Learning Service, the National Research Ethics Service, and the National Clinical Assessment Service. It closed in 2012, with its key functions transferred to *NHS England. In 2016 the same functions were transferred from NHS England to the newly formed *NHS Improvement.... national patient safety agency
(NSCLC) any type of lung cancer other than *small-cell lung cancer. Such cancers include *adenocarcinoma of the lung, large-cell carcinomas, and squamous-cell carcinoma of the lung.... non-small-cell lung cancer
(prokinetic) an agent (e.g. *domperidone) that stimulates intestinal peristalsis, thus increasing gastrointestinal motility.... prokinetic agent
(caudal regression syndrome) a severe neural tube defect specific to diabetic pregnancies. The risk may be correlated with the *glycated haemoglobin (HbA1c) level.... sacral agenesis
(enteroclysis) a radiological technique for examining the jejunum and ileum by passing a tube through the nose, oesophagus, and stomach into the small bowel and directly injecting *barium sulphate. Images are captured in real time as the contrast moves through the small bowel. It produces highly detailed images of the small bowel, making it particularly useful for investigating coeliac disease and Crohn’s disease, as well as strictures, tumours, and obstructions. It can be combined with X-ray imaging, CT, or MRI.... small-bowel enema
(barium follow-through) a technique for examining the small bowel, often used when small-bowel enema is not tolerated. The patient swallows dilute *barium sulphate suspension and then a series of abdominal radiographs are taken. A complete examination occurs when contrast reaches the first part of the large bowel (caecum). This technique is particularly useful for investigating small-bowel *Crohn’s disease.... small-bowel meal
(SCLC) a type of bronchial carcinoma characterized by small cells (or oat cells), small round or oval cells with darkly staining nuclei and scanty indistinct cytoplasm. Small-cell carcinoma is usually related to smoking and accounts for about one-quarter of bronchial carcinomas; it carries a poor prognosis due to early distant spread, typically to bones, liver, and brain. Treatment is primarily with chemotherapy and radiotherapy and paraneoplastic symptoms (see paraneoplastic syndrome) from *ectopic hormone production are common. Compare non-small-cell lung cancer.... small-cell lung cancer
congenital absence of part or all of the vagina. See Mayer–Rokitansky–Küster–Hauser syndrome.... vaginal agenesis
colonization of the small intestine with excessive concentrations of bacteria. Patients experience nausea, bloating, abdominal pain, diarrhoea, and symptoms of *malabsorption. Diagnosis is made by identifying bacteria in cultures of small bowel aspirates obtained during endoscopy or by glucose hydrogen breath testing, in which a high concentration of hydrogen in the breath after swallowing glucose indicates bacterial overgrowth. Risk factors include previous abdominal surgery, motility disorders (such as systemic sclerosis), anatomical disruption (such as diverticula, strictures, adhesions, or fistulae), diabetes mellitus, coeliac disease, and Crohn’s disease. Management involves treatment of the underlying condition, nutritional support, and cyclical antibiotics.... small intestinal bacterial overgrowth
(targeted therapy) a drug that interferes with specific molecular targets in the pathways involved in cancer cell growth and signalling, in contrast to *cytotoxic drugs that act primarily on rapidly dividing cells. It typically requires prolonged courses of treatment, and the anticancer action can be synergistic with *chemotherapy. Many new drugs are being developed and are undergoing trials to determine optimal use. The *tyrosine kinase inhibitors include imatinib and *epidermal growth factor receptor inhibitors; multitargeted agents include *sorafenib and *sunitinib. The monoclonal antibodies include *rituximab, *trastuzumab, *cetuximab, and *bevacizumab.... targeted agent
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